Abstract
Background
Methods of screening for infections at the time of suspected relapse in people with
multiple sclerosis (MS) vary across physicians. People with multiple sclerosis (MS)
are at an increased risk of urinary tract infection (UTI). Data evaluating the utility
of screening for potential UTI at the time of suspected relapse and whether there
are key subgroups of patients in which screening would be most effective are sparse.
Objectives
To evaluate demographic and clinical predictors of UTI in the context of a suspected
acute relapse in (1) a retrospective hospital admission cohort and (2) a prospectively-enrolled,
ambulatory care-based cohort, and to determine an approximate number needed to screen
to detect one UTI in both healthcare settings.
Methods
For the hospital admissions cohort, we included individuals with a known or new diagnosis
of MS or clinically isolated syndrome who were admitted at least once to the Johns
Hopkins Neurology Inpatient Service (March 2012 to December 2014). We considered those
screened via urinalysis. Possible UTI was defined as leukocyte esterase OR nitrite
positive. For the ambulatory population, we enrolled a cohort of RRMS patients aged
18–65 who were suspected of suffering from an acute MS relapse who either called or
came into clinic. Participants were screened via urinalysis; possible UTI was similarly
defined. Participants also completed questionnaires (disability, history of Uhthoff's-type
phenomenon, recent sexual intercourse, and new urologic symptoms). For both cohorts,
we calculated an approximate number needed to screen, and tested if demographic and
patient characteristics were associated with possible UTI using logistic regression
models.
Results
For the hospital admissions cohort, we included 158 individuals; 48 (30.4%) were identified
as possibly having a UTI. For possible UTI, the approximate number needed to screen
in order to detect 1 possible UTI is 3 (95% CI: 2, 6). Female sex was the only factor
associated with increased odds of UTI (odds ratio [OR]: 3.90; 95% CI: 1.59–9.61; p = 0.003). For the ambulatory cohort, we included 50 participants; 10 (20.0%) with
possible UTI. The approximate number needed to screen in order to detect 1 possible
UTI was 5 (95% CI: 3, 11) in this cohort. Foul-smelling urine was positively associated
with UTI (OR: 5.36; 95% CI: 1.10, 26.17; p = 0.04); no men had a possible UTI in this cohort, so we could not estimate odds
ratios associated with sex.
Conclusion
UTIs at the time of a suspected MS relapse are relatively uncommon. Female sex is
a strong risk factor for UTI in people with MS; foul-smelling urine is a potential
predictor of UTI in people with MS. Larger studies are needed to comprehensively evaluate
the utility of screening and risk factors for UTI at the time of suspected MS relapse.
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Article info
Publication history
Published online: July 01, 2019
Accepted:
June 29,
2019
Received in revised form:
June 28,
2019
Received:
May 21,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
