Urinary tract infections and bladder management over the first year after discharge from inpatient rehabilitation

Michael D Stillman; Jeanne M Hoffman; Jason K Barber; Steve R Williams; Stephen P Burns

doi:10.1038/s41394-018-0125-0

Urinary tract infections and bladder management over the first year after discharge from inpatient rehabilitation

Spinal Cord Ser Cases. 2018 Oct 19:4:92. doi: 10.1038/s41394-018-0125-0. eCollection 2018.

Authors

Michael D Stillman^{1

2

3}, Jeanne M Hoffman¹, Jason K Barber⁴, Steve R Williams^{1

3}, Stephen P Burns^{1

5}

Affiliations

¹ 1Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA USA.
² 2Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA USA.
³ 5Present Address: Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA.
⁴ 3Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA USA.
⁵ 4Spinal Cord Injury Service, Veterans Administration Hospital Puget Sound Health Care System, Seattle, WA USA.

Abstract

Study design: Secondary analysis of data from a prospective clinical trial of telephone counseling.

Objectives: To describe changes in bladder management and development of bladder-related complications in the first year after discharge from inpatient spinal cord injury (SCI) rehabilitation. To determine whether urinary tract infection (UTI) is associated with bladder management technique or severity of SCI during this time period.

Setting: One SCI Model System center.

Methods: Post hoc analysis of bladder-specific responses to a phone intervention meant to reduce secondary complications of paralysis in adults (n = 169) over the first year after discharge from initial inpatient rehabilitation (IR).

Results: Bladder management was associated with injury level during and immediately after inpatient rehabilitation, and with American Spinal Injury Association (ASIA) Impairment Scale (AIS) score over the entire year. During one year of follow-up, 19% of patients changed bladder management techniques. Among participants performing intermittent catheterization (IC), 20% had urinary incontinence weekly or more frequently. The cumulative incidence of UTI was 71% by the end of the study, and between 27 and 46% of subjects reported UTIs during each 3-month period. Subjects with spontaneous voiding reported significantly fewer UTIs than those using IC or indwelling catheterization (IDC), but there was no significant difference in UTIs between IC and IDC.

Conclusion: During the first year following discharge, approximately one in five patients changed the bladder management technique and urinary incontinence occurred in a substantial proportion of those performing IC. These findings suggest a need for more frequent monitoring of bladder changes and complications over the first year after IR.