Women With MS Hospitalized for UTIs, Analysis of 2009 HCUP Data

Background: Urinary tract infections (UTI) have been reported as the most common bacterial infection in the general public  (Foxman, 2003) but little information is available specific to MS or has been self reported data. For instance, the North American Research Committee on MS (NARCOMS) database was queried  regarding  the incidence of urinary symptoms, infections and hospitalizations (Marrie et al. 2007), and  over 6,184 reported a UTI in the past 6 months with 3% reporting hospitalization but due to the nature of self report no confirmation of this information is available. Although episodes of infection in individuals with MS have been reported to worsen their symptoms and  worsen disability over time, little documentation is available. The occurrences, costs, and impact of UTI in MS are a significant yet understudied events.

Objectives: To determine the total number of hospitalizations of women with MS for UTIs in 2009 from the HCUP sample. To gather descriptive data on age, race, length of stay (LOS), co-morbidities and discharge location, with a focus on who required additional care on discharge. To explore correlations between the number of co-morbidities, age, and type of insurance on LOS, as well as admission versus discharge location.

Methods: A retrospective, primarily descriptive analysis was conducted utilizing the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality data for 2009, looking at hospitalization data for women. Descriptive statistics looked at central tendency, variability and ranges of ordinal data utilizing the SAS program. Relationships between LOS, number of other chronic illnesses and age will be examined. Patients were screened for sex, diagnosis of UTI in the first or second field (ICD 599) and MS (ICD 340) in any field. This subgroup was analyzed for age, length of stay, insurance, median income per zip code, residence on admission and discharge location, total cost of hospitalization and other factors.

Results: 2,431 women with MS were admitted for urinary tract infections. The median length of stay was 5 days with costs averaging $27,463 but upper limits reaching 400,000 dollars. A significant proportion of those admitted from home did not return home on discharge or required home care services.

Conclusions: Urinary tract infections led to prolonged length of stay as well as high cost both in money and worsening symptoms that required follow-up care on discharge. Prevention and early treatment of UTI’s is a critical area of importance to prevent worsening of MS.