Clinical and microbiological characteristics of nosocomial urinary infection in the spinal cord lesioned patient Urinary infections constitute one of the main causes of intrahospitalary infections. At the Clinic for the attention of spinal cord lesioned patients, we observed that these can be the cause of high incidence rates as a consequence of multiple risks factors associated to the neurobladder as: vesical urethral reflux, vesicle lithiasis, diverticula and pseudodiverticula, urethral stenosis and permanent or intermitent catheterization. Objectives: To describe forms of presentation of urinary infection tracts in spinal cord lesioned patients with neurogenic bladder as well as their microbiological behavior. Patients and Method: We performed a descriptive, retrospective-type study on all hospitalized patients in order to program a neuro-restorative treatment for the affectation of the spinal cord from May 2003 to April 2004. They all received clinical, imagenologic and bacteriologic assessment, that is, (urocultures, urethral and vaginal exudates) to determine risk factors, forms of presentation of the infection, as well as associated complications and microbiological behavior. Results: The most frequent forms of presentation of infections are: recurrent symptomatic bacteriuria, asymptomatic bacteriuria, bacterial urethritis, vaginosis bacterial and acute pyelonephrites. Most acute germs are: E coli (for a 30% of isolation), followed by K pneumoniae (l6%), Staphylococcus (aureus and epidermidis l3%), P. mirabilis (9%) and other enterobacterias. Sensitiveness to aminoglycosides was kept high, where we observed a growing resistance to sulfas (>70%) and fluoroquinolonas (>45%) as well as the frequent circulation of microorganisms. Conclusions: Clinical peculiarities of urinary infections in the patient with neurogenic bladder, allow to perform more adequate strategies for treatment as to the clinical, microbiological and epidemiologic criteria. |
