Bacteriuria during follow-up in patients with spinal cord injury: I. Rates of bacteriuria in various bladder-emptying methods.

Data from serial follow-up evaluations of 103 patients with traumatic and atraumatic myelopathy were recorded to determine rates of significant bacteriuria associated with various types of bladder emptying in an outpatient population. Urine culture specimens were obtained by sterile catheterization. Rates of urinary tract infection in bladder-retrained patients, patients using intermittent self-catheterization, and patients with indwelling catheters were compared at sequential follow-up visits. Infection rates were similar (20% to 30%) in persons with catheter-free voiding after successful bladder retraining and in those using sterile intermittent self-catheterization. In the latter group, however, there was a trend toward higher infection rates beyond 15 months after rehabilitation. As expected, persons with indwelling catheters had universally high infection rates. Generally lower infection rates were found in persons with incomplete myelopathies (18%) than in those with complete myelopathies (34%). Tetraplegic persons had 2.5 times the infection rate of paraplegic persons in the bladder-retrained group. Infection rates tended to be lower in persons with lower motor neuron bladder dysfunction than in those with upper motor neuron or mixed bladder dysfunction.