Essay Example on UTI in SCI: Risks and Prevention

Introduction

The urinary tract infection (UTI) occurs in the urinary tract of the human being, and the areas affected are mainly the ureters, kidney, urethra, and the bladder, with most of the infection involving the lower part of the urinary tract which includes the urethra and the bladder. The UTI, if not treated and monitored in time, can lead to the morbidity and the mortality of patients with the spinal cord injury. The spinal cord injuries many times are associated with injuries from accidents on motor vehicles, violence, sports injuries, and various falls. UTI tends to be a common condition for patients with spinal cord injuries. Multiple factors contribute to the risk of the UTI, consequently exposing the patients with the spinal cord injury to more risks.

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Infection in the Neurological Bladder

The increased chances of neurological bladder infections can be a result of various factors, and these may include spinal cord injuries, brain injury, stroke, multiple sclerosis, catheter use, incomplete voiding, and intravesical pressure which is elevated. These causes, if not carefully monitored, can be fatal at times, and this calls for the need to handle every sign that could lead to neurological bladder dysfunction with much care. Ideally, the symptoms for the condition differ among individuals, and they tend to rely mainly on the person's nerve damage type. In the SCI patients, various patterns regarding the neurological bladder, which are as per the neurological level, exists, and their treatment and management are different (Leoni, & De Ruz, 2003).

Methods of Draining the Bladder

The functioning of the bladder differs according to the automatic levels of the spinal cord injury hence the need to recognize the dysfunction and come up with the appropriate plans for managing the urological care in the long term for those patients who are injured. The proper bladder management immediately during the stages that follow the SCI is crucial, with the primary aim being the renal function preservation. Thus, the appropriate choice of draining the bladder is essential, minimizing the UTI incidence (Leoni, & De Ruz, 2003).

Urethra catheters that are indwelling are mainly used in nearly all patients during the duration of the spinal shock, and approximately 15% continue to use the catheters for the management of the bladder even after five years after they have been discharged. During six to nearly twelve weeks, the spinal cord resolves among many patients, and at this time, video-urodynamic, which is full is carried out, and this is essential in helping the clinician advise the patient on various bladder management choices. The best method of choice herein is intermittent catheterization, which entails inserting and removing a clean or sterile catheter numerous times in a day. During the phase of rehabilitation, the intermittent catheter tends to reduce the infection rate within the urinary tract hence eliminating most UTIs which are associated with the indwelling urethral catheter. Another method of bladder management that is widely used in many SCI Patients is the involuntary emptying, which can be spontaneous or induced. This can be applied to both the patients with partial or incomplete injuries and to those with the dysfunction of the motor neuron that is on the upper part.

Any of the methods of bladder management can be combined in patients with spinal cord injuries, and together with appropriate drug application, the function of the urethra and the bladder can be influenced. The application of the indwelling catheters and additional methods of draining the bladder, which does not rely on the maintenance of catheter in situ, is a result of the risk, which entails the bladder tumor being associated with the indwelling catheters. Thus from this, it is clear that the usage of procedures that are more invasive portrays higher risk; hence the indwelling urethral catheter should be avoided as much as possible.

The Incidence of UTI

Risk Factors

The National Institute on Disability and Rehabilitation Research divided the risk factors for the UTI after the spinal cord injuries into those related to the urinary tract anatomy and function while others related to the demographic and sociologic characteristics. Physiologic and structural factors include the high-pressure voiding, post-void residuals that are large, vesicoureteral reflux that tends to increase the risk by 23, which is a high factor. The risk factors which are related to the demographic characteristics involve those patients who have functional independence that is lowered or those in need of maximal or complete help (Cervical injuries); the patients had more urinary tract infections compared to the rest.

The urinary drainage method is a significant risk factor when it comes to the UTI, and the application of the intermittent urethral catheters is the essential factor. The bacteriuria prevalence being 100% by the fourth day with the catheter systems that are open, 50% on the fifteenth day for catheter systems which are closed.

Clinical Diagnosis and Symptoms

The typical manifestation of UTI symptoms tends to be absent in the patients with the spinal cord injury and have the dysfunction of the neurogenic bladder and an impaired sensation. At most times, the diagnosis of the UTI among the patients with the SCI may be missed or delayed since the symptoms tend to be subtle. The suggestive symptoms and signs include fever, pain, or discomfort over the bladder or kidney, increased spasticity, cloudy urine having an odor, sense of unease, or lethargy. Among the catheterized patients, the complications include acute pyelonephritis, fever, bacteremia, and even death. A person catheterized for long, over 30 days, tend to be at higher risk of catheter obstruction, stones on the urinary tract, periurinary infections, and bladder cancer.

A bacterial range can lead to complicated infections, and most of them tend to be resistant to various antimicrobial agents. Therefore, blood and urine cultures must be obtained for the purpose of identifying the pathogen and carry out susceptibility testing. Consideration of mixed cultures should be made when more than two microorganisms get isolated. During severe illness and in the repeated UTI cases, consideration should be made in conducting diagnostic studies with the aim of determining the anatomic cause of the infection. After the treatment, the patients' needs further evaluation by urodynamic studies and intravenous urogram. Through adequate management of the lower tract, the incidence of the symptomatic infection should be reduced.

Prevention

The best way to reduce mortality, morbidity, and the associated costs of the infections associated with the catheter is through prevention. Whenever possible, other methodologies apart from the urethral catheters should be applied to enhance the urine drainage. These include the intermittent catheters and the condom catheterization. There has been an evaluation of various preventive measures for those in need of the indwelling catheters, and this includes keeping the closed catheter always closed and taking it out as soon as possible. Additionally, the collector system and the catheter connection should be sealed, and the antimicrobial drugs that exist in the drainage bag, meatal cleaning, together with the application meatalcreams and lubricants should not be used as they have been proven not to prevent the bacteriuria.

Treatment

The complicated UTIs occur among the patients with the metabolic, functional, or anatomic alteration that exists in the urinary tract. Ideally, UTIs among patients with the spinal cord injuries and have the neurogenic bladder viewed as complicated since they have an underlying urologic pathology. Through catheterization, bacteriuria eventually emerges among many patients, and eliminating it becomes painful. Basically, the routine treatments merely contribute to the resistant organism selection. Condom catheters and intermittent catheters have led to lower rates of bacteriuria. Patients who are catheterized with the symptomatic UTIs need to have the catheters changed. They should also be subjected to treatment as per the culture results through the susceptibility testing through the antimicrobial. Patients with mild or moderate illness can be subjected to oral medication, with fluoroquinolones providing a broader spectrum involving antimicrobial activity, which cover most of the expected pathogens. Parenteral antibiotics should always be initiated among patients who are hospitalized with a severe and moderate illness.

Conclusion

In conclusion, the major cause of mortality and morbidity among SCI patients is the UTI. It is, therefore, essential to define the bladder drainage method since the functioning of the bladder varies according to the SCI level. Consequently, it is preferred to optimize the bladder drainage and provide treatment to those patients with the symptoms and signs that indicate the existence of UTI.