Changes in Bacterial Spectrum and Resistance Patterns Over Time in the Urine of Patients with Neurogenic Lower Urinary Tract Dysfunction Due to Spinal Cord Injury

Abstract

<b><i>Introduction:</i></b> Urinary tract infections (UTI) are among the most common complications in persons with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI). As both asymptomatic bacteriuria and UTI are frequently treated with antibiotics, concerns about multidrug resistance arise. Therefore, we analyzed the bacterial spectrum in the urine and the resistance patterns of the strains over time in patients with NLUTD due to SCI. <b><i>Methods:</i></b> In a systematic chart review, we identified all microbiologic urine test results including resistance patterns of persons with SCI in a tertiary referral hospital at 2 time periods (2010–2011 and 2017–2018). We assessed the frequency of the bacterial strains, the resistance patterns of the 5 most frequent bacteria, and the use of antibiotics for in- as well as for outpatients. <b><i>Results:</i></b> From 2010 to 2011, 1,308 (outpatients) and 2,479 (inpatients) bacterial strains were detected in the urinalyses performed; these numbers rose to 3,162 and 6,112 during 2017–2018, respectively. The most frequently detected bacteria during both time periods were <i>Escherichia coli</i>, <i>Enterococcus faecalis</i>, <i>Klebsiella pneumoniae</i>/<i>variicola</i>, <i>Streptococcus viridans</i>, <i>Pseudomonas aeruginosa</i>, and coagulase negative Staphylococci. Fluoroquinolones were the most frequently used antibiotics during both time periods. Despite its frequent use, no relevant increase in resistance against fluoroquinolones was detected. The most prominent increase in resistance appeared in <i>E. coli</i> against amocixillin/clavulanic acid in inpatients (from 26.0 to 38.5%). <b><i>Discussion and Conclusions:</i></b> Although fluoroquinolones were used frequently, we did not observe an increased resistance against these antibiotics over time in the urine of patients with SCI.