Griffith Nicole C, Hill Brandon K, Goldman Myla D, Tingen S Ross
Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA (NCG).
Department of Pharmacy Clinical Services, University of Virginia Health, Charlottesville, VA, USA (BKH [now at GenMark Diagnostics]).
Int J MS Care. 2021 Sep-Oct;23(5):234-238. doi: 10.7224/1537-2073.2021-034. Epub 2021 Oct 26.
Patients with multiple sclerosis (MS) experience disease flares that can be precipitated by the presence of infection. Discerning asymptomatic bacteriuria from urinary tract infection (UTI) in patients with MS is complicated by lower urinary tract dysfunction, leading to potentially inappropriate antimicrobial use. In this study the antimicrobial treatment practices for positive urine cultures in patients with MS were evaluated.
In this single-center, retrospective study, positive cultures in patients with MS were included. The primary outcome was the proportion of patients appropriately treated with or without antimicrobial therapy. Secondary end points included antimicrobial selection and urinalysis positivity.
Two hundred thirty-six cultures from 139 patients were evaluated. Treatment was inappropriate in 81 of 201 treated cultures (40%). Frequency, nocturia, dysuria, and foul-smelling urine were reported by patients in 54 (23%), 10 (4%), 25 (11%), and 14 (6%) cultures, respectively. The antimicrobial selected was too broad in spectrum for 35 of 201 (17%). Of those, fluoroquinolones were the agents used in 33 of 35 cases (94%). A urinalysis was sent in 203 cases (86%), with 197 (84%) positive for at least one predefined positivity criteria.
Urinalyses and urine cultures are performed frequently in patients with MS, often independent of symptoms. Patients with MS could be treated for asymptomatic bacteriuria at higher rates than the general population, and traditional urinary symptoms may not be appropriate indicators of infection. Empirical therapy for UTI is frequently used in this population, often resulting in inappropriate and/or too broad of antimicrobial therapy.
多发性硬化症（MS）患者会经历疾病发作，感染可能会促使发作。由于下尿路功能障碍，辨别MS患者的无症状菌尿和尿路感染（UTI）变得复杂，这可能导致抗菌药物的使用不当。在本研究中，对MS患者尿培养阳性时的抗菌治疗方法进行了评估。
在这项单中心回顾性研究中，纳入了MS患者的阳性培养结果。主要结局是接受或未接受抗菌治疗的患者比例。次要终点包括抗菌药物的选择和尿液分析阳性情况。
对139例患者的236份培养结果进行了评估。在201份接受治疗的培养结果中，有81份（40%）治疗不当。患者报告尿频、夜尿、尿痛和尿液有异味的培养结果分别为54份（23%）、10份（4%）、25份（11%）和14份（6%）。在201份培养结果中，有35份（17%）选择的抗菌药物光谱过宽。其中，35例中有33例（94%）使用了氟喹诺酮类药物。203例（86%）进行了尿液分析，其中197例（84%）至少符合一项预先定义的阳性标准。
MS患者经常进行尿液分析和尿培养，且往往与症状无关。MS患者可能比普通人群更常因无症状菌尿而接受治疗，传统的泌尿系统症状可能不是感染的合适指标。该人群经常使用UTI的经验性治疗，往往导致抗菌治疗不当和/或光谱过宽。
