Increasing resistance against antibiotics in bacteria isolated from the lower urinary tract of an outpatient population of spinal cord injury patients

Abstract

Objective: To investigate changes of the bacterial spectrum and susceptibility in bacteria isolated from urine samples of spinal cord injury patients followed in a strict outpatient setting.

Subjects and methods: Due to neurogenic dysfunction, urinary tract infections are common in spinal cord injury patients. Nosocomial urinary tract infections and resistance against antibiotics are increasing problems in hospitalized spinal cord injury patients. Urine samples were obtained by aseptic catheterization during 1,293 outpatient appointments at our institution over a period of 6 years. The urine samples were analyzed for bacterial colonization and microbiologically evaluated.

Results: We demonstrate significant changes in both bacterial spectrum and bacterial resistance in an outpatient population as well. Even multiresistant staphylococcus species were detected, in spite of excluding nosocomial infections.

Conclusions: Antibiotic treatment should be limited to symptomatic urinary tract infections and be initiated after sensitivity testing only. Empiric use of antibiotics must be limited to highly symptomatic infections until the results of sensitivity testing are available.