Multifaceted Treatment of Catheter-related Urinary Tract Infection
Multifaceted Treatment of Catheter-related Urinary Tract Infection
The specific objective of this clinical trial is to demonstrate that a multifaceted approach
 for treatment for catheter-related urinary tract infection (UTI) in patients with spinal cord
 injury is effective and feasible. We plan to test the following hypothesis: a multifaceted
 treatment approach that consists of immediate removal of the indwelling bladder catheter,
 selecting antibiotics based on the finding from a urine culture that is obtained through the
 newly inserted catheter, and a 5-day course of systemic antibiotics will effectively treat
 catheter-related infection that is limited to the lower urinary tract of patients with spinal
 cord injury.
UTI is the most common infection in patients with spinal cord injury who require a catheter
 to drain urine from their bladder. These infections can cause serious medical complications,
 such as bloodstream infection, decreased kidney function, prolonged hospitalization, and add
 great cost. Unfortunately, the treatment of catheter-related urinary tract infection has not
 been standardized in this population in terms of:

 -  the need to replace the indwelling catheter;

 -  the necessity to provide antibiotic coverage against all organisms grown from urine
 cultures; and

 -  the duration of antibiotic treatment.

 The prevalent, though not scientifically well supported approach for treating
 catheter-related lower UTI in patients with spinal cord injury comprises the following:

 -  Retaining the original bladder catheter in place upon diagnosis of infection because of
 the theoretical concern that removal of the infected catheter may potentially cause the
 infecting organism to move from the bladder to the bloodstream (bacteremia). This
 theoretical complication, however, is very unlikely and even if it does occur, the
 bacteria would only remain in the bloodstream for a very short period of time and would
 not have a significant impact on the patient. In contrast, we propose that immediate
 removal of the original indwelling bladder catheter with its film of protected bacteria
 can enhance resolution of UTI.

 -  Providing antibiotic coverage against all organisms which grow from a urine culture that
 is obtained from the original indwelling bladder catheter. Although this source of urine
 culture is a sensitive method for identifying the organisms that are present in the
 urine, it suffers from poor specificity because it may yield the growth of some
 organisms that could have colonized the catheter (and, therefore, grown in a culture of
 urine obtained through that original catheter) but did not contribute to UTI. This issue
 is particularly problematic in patients with spinal cord injury because urine cultures
 in almost half of the cases of UTI in this population yield multiple bacteria.
 Therefore, we propose that collection of a urine culture while inserting the new bladder
 catheter would yield growth of only organisms that truly contribute to UTI and,
 therefore, obviate the need to administer unnecessary antibiotics to cover additional
 organisms that would grow only from urine cultures obtained through the original
 catheter.

 -  Treatment with systemic antibiotics for 10 days. There exists, however, no prospective
 randomized clinical trials indicating that this duration of antibiotic therapy is
 optimal in patients with spinal cord injury. Since catheter-free, able-bodied patients
 with lower UTI are successfully treated with courses of antibiotics as short as 1-3
 days, we propose that by removing the focus of infection (i.e. the original catheter) a
 5-day course of systemic antibiotics would be sufficient for treating catheter-related
 lower UTI in patients with spinal cord injury.

 The results of this research are expected to provide the following major benefits to veterans
 with spinal cord injury:

 -  the multifaceted approach will provide highly effective treatment of UTI;

 -  the lower number of antibiotics that are administered to cover the organisms grown from
 urine cultures obtained at the time of inserting the replacement bladder catheter will
 result in lower cost of treatment and a reduced risk for developing antibiotic
 resistance;

 -  the shorter duration of antibiotic course will decrease the overall cost of treatment,
 reduce hospital stay, and shorten rehabilitation down time.
Inclusion Criteria:

 -  Adult patients with SCI who are hospitalized at the Michael E. Debakey VA Medical
 Center and suffer from lower UTI associate with an indwelling transurethral or
 suprapubic bladder catheter will be enrolled in the study

 Exclusion Criteria:

 -  Exclusion criteria will include septicemia, chronic antimicrobial therapy and
 inability, or unwillingness to give informed consent