Routine Urine Testing at the Spinal Cord Injury Annual Evaluation Leads to Unnecessary Antibiotic Use: A Pilot Study and Future Directions

Publication date: Available online 26 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Felicia Skelton, Larissa Grigoryan, Sally Ann Holmes, Ivy Oiyee Poon, Barbara Trautner
ObjectiveTo measure the prevalence of ASB in persons with spinal cord injury (SCI) at the time of their annual examination, and examine the impact on urine testing during the annual examination on subsequent antibiotic use.Designretrospective cohort studySettinga major Veterans Health Administration SCI centerParticipantsVeterans with SCI seen for an outpatient annual evaluation in 2012 or 2013 (n=393)Main Outcome Measureantibiotic use for bacteriuria within seven days of the annual evaluation encounterResultsOf the 327 clinic visits that met inclusion criteria, of which 249 had a urine culture performed. 171 (69%) of the urine cultures were positive; 22 (13%) represented UTI cases, while 149 (87%) were ASB. Over a third of the ASB cases (53, 36%) were treated with antibiotics. None of the 78 visits with negative urine cultures received antibiotics to treat the urine; thus, a positive urine culture alone was associated with antibiotic use (p<0.01). Factors predicting antibiotic use were higher age, nitrite presence on urinalysis and urease-producing organism on culture. When comparing bladder management strategies, indwelling catheterization was associated with higher levels of pyuria and hematuria than spontaneous voiding or intermittent catheterization (p<0.01).ConclusionTwo-thirds of the urine cultures of persons with SCI presenting for their annual examination were positive. Most of the positive cultures represented ASB, and over 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 to developing antibiotic stewardship for UTI in persons with SCI.



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