August 2023 CME Activity: Retrospective Cohort Study of Patient-Reported Urinary Tract Infection Signs and Symptoms Among Individuals With Neurogenic Bladder-Retrospective Cohort Study of Patient-Reported Urinary Tract Infection Signs and Symptoms Among Individuals With Neurogenic Bladder

Retrospective Cohort Study of Patient-Reported Urinary Tract Infection Signs and Symptoms Among Individuals With Neurogenic Bladder

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Urinary tract infections (UTIs) are common in patients with neurogenic bladder (NB), but accurately diagnosing them can be challenging due to the high prevalence of asymptomatic bacteriuria (ASB). This retrospective cohort study aimed to characterize patient-reported signs and symptoms of UTIs in patients with NB to improve diagnosis accuracy. The study included adults with NB due to spinal cord injury/disorder, multiple sclerosis, and/or Parkinson's disease who had UTI encounters at four medical centers between 2017 and 2018. Data were collected through medical record review and analyzed using descriptive statistics and logistic regression. <br /><br />Of the 199 patients included in the study, 37% had multiple sclerosis, 36% had spinal cord injury/disorder, and 27% had Parkinson's disease. The most common symptom reported was fever (32%), followed by change in urine color, odor, and/or consistency (25%) and lethargy/malaise (21%). Only 38% of patients had urinary tract-specific symptoms, while 48% had only nonspecific symptoms. Patients in inpatient settings had greater odds of having only nonspecific symptoms, while patients in the emergency department had greater odds of having at least one urinary tract-specific symptom. <br /><br />The findings of this study highlight the importance of accurately diagnosing UTIs in patients with NB. Nonspecific symptoms were more common than urinary tract-specific symptoms, and many patients had symptoms that were not specific to the urinary tract. Providers should consider evaluating for alternate sources of nonspecific symptoms before attributing them to UTIs. The results of this study can help inform interventions to improve the accuracy of UTI diagnosis in patients with NB, particularly among hospitalized patients. Further research is needed to validate these findings in non-VA populations and specific subgroups of patients with NB.

Keywords

Urinary tract infections

Neurogenic bladder

Asymptomatic bacteriuria

Diagnosis accuracy

Multiple sclerosis

Spinal cord injury

Parkinson's disease

Fever

Change in urine color

Lethargy