Affiliations: Division of Infectious Disease, Department of Medicine, University of British Columbia and Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada
Abstract: Quantitative urine cultures are used to identify individuals in whom urine in the bladder is not sterile, that is, those who have bacteriuria. In people with spinal cord injury the criteria which best distinguish specimen contamination from bacteriuria have been established, and are lower than the traditional ≥1055 CFU/ml criterion. Bacteriuria mayor may not be symptomatic, and the benefits of treatment mayor may not outweigh the risks. Abnormal levels of pyuria are present in the great majority of spinal cord injured people who have indwelling catheters or who use intermittent catheterization. In the latter group, catheter urine is not homogeneous, and levels of pyuria are highest in the terminal fraction of catheter urine. Absence of pyuria is a good indicator of absence of high count gram negative bacteriuria, but pyuria may be present in the absence of bacteriuria in this population. No methods suitable for routine clinical use are currently available to localize the site of urinary infection in this population. Frequently recurrent or persistent bacteriuria is extremely common in people with spinal cord injury. Bacteriuria is most often asymptomatic, yet is clearly significant in that it is responsible for measurable short-term and long-term morbidity. However, at present, quantitative urine cultures and tests for pyuria cannot, by themselves, be used to identify spinal cord injured persons who will reliably benefit from treatment for bacteriuria.
