Urinary tract infections among patients with neurogenic bladder

Abstract

Urinary tract infections (UTIs) in patients with neurogenic bladder (NB) are a major public health issue due to their high incidence and major consequences. They are associated with high morbidity and healthcare utilization, with a major economic burden. Their physiopathology, especially immunological and neurological function, is poorly understood. Some risk factors for UTI among patients with neurological bladder have been established: indwelling catheter, urinary stasis, high bladder pressure, bladder stones. Their diagnosis is a major challenge as clinical signs are often nonspecific and poor. Microbiological data are of limited help and varied flora could be involved. A urinary sample should be analyzed in appropriate conditions before any antibiotic prescription. According to most guidelines a bacterial threshold ≥103 CFU/mL associated with symptoms are acceptable to define UTI among NB population. The management of acute, symptomatic UTI is not evidence based. A management with a single agent and a short antibiotic treatment of 10 days or less seems as effective as 15 or 21 days. Antibiotic selection should be based on patient based resistance patterns and the spectrum should be as narrow as possible. Asymptomatic bacteriuria (ABU) should not be treated, to avoid the emergence of bacterial resistance. Regarding preventive measures, use of clean intermittent catheterization (CIC), intravesical botulinum toxin injection, cycling antibiotic prevention are effective. Bacterial interference is promising but, randomized controlled trials are needed. We provide a review of data available on neurogenic bladder UTI.