Prevalence, Causative Organisms and Risk Factors for Urinary Tract Infections in Spinal Cord- Injured Patients

Abstract

Background: Spinal cord injuries (SCI) is a common occurrence in many hospitals in Kenya. Urinary tract infection is one of the major causes of morbidity and urosepsis in spinal cord- injured patients. The epidemiology of UTI in SCI varies with geographical locations. Data are scarce on the epidemiology of these infections in spinal cord injured patients in Kenya especially the prevalence, contributing factors, and the antimicrobial profile. Objective: To determine the prevalence, causative micro-organisms and risk factors for UTI in SCI. Study site: Kenyatta National Hospital. Method: Using a cross sectional study design, and consecutive sampling approach, patients who had spinal cord injury with an indwelling urethral catheter for at least 2 weeks were recruited and data collected on clinical and demographic factors, this was done at the Kenyatta National Hospital orthopedic wards. The urine was collected using and aseptic technique after change of catheter by trained research assistant. This was then transported in a cool box at 4 degrees celciul where the samples were cultures and Clinical Laboratory Standards Institute (CLSI) guidelines used for antimicrobial sensitivity testing. Results: In total, the findings reported were based on a sample of N = 69 patients with spinal cord injury. A majority were aged 26 – 40 years (50.7%), with males 88.4% bedridden 91.3% (N = 63), cervical spinal cord injury 39.1% (N = 27), with complete spinal injury 63.8% (N = 44), on latex catheter 53.6% (N = 37) and average catheterization period was 10.23 days (SD = 6.965). The prevalent of UTI was 82.6% (N = 57/69) with the most prevalence pathogens being Escherichia coli (33.3%, N = 23), and Klebsiella pneumoniae (23.2%, N = 16). Escherichia coli were most sensitive to nitrofurantoin, aminoglycosides, quinolones, and ceftriaxone. Klebsiella pneumoniae were most sensitive to gentamycin, ceftriaxone, amikacin and nitrofurantoin. Pseudomonas aeruginosa were most sensitive to quinolones such as norfloxacin and levofloxacin, with amikacin, gentamicin and piperacillin also indicated to be sensitive too. Proteus spp. were sensitive to gentamycin only. Staphylococcus aureus were sensitive to xiii ceftriaxone, nitrofurantoin, levofloxacin, amikacin, co-trimoxazole and chloramphenicol while Enterococcus faecalis were sensitive to chloramphenicol only. The main risk factors were being bedridden (p < 0.001), prolonged catheterization beyond 2 weeks (p = 0.031), and delayed catheter change past 4 weeks (p = 0.002) in addition to those with complete spinal cord injury (p = 0.022). Conclusion: This study highlights the high prevalence of UTI among spinal cord- injured patients, with E. coli and Klebsiella pneumoniae being the most common causative organisms. The antimicrobial sensitivity patterns provide valuable insights into appropriate antibiotic choices, with E. coli and Klebsiella pneumoniae showing high sensitivity to the available antibiotics both in oral and parenteral. Additionally, immobility was identified as a significant risk factor for urinary tract infections in spinal cord injured patients. These findings emphasize the need for comprehensive prevention strategies, including mobility promotion and judicious antibiotic use, to reduce the burden of urinary tract infections and improve the overall management of spinal cord injured patients