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Urinary tract infection in patients with multiple sclerosis: An overview

Published:August 26, 2020DOI:https://doi.org/10.1016/j.msard.2020.102462

      Highlights

      • Multiple Sclerosis (MS) patients have a high Urinary Tract Infection (UTI) prevalence.
      • UTIs can precipitate outbreaks that worsen the disease.
      • UTIs in MS patients are associated with a high hospitalization and mortality rate.
      • The pharmacological treatment of asymptomatic bacteriuria has no evidence of clinical efficacy.
      • The urinalysis and the presence of symptoms must guide the treatment in MS patients.

      Abstract

      Introduction

      Multiple sclerosis (MS) is a demyelinating, chronic, inflammatory, and autoimmune disease of the central nervous system (CNS) with axonal degeneration, presenting a progressive and variable course. MS patients usually have complications, such as bladder dysfunction, presence of urinary symptoms, and Urinary Tract infection (UTI), which is one of the three most common non-neurological complications in MS patients.

      Objective

      Analyze the most diverse aspects of UTI in MS patients, focusing on risk factors, prevalence, hospitalization, mortality rates, diagnosis, and treatment of UTIs in this group.

      Methods

      A non-systematic review of articles published on PubMed in the last 10 years with the search terms "Urinary Tract Infection" AND "Multiple Sclerosis".

      Discussion

      MS patients have a high UTI prevalence, mainly due to the occurrence of urinary disorders in these patients. The most common symptoms of UTI in MS patients are urinary urgency, polyuria, nocturia, urinary retention, and incontinence. Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most found organisms and treatment is based on antibiotic therapy. Moreover, UTIs can precipitate outbreaks, worsen the disease, causing more damage and a severe neurological condition deterioration. In addition, UTIs in this group are associated with a high hospitalizations rate and a high mortality rate. Therefore, patients in MS outbreaks with urinary symptoms or positive urinalysis must keep corticosteroid therapy and Disease-Modifying Treatments (DMTs). Whether clinically stable or MS relapse patients, the urinalysis and the presence of symptoms must guide the treatment in each group. Moreover, the pharmacological treatment of asymptomatic bacteriuria has no evidence of clinical efficacy. As the treatment of asymptomatic bacteriuria induces a significant increase in more resistant bacterial strains, it is recommended exceptionally in cases of recurrent acute UTIs, prior to handling of the UTI, pregnancy or patients in need of immunosuppression.

      Conclusion

      UTI represents a great risk and concern in MS patients. The high prevalence, hospitalization rate, and mortality rate of UTI in MS is worrying, such as the cause-consequence relationship between UTIs and the use of corticosteroids in outbreaks. Therefore, it is important to be aware of a UTI in this group to make early diagnoses, adequate management, and new infections prevention. Thus, further studies are needed to thoroughly analyze each nuance of this important comorbidity for MS patients.

      Keywords

      Abbreviations:

      AC (Uncomplicated Acute Cystitis), ACSS (Acute Cystitis Symptom Score), aOR (Adjusted Odds Ratio), CI (Confidence Interval), CISC (Clean Intermittent Self-Catheterization), CNS (Central Nervous System), DMTs (Disease-Modifying Treatments), EDSS (Expanded Disability Status Scale), ICD (International Classification of Diseases), MS (Multiple Sclerosis), TLR2 (Toll-like receptors type 2), UTI (Urinary Tract Infection)
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