Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
Mult Scler Relat Disord. 2019 Oct;35:61-66. doi: 10.1016/j.msard.2019.06.038. Epub 2019 Jul 2.
Methods of screening for infections at the time of suspected relapse in people with multiple sclerosis (MS) vary across physicians. People with multiple sclerosis (MS) are at an increased risk of urinary tract infection (UTI). Data evaluating the utility of screening for potential UTI at the time of suspected relapse and whether there are key subgroups of patients in which screening would be most effective are sparse.
To evaluate demographic and clinical predictors of UTI in the context of a suspected acute relapse in (1) a retrospective hospital admission cohort and (2) a prospectively-enrolled, ambulatory care-based cohort, and to determine an approximate number needed to screen to detect one UTI in both healthcare settings.
For the hospital admissions cohort, we included individuals with a known or new diagnosis of MS or clinically isolated syndrome who were admitted at least once to the Johns Hopkins Neurology Inpatient Service (March 2012 to December 2014). We considered those screened via urinalysis. Possible UTI was defined as leukocyte esterase OR nitrite positive. For the ambulatory population, we enrolled a cohort of RRMS patients aged 18-65 who were suspected of suffering from an acute MS relapse who either called or came into clinic. Participants were screened via urinalysis; possible UTI was similarly defined. Participants also completed questionnaires (disability, history of Uhthoff's-type phenomenon, recent sexual intercourse, and new urologic symptoms). For both cohorts, we calculated an approximate number needed to screen, and tested if demographic and patient characteristics were associated with possible UTI using logistic regression models.
For the hospital admissions cohort, we included 158 individuals; 48 (30.4%) were identified as possibly having a UTI. For possible UTI, the approximate number needed to screen in order to detect 1 possible UTI is 3 (95% CI: 2, 6). Female sex was the only factor associated with increased odds of UTI (odds ratio [OR]: 3.90; 95% CI: 1.59-9.61; p = 0.003). For the ambulatory cohort, we included 50 participants; 10 (20.0%) with possible UTI. The approximate number needed to screen in order to detect 1 possible UTI was 5 (95% CI: 3, 11) in this cohort. Foul-smelling urine was positively associated with UTI (OR: 5.36; 95% CI: 1.10, 26.17; p = 0.04); no men had a possible UTI in this cohort, so we could not estimate odds ratios associated with sex.
UTIs at the time of a suspected MS relapse are relatively uncommon. Female sex is a strong risk factor for UTI in people with MS; foul-smelling urine is a potential predictor of UTI in people with MS. Larger studies are needed to comprehensively evaluate the utility of screening and risk factors for UTI at the time of suspected MS relapse.
在疑似多发性硬化症（MS）复发的患者中，医生采用的感染筛查方法各不相同。多发性硬化症患者发生尿路感染（UTI）的风险增加。目前评估在疑似复发时筛查潜在 UTI 的效用的相关数据，以及确定最有可能从筛查中获益的患者亚组的相关数据都很匮乏。
在（1）回顾性住院队列和（2）前瞻性、门诊为基础的队列中，评估疑似急性复发患者中 UTI 的人口统计学和临床预测因素，并确定在这两种医疗环境下，筛查以检测一例 UTI 需要筛查的近似数量。
对于住院患者队列，我们纳入了已知或新诊断为 MS 或临床孤立综合征且至少因该疾病住院一次的患者，他们均在约翰霍普金斯神经病学住院服务中心（2012 年 3 月至 2014 年 12 月）就诊。我们考虑了通过尿分析进行筛查的患者。可能的 UTI 定义为白细胞酯酶或亚硝酸盐阳性。对于门诊人群，我们纳入了年龄在 18-65 岁之间的 RRMS 患者队列，他们疑似患有急性 MS 复发，要么打电话，要么来诊所就诊。通过尿分析对患者进行筛查，类似地，我们将可能的 UTI 定义为白细胞酯酶或亚硝酸盐阳性。所有参与者还完成了问卷（残疾、Uhthoff 型现象病史、最近的性行为和新的泌尿系统症状）。对于两个队列，我们计算了筛查的近似数量，并使用逻辑回归模型检验人口统计学和患者特征是否与可能的 UTI 相关。
对于住院患者队列，我们纳入了 158 名患者；其中 48 名（30.4%）被确定可能患有 UTI。对于可能的 UTI，为检测一例可能的 UTI，需要筛查的近似数量为 3（95%CI：2，6）。女性是唯一与 UTI 风险增加相关的因素（优势比[OR]：3.90；95%CI：1.59-9.61；p=0.003）。对于门诊队列，我们纳入了 50 名参与者；其中 10 名（20.0%）患有可能的 UTI。在该队列中，为检测一例可能的 UTI，需要筛查的近似数量为 5（95%CI：3，11）。在该队列中，尿液有异味与 UTI 呈正相关（OR：5.36；95%CI：1.10，26.17；p=0.04）；该队列中没有男性患有可能的 UTI，因此我们无法估计与性别相关的优势比。
在疑似 MS 复发时发生 UTI 的情况相对较少。女性是 MS 患者发生 UTI 的一个强烈危险因素；尿液有异味是 MS 患者发生 UTI 的一个潜在预测因素。需要更大规模的研究来全面评估在疑似 MS 复发时筛查的效用和 UTI 的风险因素。
