Screening for urinary tract colonisation prior to corticosteroid administration in acute multiple sclerosis relapses: Validation of an updated algorithm

O'Herlihy, Fergus; John, Nevin; Li, Vivien; Porter, Bernadette; Lyons, Lucy; Rakuša, Martin; Curtis, Carmel; Panicker, Jalesh N.; Chataway, Jeremy

doi:10.1016/j.jns.2019.116456

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…worsening disease, and concern that the use of immunosuppression in the treatment of MS may put patients at increased risk of infection. 6,10,11 However, growing concern for antimicrobial resistance and findings that the treatment of ASB, including in patients with spinal dysfunction, is not associated with beneficial outcomes has transitioned the focus to distinguishing symptomatic UTI from ASB in patients with MS before antimicrobial treatment. 6,12,13 Unfortunately, previously published literature has not sufficiently defined UTI-associated symptoms in this unique patient population or reviewed prescribing practices.…”

Section: End Pointsmentioning

confidence: 99%

Evaluation of Treatment Practices for Urinalyses and Urine Cultures at an Outpatient Multiple Sclerosis Clinic

Griffith

Hill

Goldman

et al. 2021

International Journal of MS Care

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CE Information Activity Available Online: To access the article, post-test, and evaluation online, go to https://www.highmarksce.com/mscare. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, pharmacists, and other health care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: 1) Describe the characteristic factors of MS disease that can confound the identification of symptomatic urinary tract infection (UTI). 2) Distinguish appropriate, potentially appropriate, and inappropriate testing and treatment practices for the diagnosis and treatment of UTIs in patients with MS. Accreditation Statement: In support of improving patient care, this activity has been planned and implemented by the Consortium of Multiple Sclerosis Centers (CMSC) and Delaware Media Group. The CMSC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Physician Credit: The CMSC designates this journal-based activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Credit: The CMSC designates this enduring material for 0.5 contact hour of nursing continuing professional development (NCPD) (none in the area of pharmacology). Pharmacist Credit: This knowledge-based activity (UAN # JA4008165-9999-21-021-H01-P) qualifies for 0.5 contact hour (0.05 CEUs) of continuing pharmacy education credit. Disclosures: Francois Bethoux, MD, Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has disclosed relationships with Springer Publishing (royalty); Qr8 (receipt of intellectual property rights/patent holder); Biogen (receipt of intellectual property rights/patent holder, speakers' bureau); MedRhythms (consulting fee, contracted research); GW Pharmaceuticals, Genentech, Helius Medical Technologies, Osmotica, Ipsen (consulting fee); and Adamas Pharmaceuticals (contracted research). Alissa Mary Willis, MD, Associate Editor of IJMSC, has disclosed relationships with Greenwich Biosciences (consulting fee); Alexion (consulting fee, speakers' bureau, contracted research); Genentech (consulting fee, speakers' bureau); and Biogen, Bristol Myers Squibb (speakers' bureau). Nicole C. Griffith, PharmD, has disclosed no relevant financial relationships. Brandon K. Hill, PharmD, has disclosed no relevant financial relationships. Myla D. Goldman, MD, has disclosed relationships with Adamas Pharmaceuticals, Biogen, Brainstorm Cell Therapeutics Ltd, EMD Serono, Genentech, Greenwich Biosciences, Immunic, MedDay, and Sanofi Genzyme (consulting fees). S. Ross Tingen, PharmD, has disclosed a relationship with Novartis (advisory board). The staff at IJMSC, CMSC, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Laurie Scudder, DNP, NP, Continuing Education Director CMSC, has served as Reviewer for this activity. She has disclosed no relevant financial relationships. One peer reviewer for IJMSC has disclosed relationships with EMD Serono, Novartis, Bristol Myers Squibb, and Genentech (consulting fees). The other peer reviewer has disclosed no relevant financial relationships. Note: Financial relationships may have changed in the interval between listing these disclosures and publication of the article. Method of Participation: Release Date: October 1, 2021 Valid for Credit Through: October 1, 2022 In order to receive CME/NCPD/CPE credit, participants must: 1) Review the continuing education information, including learning objectives and author disclosures.2) Study the educational content.3) Complete the post-test and evaluation, which are available at https://www.highmarksce.com/mscare. Statements of Credit are awarded upon successful completion of the evaluation and the post-test with a passing score of >70%. The post-test may be retaken if necessary. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. The CMSC and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the CMSC or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.

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Section: End Pointsmentioning

confidence: 99%

Evaluation of Treatment Practices for Urinalyses and Urine Cultures at an Outpatient Multiple Sclerosis Clinic

Griffith

Hill

Goldman

et al. 2021

International Journal of MS Care

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“…Clinicians should ideally treat concurrent infections first, as this may alleviate the symptoms, and avoid using corticosteroids if there are systemic symptoms 28. However, corticosteroids and antibiotics may perhaps be given concurrently, if there are no systemic symptoms, especially when antibiotic sensitivity is available 29 30…”

Section: Summary Of the Evidencementioning

confidence: 99%

Multiple sclerosis and the risk of infection: Association of British Neurologists consensus guideline

et al. 2022

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“…The algorithm showed a specificity of 94%, a predictive negative value of 91% and an accuracy of 87%. Although the sensitivity is 24%, the algorithm has improved accuracy and safety for conduct with antibiotic therapy in MS patients (O'Herlihy et al, 2019).…”

Section: Diagnosis Of Uti In the Ms Populationmentioning

confidence: 99%

Urinary Tract Infection in Patients with Multiple Sclerosis: An Overview

Medeiros¹,

Demore²,

Mazaro³

et al. 2020

Preprint

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Introduction: 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. Objective: Analyze the most diverse aspects of UTI in MS patients, focusing on risk factors, prevalence, hospitalization and mortality rates of UTIs in this group. Methods: A non-systematic review of articles published on PubMed in the last 10 years with the search terms "Urinary Tract Infection" AND "Multiple Sclerosis". Discussion: 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. Therefore, UTIs in this group are associated with a high hospitalizations rate and a high mortality rate. Conclusion: 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.

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Screening for urinary tract colonisation prior to corticosteroid administration in acute multiple sclerosis relapses: Validation of an updated algorithm

Cited by 4 publications

References 19 publications

Evaluation of Treatment Practices for Urinalyses and Urine Cultures at an Outpatient Multiple Sclerosis Clinic

Evaluation of Treatment Practices for Urinalyses and Urine Cultures at an Outpatient Multiple Sclerosis Clinic

Multiple sclerosis and the risk of infection: Association of British Neurologists consensus guideline

Urinary Tract Infection in Patients with Multiple Sclerosis: An Overview

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