1. Screening for urinary tract colonisation prior to corticosteroid administration in acute multiple sclerosis relapses: Validation of an updated algorithm.
- Author
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O'Herlihy F, John NA, Li V, Porter B, Lyons L, Rakusa M, Curtis C, Panicker JN, and Chataway J
- Subjects
- Adult, Algorithms, Female, Humans, Male, Mass Screening, Middle Aged, Prospective Studies, Recurrence, Sensitivity and Specificity, Adrenal Cortex Hormones therapeutic use, Bacteriuria diagnosis, Multiple Sclerosis drug therapy, Urinary Tract Infections diagnosis
- Abstract
Introduction: To evaluate an updated algorithm in the detection of urinary tract infection (UTI) prior to high-dose corticosteroid treatment in acute relapses in multiple sclerosis (MS). This updated algorithm aimed to decrease the unnecessary use of antibiotics, whilst maintaining accuracy and safety., Methods: Prospective cohort study of 471 consecutive patients with MS relapses in a hospital-based outpatient acute relapse clinic. 172 patients met exclusion criteria, leaving 299 patients for analysis. Patients underwent urine dipstick and were treated for UTI if 2 or more of: nitrites, leukocyte esterase and cloudy urine were positive. Patients with confirmed acute MS relapse were treated with high dose intravenous or oral methylprednisolone., Results: Significant bacteriuria (>10
5 colony forming units/mL) was present in 33 (11%, 95% CI 8-15) patients. The algorithm sensitivity and specificity was 24% and 94% respectively; the negative predictive value was 91%. The overall accuracy of the algorithm was 87%. No adverse sequelae were identified in 25 patients who received high dose methylprednisolone in the presence of an untreated UTI., Conclusion: With an improved specificity, this updated algorithm addresses previous issues concerning the unnecessary prescription of antibiotics, whilst improving accuracy and maintaining safety., (Copyright © 2019 Elsevier B.V. All rights reserved.)- Published
- 2019
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