Epidemiology of urinary tract infections: incidence, morbidity, and economic costs

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Abstract

Urinary tract infections (UTIs) are considered to be the most common bacterial infection. According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, UTI accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations. Nevertheless, it is difficult to accurately assess the incidence of UTIs, because they are not reportable diseases in the United States. This situation is further complicated by the fact that accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture.

Women are significantly more likely to experience UTI than men. Nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetime. Specific subpopulations at increased risk of UTI include infants, pregnant women, the elderly, patients with spinal cord injuries and/or catheters, patients with diabetes or multiple sclerosis, patients with acquired immunodeficiency disease syndrome/human immunodeficiency virus, and patients with underlying urologic abnormalities. Catheter-associated UTI is the most common nosocomial infection, accounting for >1 million cases in hospitals and nursing homes. The risk of UTI increases with increasing duration of catheterization. In noninstitutionalized elderly populations, UTIs are the second most common form of infection, accounting for nearly 25% of all infections.

There are important medical and financial implications associated with UTIs. In the nonobstructed, nonpregnant female adult, acute uncomplicated UTI is believed to be a benign illness with no long-term medical consequences. However, UTI elevates the risk of pyelonephritis, premature delivery, and fetal mortality among pregnant women, and is associated with impaired renal function and end-stage renal disease among pediatric patients. Financially, the estimated annual cost of community-acquired UTI is significant, at approximately $1.6 billion.

Section snippets

Symptomatic UTI

Symptomatic UTI is very common among sexually active women15 and far more common among women than men. An estimated 1 in 3 women will have at least 1 UTI diagnosed by a clinician requiring antimicrobial treatment by the age of 24 years,16 and 40% to 50% of women will experience at least 1 UTI during their lifetime16, 17, 18, 19(Figure 2). A recent random digit dialing survey of 2,000 women in the United States found that 10.8% of women >18 years reported at least 1 presumed UTI during the

Pediatrics

Approximately 3% of prepubertal girls and 1% of prepubertal boys are diagnosed with UTI5(Table 3). Many girls who do not undergo radiographic evaluation after an initial UTI experience a recurrence within 1 year,5 and girls who experience recurrent UTI are at increased risk of renal scarring,46 which then increases their risk of progressive renal disease in adulthood.47 A retrospective study recently found that 35% of boys and 32% of girls who had their first UTI at <1 year of age contracted a

Uncomplicated UTI

Acute uncomplicated UTI (cystitis) in the nonobstructed adult, nonpregnant woman is believed to be a benign illness with no long-term medical sequelae. To date, however, there are no large-scale prospective studies verifying this assumption. There are data highlighting significant short-term ramifications of acute uncomplicated UTI. Research on college women found that UTI resulted in 6.1 symptomatic days, 2.4 days of restricted activity, and 0.4 days of bed rest.30 Within 3 to 4 months of an

Financial implications of UTI

The financial implications of UTI are enormous, predominantly a result of the high incidence of UTI. Direct costs include the costs of outpatient doctor visits, antimicrobial prescriptions, and hospitalization expenses, as well as the nonmedical costs associated with travel, sick days, and morbidity. The indirect costs of lost output must also be considered. Although acute uncomplicated UTI is considered to be a benign condition with minimal long-term sequelae, it is associated with significant

Summary

UTI is the most common bacterial infection. It is generally associated with minimal morbidity except among specific subpopulations. However, there is a significant absence of data regarding its accurate incidence, factors that increase susceptibility to UTI, and the long-term medical sequelae of UTI.

There are many areas for future investigational effort. There is a need for accurate data regarding the incidence of symptomatic UTI and pyelonephritis among all populations. There is an increasing

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