Prevention and Management of Urinary Tract Infections in Paralyzed Persons

Published in: Evidence Report/Technology Assessment No. 6 (Prepared by Southern California/RAND Evidence-Based Practice Center, under Contract No. 290-97-0001). AHRQ Publication No. 99-E008. (Rockville, MD: Agency for Healthcare Research and Quality, Feb. 1999), 4 p

Posted on RAND.org on January 01, 1999

by Barbara Vickrey, Paul G. Shekelle, Sally C. Morton, Kenneth A. Clark, Mayank Pathak, Caren Kamberg

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The management of urinary tract complications is a major health policy concern in the treatment of paralyzed persons (for example those with spinal cord injury and multiple sclerosis.) Concerns include the significant cost of care and the likelihood that current care delivery does not reflect the most recent scientific literature on the prevention and management of urinary tract infections (UTIs.) The goals of this study, conducted with the Consortium for Spinal Cord Medicine, were to perform a systematic literature review, with a particular focus on prevention and management of urinary tract infections in this population. Methodology: RAND convened a panel of experts that included physicians, nurses, other health care professionals, patients, and representatives from managed care organizations. According to the panel, the most important questions to answer with a literature review were the definition of UTIs, appropriate diagnosis and follow-up of complications, and identification of risk factors for recurrence, and prevention. The scientific literature was searched for the period from 1966 through 1998, research reports were evaluated and reviewed according to methods developed by the Center, and formal meta-analysis was performed. Outcomes: Among the findings were the following: The occurrence of febrile episodes was found to be associated with later upper urinary tract complications; intermittent catheterization lowers the frequency of infections relative to use of indwelling catheters; and antibiotic prophylaxis is not recommended.

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