title: Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction.
abstract: METHODS
  Retrospective investigation.
  
  
  OBJECTIVE
  To investigate the association of patient and injury characteristics, as well as bladder management, with the occurrence of patient-reported, symptomatic urinary tract infection(s) UTI(s) in patients with chronic neurogenic lower urinary tract dysfunction (NLUTD).
  
  
  METHODS
  Tertiary urologic referral center.
  
  
  METHODS
  The patient database was screened for patients with chronic (>12 months) NLUTD who had presented between 2008 and 2012. Patient characteristics, bladder evacuation management, the annual number of patient-reported, symptomatic UTIs and the type of prophylactic treatment to prevent UTIs were collected. Binary logistic regression analysis was used to investigate the effects of the investigated risk factors on the occurrence of symptomatic UTI(s) and recurrent symptomatic UTIs (⩾3 annual UTIs).
  
  
  RESULTS
  The data of 1104 patients with a mean NLTUD duration of 20.3±11.6 years were investigated. The evacuation method was a significant (P⩽0.004) predictor for the occurrence of symptomatic UTI and recurrent symptomatic UTIs. The greatest annual number of symptomatic UTIs was observed in patients using transurethral indwelling catheters, and the odds of experiencing a UTI and recurrent UTIs were increased more than 10- and 4-fold, respectively. The odds of a UTI or recurrent UTIs were also increased significantly (P⩽0.014) in patients using intermittent catheterization (IC). Botulinum toxin injections into the detrusor increased the odds of a UTI ~10-fold (P=0.03).
  
  
  CONCLUSIONS
  The bladder evacuation method is the main predictor for symptomatic UTIs in individuals with NLUTD. Transurethral catheters showed the highest odds of symptomatic UTI and should be avoided whenever possible.
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Krebs
authors.affiliation: Department of Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Wöllner
authors.affiliation: Department of Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Pannek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001905:Botulinum Toxins / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D057566:Self Report; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D009498:Neurotoxins; D001905:Botulinum Toxins