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  1. Can-SCIP
  2. Recommendations
  3. Guidelines
  4. Section 2 - MANAGEMENT OF SCI COMPLICATIONS

K - BLADDER FUNCTION




Clinicians should not treat positive dipstick or culture in asymptomatic patients who catheterize except in the setting of nephrolithiasis and stone-forming bacteria as bacterial colonization will likely be present in individuals using a catheter (indwelling or intermittent), and so urine dipstick testing and bacterial culture may be unreliable for diagnosing active infection. (Adapted from NICE 2012, p.50; Level C)
We recommend clinicians do not screen or treat individuals with asymptomatic bacteriuria with neurogenic lower urinary tract dysfunction (except in pregnancy as it promotes antibiotic resistance and can increase the likelihood of symptomatic urinary tract infection). Treatment should be limited to individuals with positive urine culture in the presence of clinical symptoms, including leukocyturia, bacteriuria. (Adapted from CUA 2019, p.164; Level B)
Use the presence of leukocyturia, bacteriuria, and clinical symptoms to diagnose UTI in individuals with SCI and neurogenic lower urinary tract dysfunction (except in pregnancy): treatment should be limited to individuals with positive urine culture in the presence of clinical symptoms of UTI. (Adapted from CUA 2019, p.164; Level B)
Urinalysis and urine culture should always be obtained prior to initiating antibiotic therapy due to the increased risk of multidrug-resistant microorganisms. (Adapted from CUA 2019, p.164; Level B)
If an individual is systemically unwell or symptoms are intolerable, collect culture, start antibiotic therapy, and modify or discontinue antibiotic therapy based on culture results. (Adapted from CUA 2019, p.164; Level B)
Clinicians should prescribe individuals with SCI and a culture confirmed UTI with a course of antibiotics for at least 7 days and 10–14 days for those with significant infection or a delayed response. (Adapted from CUA 2019, p.164; Level B)
Clinicians should avoid the provision of routine anti-microbial prophylaxis for individuals with SCI and neurogenic lower urinary tract dysfunction and frequent urinary tract infection. (Adapted from CUA 2019, p.165; Level A)
Consider antibiotic prophylaxis only for individuals who have a recent history of frequent urinary tract infections once reversible causes have been ruled out (such as urolithiasis). (Adapted from NICE 2012, p.271; Level C)