多发性硬化症中的尿路感染

Urinary tract infections in multiple sclerosis.

作者信息

Phé Véronique, Pakzad Mahreen, Curtis Carmel, Porter Bernadette, Haslam Collette, Chataway Jeremy, Panicker Jalesh N

机构信息

Department of Uro-Neurology and The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK/Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France

Department of Uro-Neurology and The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK.

出版信息

Mult Scler. 2016 Jun;22(7):855-61. doi: 10.1177/1352458516633903. Epub 2016 Feb 18.

DOI:10.1177/1352458516633903

PMID:26892318

Abstract

BACKGROUND

Urinary tract infections (UTIs) are commonly reported by people with multiple sclerosis (PwMS) and significantly impact quality of life.

OBJECTIVE

To provide an overview of the problem of UTIs in PwMS and offer a practical approach for the diagnosis and management.

METHODS

A review of the literature through a Pubmed search up to October 2015 was performed using the following keywords: multiple sclerosis, neurogenic bladder, urinary tract infections, relapse, dipsticks, culture, recurrent and prevention.

RESULTS

Noteworthy topics include the definition of a confirmed symptomatic UTI as a positive urine culture defined by >10(5) colony-forming units (CFU)/mL or >10(4) CFU/mL if a urethral catheter urine sample is taken, or any count of bacteria in a suprapubic bladder puncture specimen, both in addition to symptoms including fever, pain, changes in lower urinary tract symptoms or neurological status. Urinalysis is useful to exclude a UTI; however, on its own is insufficient to confirm a UTI, for which urine culture is required. Experts advise asymptomatic UTIs should not be treated except in the context of an acute relapse. From international guidelines, there is no validated strategy to prevent recurrent UTIs in PwMS.

CONCLUSION

This review provides an overview of the diagnosis, treatment and prevention of UTIs in the setting of multiple sclerosis (MS).

摘要

背景

多发性硬化症患者（PwMS）常报告有尿路感染（UTIs），且对生活质量有显著影响。

目的

概述PwMS中UTIs问题，并提供诊断和管理的实用方法。

方法

通过使用以下关键词在Pubmed上检索截至2015年10月的文献：多发性硬化症、神经源性膀胱、尿路感染、复发、试纸、培养、复发和预防。

结果

值得注意的主题包括确诊的有症状UTIs的定义，即尿培养阳性，定义为>10(5)菌落形成单位（CFU）/mL，若采集尿道导管尿液样本则为>10(4) CFU/mL，或耻骨上膀胱穿刺标本中的任何细菌计数，同时伴有发热、疼痛、下尿路症状或神经状态改变等症状。尿液分析有助于排除UTIs；然而，仅凭其本身不足以确诊UTIs，确诊需要进行尿培养。专家建议，无症状UTIs除非在急性复发的情况下否则不应治疗。根据国际指南，尚无经过验证的策略来预防PwMS中的复发性UTIs。