PM&R News   •   March 2018

The annual evaluation for patients with spinal cord injury (SCI) was a groundbreaking service that led to the decrease in mortality for these patients. Gone are the days where the leading cause of death in long term spinal cord injury was kidney disease, however, are the recommendations perfected yet?  In this study by Skelton et al, they evaluate whether routine urine testing at the annual evaluation leads to unnecessary antibiotic use. As physiatrists, we have learned through our training not to treat asymptomatic bacteriuria but all providers are not as familiar with the guidelines and sometimes these providers are providing SCI care for our patients. The study enrolled nearly 250 veterans seen for outpatient annual evaluations and had a main outcome measure of antibiotic use for bacteriuria within 7 days of the annual evaluation. The study found 69% of urine cultures were positive for bacteria but only 13% of those represented urinary tract infection, leaving 87% categorized as asymptomatic bacteriuria. Unfortunately, over 33% of the asymptomatic bacteriuria patients were treated with antibiotics. Some of the factors leading to antibiotic treatment in asymptomatic patients were nitrate presence, older age, indwelling catheter, and urease-producing organisms on culture media. This study should have us question our annual evaluation practice and whether the urinalysis with reflexive culture is necessary. What information are we gaining from the urinalysis? Should it no longer be collected? Are we promoting antibiotic resistance in a current culture of antibiotic stewardship? We would argue against annual collection and suggest studying the utility of obtaining a KUB at the annual evaluation. As without symptoms, are we exposing our patients to unnecessary radiation and asymptomatic findings?