Title: Role of Prophylactic Antibiotics in Bladder Management of Paraplegics – A Randomised Controlled Study
Authors: Babu Varghese .A.J, Raini. K.P
DOI: https://dx.doi.org/10.18535/jmscr/v6i6.72
Abstract
Introduction: Traumatic spinal cord injury is not an uncommon disease in the developing world. The most common cause being fall from heights. In spinal cord injured patients both bladder sensation and control are impaired. Urinary tract infections are one among the frequent complications seen in spinal cord injured patients The primary objective of this study is the role of prophylactic antibiotics in the prevention of significant bacteriuria in spinal cord injured patients with neurogenic bladder who are on intermittent clean catheterization.
Methodology: The randomized controlled study included 30 patients who had sustained injury to the thoracic and lumbar spinal cord admitted in the wards of departments of Physical Medicine and Rehabilitation, Orthopaedics and Neuromedicine were potential subjects of the study. Microscopical examination and culture of urine samples of all the 30 patients were done at the end of first, third and sixth months. The data obtained was subjected to statistical analysis using appropriate statistical method – SPSS.
Results: Thirty patients enrolled in this study were analyzed & compared with existing studies in the literature.18 patients put in the intervention group & 12 patients put in the control group. This study has shown that 61.11% of the patients sustained injury due to fall from height. 55.56% of the patients were treated with surgical fixation procedures like Steffee plate fixation showing that surgical intervention is commonly undertaken in these patients. This study has shown that administering prophylactic antibiotics along with catheter care and intake of oral fluids significantly reduced bacteriuria in these patients at the end of first, third and sixth months of follow up.
Conclusion: Administration of prophylactic antibiotics in spinal cord injured patients with neurogenic bladder on intermittent clean catheterization proved to be effective in the prevention of bacteriuria.
Keywords: Spinal cord injury, asymptomatic bacteriuria, urinary tract infection, prophylactic antibiotics, paraplegia.
References
- Stover SL ,Lloyd LK , Waites KB , Jackson AB , Urinary tract infection in spinal cord injury.Archives of Physical Medicine and Rehabilitation[01 Jan 1989, 70(1):47-54]
- GarcíaLeoni ME, Esclarín De Ruz A., Management of urinary tract infection in patients with spinal cord injuries. Clin Microbiol Infect.2003 Aug;9(8):780-5.
- Charlesnika T. Evans), Sherri L. La Vela, Frances M. Weaver , Michael Priebe et al, Epidemiology of Hospital-Acquired Infections in Veterans With Spinal Cord Injury and Disorder, Volume 29, Issue 3, March 2008 , pp. 234-242
- Paul Abrams, Meena Agarwal, Marcus Drake, et al., A proposed guideline for the urological management of patients with spinal cord injury,Volume101, Issue8, April 2008 Pages 989-994
- Roussey-Keslera V. Gadjosc N. Idresd B. HorenoL. Ichaye M.D.Leclair et al. , Antibiotic Prophylaxis for the Prevention of Recurrent Urinary Tract Infection in Children With Low Grade Vesicoureteral Reflux: Results From a Prospective Randomized Study. The Journal of Urology, Volume 179, Issue 2, February 2008, Pages 674-679
- Paul W. Brazis, Joseph C. Masdeu, and José Biller et al. Localization in Clinical Neurology, 3rd Ed. 1996, chapter 4.
- La Rosa G1, Conti A, Cardali S, Cacciola F, Tomasello F.,Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach,Spinal Cord.2004 Sep;42(9):503-12.
- Frederic J. Kottke, Justus F Lehmann, Krusen's Handbook of Physical Medicine and Rehabilitation, 4th Ed.March 1990 Chapter 32.
- Joel A. DeLisa, Bruce Michael Gans, Lynn H. Gerber , Rehabilitation Medicine: Principles and Practice, 3rd Ed. August 1998, Chapter 51.
- Randall L. Braddom, Physical Medicine/ Rehabilitation,1st Ed. January 1996, Chapter 55.