1679 - Evaluation of the Treatment of Urinalyses and Urine Cultures in Multiple Sclerosis Patients

Background: Patients with Multiple Sclerosis (MS) experience lower urinary tract dysfunction (LUTD) that in some cases, may necessitate catheterization. Discerning asymptomatic bacteriuria (ASB) from urinary tract infection (UTI) in MS patients is complicated by LUTD, leading to potentially inappropriate antimicrobial use. The purpose of this study was to evaluate the antimicrobial treatment practices of positive urine cultures in patients with MS.

Methods:

A single-center, retrospective study. Positive cultures in patients with diagnosed MS (ICD10: G35) were included. The primary outcome was the proportion of patients that were appropriately treated with or without antimicrobial therapy. Secondary endpoints included antimicrobial selection and urinalysis obtainment and positivity.

Results: 236 cultures from 139 patients were evaluated. Frequency, nocturia, dysuria, and foul-smelling urine were reported by patients in 54 (23%), 10 (4%), 25 (11%), and 14 (6%) of cases, respectively. Treatment was inappropriate in 81/201 (40%) of treated cultures. The agent selected was considered too broad in 35/201 (17%) instances. Of those, fluoroquinolones were the agents utilized in 33/35 (94%) cases. A urinalysis was sent in 200 (85%) cases, with 197/200 (99%) positive for at least one of four pre-defined positivity criteria.

Conclusion: Urinalyses and urine cultures are obtained frequently in patients with MS, often independent of patient symptomatology. Multiple sclerosis patients may be treated for ASB at higher rates than the general population, and traditional urinary symptoms may not be appropriate indicators of infection. Empiric therapy for UTI is frequently utilized in this population, often resulting in too broad of antimicrobial therapy.