Time Trends in Spain from 2001 to 2018 in the Incidence and Outcomes of Hospitalization for Urinary Tract Infections in Patients with Type 2 Diabetes Mellitus

Abstract

We aim to examine the incidences, clinical characteristics, and in-hospital outcomes of type 2 diabetes (T2DM) patients hospitalized with urinary tract infections (UTIs) in Spain and to identify the factors associated with in-hospital mortality (IHM). A retrospective observational study was carried out with a sample that included all adult patients who were hospitalized for UTIs between 2001 and 2018 and collected in the Spanish National Health System Hospital Discharge Database. We identified 850,276 patients with UTIs (25.49% with T2DM). The incidence of UTIs increased in patients with and without diabetes from 290.76 and 74.79 cases per 100,000 inhabitants in the period from year 2001 to year 2003 to 568.45 and 144.0 in the period from 2016 to 2018, respectively (p < 0.001). Adjusted incidence of UTIs was higher in T2DM patients (incidence rate ratio (IRR) 4.36; 95% CI 4.35–4.39). The multivariable analysis showed a significant reduction in the IHM over time for men and women with T2DM. In T2DM, patients’ higher IHM was associated with older age, comorbidities, and Staphylococcus aureus isolation. Women with T2DM had a higher risk of dying than men. The risk of IHM with an episode of UTIs was independent of the presence of T2DM (odds ratio (OR) 0.97; 95% CI 0.91–1.01). We conclude that the incidence of UTIs was over four times higher in T2DM than nondiabetic patients and has increased over time.

Trends in Incidence and Outcomes of Hospitalizations for Urinary Tract Infection among Older People in Spain (2001–2018)

“…We found that Escherichia coli was the most prevalent pathogen in both sexes regarding isolated pathogens, which is in line with previous reports [ 1 , 7 , 26 , 28 , 33 , 34 , 35 ]. However, the risk of IHM was associated with Staphylococcus aureus , but the risk decreased with other isolated pathogens, which is also observed among patients with COPD and type 2 diabetes mellitus [ 7 , 27 ]. Staphylococcus aureus bacteriuria is associated with bacteremia by this microorganism, which presents a complicated course with higher IHM [ 12 , 36 , 37 , 38 ].…”

“…The significant association between older age and higher incidence and IHM in patients with UTI observed here is supported by previous reports demonstrating that the risk of mortality increases in older ages [ 5 , 7 , 26 , 27 , 28 ]. It may be justified by the association between aging and a reduced innate and adaptive immune response, which is known as immune senescence [ 8 ].…”

“…Furthermore, there are differences in UTI-related IHM risk between women and men within the older population. Previous studies in hospital admissions of older chronic obstructive pulmonary disease (COPD) patients [ 27 ] and older patients with diabetes [ 7 ] with a principal diagnosis of UTI, reported that the oldest women (>84 years old) showed a higher risk for IHM when compared with the oldest men. COPD patients showed OR 18.27 (95% CI: 4.46–74.85) versus OR 5.33 (95% CI: 2.82–10.09), women versus men, respectively.…”

“…COPD patients showed OR 18.27 (95% CI: 4.46–74.85) versus OR 5.33 (95% CI: 2.82–10.09), women versus men, respectively. In addition, women with diabetes showed OR 12.8 (95% CI: 8.2–19.97) versus the OR 9.8 (95% CI: 6.03–15.94) of men with diabetes [ 7 ].…”

“…Furthermore, it is estimated that, at a global level, after 65 years of age in noninstitutionalized people, the rate of UTI was 10.9% for men and 14% for women [ 4 ]. UTIs have been associated with several comorbidities such as vertebral fractures, rheumatic disease, multi-infarct dementia [ 4 ], undernourishment, diabetes, neuropathy, fecal and/or urinary incontinence [ 5 , 6 , 7 ], chronic diseases, and functional abnormalities [ 8 , 9 , 10 ]. Other factors predisposing to UTIs include estrogen deficiency and immune senescence [ 8 ], bed rest, hospitalizations, long-term medical institutionalization [ 5 , 6 , 7 , 8 , 10 ], iatrogenic factors, including anticholinergic agents, antibiotics, and the presence of urinary catheters [ 6 , 8 ].…”