Intermittent catheterization (IC) has gained acceptance as the preferred method of early neurogenic bladder management. Although debate continues over the significance of recurrent urinary tract infection (UTI) in long-term management, nosocomial UTIs remain a concern for the newly hospitalized spinal cord injured (SCI) individual. This results in loss of therapy time, increased hospital costs, and lengthened hospital stays. Numerous studies documented colonization of the distal urethra with pathogenic organisms that can be carried into the bladder during IC. Studies at this hospital have shown substantial distal urethral colonization of men with Pseudomonas and Klebsiella; however there was little colonization of women with these organisms. Our findings show that 80% of the UTIs in women on IC are E. coli and Enterococcus. Recently a new catheter system with an introducer tip designed to bypass the first 1.5 cm (colonized section) of the urethra has reduced the infection rate of SCI patients on IC at this institution by 30%. Since female patients represent a minority of SCI persons and there are few studies which address their unique concerns; this study will examine the UTI rates of men and women separately. We will study the incidence of UTIs in men and women using a catheter kit with/ without introducer tip in the following categories: A) Male patients on IC, not voiding, no external urinary collection system (EUCS). B) Male patients on IC, voiding, EUCS. C) Female patients on IC, not voiding, no padding. D) Female patients on IC, voiding, wearing padding. In addition, the study will evaluate if urethral colonization with E. coli in women account for their higher incidence of UTI. The significance of elevated intravesical pressures in relationship to the overall UTI outcomes will be evaluated.
