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The prevention and management of hospital admissions for urinary tract infection in patients with multiple sclerosis

  • Vivien Li
    Correspondence
    Corresponding author.
    Affiliations
    Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom

    Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Noreen Barker
    Affiliations
    Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
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  • Carmel Curtis
    Affiliations
    Department of Clinical Microbiology, University College London Hospitals, London, United Kingdom
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  • Bernadette Porter
    Affiliations
    Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
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  • Jalesh N Panicker
    Affiliations
    Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Jeremy Chataway
    Affiliations
    Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom

    National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
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  • Mahreen Pakzad
    Affiliations
    Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, United Kingdom
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      Highlights

      • Urinary tract infection is a major cause for hospitalisation in patients with MS.
      • Hospitalised patients are older, have progressive MS and high disability levels.
      • A small number of patients account for a large proportion of hospital admissions.
      • Antibiotic resistance was more frequent in patients with multiple presentations.
      • Management should emphasise good bladder, catheter and general physical care.

      Abstract

      Introduction

      Urinary tract infections (UTIs) are one of the commonest reasons for patients with multiple sclerosis (PwMS) presenting to hospital. Management of recurrent UTIs in PwMS can be challenging and characteristics of such patients are not well described.

      Aims

      To describe the neurological and urological features of PwMS presenting to hospital for UTIs and identify areas of management that could be improved to reduce UTI frequency.

      Methods

      Health episode statistics data were used to identify PwMS presenting to a tertiary hospital with UTI over a 5-year period. Medical records were reviewed for demographic, MS and urological history. The seven PwMS with the highest numbers of encounters were seen in a multidisciplinary clinic to enable detailed assessments.

      Results

      52 PwMS (25 female, 27 male) with mean age of 60 had 112 emergency department presentations and 102 inpatient admissions for UTI. 24 presented multiple times and were more likely to be older and male with progressive MS. Almost two-thirds were using a urinary catheter. Less than half were under current urological and neurological follow-up. Escherichia coli and Pseudomonas spp were the commonest organisms cultured. Resistance to antibiotics was more frequent in patients with multiple presentations.

      Conclusions

      PwMS presenting to hospital for UTIs are more often male, older, with progressive MS and high levels of disability. A small group of PwMS accounted for a large number of encounters. Preventative and management strategies can be applied in primary and secondary care settings, with an emphasis on bladder, catheter and general physical care.
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