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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 26, 2020
Accepted:
August 21,
2020
Received in revised form:
August 19,
2020
Received:
April 30,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
