Darouiche et al. 1997 USA
PEDro=7
RCT (study 1)
Pre-post (study 2)
Study 1 N=45/40
Study 2 N=12

Population: SCI with symptomatic polymicrobial UTI: Age = 23-84 yrs; Gender: males.
Treatment: Limited vs full microbiological investigation for management of symptomatic polymicrobial UTI (limited = cultures for specific organisms not used to guide antibiotic selection).
Outcome Measures: Clinical improvement following symptomatic UTI (criteria defined as presence of bacteria + one symptom) by 4 days after treatment with antibiotic, time to start antibiotic, cost of entire therapy and lab tests.

• No difference in therapy response between full vs limited approach (95% vs 85%, p=0.4);
• Limited approach antibiotic initiation earlier at 1.2+/-1.4 days vs 3.3+/-2.5 days for full approach (p=.01);
• Higher proportion of people in limited group required no change in initial antibiotic than with full approach 85% vs 33% (p=.006);
• Recurrence at 1 month due to at least 1 of the originally infecting species was similar for both groups (p=1.0);
• Costs for limited investigation-directed therapy less @ $157+/- $174 vs $252 +/- $237 for full approach indicative of a trend but not significantly different (p=.18)

Horton et al. 1998
USA
PEDro=6
RCT
N=40

Population: SCI, inpatients.
Treatment: Urine sample was processed within 4 hrs of sampling (“fresh”) vs 24 (“refrigerated” ) hours of refrigeration.
Outcome Measures: Cultures, colony counts, urinalysis.

• No significant difference between fresh and refrigerated samples in:
• WBC (p=0.724),
• # bacteria (p = 0.440)
• leukocytes (p = 0.782),
• colony counts of E. fecalis & Pseudomonas (p =0.317), E. coli, Citrobacter, Streptococcus, Yeast, or Acinetobacter (p=1.0).
• Sig diff btwn fresh & refrigerated samples with colony counts <50 k: "mixed" organisms (p = 0.010)
• Staph aureus trend only (p=0.066)
• No cultures/colony count changes in up to 24h refrigeration to alter treatment or clinically significant urinalysis/culture results.

Shah et al. 2005
USA
PEDro=4
Prospective controlled trial
N=85

Population: SCI inpatients with indwelling / suprapubic catheter and suspected of having a UTI; Control group (n=41): mean age = 55.6yrs; Treatment group (n=44): mean age = 64.1yrs.
Treatment: Patients were admitted to two spinal cord units: 1) continued the routine practice of examining urine samples without replacing the catheter (Control group) ; vs 2) nurses replaced catheter before obtaining urine samples (Treatment group) for urinary analysis.
Outcome Measures: Prevalence of organisms, types of organisms, laboratory costs.

• More clinically significant organisms (≥105 cfu/mL) were found in those whose catheter was not changed vs changed (89/41 patients vs 60/44 patients, p=0.01).
• Fewer non-clinically significant organisms (<105 cfu/mL) were found in those whose catheter was not changed vs changed (4/41 patients vs 19/44 patients, p=0.01).
• Changed catheter group had significantly less multidrug resistant organisms than the control group (p<0.001). 
• The changed vs unchanged catheter approach resulted in a total cost reduction of $15.64 per patient.

Tantisiriwat et al. 2007
Thailand
Downs and Black score=16
Case series
N=76

Population: SCI hospitalized at Rehabilitation Center (Thai Red Cross Society); Mean age = 44.7 yrs ; Gender: males = 50, females = 26; Type of neurogenic bladder: detrusor overactivity = 39, detrusor underactivity = 9.
Treatment: Retrospectively chart review to assess UTI prevalence, causative bacteria and susceptibility patterns.
Outcome Measures: Causative bacteria, susceptibility to antibiotic, prevalence of UTI.

• Prevalence of UTI was higher in patients with neurogenic detrusor overactivity (97.14%) than underactivity (66.67%).
• Of urine culture performed in 41/68 episodes of UTI, 39 positive cultures identified with E. coli (74.4%), K. pneumonia (12.8%), Enterococcus faecalis (5%) and Proteus mirabilis (5%) most common.
• E. coli was most susceptible to amikacin (96.1%), ceftazidime (88.9%), and cetriaxone (75%).
• K. pneumonia was most susceptible to ceftazidime (80.0%), cetriaxone (80.0%), amikacin (60.0%) and cotrimoxazole (60%).

Hoffman et al. 2004
USA
Downs & Black score=16
Cohort
N=56

Population: SCI > 6months post-injury who reported recurrent UTIs: Mean age = 38.86 yrs; Gender: males = 42, females = 14; Level of injury: tetraplegia = 34.
Treatment: Comparing dipstick results for Nitrites or leukocyte esterase (LE) to urine culture results.
Outcome Measures: Urine samples (nitrate, LE and culture) and self-report of symptoms, UTI presence and treatment collected monthly over 3 years and then only for 10 months over last 2 years.  Sensitivity, specificity, undertreatment, overtreatment were assessed.

• In predicting significant bacteriuria, when either Nitrates or LE separately or both were positive there was a low sensitivity (0.63) and overtreatment rate (0.04) with a high specificity (0.89) and undertreatment rate (0.96).
• In predicting NIDRR-based UTI, when either Nitrates or LE separately or both were positive there was a low sensitivity (0.64) but also a low specificity (0.52) resulting in a higher overtreatment (0.66) and lower undertreatment rate (0.22) than seen with bacteriuria prediction.
• Overall results suggest using dipstick testing as a treatment guide could result in overtreatment rates of 70% and low rates of undertreatment.

Faarvang et al. 2000
Denmark
Downs and Black score=7
Pre-Post
N=143

Population: Those with spinal cord lesion admitted to inpatient SCI program.
Treatment: 256 morning urine samples were collected from patients using a standardized ‘clean’ technique. Analysis was conducted with chemical dipstick and microscopy within 3 hours.
Outcome Measures: Prevalence of bacteria compared with nitrite/leukocyte dipstick tests (positive and negative predictive values), types of bacteria.

• The authors suggested that results comparing +ive and -ive predictive values indicated that the dipstick and microscopy tests are both equally valuable.
• True –ive predictive value ~0.7 and true +ive predictive value of ~0.9.
• 128 out of 256 urine samples contained significant bacteriuria.
• Only 87 contained just one microorganism.