Screening for urinary tract colonisation prior to corticosteroid administration in acute multiple sclerosis relapses: Validation of an updated algorithm

Fergus O'Herlihy; Nevin A John; Vivien Li; Bernadette Porter; Lucy Lyons; Martin Rakusa; Carmel Curtis; Jalesh N Panicker; Jeremy Chataway

doi:10.1016/j.jns.2019.116456

Screening for urinary tract colonisation prior to corticosteroid administration in acute multiple sclerosis relapses: Validation of an updated algorithm

J Neurol Sci. 2019 Dec 15:407:116456. doi: 10.1016/j.jns.2019.116456. Epub 2019 Sep 16.

Authors

Fergus O'Herlihy¹, Nevin A John², Vivien Li³, Bernadette Porter⁴, Lucy Lyons⁴, Martin Rakusa⁵, Carmel Curtis⁶, Jalesh N Panicker⁷, Jeremy Chataway⁸

Affiliations

¹ University College Dublin School of Medicine and Medical Science, Dublin, Ireland.
² Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
³ Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK; Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK.
⁴ National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
⁵ Department of Neurology, University Medical Centre Maribor, Slovenia.
⁶ National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Department of Clinical Microbiology, University College London Hospitals, London, UK.
⁷ Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK.
⁸ Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. Electronic address: j.chataway@ucl.ac.uk.

PMID: 31618683
DOI: 10.1016/j.jns.2019.116456

Abstract

Introduction: To evaluate an updated algorithm in the detection of urinary tract infection (UTI) prior to high-dose corticosteroid treatment in acute relapses in multiple sclerosis (MS). This updated algorithm aimed to decrease the unnecessary use of antibiotics, whilst maintaining accuracy and safety.

Methods: Prospective cohort study of 471 consecutive patients with MS relapses in a hospital-based outpatient acute relapse clinic. 172 patients met exclusion criteria, leaving 299 patients for analysis. Patients underwent urine dipstick and were treated for UTI if 2 or more of: nitrites, leukocyte esterase and cloudy urine were positive. Patients with confirmed acute MS relapse were treated with high dose intravenous or oral methylprednisolone.

Results: Significant bacteriuria (>10⁵ colony forming units/mL) was present in 33 (11%, 95% CI 8-15) patients. The algorithm sensitivity and specificity was 24% and 94% respectively; the negative predictive value was 91%. The overall accuracy of the algorithm was 87%. No adverse sequelae were identified in 25 patients who received high dose methylprednisolone in the presence of an untreated UTI.

Conclusion: With an improved specificity, this updated algorithm addresses previous issues concerning the unnecessary prescription of antibiotics, whilst improving accuracy and maintaining safety.

Keywords: Acute MS relapse treatment; Multiple sclerosis; Urinary tract colonisation; Urine dipstick.

Publication types

Validation Study

MeSH terms

Adrenal Cortex Hormones / therapeutic use*
Adult
Algorithms
Bacteriuria / diagnosis*
Female
Humans
Male
Mass Screening
Middle Aged
Multiple Sclerosis / drug therapy*
Prospective Studies
Recurrence
Sensitivity and Specificity
Urinary Tract Infections / diagnosis*

Substances

Adrenal Cortex Hormones