Urinary tract infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society - 24/11/20

Doi : 10.1016/j.neurol.2020.02.011

C. Donzé ^a,^⁎ , C. Papeix ^b, C. Lebrun-Frenay ^c
French Group for Recommendations in Multiple Sclerosis (France4MS)
the Société francophone de la sclérose en plaques (SFSEP)^¹
Steering committee.
SPILF
Co-chairs
C. Donzé ^d, C. Papeix ^e, C. Lebrun-Frénay ^f
^d Lomme, France
^e Paris, France
^f Nice, France

Supervision of the readers
N. Collongues ^g, M. de Seze ^h, A. Dinh ⁱ, A. Even ⁱ, C. Scheiber-Nogueira ^j
^g Strasbourg, France
^h Bordeaux, France
ⁱ Paris, France
^j Lyon, France

Readers
C. Bensa ^k, B. Bourre ^l, C. Carra-Dallière ^m, J. Ciron ⁿ, M. Cohen ^o, A.M. Guennoc ^p, C. Louapre ^k, F. Lebreton ^k, L. Michel ^q, E. Maillart ^k
^k Paris, France
^l Rouen, France
^m Montpellier, France
ⁿ Toulouse, France
^o Nice, France
^p Tours, France
^q Rennes, France

Rating group
B. Audoin ^r, X. Ayrignac ^s, P. Bernady ^t, B. Brochet ^u, P. Clavelou ^v, R. Colamarino ^w, A. Declemy ^x, J. de Seze ^y, N. Derache ^z, J.-M. Faucheux ^aa, O. Heinzlef ^ab, P. Labauge ^s, D. Laplaud ^ac, E. Lepage ^ad, E. Leray ^ad, L. Magy ^ae, G. Mathey ^af, C. Mekies ^ag, V. Mondain ^x, E. Planque ^ah, J. Pelletier ^r, S. Pittion ^af, B. Stankhof ^ai, P. Tournaire ^aj, E. Thouvenot ^ak, S. Vukusic ^al, S. Wiertlevski ^ac, H. Zephir ^am
^r Marseille, France
^s Montpellier, France
^t Bayonne, France
^u Bordeaux, France
^v Clermont-Ferrand, France
^w Vichy, France
^x Nice, France
^y Strasbourg, France
^z Caen, France
^aa Agens, France
^ab Poissy-Saint-Germain, France
^ac Nantes, France
^ad Rennes, France
^ae Limoges, France
^af Nancy, France
^ag Toulouse, France
^ah Epinal, France
^ai Paris, France
^aj Avignon, France
^ak Nîmes, France
^al Lyon, France
^am Lille, France

Reading group
H. Alchaar ^an, G. Androdias ^ao, M. Benazet ^ap, D. Bensmail ^aq, D. Biotti ^ap, A. Blanchard-Dauphin ^ar, M. Bonnan ^as, C. Boutière ^at, P. Branger ^au, S. Bresch ^an, J.-P. Bru ^av, J.-P. Camdessanché ^aw, E. Castel Canal ^ax, M. Coustans ^ay, O. Casez ^az, B. Castan ^ba, A. Creange ^bb, E. Creisson ^ap, T. De Broucker ^bc, R. Depaz ^bd, X. Douay ^ar, C. Dulau ^be, F. Durand-Dubief ^ao, O. Fagniez ^bf, M. Faucher ^bg, A. Floch ^bh, M. Fournier ^an, A. Fromont ^bi, P. Gallien ^ax, X. Gamé ^ap, D. Gault ^bj, A. Gayou ^bk, M. Giroux ^bl, O. Gout ^bd, J. Grimaud ^bm, P. Hautecoeur ^bn, A. Kerbrat ^ax, L. Kremer ^bj, A. Kwiatkowski ^bn, C. Labeyrie ^bo, S. Lachaud ^bh, C. Lanctin-Garcia ^bp, L. Lanotte ^bj, E. Manchon ^bq, A. Maurousset ^br, L. Michel ^ax, A.-M. Milor ^bs, X. Moisset ^bt, A. Mont-Cuquet ^bs, T. Moreau ^bi, J.-C. Ouallet ^be, I. Patry ^bu, D. Peaureaux ^ap, M.-C. Pouget ^ao, V. Pourcher Martinez ^bd, C. Radot ^bv, A. Ruet ^be, C. Saint-Val ^bd, A. Salmon ^ax, F. Taithe ^bt, P. Tatevin ^bw, M. Vaillant ^az, J.-P. Stahl ^az, F. Vuoto ^ar, C. Zaenker ^bj
^an Nice, France
^ao Lyon, France
^ap Toulouse, France
^aq Garches, France
^ar Lille, France
^as Pau, France
^at Marseille, France
^au Caen, France
^av Nancy, France
^aw Saint-Étienne, France
^ax Reims, France
^ay Saint-Malo, France
^az Grenoble, France
^ba Périgueux, France
^bb Créteil, France
^bc Saint-Denis, France
^bd Paris, France
^be Bordeaux, France
^bf Poissy, France
^bg Bruges, France
^bh Cannes, France
^bi Dijon, France
^bj Strasbourg, France
^bk Talence, France
^bl Valenciennes, France
^bm Chartres, France
^bn Lomme, France
^bo Kremlin-Bicêtre, France
^bp Nantes, France
^bq Gonesse, France
^br Tours, France
^bs Limoges, France
^bt Clermont-Ferrand, France
^bu Fontenay-sous-Bois, France
^bv Hyères, France
^bw Rennes, France

^a Faculté de médecine et de maïeutique de Lille, hôpital Saint-Philibert, groupement des hôpitaux de l’institut catholique de Lille, Lomme, France
^b Département de neurologie, CRCSEP, Sorbonne université, hôpital de la Salpêtrière, AP–HP6, Paris 13, France
^c URC2A, université Nice Côté-d’Azur, CRCSEP, neurologie hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06003 Nice, France

^⁎Corresponding author at: Service de médecine physique et réadaptation, hôpital Saint-Philibert, rue du Grand But, BP 249, 59462 Lomme cedex, France.Service de médecine physique et réadaptation, hôpital Saint-Philibertrue du Grand But, BP 249Lomme cedex59462France

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Abstract

Objectives

Establish recommendations for the management of UTIs in MS patients.

Background

Urinary tract infections (UTIs) are common during multiple sclerosis (MS) and are one of the most common comorbidities potentially responsible for deaths from urinary sepsis.

Methods

The recommendations attempt to answer three main questions about UTIs and MS. The French Group for Recommendations in MS (France4MS) did a systematic review of articles from PubMed and universities databases (01/1980–12/2019). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. 26 MS experts worked on the full-text review and a group of 70 multidisciplinary health care specialists validated the final evaluation of summarized evidences.

Results

UTIs are not associated with an increased risk of relapse and permanent worsening of disability. Only febrile UTIs worsen transient disability through the Uhthoff phenomenon. Some immunosuppressive treatments increase the risk of UTIs in MS patients and require special attention especially in case of hypogammaglobulinemia. Experts recommend to treat UTIs in patients with MS, according to recommendations of the general population. Prevention of recurrent UTIs requires stabilization of the neurogenic bladder. In some cases, weekly oral cycling antibiotics can be proposed after specialist advice. Asymptomatic bacteriuria should not be screened for or treated systematically except in special cases (pregnancy and invasive urological procedures).

Conclusion

Physicians and patients should be aware of the updated recommendations for UTis and MS.

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Keywords : Multiple sclerosis, Urinary tracts infections, Asymptomatic bacteriuria, Disease modifying therapy, Practice guidelines

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Question 1: are urinary tract infections associated with an increased risk of relapse? Of transient worsening disability? Of prolonged worsening disability in patients with MS

Question 2: Is the risk of a urinary tract infection increased by treatments for MS?

Question 3: Should multiple sclerosis patients be treated for bacteriuria?

Disclosure of interest

Esportazione

Vol 176 - N° 10

P. 804-822 - dicembre 2020 Ritorno al numero

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Urinary tract infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society - 24/11/20

Abstract

Objectives

Background

Methods

Results

Conclusion

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