Medeiros Junior Washigton Luiz Gomes de, Demore Caio Cesar, Mazaro Larissa Peres, de Souza Matheus Fellipe Nascimento, Parolin Laura Fiuza, Melo Luiz Henrique, Junior Claudio Rogerio Werka, Gonçalves Marcus Vinicius Magno
Medical student - Department of Medicine, University of the Region of Joinville (UNIVILLE), Brazil.
Medical Doctor and Professor of Neurology, University of the Region of Joinville (UNIVILLE), Brazil.
Mult Scler Relat Disord. 2020 Nov;46:102462. doi: 10.1016/j.msard.2020.102462. Epub 2020 Aug 27.
Multiple sclerosis (MS) is a demyelinating, chronic, inflammatory, and autoimmune disease of the central nervous system (CNS) with axonal degeneration, presenting a progressive and variable course. MS patients usually have complications, such as bladder dysfunction, presence of urinary symptoms, and Urinary Tract infection (UTI), which is one of the three most common non-neurological complications in MS patients.
Analyze the most diverse aspects of UTI in MS patients, focusing on risk factors, prevalence, hospitalization, mortality rates, diagnosis, and treatment of UTIs in this group.
A non-systematic review of articles published on PubMed in the last 10 years with the search terms "Urinary Tract Infection" AND "Multiple Sclerosis".
MS patients have a high UTI prevalence, mainly due to the occurrence of urinary disorders in these patients. The most common symptoms of UTI in MS patients are urinary urgency, polyuria, nocturia, urinary retention, and incontinence. Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most found organisms and treatment is based on antibiotic therapy. Moreover, UTIs can precipitate outbreaks, worsen the disease, causing more damage and a severe neurological condition deterioration. In addition, UTIs in this group are associated with a high hospitalizations rate and a high mortality rate. Therefore, patients in MS outbreaks with urinary symptoms or positive urinalysis must keep corticosteroid therapy and Disease-Modifying Treatments (DMTs). Whether clinically stable or MS relapse patients, the urinalysis and the presence of symptoms must guide the treatment in each group. Moreover, the pharmacological treatment of asymptomatic bacteriuria has no evidence of clinical efficacy. As the treatment of asymptomatic bacteriuria induces a significant increase in more resistant bacterial strains, it is recommended exceptionally in cases of recurrent acute UTIs, prior to handling of the UTI, pregnancy or patients in need of immunosuppression.
UTI represents a great risk and concern in MS patients. The high prevalence, hospitalization rate, and mortality rate of UTI in MS is worrying, such as the cause-consequence relationship between UTIs and the use of corticosteroids in outbreaks. Therefore, it is important to be aware of a UTI in this group to make early diagnoses, adequate management, and new infections prevention. Thus, further studies are needed to thoroughly analyze each nuance of this important comorbidity for MS patients.
多发性硬化症（MS）是一种中枢神经系统（CNS）的脱髓鞘、慢性、炎症性自身免疫疾病，伴有轴突变性，病程呈进行性且多变。MS患者通常有并发症，如膀胱功能障碍、泌尿系统症状以及尿路感染（UTI），这是MS患者最常见的三种非神经学并发症之一。
分析MS患者UTI的各个方面，重点关注该群体UTI的危险因素、患病率、住院情况、死亡率、诊断和治疗。
对过去10年在PubMed上发表的文章进行非系统性综述，检索词为“尿路感染”和“多发性硬化症”。
MS患者UTI患病率较高，主要是由于这些患者出现泌尿系统疾病。MS患者UTI最常见的症状是尿急、多尿、夜尿、尿潴留和尿失禁。大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌是最常见的病原体，治疗以抗生素治疗为主。此外，UTI可引发病情发作，使疾病恶化，造成更多损害并导致严重的神经状况恶化。此外，该群体的UTI与高住院率和高死亡率相关。因此，MS病情发作且有泌尿系统症状或尿检呈阳性的患者必须持续进行皮质类固醇治疗和疾病修正治疗（DMTs）。无论是临床稳定患者还是MS复发患者，尿检和症状都必须指导每组患者的治疗。此外，无症状菌尿的药物治疗尚无临床疗效证据。由于无症状菌尿的治疗会导致更具耐药性的细菌菌株显著增加，因此仅在复发性急性UTI、UTI发作前、妊娠或需要免疫抑制的患者中例外推荐使用。
UTI是MS患者的重大风险和关注点。MS患者UTI的高患病率、住院率和死亡率令人担忧，例如UTI与病情发作时使用皮质类固醇之间的因果关系。因此，了解该群体中的UTI以进行早期诊断、适当管理和预防新感染非常重要。因此，需要进一步研究以全面分析这种MS患者重要合并症的每个细微差别。
