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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Article info
Publication history
Published online: July 29, 2020
Accepted:
July 29,
2020
Received in revised form:
July 22,
2020
Received:
April 28,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
