Acute pyelonephrosis and significance of asymptomatic bacteriuria in patients with spinal cord injury

Park, Won Hee; Song, Byung Joo; Lee, Chongwook

Abstract

A study was performed to define the risk factors, a significance of asymptomatic bacteriuria, and a role of prophylactic antibiotics in development of acute pyelonephritis in patients with spinal cord injury. We took monthly urine culture and sensitivity test in 53 patients with spinal cord injuries with asymptomatic bacteriuria during a one year period from June 1989 at Korea Veterans Hospital. We investigated the bacterial species, the sensitivity to antibiotics, and the degree of changes in bacterial flora in 22 patients with a prophylactic antibiotics(group 1) and 31 without it (group 2). We compared the results of urine culture at the time of acute pyelonephritis with those in about 1 month prior to acute pyelonephritis in 16 patients. And we evaluated a group of 26 patients with a history of acute pyelonephritis and the control group of 27 randomly selected patients without acute pyelonephritis to search for potential risk factors. Age, the time elapsed after injury, the site or the extent of injury, renal or bladder stone, vesicoureteral reflux, prophylactic antibiotics, indwelling urinary catheter, bladder capacity, and renal function were considered as possible risk factors. The most common bacterial species were Pseudomonas (20.5%), Providencia (15.6%), Acinetobacter (11.3%), and E. coli (9.6%) in order. There was no difference between group 1 (95.4% ) and group 2 (97.1%) in the incidence of bacteriuria, but the patterns of bacterial species were quite different from each group. Prophylactic antibiotics did not prevent the development of acute pyelonephritis. There was a rapidly changing polymicrobial flora averaging 1.8 changes per month in group 1 and 1.9 in group 2. The bacterial species found at the time of pyelonephritis was not identical with the latest one in all cases except one. We found that long elapsed time from injury, presence of vesicoureteral reflux, and small bladder capacity were significant risk factors to develop an acute pyelonephritis. Prophylactic antibiotics appeared to be not beneficial, and a periodic urine culture was not informative because of rapid changes of bacterial species and low similarity to the species of acute pyelonephritis.