The neurogenic bladder is well described in multiple sclerosis (MS). Bladder dysfunction increases risk of urinary tract infections (UTI) which can be recurrent and disabling. Moreover, infection may play a role in disease pathogenesis. We aimed to quantify this burden specifically; frequency of emergency department (ED) attendances and predictive factors for hospital admission.
Data from electronic health records (EHR) of MSers was extracted to create ‘BartsMS Database’. Through this and using information from EHRs we analysed ED visits and hospital admissions over 6 years. Further data calculated cost of UTI admissions. Data was analysed using univariate analysis.
991 MSers were encoded within the database. There were 690 ED attendances within this cohort with bladder dysfunction the commonest cause (240/690, 35%). 73% (175/240) of these required admission. 70% (168/240) had UTIs and 16% (38/240) had blocked urinary catheters. MSers with progressive disease and urinary catheters were most likely to be admitted for UTI (84%, 147/175 and 70%, 123/175 respectively) and had significantly longer admissions than patient with UTIs and other chronic diseases (mean 7.7 days MS vs 3.2 dementia vs 2.9 diabetes p<0.05). Annual cost of UTIs in MS was £700,000.
This data demonstrates an unmet need within a local MS community. The individual and economic burden is significant. If concurrent infection plays a role in disease pathogenesis, the untreated UTI is a missed opportunity for disease modification. MSers with indwelling catheters are most vulnerable. Research into an innovation to prevent catheter associated UTIs is underway within our group.