Urinary tract infections in multiple sclerosis: under-diagnosed and under-treated? A clinical audit at a large...

Multiple sclerosis (MS) is a chronic demyelinating immune-mediated disease of the central nervous system. Infections have been implicated in different aspects of the disease such as induction of relapses and possibly, progression. Bladder dysfunction and associated urinary tract colonization (UTC) and infections (UTIs) are common in MS patients. UTIs can exacerbate neurological symptoms in MS, whilst high-dose steroid treatment of acute neurological worsening with concurrent untreated UTC may lead to unmasking of infection. This clinical audit was designed to investigate whether our institution is adhering to the National Institute for Health Care and Excellence (NICE) Clinical Guideline 148 for the management of patients with lower urinary tract symptoms due to neurogenic bladder dysfunction. We identified 21 patients with abnormal urine dipsticks out of 118 patients presenting at Nottingham University Hospitals for clinical review or for assessment of a relapse. Patients were asked about catheter status and the presence of any lower urinary tract symptoms. In all cases of relapse assessment, current practice at our institution had been to delay treatment with methylprednisolone (MP), pending the results of microbiology culture and sensitivity testing. If the patient was confirmed to have an infection, treatment with MP was delayed further awaiting completion of a course of antibiotics. We suggest that corticosteroid treatment need not be delayed but rather administered simultaneously with antibiotic treatment for the UTI, provided that the patient has no systemic symptoms of infection (e.g. fever, rigors, raised CRP). Patients must be educated and cautioned to contact their doctor in the event that systemic symptoms do develop during treatment.