From symptoms to solutions: How new guidelines are changing UTI care in spinal cord injury patients

Imagine you’re caring for someone with a spinal cord injury (SCI), and they suddenly feel unwell. You suspect a urinary tract infection (UTI), but it’s hard to tell for sure; the symptoms are vague and can be easily confused with other issues. That’s where the new SCI Model Systems guidelines come in — they help doctors and caregivers figure out if it’s a complicated UTI (cUTI) based on symptoms alone, without waiting for lab tests.

A cUTI is more serious than a regular one. It can cause fever, chills or confusion, and it may show up as increased muscle spasms or changes in bladder function in people with SCIs. These guidelines help spot those signs early.

People with SCIs manage their bladder in different ways. Some use catheters they insert and remove themselves (intermittent catheterization), others have a catheter that stays in all the time (indwelling catheterization), and some can urinate on their own (voiding). The guidelines include three different questionnaires tailored to each method, making it easier to assess symptoms accurately.

The main takeaway? These guidelines empower both patients and caregivers. They offer a clear, symptom-based tool to decide whether a cUTI is likely and what steps to take next. That means faster decisions, fewer unnecessary antibiotics and better care.

For example, imagine a caregiver notices their loved one with an indwelling catheter is more tired than usual and has cloudy urine. Using the questionnaire, they find that these symptoms match a moderate likelihood of cUTI. They contact the doctor, who uses the same tool to confirm and start treatment right away — no waiting for lab results.

One caregiver shared how the guidelines helped her avoid a hospital visit. Her husband, who uses intermittent catheterization, had mild symptoms. The questionnaire showed a low likelihood of cUTI, so they monitored him at home. He recovered without needing antibiotics or a trip to the ER.

Compared to older methods that relied heavily on lab tests, these guidelines are faster and safer. They reduce unnecessary treatments and help catch serious infections early. The big picture? Better outcomes and less stress for everyone involved.

Creating these guidelines was a global effort. Clinicians from different specialties and countries worked together, sharing insights and experiences. One key lesson was how symptoms can vary widely depending on bladder management method — so tailored tools were essential.

My interest in this field began when I saw how often UTIs were misdiagnosed in people with SCIs. I wanted to find a better way — one that respected their unique needs and gave providers and caregivers more confidence. Work completed during my VA Health Systems R&D career development award contributed to these guidelines, and I’m very proud of that.

As these tools evolve, they also open the door to meaningful health policy advancements. For example, successful implementation of the cUTI guidelines into clinical practice can go a long way in advancing Baylor’s goal to further develop as a Learning Health System (LHS): a healthcare model in which data and experience from clinical practice are continuously collected, analyzed and used to improve care, and has been championed by federal health policy agencies such as the Centers for Medicare and Medicaid Services and the Veterans Health Administration. In a LHS, research, clinical care and quality improvement are tightly integrated, so that every patient interaction contributes to learning, and that learning is rapidly applied to enhance outcomes. The goal is to keep improving care and making life easier for patients and providers alike.

By Dr. Felicia Skelton, associate professor and program director of the Spinal Cord Injury Medicine Fellowship, Baylor College of Medicine