Microbiological profile and antibiotic susceptibility profile of urine cultures in patients with spinal cord injury-retrospective study.

Abstract

Background: Urinary tract infections (UTIs) and urinary tract colonizations (UTCs) are common in patients with spinal cord injury (SCI). The aim of this study was to characterize the microbiological profile of urine cultures in patients with SCI and to determine the antibiotic susceptibility profile of most common microorganisms, to track antibiotic resistance and facilitate empiric antibiotic selection.

Methods: A retrospective observational study was conducted on 235 urine culture results of 29 patients with SCI followed at a Physical and Rehabilitation Medicine outpatient consultation between January 2016 and April 2024. Data regarding sociodemographics, cause of SCI, American Spinal Injury Association Impairment Scale classification, voiding method, microbiological urine culture profile, and antimicrobial resistance were collected and statistically analyzed. UTIs (defined as bacteriuria, leukocyturia, positive urine culture, and new onset of signs and/or symptoms) were differentiated from UTCs.

Results: Patients were mostly men (86%), with a mean age of 52.1 years. UTIs occurred in 134 specimens (57%) and UTCs in 101 (43%). In both UTIs and UTCs, microbiological agents were mostly bacteria; Escherichia coli was the commonest overall (39%) and more frequent in indwelling catheterization (in UTIs) and intermittent self-catheterization (in UTCs); more frequently identified microorganisms were E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus faecalis. For these 5 more frequent bacteria, antibiotic susceptibility profiles were determined. High resistance to fluoroquinolones, low resistance to cephalosporins, and very low resistance to nitrofurantoin were found. Specific multidrug-resistant organisms (MDROs) accounted for 11.2%, mostly identified in patients with indwelling catheters. Antibiotic prescriptions in UTIs were according to antibiograms.

Conclusions: In UTIs and UTCs, E. coli was the most common microorganism; microorganisms were distinct on different types of voiding methods. Antibiotic susceptibility profiles were determined for the more frequent bacteria. Very low resistance to nitrofurantoin of E. coli and E. faecalis, low resistance to cephalosporins, and high resistance to fluoroquinolones were found. The data now reported can, in selected cases, facilitate empiric antibiotic selection.