Urinary tract infection in patients with spinal cord lesions: antibody-coated bacteria tests as a diagnostic aid.

Urine cultures and antibody-coated bacteria (ACB) tests were performed on urine specimens from 176 spinal cord injured patients at the time of annual renal function follow-up. Sixty-nine percent of the cultures were positive; and of these, 55% were positive for ACB. The highest incidence of positive ACB tests occurred in the specimens from patients with external catheters (67%), ileal diversions (63%) and suprapublic catheters (60%). The organisms which occurred most frequently as a single isolate were Escherichia coli and Pseudomonas aeruginosa; 54% of the E coli and 57% of the P aeruginosa were antibody coated. Proteus rettgeri was recovered less frequently as a single isolate but in these instances the ACB test was always positive. X-ray studies showed that 28% of patients with positive ACB tests had upper tract changes. Thirty-eight patients with positive ACB tests received treatment. After treatment, follow-up cultures from 26 (69%) of these patients showed no growth or a negative ACB test. Patients with roentgenographically abnormal tracts and positive ACB tests were found to be more resistant to treatment. Although additional studies are needed, this test at present can aid clinicians in management of urinary tract infection in spinal cord injured patients.