CP-161 Incidence of abnormalities of urinary dipstick tests in patients receiving biotherapies

Abstract

BackgroundBiotherapies are mostly used in the treatment of chronic inflammatory rheumatism, such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Because they expose patients to a higher risk of infection, a urinary dipstick test (UDT) is performed in all patients who receive biotherapies.PurposeThe aim of this study was to evaluate the relevance of systematically performing a UDT in patients in the rheumatology day hospitalisation unit.Material and methodsA UDT was done for each patient during hospitalisation. When they were positive (positive nitrites and/or leukocytes strong), a cytobacteriological examination of urine (CBEU) was performed as well as a summary of clinical information.Results553 UDT were performed in 354 patients over 2 months. Median age of the patients was 56 years and 66% were female.From the 553 UDT performed, only 15 (3%) were positive: 10 UDT had only strong leukocytes and 5 had only positive nitrites. 3 positive UDT did not lead to a CBEU: 2 of them did not show any clinical signs and biotherapies were injected. The third patient was already septic on arrival and was receiving antibiotics. Of the 12 CBEU performed, 6 showed significant bacteriuria: 5 positive for Escherichia coli and 1 for Enterococcus faecalis.Among these 6 patients: 3 had asymptomatic bacteriuria and received their biotherapy and 3 were symptomatic. 2 patients were diagnosed with cystitis and pyelonephritis was discovered in a third patient. All were treated with an appropriate dose of ofloxacin. Only the patient with pyelonephritis did not receive biotherapy; for the other 2, the injection was delayed.ConclusionGiven the low frequency of abnormalities in the UDT, the therapeutic approach was modified in 3 cases and each time patients showed clinical signs. According to the literature, the risk of infection is higher during the first 6 months of treatment with biotherapies: 2 of the 3 patients had started their biotherapy less than a year before the onset of the urinary tract infection. Examination and clinical review should remain the primary elements in the diagnosis of a possible UTI and the therapeutic decision making.No conflict of interest.