Effects of Antimicrobial Prophylaxis on Asymptomatic Bacteriuria and Predictors of Failure in Patients with Multiple Sclerosis

Abstract

We studied the effects of antimicrobial prophylaxis and possible predictors of failure in multiple sclerosis patients with bacteriuria and bladder dysfunction. Patients were categorized into 3 groups, according to post-voided residual urine volume (PVR): patients with indications for self intermittent catheterization (SIC) who elected (Group A, n=39) or not (Group b, n=53) to use SIC and patients with no indication for SIC (Group C, n=75). In group A, 90% of patients developed bacteriuria after SIC. Rates of bacteriuria in groups b and C were significantly lower (34% and 24%, respectively, all p<0.001). prophylaxis failed in 31% and 22% of patients in groups A and b, respectively whereas all group C patients responded to prophylaxis. Symptomatic urinary tract infection was observed only in 14% of group A patients. Significant predictors of prophylaxis failure were an expanded disability status scale (EDSS) score ≥6 (p≤0.05), a high PVR (p≤0.075) and resistance to prophylaxis regimen (p≤0.007). SIC did not have a significant association with prophylaxis failure. In multivariate analysis only a higher EDSS score (≥6) predicted prophylaxis failure (p=0.019).

Keywords:

• urinary tract infection
• self-intermittent catheterization
• antibiotic prophylaxis
• expanded disability status scale
• norfloxacin
• nitrofurantoin