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Research Registry No |
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PLRID-00791_V2 |
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Postgraduate Research |
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No |
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University Departmental Research |
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Yes |
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Name of University |
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University of Medicine (1), Yangon |
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Department |
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Physical Medicine and Rehabilitation |
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Registration Date |
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2020-08-15 |
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Principle Investigator |
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Hein Thuya Linn |
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Co-Investigators |
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Khin Myo Hla, Mya Hnin Yu, Phyo Pa Pa Win |
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Title of Research |
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Etiologic Agents and Antibiotics Susceptibility for Urinary Tract Infections in Spinal Cord Injury Patients |
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Field of Research |
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Rehabilitation Medicine |
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Preliminary Research Design |
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Descriptive Study |
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Preliminary Research Type |
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Applied |
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Preliminary Justification |
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Urinary tract infection is one of the most important causes of morbidity and mortality in patients with spinal cord injury. The occurrence of urinary tract infection in SCI is at a rate of 2.5 events per patient per year. In acute SCI, 22% of patients develop UTI within first 50 days and in chronic SCI, annual UTI incidence is nearly 20%.
The mortality in SCI patients is mainly due to respiratory diseases, heart diseases and infection. UTI which is one of the infection has a death rate of about 15% among them. However, management of UTI has been more improved, mortality due to urinary sepsis decreases in nowadays.
UTI in SCI patients is different from and more complicated than UTI in other patients because of chance of foreign body insertion (catheterization), nature of neurogenic bladder and high risk of antibiotics resistances. Therefore, treatment consideration of UTI in SCI is also more or less different than routine antibiotics management.
First and foremost, 61.5% of catheterized patients are detected to have UTI. It was also observed that UTI was more frequent in patients with a permanent catheter compared to those employing clean intermittent cathetertization (CIC). Therefore, the most important preventative measures include closed catheter drainage in patients with an indwelling catheter and the use of clean intermittent catheterization (CIC) over other methods of bladder management if possible.
As a result of neurogenic bladder in SCI, the microorganisms of UTI form biofilms on the bladder wall. It may be found within 1–3 days following insertion and they form both intra and extraluminally. Biofilms produced by Proteus species, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Providencia species leads to hydroxyapatite, struvite and encrustations that may obstruct catheters and further prevent urinary drainage.
The risk of antibiotics resistance in UTI among SCI patients is also very high due to formation of the biofilms which leads to difficulty in eradication of the infection. Antimicrobial resistance of urinary tract organisms in SCI patients are approximately 33% of urinary cultures isolated. Age over 65 years, use of urinary catheter, previous hospitalization, and prior antimicrobial use have been identified as common risk factors. SCI patients have also long hospital stay which will relate to more risk of antibiotics resistance. All of these may finally lead to inappropriate antibiotics selection and treatment failure.
There are many treatment protocols in management of UTI, especially regarding with the duration of treatment course. Generally, an acute, symptomatic UTI should be treated with antibiotics for 5–14 days depending on the severity of the presentation. Antibiotic selection should be based on local and patient based resistance patterns and the spectrum should be as narrow as possible if there are no concerns regarding urosepsis. Treatment of asymptomatic bacteriuria shall be considered based on risk of rising resistance patterns and probability of clinical efficacy. But, there has been no significant difference between the distribution of agents isolated from patients with asymptomatic bacteriuria and patients with symptomatic urinary system infection.
There is also a significant correlation between UTIs and functional improvement of SCI rehabilitation. According to functional independence measures (FIM), decrease in functional gains of a SCI can be caused by delayed improvement in bladder function because of UTI. Bladder management is a crucial element in improving outcomes for individuals with SCI. Eradication of UTI is one of the first and major steps of rehabilitation of neurogenic bladder.
In order to achieve this effective antibiotic therapy for UTI, the treatment of choice should be commenced according to the local bacterial ecology, especially during pending of laboratory C & S results. On this subject, identification of etiologic agents and their antibiotics susceptibility is essential for practicing the most appropriate treatment. Moreover, the results of the study will also help to provide more practical usefulness of antibiotic drug policy, and thereby reducing severity and duration of illness of UTI in SCI. This can also again lead to reduce the risk of septicemia and mortality due to UTI. The study is to explore the etiologic agents and their antibiotics susceptibility for UTIs among hospital-residing SCI patients in Yangon General Hospital which can be used for practical purpose in UTI management by establishing effective antibiotic treatment. |
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Preliminary Aim |
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To study the causative agents and antibiotics susceptibility of urinary tract infections in patients with spinal cord injury in Physical Medicine and Rehabilitation Ward, Yangon General Hospital from May 2020 to December 2020 |
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Preliminary Objectives |
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1.To identify the microorganisms of urinary tract infections in patients with spinal cord injury 2.To determine antibiotics susceptibility of urinary tract infections in patients with spinal cord injury 3. To observe the effects and responses of proper antibiotic therapy on urinary tract infections in patients with spinal cord injury |
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Preliminary Sample Size |
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Spinal Cord Injury Patients with Urinary Tract Infection in Physical Medicine and Rehabilitation Department, Yangon General Hospital |
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Preliminary Study Duration |
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From May 2020 to December 2020 |
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Preliminary Study Area |
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Physical Medicine and Rehabilitation Department, Yangon General Hospital |
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Preliminary Study Method |
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Prospective Observational Study |
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Preliminary Research Outcome |
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Pending |
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Preliminary Research Finding |
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Pending |
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Preliminary Progress Report |
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Pending |
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Study Starting Date |
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2020-05-29 |
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IRB/PRC/ERC Approval Date |
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2020-05-29 |
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Placement of IRB/PRC/ERC |
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Yangon General Hospital |
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IRB/PRC/ERC Approval Letter/Document |
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15082020034543IRBapproval.pdf |
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Pre-existing Registration ID |
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- |
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Pre-existing Name of Organization |
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- |
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Pre-existing Name of Organization Website |
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- |
