Urinary tract infection in patients with spinal cord injury

Deposited with permission of the author. © 1975 Dr. L. Valerie AscheThis study was made to ascertain the aetiology, origin and pathways of infection as well as the reason for recurrence of urinary tract infection in male patients with permanent indwelling catheter, at the Spinal Injuries Unit, Austin Hospital, Australia. There has been no detailed bacteriological report published since the Unit opened in 1956. Since urinary infections are frequent during the life of spinal paralytics, it is important in the management of such patients to determine whether it is relapse or re—infection which plays the major role of infection. The main body of this thesis presents the findings of a detailed search for wall—defective bacteria (L—forms) in an attempt to confirm or deny the hypothesis that persistent L—forms play a part in the repeated isolation of the same organism from a patient over a number of years. The aetiology of urinary infection occurring in new admissions was a reflection of the ward flora present at different times of survey, which in turn depended on the disinfection measures taken. Gram—negative, urea splitting organisms such as Klebsiella, Proteus, and Providence as well as the nosocomial bacteria Acinetobacter, Pseudomonas and Serratia were found to be more common in causing urinary infection than the traditional Escherichia coli and Streptococcus faecalis. The chlorhexidine solution used for bladder irrigation was shown to be the source of Acinetobacter infections acquired during 1971-2 in new admissions. From weekly examinations during 1971-2 of new admissions there was little evidence that the urinary infections came from the patients' own faecal or nasal flora even when Klebsiella, Proteus or Pseudomonas were regularly isolated from such material. (Open document to view complete abstract