Should We Delay Urodynamic Study When Patients With Spinal Cord Injury Have Asymptomatic Pyuria?

Annals of Rehabilitation Medicine, 2021 · DOI: https://doi.org/10.5535/arm.20241 · Published: June 14, 2021

Simple Explanation

This study looks at whether it's necessary to delay a urodynamic study (UDS) in patients with spinal cord injury (SCI) who have pyuria (white blood cells in the urine) but no symptoms of a urinary tract infection (UTI). The researchers wanted to know if performing a UDS in these patients would increase their risk of developing a UTI after the procedure. The study also investigates whether using prophylactic antibiotics helps to prevent UTIs in these patients.

Study Duration

4 years

Participants

399 patients with spinal cord injury

Evidence Level

Not specified

Key Findings

1
The study found no statistically significant difference in the prevalence of post-UDS UTI between patients with and without pyuria before the UDS.
2
Most of the bacteria found in the urine samples were resistant to common antibiotics like ciprofloxacin and cephalosporin, but less resistant to trimethoprim/sulfamethoxazole (TMP/SMT).
3
The presence of pyuria before UDS had a high sensitivity (89.5%) and specificity (63.2%) for predicting bacteriuria.

Research Summary

This study evaluated the risk of post-urodynamic study (UDS) urinary tract infection (UTI) in spinal cord injury (SCI) patients with pre-UDS pyuria. The study found no statistically significant difference in post-UDS UTI rates between patients with and without pre-UDS pyuria, suggesting that UDS can be performed safely in SCI patients with pre-UDS pyuria when prophylactic antibiotics are administered. The study also examined antibiotic resistance patterns and found that trimethoprim/sulfamethoxazole (TMP/SMT) may be a suitable first-line antibiotic for preventing post-UDS UTI in the Korean population studied. Limitations include the small number of post-UDS UTI cases, hindering robust risk factor evaluation, and the lack of comparative analysis of different prophylactic antibiotic regimens.

Practical Implications

Clinical Practice

UDS should not be delayed in SCI patients with asymptomatic pyuria if prophylactic antibiotics are administered.

Antibiotic Selection

TMP/SMT could be considered as a first-line antibiotic for preventing post-UDS UTI in Korea, given the lower resistance compared to ciprofloxacin and cephalosporin.

Further Research

Further research is needed to compare the duration, type, and dose of antibiotic administration to develop accurate guidelines.

Study Limitations

1
The number of patients with UTI was too small (n=6) for risk factor evaluation.
2
UDS was performed before release of the results of pre-UDS culture.
3
Analysis of the type and duration of prophylactic antibiotic therapy was not performed.

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