Urinary Tract Infection Diagnosis Among People With Neurogenic Lower Urinary Tract Infection Due to Spinal Cord Injury and Disease: Time for a Change.

Urinary tract infection (UTI) is the most common infection for people with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury/disease (SCI/D). While the current diagnostic pillars include symptoms, inflammation, and bacterial load, each is uniquely problematic when applied to NLUTD-related UTI. Authoritative guidelines have not taken into account the impact of bladder management on symptoms; baseline inflammation in the absence of symptoms limits usefulness of white blood count; and bacteriuria in the absence of symptoms and limitations of standard urine culture (SUC) limits utility of SUC-based determination of bacterial load. Newer approaches are being developed to better guide diagnosis and antibiotic use. These include the Urinary Symptom Questionnaires for Neurogenic Bladder for symptom measurement and decision-making around symptoms, novel inflammatory markers (urine NGAL, IL-1, and IL-8), and culture-independent microbial detection methods. Rapid antimicrobial susceptibility testing (AST) methods have been developed utilizing a number of different approaches, increasing the likelihood of point-of-care application in the future. Advancements in UTI diagnosis will include reconceptualization of "urine is sterile" to "eubiosis and dysbiosis," symptom complexes to aid decision-making, use of novel inflammatory markers, and less reliance on SUC with increased emphasis on culture-independent methods for bacterial identification, AST, and decision-making.