title: Testing for urinary tract colonization before high-dose corticosteroid treatment in acute multiple sclerosis relapses: prospective algorithm validation.
abstract: OBJECTIVE
  To evaluate a dipstick algorithm for urinary tract colonization, prior to high-dose corticosteroid treatment in acute relapses of multiple sclerosis (MS).
  
  
  METHODS
  Prospective cohort study of 267 consecutive patients with MS relapses requiring corticosteroid treatment in a hospital-based, ambulatory, acute MS relapse clinic. A total of 18 participants met the exclusion criteria, leaving 249 for analysis. Main outcome measures were urinary dipstick sensitivity, specificity, positive predictive value, negative predictive value and safety of antibiotic co-treatment with high-dose corticosteroids.
  
  
  RESULTS
  Significant bacteriuria (≥10(5)  colonies ml) rate in this population was 11% (95% CI, 7.1-14.9). Specificity and sensitivity of positive leucocyte esterase or nitrite were 78% and 65%. Negative predictive value of urine dipstick was 96%. No clinical adverse events occurred in the 3% (95% CI, 0.9-5.1) of patients with a false-negative dipstick. Eighteen per cent of patients were unnecessarily treated with antibiotics for 48 h.
  
  
  CONCLUSIONS
  Urinary dipstick testing allows for rapid and safe management of patients suffering from an acute MS relapse. The algorithm is conservative, and future work is needed to reduce the false-positive rate.
authors: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.|Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia.
authors: M
authors: M
authors: Rakusa
authors: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
authors: O
authors: O
authors: Murphy
authors: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
authors: L
authors: L
authors: McIntyre
authors: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
authors: B
authors: B
authors: Porter
authors: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
authors: J
authors: J
authors: Panicker
authors: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
authors: C
authors: C
authors: Fowler
authors: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
authors: G
authors: G
authors: Scott
authors: National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
authors: J
authors: J
authors: Chataway
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000465:Algorithms; D001437:Bacteriuria / Q000150:complications / Q000175:diagnosis / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000188:drug therapy* / Q000652:urine*; D012680:Sensitivity and Specificity
chemical_list: D000305:Adrenal Cortex Hormones