Urinary Tract Infection and Antimicrobial Susceptibility Pattern Associated with Asymptomatic Bacteriuria in those Receiving Clean Intermittent Catheterization for Neurogenic Bladder - Abstract
Clean intermittent catheterization (CIC) is a frequently performed procedure on patients with neurogenic bladder to assist with voiding and is associated with bacteriuria. Due to this bacteriuria, this patient population is frequently subjected to multiple courses of antibiotics, whether appropriate or not and often become colonized with multi-drug resistant organisms. Choosing appropriate empirical antibiotics is a clinical dilemma when encountering these patients at the beginning of an illness. We reviewed antimicrobial susceptibility patterns of urine cultures for 50 myelomeningocele patients over the course of 1 year. Data for 192 organisms was available for analysis and E. coli was the most commonly recovered organism. Using univariate analysis we sought to detect differences identifying subjects who were most likely to be colonized with resistant E. coli strains versus those subjects that had susceptible strains. Though the probability of resistance is higher than that in the community, it did not proportionately increase with olderage, increased duration of clean catheterization, or related to route of catheterization. Decisions for empirical therapy ought to be guided by individual patient’s previous culture results with particular attention to colonization with resistant organisms, but broad spectrum coverage may not be necessary in all patients utilizing clean intermittent catheterization.