title: UTIs in patients with neurogenic bladder.
abstract: Urinary tract infections (UTI) remain one of the most prevalent and frustrating morbidities for neurogenic bladder patients, and death attributed to urosepsis in the spinal cord injury (SCI) patient is higher when compared to the general population. Risk factors include urinary stasis, high bladder pressures, bladder stones, and catheter use. While classic symptoms of UTI include dysuria, increased frequency and urgency, neurogenic bladder patients present differently with increased spasticity, autonomic dysreflexia, urinary incontinence, and vague pains. Multiple modalities have been assessed for prevention including catheter type, oral supplements, bladder irrigation, detrusor injections and prophylactic antimicrobials. Of these, bladder inoculation with E. coli HU2117, irrigation with iAluRil(®), detrusor injections, and weekly prophylaxis with alternating antibiotics appear to have a positive reduction in UTI but require further study. Ultimately, treatment for symptomatic UTI should account for the varied flora and possible antibiotic resistances including relying on urine cultures to guide antibiotic therapy.
authors.affiliation: University of Miami Miller School of Medicine, 816 NW 11th St., Apt. 508, Miami, FL, 33136, USA, msjahromi@med.miami.edu.
authors.forename: Mona S
authors.initials: MS
authors.lastname: Jahromi
authors.forename: Amanda
authors.initials: A
authors.lastname: Mure
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Gomez
mesh_terms: D000283:Administration, Intravesical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000975:Antioxidants / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000517:prevention & control*; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016233:Immunotherapy, Active / Q000379:methods*; D008358:Mannose / Q000627:therapeutic use; D008709:Methenamine / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000150:complications; D009465:Neuromuscular Agents / Q000627:therapeutic use; D044945:Proanthocyanidins / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use; D012008:Recurrence; D013119:Spinal Cord Injuries / Q000150:complications; D001750:Urinary Bladder, Neurogenic / Q000150:complications* / Q000188:drug therapy; D014546:Urinary Catheterization / Q000379:methods; D062885:Urinary Catheters; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D000892:Anti-Infective Agents, Urinary; D000975:Antioxidants; D009465:Neuromuscular Agents; D044945:Proanthocyanidins; C013221:proanthocyanidin; D019274:Botulinum Toxins, Type A; D008709:Methenamine; D008358:Mannose; D001205:Ascorbic Acid
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