Significance of bacteriuria in neurogenic bladder.

OBJECTIVE: To investigate the usefulness of performing routine urine cultures in veterans with spinal cord injury (SCI) who come for annual evaluation. RESEARCH DESIGN/PARTICIPANTS: This retrospective study was performed on asymptomatic patients who came for outpatient annual evaluation. The records of 89 healthy male veterans with SCI between the ages of 22 and 82 years (mean age = 50.6) were reviewed from March through October 2000.
METHODS: The following information was collected: patient's name, social security numbers, age, year of injury, level of injury, American Spinal Injury Association (ASIA) classification, urinalysis including white blood cell (WBC) count and presence or absence of nitrite, urine culture results (> or <100,000 colony-forming units of uropathogens per milliliter), blood WBC count, and mode of bladder management. The data were analyzed statistically to look at the effects of age at injury, level of injury, injury category (ASIA classification), pyuria, urinary nitrite, serum WBC count, and mode of bladder control on the presence of bacteriuria.
RESULTS: Results revealed that regardless of the level of injury, individuals with ASIA A injuries were at high risk of having bacteriuria with positive culture results. Patients who were nitrite positive and/or had > or =6 WBCs per high-powered field (HPF) in the urine were also at high risk for significant bacteriuria.
CONCLUSION: Urinary tract infections (UTIs) in the SCI population frequently are asymptomatic, polymicrobial, caused by antibiotic-resistant bacteria, and very likely to recur or relapse. However, there are no data to support or justify treatment of asymptomatic bacteriuria. The present study suggests that healthy asymptomatic patients with SCI who come for annual evaluations should not have routine urine cultures if they are at low risk for UTIs; that is, <6 WBC/HPF in the urine and/or nitrite negative.