慢性脊髓損傷病患合併尿路感染的影響因子
簡宏祐1、黃玉慧2,3、 謝佐宜1,2、陳文榮1,2、王紹全1,2、陳順郎1,2
中山醫學大學附設醫院 1泌尿科 中山醫學大學 2醫學系
Factors associated with urinary tract infection in patients with chronic spinal cord injury
Horn-Yo Chien1,Yu-Hui Huang2,3, Tuzo-Yi Hsieh1,3, Wen-Jung Chen1,3, Shao- Chuan Wang1.3, Sung-Lang Chen13,
1Department of Urology, 2Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
3School of Medicine, Chung Shan Medical University, Taichung, Taiwan
Purpose: Urinary tract infections (UTIs) in patients with chronic spinal cord injury (SCI) are important causes of morbidity and mortality. We identified the incidence and risk factors associated with urinary tract infection in different drainage methods in chronic spinal cord injured patients.
Materials and Methods: A total of 113 SCI patients with follow-up at least 5 years were enrolled in this study. Laboratory biochemistry examination and kidney ultrasound were checked up every 3 months. Videourodynamic study (VUDS) and effective renal plasma flow (ERPF) were performed every 6-12 months. UTI events were traced by medical chart and patient interview during follow-up. Major UTI definition was episode that cause patient admission or significant pyresis (>38’C). Minor UTI was turbid urine, ordered urine or deep colored urine and new onset of voiding problems, kidney or bladder discomfort and autonomic dysreflexia without other causes.
Results: There were 82 males and 31 females with an average age of 48.8±13.6 and average injury duration of 14.9±8.3 years. The injury patterns were: 58 cervical, 41 thoracic and 14 lumbar; 48 complete and 65 incomplete injuries. The average rate of major UTI, minor UTI and all UTIs (major + minor UTI) were 0.32±0.38, 0.45±0.46, and 0.77±0.65 time per year. Gender, injury level, injury duration and injury completeness or not are not associated with frequency of both major and minor UTIs. However, statistically significant difference of UTI was noted among various bladder management methods (Urethra catheter indwelling> suprapubic cystosotmy > intermittent catheterization> reflex voiding, p< 0.001) Hydronephrosis and bladder wall trabeculation were also associated with both major and minor UTIs. But bladder wall compliance disclosed no association with UTI.
Conclusion: UTIs rate are decreased in recent years, However, SCI patients bladder management with urethra catheter and hydronephrosis or bladder trabeculation are at higher risk for UTI.