Role of antibiotics during change over from continuous bladder drainage to intermittent clean catheterization in patients with spinal cord injury

INTRODUCTION: Neurogenic bladder dysfunction is a great challenge in patients with traumatic or non-traumatic spinal cord injuries (SCI). The neurological level of injury and the completeness of the spinal cord lesion are the two main factors deciding the type of bladder dysfunction, with the bladder evacuation function varying between detrusor over-activity and no detrusor activity. Bladder dysfunction continues to affect the quality of life of individuals with SCI many years following the initial trauma. Neurogenic bladder can result in multiple complications including urinary tract infections, calculi, hydronephrosis and renal failure.Prior to the 1970s, renal disease was the leading cause of mortality in chronic SCI. In the mid-1970s, Lapides et al. reported on the effectiveness of intermittent clean catheterisation (ICC) in those with SCI to improve continence and allow storage at low pressures. Since the advent of these programs, the prevalence of renal disease has decreased dramatically. The survival rates in spinal cord injury patients have improved over the last few decades and a better enhanced urinary tract management has doubtlessly played a major role in this process. AIM OF THE STUDY: To test the hypothesis that the initiation of intermittent clean catheterization (ICC) under antibiotic cover is not superior to the initiation of ICC without antibiotic cover in long term catheterized spinal cord injury patients. MATERIALS AND METHODS: A total of 32 subjects with spinal cord injury participated in a randomized controlled trial of either antibiotic prophylaxis or no antibiotic medication during the initiation of intermittent clean catheterisation(ICC). Urine culture and sensitivity, routine urine examination, Urine dip stick test and Gram stain were used for analysing symptomatic urinary tract infections according to modified CDC criteria. All subjects were observed for symptomatic UTI for one week time. Chi-Square test and T test were used for the statistical analysis. RESULTS: Of the total 32 subjects, febrile urinary tract infection occurred in one case each in both antibiotic and non antibiotic groups during a period of one week. Nitrofurantoin (NFN) was used in 81% of the intervention group with NFN alone in 56%. Chi-Square test done showed no significant difference in the occurrence of symptomatic UTI between the 2 study groups (Fisher's Exact Test with exact Significance 1.00). CONCLUSION: There was no statistically significant difference in the incidence of symptomatic urinary tract infection in the antibiotic and non-antibiotic groups after the initiation of ICC. Hence the study suggests that it may not be necessary to use antibiotic cover during initiation of intermittent clean catheterisation in spinal cord injury patients. However the study was limited by a small sample size and short duration of follow up