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Fitzpatrick MA, Wirth M, Solanki P, Burns SP, Suda KJ, Weaver FM, Collins EG, Safdar N, Evans CT. A survey of knowledge, experiences, and quality of life impacts related to urinary tract infections among people with neurogenic bladder. J Spinal Cord Med 2025:1-9. [PMID: 40366869 DOI: 10.1080/10790268.2025.2503051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2025] Open
Abstract
BACKGROUND Urinary tract infections (UTI) are common complications in people with neurogenic bladder (NB). Limited data exist on UTI-related knowledge, experiences, and quality of life (QoL) impacts in this population. METHODS We mailed surveys to 289 Veterans with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis, or Parkinson's Disease who had a UTI diagnosis at four Veterans Affairs Medical Centers between May 2022-May 2023. The survey was adapted from existing instruments and previously collected qualitative data and assessed patient knowledge and experiences with UTI and QoL impacts. Descriptive statistics summarized responses and scaled QoL scores were calculated, with higher scores indicating greater negative impact. RESULTS Most respondents (n = 71) were older (mean age = 69), had SCI/D (77%), and used urinary catheters (77%). Over a third had misperceptions about antibiotic risks and the significance of a positive urine culture or bacteriuria for diagnosing UTI. 18% wanted more information about UTIs, with most preferring written materials (77%) or information at healthcare provider visits (62%). The strongest QoL impacts were on daily activities, with many respondents indicating UTIs affect diet (50%), travel (53%), and sex life (60%). Mean [standard deviation (SD)] scaled QoL score was 40.8 (15.3) out of a maximum of 75, with ≥ 3 UTIs in the prior year associated with higher scores (p = 0.02). CONCLUSIONS People with NB may have misperceptions about UTI diagnosis and antibiotic risks, and experience substantial QoL impacts from UTIs. Provider encounters for suspected UTI may be good opportunities for delivering written education and assessing QoL impacts.
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Affiliation(s)
- Margaret A Fitzpatrick
- Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Pooja Solanki
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Stephen P Burns
- Spinal Cord Injury/Disorders Service, VA Puget Sound Healthcare System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
- Loyola University Chicago Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Eileen G Collins
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
- William S. Middleton VA Hospital, Madison, Wisconsin, USA
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Zhang J, Lei Y, Du H, Li Z, Wang X, Yang D, Gao F, Li J. Exploring urinary microbiome: insights into neurogenic bladder and improving management of urinary tract infections. Front Cell Infect Microbiol 2025; 15:1512891. [PMID: 40235931 PMCID: PMC11996777 DOI: 10.3389/fcimb.2025.1512891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 03/13/2025] [Indexed: 04/17/2025] Open
Abstract
The traditional view of sterile urine has been challenged by advancements in next-generation sequencing, revealing that the urinary microbiome significantly influences individual health and various urinary system diseases. Urinary tract infections in patients with neurogenic bladder are highly prevalent, recurrent, and lifelong. If frequent urinary tract infections are not adequately managed, they may ultimately lead to chronic renal failure. The excessive use of antibiotics to prevent and treat urinary tract infections may lead to increased bacterial resistance, limiting future therapeutic options. This review summarizes commonly used microbiome research techniques and urine collection methods, compiles current studies on the urinary microbiome in neurogenic bladder patients, and discusses the potential implications of urinary microbiome composition for preventing, diagnosing, and treating urinary tract infections. By summarizing current research findings, we aim to enhance understanding of the urinary microbiome in neurogenic bladder patients and promote the standardization and clinical translation of microbiome research.
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Affiliation(s)
- Jinming Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Yingyun Lei
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Huayong Du
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Zehui Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Xiaoxin Wang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Degang Yang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Feng Gao
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Jianjun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
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Estraneo A, Fiorentino MR, Cibellis T, Campana B, Balbi P, Carli V, Vatteroni E, Devalle G, Mantelli F, Villa M, Bianchi A, Costa MC, Rossi M, Comanducci A, Navarro J, Viganò A, De Nisco A, Draghi F, Hakiki B, Magliacano A. The clinical complication scale of Fondazione Don Gnocchi for classifying clinical complications in patients with severe acquired brain injury: development and multicenter validation. Front Neurol 2025; 16:1537093. [PMID: 40144623 PMCID: PMC11936823 DOI: 10.3389/fneur.2025.1537093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 02/25/2025] [Indexed: 03/28/2025] Open
Abstract
Introduction Patients with severe acquired brain injury have a high risk of developing clinical complications that affect clinical outcome and rehabilitation program. Early identification of clinical complications would allow to treat them appropriately and to prevent their worsening. However, available clinical scales for recording clinical complications are not appropriately tailored for this population. The present multicenter study aimed at developing and validating a new scale to categorize the clinical complications: the Clinical Complication Scale of the Fondazione Don Gnocchi (FDG-CCS). Methods Six Intensive Neurorehabilitation Units enrolled consecutively admitted patients with severe brain injury. Demographic, anamnestic, and clinical data were collected at study entry. For each enrolled patient, two independent examiners (A and B) administered the FDG-CCS considering 2 weeks as an observation time window. Concurrently, a third examiner (C) administered the Comorbidities Coma Scale. The blinded examinations were analyzed to assess the inter-rater agreement (A vs. B) and the concurrent validity of the FDG-CCS with respect to the Comorbidities Coma Scale (C). Results A total of 42 patients (22 patients with and 20 emerged from prolonged disorder of consciousness) were enrolled. The FDG-CCS total score did not differ in the two subgroups of patients. Metabolic (examiner A = 33%; examiner B = 43%), gastro-intestinal (A = 31%; B = 26%), cardio-vascular (A = 26%; B = 29%), respiratory (A = 21%; B = 21%), and musculo-skeletal disorders (A = 19%; B = 14%) were the most frequent complications. Inter-rater agreement for the total score of the FDG-CCS resulted to be good (intra-class correlation coefficient = 0.865; p < 0.05), and the FDG-CCS total score correlated significantly with the total score of the Comorbidities Coma Scale (A, ρ = 0.356; p = 0.01; B, ρ = 0.317; p = 0.02). Discussion The present multicenter study proposed and validated a novel clinical tool for the categorization of clinical complications of patients with severe brain injury. This clinical tool could help the rehabilitation team for planning tailored treatment and prevention of clinical complications that negatively impact patients' outcomes and hamper rehabilitation programs.
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Affiliation(s)
- Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Maria Rosaria Fiorentino
- Polo Specialistico Riabilitativo, Fondazione Don Carlo Gnocchi ONLUS, Sant’Angelo dei Lombardi, Italy
| | - Tommaso Cibellis
- Polo Specialistico Riabilitativo, Fondazione Don Carlo Gnocchi ONLUS, Sant’Angelo dei Lombardi, Italy
| | - Biagio Campana
- Polo Specialistico Riabilitativo, Fondazione Don Carlo Gnocchi ONLUS, Sant’Angelo dei Lombardi, Italy
| | - Pietro Balbi
- Centro S. Maria dei Poveri, Polo Riabilitativo del Levante Ligure Fondazione Don Carlo Gnocchi ONLUS, La Spezia, Italy
| | - Valentina Carli
- Centro S. Maria dei Poveri, Polo Riabilitativo del Levante Ligure Fondazione Don Carlo Gnocchi ONLUS, La Spezia, Italy
| | - Elena Vatteroni
- Centro S. Maria dei Poveri, Polo Riabilitativo del Levante Ligure Fondazione Don Carlo Gnocchi ONLUS, La Spezia, Italy
| | - Guya Devalle
- Istituto Palazzolo Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Mattia Villa
- Istituto Palazzolo Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | - Marina Rossi
- Centro Spalenza Fondazione Don Carlo Gnocchi ONLUS, Rovato, Italy
| | | | - Jorge Navarro
- IRCCS SM Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Grant A, Cohen Z, Cooper KL. Management of Asymptomatic Bacteriuria in Non-Catheterized Adults. Urol Clin North Am 2024; 51:561-570. [PMID: 39349023 DOI: 10.1016/j.ucl.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Understanding the management of asymptomatic bacteriuria (ASB) is important given the prevalence of the condition, associated risks in certain patient populations, and the risks associated with inappropriate antibiotic administration. Generally, screening and treatment is only recommended in pregnant women and in those undergoing urologic procedures that will violate the urothelium. Knowing the appropriate time to screen and treat ASB is critical for managing high-risk patients and preventing the growth of antibiotic resistance. Recent research into the protective nature of avirulent strains of Escherichia coli might offer a new approach to management of ASB.
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Affiliation(s)
- Allison Grant
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA.
| | - Zoë Cohen
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA
| | - Kimberly L Cooper
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA
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Böthig R, Schöps W, Kowald B, Golka K. [Oncological relevance of neuro-urological diseases]. Aktuelle Urol 2024; 55:326-336. [PMID: 38599592 DOI: 10.1055/a-2269-1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Apart from a few exceptions, there is currently little scientific evidence on the oncological relevance of neuro-urological diseases. Most research has been conducted into the association between long-term spinal cord injury with its consequences for the lower urinary tract and the occurrence of bladder cancer. These cancers differ in many ways from bladder cancers in patients without spinal cord injury: patients are 20 years younger on average, tumours are very often already muscle-invasive and poorly differentiated with a high proportion of squamous cell carcinomas, and the prognosis is poor. These characteristics also occur in spinal cord injury patients without permanent catheter drainage of the urinary bladder. Although the pathophysiological association has not been clarified in detail, the presence of a neurogenic bladder appears to be the decisive link between spinal cord injury and the occurrence of bladder cancer. Pathological pressure conditions in the urinary bladder and frequent urinary tract infections or asymptomatic bacteriuria resulting from neurogenic lower urinary tract dysfunction could be the decisive pathophysiological factors. In this respect, urinary bladder cancer in persons with a chronic spinal cord injury represents a model tumour after denervation. The clinically important question of screening requires future interdisciplinary research approaches.
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Affiliation(s)
- Ralf Böthig
- Abt. Neuro-Urologie, Querschnittgelähmten-Zentrum, BG Klinikum Hamburg, Hamburg, Germany
| | | | - Birgitt Kowald
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany
| | - Klaus Golka
- Leibniz-Institut für Arbeitsforschung an der TU Dortmund (IfADo), Dortmund, Germany
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