Patient subjective assessment of urinary tract infection frequency and severity is associated with bladder management method in spinal cord injury

Joshua D. Roth, Joseph J Pariser, John T. Stoffel, Sara M. Lenherr, Jeremy B. Myers, Blayne Welk, Sean Elliott

Research output: Contribution to journalArticle

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Abstract

Study design: The Neurogenic Bladder Research Group (NBRG) registry is a multicenter prospective observational study. This manuscript is retrospective based on a cross-sectional survey. Objectives: To assess patient subjective assessment of urinary tract infection (UTI) frequency and severity are associated with the degree of use of catheters or incontinence products. Setting: Multiple hospitals across the United States. Methods: Eligibility included: age > 18 years and acquired SCI. Over 1.5 years, 1479 eligible participants were enrolled. We excluded those with surgical reconstruction or diversion of the bladder. In total, 1282 participants were grouped by bladder management: (1) indwelling catheter (IDC), (2) clean intermittent catheterization (CIC), (3) external devices (pads/condom), and (4) volitional voiding (Void). UTI frequency was classified as 0, 1–3, 4–6, or > 6 over the prior year. UTI severity was determined by hospitalization for UTI in the prior year. Multivariate regression compared these factors across groups. Results: UTIs were least frequent in Void followed by pads/condom, CIC, and IDC (all p ≤ 0.001). UTI severity followed a similar pattern. Controlling for covariates, the adjusted odds of UTI frequency (Void = reference) were 2.28 (1.38–3.76) for pads/condom, 3.42 (2.25–5.18) for CIC, and 4.3 (2.59–6.70) for IDC (all p ≤ 0.001). Conclusions: Patient subjective assessment of UTI frequency is highest with IDC, followed by CIC, pads/condom, and lowest with spontaneous voiding. The odds of hospitalization for UTI were three times higher for IDC than spontaneous voiding. UTI risk should be considered when counseling patients about bladder management options. These associations do not imply causation but warrant further investigation in a prospective manner. Sponsorship: Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138).

Original languageEnglish (US)
Pages (from-to)700-707
Number of pages8
JournalSpinal Cord
Volume57
Issue number8
DOIs
StatePublished - Aug 1 2019

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Spinal Cord Injuries
Urinary Tract Infections
Urinary Bladder
Indwelling Catheters
Intermittent Urethral Catheterization
Condoms
Hospitalization
Patient Outcome Assessment
Neurogenic Urinary Bladder
Causality
Observational Studies
Registries
Counseling
Catheters
Cross-Sectional Studies
Prospective Studies
Equipment and Supplies
Research

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  • Journal Article

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Patient subjective assessment of urinary tract infection frequency and severity is associated with bladder management method in spinal cord injury. / Roth, Joshua D.; Pariser, Joseph J; Stoffel, John T.; Lenherr, Sara M.; Myers, Jeremy B.; Welk, Blayne; Elliott, Sean.

In: Spinal Cord, Vol. 57, No. 8, 01.08.2019, p. 700-707.

Research output: Contribution to journalArticle

Roth, Joshua D. ; Pariser, Joseph J ; Stoffel, John T. ; Lenherr, Sara M. ; Myers, Jeremy B. ; Welk, Blayne ; Elliott, Sean. / Patient subjective assessment of urinary tract infection frequency and severity is associated with bladder management method in spinal cord injury. In: Spinal Cord. 2019 ; Vol. 57, No. 8. pp. 700-707.
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abstract = "Study design: The Neurogenic Bladder Research Group (NBRG) registry is a multicenter prospective observational study. This manuscript is retrospective based on a cross-sectional survey. Objectives: To assess patient subjective assessment of urinary tract infection (UTI) frequency and severity are associated with the degree of use of catheters or incontinence products. Setting: Multiple hospitals across the United States. Methods: Eligibility included: age > 18 years and acquired SCI. Over 1.5 years, 1479 eligible participants were enrolled. We excluded those with surgical reconstruction or diversion of the bladder. In total, 1282 participants were grouped by bladder management: (1) indwelling catheter (IDC), (2) clean intermittent catheterization (CIC), (3) external devices (pads/condom), and (4) volitional voiding (Void). UTI frequency was classified as 0, 1–3, 4–6, or > 6 over the prior year. UTI severity was determined by hospitalization for UTI in the prior year. Multivariate regression compared these factors across groups. Results: UTIs were least frequent in Void followed by pads/condom, CIC, and IDC (all p ≤ 0.001). UTI severity followed a similar pattern. Controlling for covariates, the adjusted odds of UTI frequency (Void = reference) were 2.28 (1.38–3.76) for pads/condom, 3.42 (2.25–5.18) for CIC, and 4.3 (2.59–6.70) for IDC (all p ≤ 0.001). Conclusions: Patient subjective assessment of UTI frequency is highest with IDC, followed by CIC, pads/condom, and lowest with spontaneous voiding. The odds of hospitalization for UTI were three times higher for IDC than spontaneous voiding. UTI risk should be considered when counseling patients about bladder management options. These associations do not imply causation but warrant further investigation in a prospective manner. Sponsorship: Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138).",
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AU - Roth, Joshua D.

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AU - Stoffel, John T.

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AU - Myers, Jeremy B.

AU - Welk, Blayne

AU - Elliott, Sean

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N2 - Study design: The Neurogenic Bladder Research Group (NBRG) registry is a multicenter prospective observational study. This manuscript is retrospective based on a cross-sectional survey. Objectives: To assess patient subjective assessment of urinary tract infection (UTI) frequency and severity are associated with the degree of use of catheters or incontinence products. Setting: Multiple hospitals across the United States. Methods: Eligibility included: age > 18 years and acquired SCI. Over 1.5 years, 1479 eligible participants were enrolled. We excluded those with surgical reconstruction or diversion of the bladder. In total, 1282 participants were grouped by bladder management: (1) indwelling catheter (IDC), (2) clean intermittent catheterization (CIC), (3) external devices (pads/condom), and (4) volitional voiding (Void). UTI frequency was classified as 0, 1–3, 4–6, or > 6 over the prior year. UTI severity was determined by hospitalization for UTI in the prior year. Multivariate regression compared these factors across groups. Results: UTIs were least frequent in Void followed by pads/condom, CIC, and IDC (all p ≤ 0.001). UTI severity followed a similar pattern. Controlling for covariates, the adjusted odds of UTI frequency (Void = reference) were 2.28 (1.38–3.76) for pads/condom, 3.42 (2.25–5.18) for CIC, and 4.3 (2.59–6.70) for IDC (all p ≤ 0.001). Conclusions: Patient subjective assessment of UTI frequency is highest with IDC, followed by CIC, pads/condom, and lowest with spontaneous voiding. The odds of hospitalization for UTI were three times higher for IDC than spontaneous voiding. UTI risk should be considered when counseling patients about bladder management options. These associations do not imply causation but warrant further investigation in a prospective manner. Sponsorship: Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138).

AB - Study design: The Neurogenic Bladder Research Group (NBRG) registry is a multicenter prospective observational study. This manuscript is retrospective based on a cross-sectional survey. Objectives: To assess patient subjective assessment of urinary tract infection (UTI) frequency and severity are associated with the degree of use of catheters or incontinence products. Setting: Multiple hospitals across the United States. Methods: Eligibility included: age > 18 years and acquired SCI. Over 1.5 years, 1479 eligible participants were enrolled. We excluded those with surgical reconstruction or diversion of the bladder. In total, 1282 participants were grouped by bladder management: (1) indwelling catheter (IDC), (2) clean intermittent catheterization (CIC), (3) external devices (pads/condom), and (4) volitional voiding (Void). UTI frequency was classified as 0, 1–3, 4–6, or > 6 over the prior year. UTI severity was determined by hospitalization for UTI in the prior year. Multivariate regression compared these factors across groups. Results: UTIs were least frequent in Void followed by pads/condom, CIC, and IDC (all p ≤ 0.001). UTI severity followed a similar pattern. Controlling for covariates, the adjusted odds of UTI frequency (Void = reference) were 2.28 (1.38–3.76) for pads/condom, 3.42 (2.25–5.18) for CIC, and 4.3 (2.59–6.70) for IDC (all p ≤ 0.001). Conclusions: Patient subjective assessment of UTI frequency is highest with IDC, followed by CIC, pads/condom, and lowest with spontaneous voiding. The odds of hospitalization for UTI were three times higher for IDC than spontaneous voiding. UTI risk should be considered when counseling patients about bladder management options. These associations do not imply causation but warrant further investigation in a prospective manner. Sponsorship: Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138).

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