Urinary tract infections are a common cause of hospitalization among people with multiple sclerosis (MS), especially older patients with progressive disease, and more attention should be given to their bladder, catheter, and general physical care, a U.K. study reported.
These infections are often linked to an emergency hospital admission, and carry a risk of death as well as higher costs to the healthcare system, its researchers wrote.
The study, “The prevention and management of hospital admissions for urinary tract infection in patients with multiple sclerosis,” was published in the journal Multiple Sclerosis and Related Disorders.
UTIs are relatively common among people with MS, but the epidemiology and characteristics of those who experience frequent unplanned hospital admissions due to UTIs are not well described.
Researchers at University College London reviewed patient records over a five-year period (April 2014 through March 2019) to identify areas where better management might lessen emergency admissions and lower the frequency of urinary tract infections (UTIs) in these people.
Records of 52 MS patients (25 female, 27 male), with an average age of 60, who either arrived at a hospital’s emergency department or were otherwise been admitted for a UTI were analyzed.
The median expanded disability status scale (EDSS) score for this group was 8.5, meaning that many were restricted to bed for much of day, but retained some use of their arms and could do some basic self-care.
Collectively, this group made 112 emergency hospital visits over those five years, resulting in 102 inpatient admissions, each with an average stay of 8.6 days.
Six had “recurrent” UTI visits under the European Association of Urology criteria, defined as three or more in one year and two or more within six months, and 18 others “had multiple presentations not meeting these criteria,” the researchers wrote. None of these recurrent or multiple UTI patients had undergone renal tract imaging in the previous year.
A small group, 10 of these 52 patients, accounted for half of all visits and admissions analyzed.
Thirty-three patients used a catheter, and tended to make more frequent visits to the emergency department — a mean of 2.6 visits versus 1.3 for those not needing a catheter. Antibiotics were administered for 53 UTI episodes.
Non-infectious UTI complications included delirium (27 patients), and acute kidney injury (six patients). Infectious complications included urosepsis, or serious urinary tract infection (in seven patients), inflammation of the testicles and of the prostate (one patient), and Clostridium difficile infection (one patient).
Bacterial cultures taken from urine samples showed a greater number of antibiotic-resistant pathogens among people making multiple emergency visits. Escherichia coli and Pseudomonas species were the most common pathogens cultured.
Factors identified as contributing to a high risk for a UTI included male sex, older age (above 60), progressive MS, the use of catheters, urinary tract dysfunction caused by neurological problems, and a history of recurrent and/or severe UTIs.
The team made several recommendations to better prevent and manage UTIs in MS patients, including limiting the long-term use of antibiotics that risk contributing to antibiotic resistance.
They also recommended optimizing patients’ catheter types, such as changing from indwelling catheters (which remain inside the bladder) to suprapubic catheters, in which a tube is inserted into the bladder through an incision below the bellybutton.
Monitoring for, and treating, early signs of infection are also advised.
“In patients with recurrent UTIs, renal tract imaging should be performed to exclude underlying abnormalities such as [bladder and renal] stones,” the team added.
Researchers also urged better communication with the broader network of caregivers and healthcare providers to optimize catheter care, perineal hygiene, hydration, and timely access to needed advice and attention.
“Routine general physical review by a trained health care professional, in either primary or secondary care, to identify and address these issues is important for overall management of MS as well as to reduce UTIs,” the researchers wrote.
Taken together, the team concluded that MS patients “presenting to hospital for UTIs are more often male, older, with progressive MS and high levels of disability,” and that UTI “management should emphasise good bladder, catheter and general physical care.”
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