Experiences of Veterans with Spinal Cord Injury Related to Annual Urine Screening and Antibiotic use for Urinary Tract Infections

PM R, 2021 · DOI: 10.1002/pmrj.12568 · Published: December 1, 2021

Spinal Cord Injury Immunology Healthcare

Simple Explanation

This study investigates how veterans with spinal cord injuries (SCI) perceive urine testing and antibiotic use for urinary tract infections (UTIs). It highlights the importance of appropriate antimicrobial use due to the increasing threat of antimicrobial-resistant bacteria, particularly in the SCI population. The research combines surveys and interviews to understand patient adherence to medication, knowledge of antimicrobial stewardship, and satisfaction with their bladder care management. It explores the delicate balance between routine urine screening and the potential for unnecessary antibiotic use in SCI patients who often have asymptomatic bacteriuria. Ultimately, the goal is to inform interventions that promote evidence-based practices in urine testing and antibiotic prescriptions for SCI patients, addressing both patient needs and the broader concern of antimicrobial resistance.

Study Duration

June 2018 and October 2019

Participants

Veterans identified as having a SCI seen at a VHA facility nationwide

Evidence Level

Mixed methods

Key Findings

1
Veterans with SCI generally report high adherence to prescribed antimicrobial courses and high levels of satisfaction with current outpatient VHA SCI bladder care.
2
Many patients were able to describe some aspects of antimicrobial stewardship principles, understanding when antibiotics are necessary and the dangers of overuse.
3
Patients discussed level of injury and bladder management strategy as key factors in successful prevention, identification, and treatment of UTIs.

Research Summary

This mixed-methods study explores the experiences of veterans with SCI regarding annual urine screening and antibiotic use for UTIs. It aims to understand patient adherence, knowledge, and attitudes towards current practices to inform interventions promoting appropriate antimicrobial use. The study found that SCI patients generally have high medication adherence and satisfaction with their bladder care. They also demonstrate an understanding of antimicrobial stewardship principles, though some desire more information on UTI prevention and bladder management. The findings suggest that interventions targeting providers are key to align antibiotic use with stewardship goals. Clear, consistent, and evidence-based information from providers is crucial for this vulnerable population.

Practical Implications

Provider Education

Clinicians should receive targeted education on evidence-based guidelines for UTI management in SCI patients, focusing on diagnostic and antibiotic stewardship.

Patient Education

Develop patient education materials addressing UTI prevention strategies, the risks of unnecessary antibiotic use, and the importance of adhering to prescribed treatments.

Practice Guidelines

Implement updated VHA SCI guidelines that align with IDSA recommendations for urine testing, emphasizing symptom-based testing rather than routine screening.

Study Limitations

1
The study had a challenging time obtaining an adequate sample size from a nationwide cohort.
2
The heterogeneous approach of survey methodologies may have introduced bias in survey responses.
3
Social desirability bias may have impacted the qualitative themes that emerged from our interview data, such as the highly adherent behaviors.

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