Community-Acquired Urinary Tract Infection Causing Microorganisms among Paraplegic Patients in Gaza Strip

Abstract

Background: Urinary tract infection is one of the most common causes of morbidity in patients with spinal cord injury after they have recovered from the initial effects of trauma. Unique factors that predispose to UTI in this population include urinary stasis and bladder catheterization. Objectives of the study: the aims of the study were to identify the most common UTI causing microorganisms and some pertinent risk factors among paraplegic patients inGaza strip, to study the antimicrobial sensitivity of the isolated microorganisms and determine the most effective antimicrobial agents, and to describe the most common method of bladder management. Study design: the present work is a descriptive cross-sectional study, which was conducted in El Wafa Medical Rehabilitation Hospital laboratory-Gaza Strip-Palestine, in the year 2008. Methodology: a questionnaire, urine analysis and culture were used to collect data from 170 patients (85 target and 85 control) from the community. The collected data were discussed in terms of their effects on the outcomes of the study. Results: the uropathogens identified in this study were E. coli (30.0%), Klebsiella species (21.2%), Proteus species (15.3%), Pseudomonas species (4.7%) and Staphylococci species (2.4%). All the isolates were subjected to antimicrobial susceptibility. Our results indicated that, a high proportion of the isolates were resistant to Doxycycline (47.6 %), Sulphamethoxazole-trimethoprim (46.5 %) and Nalidixic acid (42.4 %). On the other hand, the most effective antimicrobial agents against all isolated uropathogens were Cefatriaxone (90.4%) followed by Amikacin (80.0%), Gentamicin (67.2%) and Ciprofloxacin (61.6%). We found that, Self Intermittent Catheter (SIC), followed by external catheter “condom” (only for males), are the most commonly used methods for bladder management among paraplegic patients. Conclusions: E. coli was the predominant microorganism that causes community-acquired UTI in both target and control groups and Self Intermittent Catheter (SIC) is the most commonly used method for bladder management in paraplegic patients. Urogenic bladder and bladder catheterizations are among the most common risk factors causing UTI in paraplegic patients.