Systematic Review of Risk Factors for Urinary Tract Infection in Adults with Spinal Cord Dysfunction

Published in: Journal of Spinal Cord Medicine, v. 22, no. 4, Winter 1999, p. 258-272

Posted on RAND.org on December 31, 1998

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

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Recurrent urinary tract infections (UTIs) occur frequently in persons with neurogenic bladders due to spinal cord dysfunction, resulting in increased morbidity and cost. The authors conducted a systematic review to identify risk factors for UTI using controlled clinical trials, cohort, and cross-sectional studies that assessed risk factors for UTI and included bacteriuria or UTI as an outcome. Twenty-two studies met the inclusion criteria. Quality assessment revealed important methodological deficiencies. Two studies provide evidence supporting increased bladder residual volume as a risk factor. Most of the retrieved studies investigated method of drainage with the consistent finding that persons using intermittent catheterization had fewer infections than those with indwelling catheters. There is conflicting evidence over the value of sterile or no touch catheter techniques compared with clean intermittent catheterization. There is insufficient evidence to assess risk due to psychosocial, behavioral, and hygiene factors; sex; level of function; and time since injury.

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