Treatment patterns and burden of uncomplicated urinary tract infection in England.

Abstract

Uncomplicated urinary tract infections (uUTIs) are common bacterial infections. Evaluate the burden of uUTI in England for 1) potential determinants of disease progression; 2) extent and impact of antimicrobial prescribing non-concordant with treatment guidelines; and 3) economic burden and costs. Retrospective cohort study utilising patient data from the Clinical Practice Research Datalink (CPRD) linked to English Hospital Episodes Statistics. Female patients aged≥12 years with a new uUTI between 2018-2019,≥14 months' continuous CPRD enrolment (≥12 months baseline,≥2 months follow-up), and≥1 oral antibiotic prescription±5 days of uUTI diagnosis were included. Baseline characteristics were described in patients with/without disease progression (hospitalisation for acute pyelonephritis/bacteraemia/sepsis). Treatment non-concordance with current English guidelines was assessed. Burden (all-cause and UTI-related healthcare resource use [HCRU] and costs) was evaluated in a 1:1 age-/comorbidity-matched uUTI-free cohort. Of 120,519 patients, 207 (0.2%) had disease progression requiring hospitalisation (during index uUTI episode); determinants included older age, index home consultation, prior hospitalisation and medications prescribed for comorbid conditions in the prior 12 months (British National Formulary classes: cardiovascular, eye, other). Non-concordant treatment was observed in 43.5% of patients. All-cause HCRU burden and costs were significantly higher in patients with uUTI versus age-/comorbidity-matched controls (P<0.001) at 28 days (£160.06 versus £37.63) and in the 12-month follow-up (£1206.77 versus £460.97). All-cause HCRU burden and costs were significantly higher in uUTI patients versus matched controls (P<0.001). Hospitalisation for acute pyelonephritis, bacteraemia, or sepsis following uUTI was uncommon.