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Multidrug-resistant bacteria in urine culture among patients with spinal cord injury and disorder: Time to first detection and analysis of risk factors


Study design

Retrospective cohort study.


The aim of this study was to assess the time to first detection of multidrug-resistant bacteria (MDRB) in urine culture and identify risk factors associated with the first detection of MDRB (1st MDRB).


Spinal Care Ward and Department of Microbiology, Regional Hospital Liberec a.s., Liberec, Czech Republic.


We cultured urine samples from patients in the acute phase of spinal cord injury or disorder (SCI/D). Multidrug resistance (MDR) was defined as acquired nonsusceptibility to at least one agent from three or more antimicrobial categories. Multivariate logistic regression was used to assess the association of bladder management, broad-spectrum antibiotic exposure, mechanical ventilation, pressure ulcers, positive urine culture on admission, and other risk factors with 1st MDRB. We used only the first urine culture with MDRB for evaluation.


A total of 655 urine cultures from 246 individuals were evaluated, and 829 isolates were obtained. The MDRB prevalence among all isolates was 40.2%. MDRB was detected in 146 (59.3%) patients for the first time, and 76.0% of these isolates were from patients with asymptomatic bacteriuria. The median time to 1st MDRB was 37 days (95% CI, 33–41). According to multivariate logistic regression, 1st MDRB was associated with bladder management with urethral or suprapubic catheterization (OR: 2.8, 95% CI, 1.1–7.2).


The prevalence of infections caused by MDRB was high among the SCI/D population, with three-quarters from patients with asymptomatic bacteriuria. Bladder management with an indwelling catheter is associated with an increased risk of 1st MDRB.

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Fig. 1: Kaplan–Meier plots of 1st MDRB.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


  1. Penders J, Huylenbroeck AA, Everaert K, Van Laere M, Verschraegen. GL. Urinary infections in patients with spinal cord injury. Spinal Cord. 2003;41:549–52.

    CAS  Article  Google Scholar 

  2. Esclarin De Ruz A, Garcia Leoni E, Herruzo Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol. 2000;164:1285–9.

    CAS  Article  Google Scholar 

  3. Adriaansen JJ, Ruijs LE, van Koppenhagen CF, van Asbeck FW, Snoek GJ, et al. Secondary health conditions and quality of life in persons living with spinal cord injury for at least ten years. J Rehabil Med. 2016;48:853–60.

    Article  Google Scholar 

  4. Rabadi MH, Aston CE. Predictors of mortality in veterans with multiple sclerosis in an outpatient clinic setting. Int J MS Care. 2017;19:265–73.

    Article  Google Scholar 

  5. Waites KB, Canupp KC, Chen Y, DeVivo MJ, Moser SA. Bacteremia after spinal cord injury in initial versus subsequent hospitalizations. J Spinal Cord Med. 2001;24:96–100.

    CAS  Article  Google Scholar 

  6. Hsiao CY, Yang HY, Chang CH, Lin HL, Wu CY, et al. Risk factors for development of septic shock in patients with urinary tract infection. Biomed Res Int. 2015;2015:717094.

    Article  Google Scholar 

  7. Welk B, Fuller A, Razvi H, Denstedt J. Renal stone disease in spinal-cord-injured patients. J Endourol. 2012;26:954–9.

    Article  Google Scholar 

  8. Toner L, Papa N, Aliyu SH, Dev H, Lawrentschuk N, et al. Extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospital urinary tract infections: incidence and antibiotic susceptibility profile over 9 years. World J Urol. 2016;34:1031–7.

    CAS  Article  Google Scholar 

  9. Ryu KH, Kim YB, Yang SO, Lee JK, Jung TY. Results of urine culture and antimicrobial sensitivity tests according to the voiding method over 10 years in patients with spinal cord injury. Korean J Urol. 2011;52:345–9.

    Article  Google Scholar 

  10. Waites KB, Chen Y, DeVivo MJ, Canupp KC, Moser SA. Antimicrobial resistance in gram-negative bacteria isolated from the urinary tract in community-residing persons with spinal cord injury. Arch Phys Med Rehabil. 2000;81:764–9.

    CAS  Article  Google Scholar 

  11. Evans CT, Fitzpatrick MA, Jones MM, Burns SP, Poggensee L, et al. Prevalence and factors associated with multidrug-resistant gram-negative organisms in patients with spinal cord injury. Infect Control Hosp Epidemiol. 2017;38:1464–71.

    Article  Google Scholar 

  12. (EU-CAST), E.C.o.A.S.t. Clinical breakpoints - breakpoints and guidance. 2020 2.11.2020; Available from:

  13. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.

    CAS  Article  Google Scholar 

  14. Mylotte JM, Kahler L, Graham R, Young L, Goodnough S. Prospective surveillance for antibiotic-resistant organisms in patients with spinal cord injury admitted to an acute rehabilitation unit. Am J Infect Control. 2000;28:291–7.

    CAS  Article  Google Scholar 

  15. Fitzpatrick MA, Suda KJ, Safdar N, Burns SP, Jones MM, et al. Changes in bacterial epidemiology and antibiotic resistance among veterans with spinal cord injury/disorder over the past 9 years. J Spinal Cord Med. 2018;41:199–207.

    Article  Google Scholar 

  16. Suda KJ, Patel UC, Sabzwari R, Cao L, Ramanathan S, et al. Bacterial susceptibility patterns in patients with spinal cord injury and disorder (SCI/D): An opportunity for customized stewardship tools. Spinal Cord. 2016;54:1001–9.

    CAS  Article  Google Scholar 

  17. Ramanathan S, Fitzpatrick MA, Suda KJ, Burns SP, Jones MM, et al. Multidrug-resistant gram-negative organisms and association with 1-year mortality, readmission, and length of stay in Veterans with spinal cord injuries and disorders. Spinal Cord. 2020;58:596–608.

    Article  Google Scholar 

  18. Forster CS, Courter J, Jackson EC, Mortensen JE, Haslam DB. Frequency of multidrug-resistant organisms cultured from urine of children undergoing clean intermittent catheterization. J Pediatr Infect Dis Soc. 2017;6:332–8.

    Google Scholar 

  19. Fan NC, Chen HH, Chen CL, Ou LS, Lin TY, et al. Rise of community-onset urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli in children. J Microbiol Immunol Infect. 2014;47:399–405.

    Article  Google Scholar 

  20. Mota ÉC, Oliveira AC. Catheter-associated urinary tract infection: Why do not we control this adverse event? Rev Esc Enferm USP. 2019;53:e03452.

    Article  Google Scholar 

  21. Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis. 1982;146:719–23.

    CAS  Article  Google Scholar 

  22. Fitzpatrick MA, Suda KJ, Burns SP, Poggensee L, Ramanathan S, et al. Pre-operative screening for asymptomatic bacteriuria and associations with post-operative outcomes in patients with spinal cord injury. J Spinal Cord Med. 2019;42:255–9.

    Article  Google Scholar 

  23. Afsar SI, Yemisci OU, Cosar SN, Cetin N. Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study. Spinal Cord. 2013;51:645–9.

    CAS  Article  Google Scholar 

  24. Cardenas DD, Hooton TM. Urinary tract infection in persons with spinal cord injury. Arch Phys Med Rehabil. 1995;76:272–80.

    CAS  Article  Google Scholar 

  25. Mortazavi-Tabatabaei SAR, Ghaderkhani J, Nazari A, Sayehmiri K, Sayehmiri F, et al. Pattern of antibacterial resistance in urinary tract infections: A systematic review and meta-analysis. Int J Prev Med. 2019;10:169.

    Article  Google Scholar 

  26. Girard R, Mazoyer MA, Plauchu MM, Rode G. High prevalence of nosocomial infections in rehabilitation units accounted for by urinary tract infections in patients with spinal cord injury. J Hosp Infect. 2006;62:473–9.

    CAS  Article  Google Scholar 

  27. Trautner BW, Darouiche RO. Prevention of urinary tract infection in patients with spinal cord injury. J Spinal Cord Med. 2002;25:277–83.

    Article  Google Scholar 

  28. Wyndaele JJ, Brauner A, Geerlings SE, Bela K, Peter T, et al. Clean intermittent catheterization and urinary tract infection: review and guide for future research. BJU Int. 2012;110:E910–7.

    Article  Google Scholar 

  29. Kang MS, Lee BS, Lee HJ, Hwang SW, Han ZA. Prevalence of and risk factors for multidrug-resistant bacteria in urine cultures of spinal cord injury patients. Ann Rehabil Med. 2015;39:686–95.

    Article  Google Scholar 

  30. Wyndaele JJ. The encrustation and blockage of longterm indwelling catheters. Spinal Cord. 2010;48:783.

    CAS  Article  Google Scholar 

  31. Dedeić-Ljubović A, Hukić M. Catheter-related urinary tract infection in patients suffering from spinal cord injuries. Bosn J Basic Med Sci. 2009;9:2–9.

    Article  Google Scholar 

  32. Faarvang KL, Müller P, Lomberg B, Biering-Sørensen F. Screening for bacteriuria in patients with spinal cord lesion: Dipstick test, microscopic examination and urine culture. Spinal Cord. 2000;38:106–8.

    CAS  Article  Google Scholar 

  33. García Leoni ME, Esclarín De Ruz A. Management of urinary tract infection in patients with spinal cord injuries. Clin Microbiol Infect. 2003;9:780–5.

    Article  Google Scholar 

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The authors would like to thank Hana Kolářová, Ph.D. for assistance with data processing and statistical evaluation.


This work was supported by funding from the Scientific Board of Krajská nemocnice Liberec, a.s.

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Authors and Affiliations



Study concept and design: VŠ, VP. Data analysis and interpretation: VŠ, HK. Microbiology expertise: DF. Manuscript preparation: VŠ, VP. Manuscript review: VŠ, JM. All authors read and approved the final manuscript. All authors consent to the publication of the manuscript in Spinal Cord.

Corresponding author

Correspondence to Vladimír Šámal.

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The authors declare no competing interests.

Ethical approval

This study was approved by the relevant Institutional Review Boards. We certify that all applicable institutional and governmental regulations concerning the ethical use of human subjects data were followed during the course of this research.

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Šámal, V., Paldus, V., Fáčková, D. et al. Multidrug-resistant bacteria in urine culture among patients with spinal cord injury and disorder: Time to first detection and analysis of risk factors. Spinal Cord (2022).

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