Felicia Skelton1, Larissa Grigoryan2, Sally Ann Holmes3, Ivy Oiyee Poon4, Barbara Trautner5. 1. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX. Electronic address: felicia.skelton@bcm.edu. 2. Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX. 3. Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX. 4. Department of Pharmacy Practice, Texas Southern University, Houston, TX. 5. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Infectious Disease Section, Department of Medicine, Baylor College of Medicine, Houston, TX.
Abstract
OBJECTIVES: To measure the prevalence of asymptomatic bacteriuria (ASB) in persons with spinal cord injury (SCI) at the time of their annual examination and to examine the effect on urine testing during the annual examination on subsequent antibiotic use. DESIGN: Retrospective cohort study. SETTING: A major SCI center. PARTICIPANTS: Veterans (N=393) with SCI seen for an outpatient annual evaluation in 2012 or 2013. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Antibiotic use for bacteriuria within 7 days of the annual evaluation encounter. RESULTS: There were 327 clinic visits that met inclusion criteria; of these 327 veterans, 249 had a urine culture performed. A total of 171 urine cultures (69%) were positive for bacteria, of which 22 (13%) represented urinary tract infection (UTI) cases and 149 (87%) were ASB cases. More than a third of the ASB cases (n=53 [36%]) were treated with antibiotics. None of the 78 visits with negative urine cultures received antibiotics to treat the UTI; thus, a positive urine culture alone was associated with antibiotic use (P<.01). Factors predicting antibiotic use were higher age, nitrite presence on urinalysis, and urease-producing organism on culture media. When comparing bladder management strategies, indwelling catheterization was found to be associated with higher levels of pyuria and hematuria than did spontaneous voiding or intermittent catheterization (P<.01). CONCLUSIONS: Two-thirds of the urine cultures of persons with SCI presenting for their annual examination were positive. Most of the positive cultures represented ASB cases, and more than a third of these were treated with antibiotics. A better understanding of the mandate for urine testing at the annual examination and the outcomes of this practice is an important first step in developing antibiotic stewardship for UTI in persons with SCI. Published by Elsevier Inc.
OBJECTIVES: To measure the prevalence of asymptomatic bacteriuria (ASB) in persons with spinal cord injury (SCI) at the time of their annual examination and to examine the effect on urine testing during the annual examination on subsequent antibiotic use. DESIGN: Retrospective cohort study. SETTING: A major SCI center. PARTICIPANTS: Veterans (N=393) with SCI seen for an outpatient annual evaluation in 2012 or 2013. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES: Antibiotic use for bacteriuria within 7 days of the annual evaluation encounter. RESULTS: There were 327 clinic visits that met inclusion criteria; of these 327 veterans, 249 had a urine culture performed. A total of 171 urine cultures (69%) were positive for bacteria, of which 22 (13%) represented urinary tract infection (UTI) cases and 149 (87%) were ASB cases. More than a third of the ASB cases (n=53 [36%]) were treated with antibiotics. None of the 78 visits with negative urine cultures received antibiotics to treat the UTI; thus, a positive urine culture alone was associated with antibiotic use (P<.01). Factors predicting antibiotic use were higher age, nitrite presence on urinalysis, and urease-producing organism on culture media. When comparing bladder management strategies, indwelling catheterization was found to be associated with higher levels of pyuria and hematuria than did spontaneous voiding or intermittent catheterization (P<.01). CONCLUSIONS: Two-thirds of the urine cultures of persons with SCI presenting for their annual examination were positive. Most of the positive cultures represented ASB cases, and more than a third of these were treated with antibiotics. A better understanding of the mandate for urine testing at the annual examination and the outcomes of this practice is an important first step in developing antibiotic stewardship for UTI in persons with SCI. Published by Elsevier Inc.
Authors: Felicia Skelton-Dudley; James Doan; Katie Suda; S Ann Holmes; Charlesnika Evans; Barbara Trautner Journal: Top Spinal Cord Inj Rehabil Date: 2019
Authors: Felicia Skelton; Sarah May; Larissa Grigoryan; Ivy Poon; Sally Ann Holmes; Lindsey Martin; Barbara W Trautner Journal: PM R Date: 2020-05-13 Impact factor: 2.298
Authors: Joshua D Roth; Joseph J Pariser; John T Stoffel; Sara M Lenherr; Jeremy B Myers; Blayne Welk; Sean P Elliott Journal: Spinal Cord Date: 2019-03-14 Impact factor: 2.772
Authors: Casey Hines-Munson; Sarah May; Ivy Poon; S Ann Holmes; Lindsey Martin; Barbara W Trautner; Felicia Skelton Journal: PM R Date: 2021-07-22 Impact factor: 2.298