Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States

Abstract

Objective To determine the incidence and characteristics of women with uncomplicated recurrent UTIs and to explore whether the use of culture-driven treatment affects rates of UTI-related complications and resource utilization. Methods Using MarketScan claims from 2003 to 2011, we identified UTI naive women ages 18–64 with incident uncomplicated recurrent UTIs. Recurrent UTIs were defined as 3 UTI visits associated with antibiotics during a 12-month period. Cases were excluded if they had a UTI in the preceding year, or if they had any complicating factors (e.g. abnormality of the urinary tract, neurologic condition, pregnancy, diabetes, or currently taking immunosuppression). We next assessed use of urine cultures, imaging, and cystoscopy and performed propensity score matching with logistic regression to determine whether having a urine culture associated with >50% of UTIs affected rates of complications and downstream resource utilization. Results We identified 48,283 women with incident uncomplicated recurrent UTIs, accounting for an overall incidence of 102 per 100,000 women, highest among women ages 18–34 and 55–64. 61% of these women had at least 1 urine culture, 6.9% had imaging, and 2.8% had cystoscopy. Having a urine culture >50% of the time was associated with fewer UTI-related hospitalizations and lower rates of IV antibiotic use, while demonstrating higher rates of UTI-related office visits and pyelonephritis. Conclusions The incidence of uncomplicated recurrent UTIs increases with age. Urine culture directed care is beneficial in reducing high cost services including UTI related hospitalizations and IV antibiotic use, making them a valuable component to management of these patients.

Presentation and Management Patterns of Lower Urinary Tract Symptoms in Adults Due to Rare Inherited Neuromuscular Diseases

“…14 While it is difficult to reliably trust UTI data based on coding, this rate is higher than the rate of UTI in a national sample of women in the United States (incidence 1/1000). 20 The rates of kidney stones and urinary retention were also higher among individuals with RTT, with the general population developing kidney stones at an annual rate of 0.5-1/1000 individuals and urinary retention in the female general population at an annual rate of 0.07/1000 individuals. 21,22 Likely due to our small sample size, kidney stones were not observed in the RTT patients in our study, however, their primary reason for presenting to a urologist was urinary retention, corroborating what was previously reported.…”

Evaluation of the trends and appropriateness of fluoroquinolone use in the outpatient treatment of acute uncomplicated cystitis at five family practice clinics

“…To assess the trends and predictors of FQ use, the following additional data were collected: age, clinic at which the patient was treated and comorbidities. Comorbidities of interest included diabetes mellitus, chronic kidney disease, HIV/AIDS, malignancy, solid organ transplant, hematopoietic stem cell transplant, respiratory disorders (such as chronic obstructive pulmonary disease, asthma and interstitial lung disease), cardiac disorders (such as arrhythmia and myocardial infarction) and recurrent UTIs (3 or more episodes in the previous 12 months or 2 episodes in the previous 6 months).…”

Recurrent Urinary Tract Infections in Women: What Is the Evidence for Investigating with Flexible Cystoscopy, Imaging and Urodynamics?

“…Data was not extractable in 2 studies [20,21]. One study was focusing at the incidence of recurrent UTIs and did not report on investigation findings [2]. Seven studies did not provide a breakdown in their data to dif-Review ferentiate: recurrent UTI patients from septic inpatients [22], haematuria [23][24][25] or gender [26][27][28].…”

“…It is a common condition in women under 65 with an incidence of 1 in 1,000 [2]. These women are commonly referred to urology clinics for further investigation; however, current practice on how these patients are investigated varies greatly among urologists worldwide.…”