Fatigue. Fever. Cloudy urine. Could it be a UTI? What should I do? ^{2, 11} I’ll explain why a urine culture is the most important first step.

UTIs are one of the most common complications with spinal cord injuries for those who intermittently catheterize.^{3, 11} People using a Foley or suprapubic catheters may have a slightly higher risk of UTIs than those who intermittently catheterize (either through the urethra or Mitrofanoff) or use a condom catheter (male external catheters).²

Common causes

The most common cause of UTIs according to the literature is E.coli bacteria that are in stool. Staphylococcus and Proteus are two other types of bacteria that are common causes of UTIs.⁴ These bacteria can be introduced into the bladder during or after bowel programs or during routine catheterization.^1,2

What to do

So when you have two or more of these symptoms, or even when uncertain or are 100% sure it’s a UTI, what should we do?

After contacting your doctor, he or she may recommend that you have a urinalysis and a urine culture. If you are symptomatic, a doctor may call in a prescription but based on the culture and sensitivity tests it may need to be modified.⁶

Why is a urine culture so important?

Why aren’t my symptoms or a urinalysis enough? A urinalysis is only a basic test of urine; it is recommended that antibiotics never be prescribed solely on urinalysis results.⁶

A urine culture actually places samples of urine into small plates for one to two days to see which bacteria will grow. Knowing the specific bacteria and number of bacteria in the urine is the only way to be sure which antibiotic will be effective in treating the infection.⁸

Resistant bacteria

When a person takes antibiotics, sensitive bacteria are killed, but resistant bacteria are left to grow and multiply.⁹ This is why repeated use – and misuse – of antibiotics is increasing the number of drug-resistant bacteria.^{9, 10}

A common misconception is that a person becomes resistant to an antibiotic. But the fact is bacteria become resistant to an antibiotic. Resistant bacteria can spread to family members, coworkers and throughout our communities.⁹

The situation with antibiotic-resistant bacteria is becoming so dire that the CDC is calling it “one of the world’s most pressing public health problems.”⁹ In a 2015 report by the World Health Organization, “scientists found rates above 25 to 50 percent of resistance to antibiotics commonly used to treat UTIs.”¹⁰

Guys, this is serious. Our health may depend on it.

As a community, let’s recommend getting cultures before taking antibiotics whenever possible.

So what should I do to help protect myself and my community from antibiotic resistance? 

Here is what the CDC recommends: ⁹

• Ask your healthcare professional if there are steps you can take to feel better and get symptomatic relief without using antibiotics.
• Take the prescribed antibiotic exactly as your healthcare professional tells you.
• Discard any leftover medication.
• Ask your healthcare professional about vaccines recommended for you and your family to prevent infections that may require an antibiotic.
• Never skip doses or take an antibiotic for a viral infection like a cold or the flu.
• Don’t pressure your healthcare professional to prescribe an antibiotic.
• Never save antibiotics for the next time you get sick.
• Don’t take antibiotics prescribed for someone else.

The key with everything is to be your own advocate. Talk to your doctor and be proactive. UTI’s are a common complication for us and knowing how to manage is crucial. I hope this blog has provided you with some important information on the need to make sure you are treating your UTI with the right antibiotics.

References

1. Newman DK, Willson MM. Review of intermittent catheterization and current best practices. Urologic nursing. https://www.ncbi.nlm.nih.gov/pubmed/21542441. Accessed September 13, 2017. 
2. Spinal Cord Injury Model Systems. Urinary Tract Infection and Spinal Cord Injury. Urinary Tract Infection and Spinal Cord Injury. http://www.msktc.org/lib/docs/Factsheets/SCI_UTI.pdf. Accessed May 30, 2018. 
3. Tofte N. etl. Chronic urinary tract infections in patients with spina cord lesions – biofilm, infection with need to long-term antibiotic treatment.  APMIS 2017 125: 385-391.  
4. Urine Culture: How the Test Works. Healthline. https://www.healthline.com/health/urine-culture. Accessed May 30, 2018. 
5. General Background: About Antibiotic Resistance. Alliance for the Prudent Use of Antibiotics. http://emerald.tufts.edu/med/apua/about_issue/about_antibioticres.shtml. Accessed May 30, 2018. 
6. Bates BN. Interpretation of Urinalysis and Urine Culture for UTI Treatment. U.S. Pharmacist – The Leading Journal in Pharmacy. https://www.uspharmacist.com/article/interpretation-of-urinalysis-and-urine-culture-for-uti-treatment. Published November 15, 2013. Accessed May 30, 2018. 
7. Thread: Urinalysis vs. Urine Culture. CareCure Forums RSS. http://sci.rutgers.edu/forum/showthread.php?88018-Urinalysis-vs-Urine-Culture. Accessed May 30, 2018. 
8. Understanding urine tests. Advances in pediatrics. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072534/. Published December 30, 2016. Accessed May 30, 2018. 
9. Antibiotic Prescribing and Use in Doctor’s Offices. Centers for Disease Control and Prevention. https://www.cdc.gov/antibiotic-use/community/about/antibiotic-resistance-faqs.html. Published December 7, 2017. Accessed May 30, 2018. 
10. Racco M. Antibiotic resistant UTIs are on the rise. Here’s what you need to know. Global News. https://globalnews.ca/news/4229300/antibiotic-resistant-uti/. Published May 25, 2018. Accessed May 30, 2018. 
11. Taweel W. Seyam R. Neurogenic bladder in spinal cord injury patients.  Research and Reports in Urology 2015:7 85-89. Dove Medical Press Limited.