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. 2022 Jan 10;9(1):ofab591.
doi: 10.1093/ofid/ofab591. eCollection 2022 Jan.

Descriptive Epidemiology and Outcomes of Hospitalizations With Complicated Urinary Tract Infections in the United States, 2018

Marya D Zilberberg  1 , Brian H Nathanson  2 , Kate Sulham  3 , Andrew F Shorr  4
Affiliations

Descriptive Epidemiology and Outcomes of Hospitalizations With Complicated Urinary Tract Infections in the United States, 2018

Marya D Zilberberg et al. Open Forum Infect Dis. .

Abstract

Background: Hospitalizations with complicated urinary tract infection (cUTI) in the United States have increased. Though most often studied as a subset of cUTI, catheter-associated UTI (CAUTI) afflicts a different population of patients and carries outcomes distinct from non-CA cUTI (nCAcUTI). We examined the epidemiology and outcomes of hospitalizations in these groups.

Methods: We conducted a cross-sectional multicenter study within the 2018 National Inpatient Sample (NIS) database, a 20% stratified sample of discharges from US community hospitals, to explore characteristics and outcomes of patients discharged with a UTI diagnosis. We divided cUTI into mutually exclusive categories of nCAcUTI and CAUTI. We applied survey methods to develop national estimates.

Results: Among 2 837 385 discharges with a UTI code, 500 400 (17.6%, 19.8% principal diagnosis [PD]) were nCAcUTI and 126 120 (4.4%, 63.8% PD) were CAUTI. Though similar in age (CAUTI, 70.1 years; and nCAcUTI, 69.7 years), patients with nCAcUTI had lower comorbidity (mean Charlson, 4.3) than those with CAUTI (mean Charlson, 4.6). Median (interquartile range [IQR]) length of stay (LOS) was 5 (3-8) days in nCAcUTI and 5 (3-9) days in CAUTI. Overall median (IQR) hospital costs were similar in nCAcUTI ($9713 [$5923-$17 423]) and CAUTI ($9711 [$5969-$17 420]). Though low in both groups, hospital mortality was lower in nCAcUTI (2.8%) than in CAUTI (3.4%). Routine discharges home were higher in nCAcUTI (41.5%) than CAUTI (22.1%).

Conclusions: There are >626 000 hospital admissions with a cUTI, comprising ~1.8% of all annual admissions in the United States; 4/5 are nCAcUTI. Because CAUTI is frequently the reason for admission, preventive efforts are needed beyond the acute care setting.

Keywords: UTI; epidemiology; hospitalization; outcomes.

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Figures

Figure 1.
Figure 1.
Hospital characteristics. Abbreviations: CAUTI, catheter-associated UTI; non-CA cUTI, non-catheter-associated complicated urinary tract infection.
Figure 2.
Figure 2.
Discharge destinations among survivors. aIncludes skilled nursing facility, intermediate care, and another type of facility. bIncludes against medical advice, destination unknown, and missing. Abbreviations: CAUTI, catheter-associated UTI; non-CA cUTI, non-catheter-associated complicated urinary tract infection.
See this image and copyright information in PMC

References

    1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002; 113:5S–13S. - PubMed
    1. Simmering JE, Tang F, Cavanaugh JE, Polgreen LA, Polgreen PM.. The increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998-2011. Open Forum Infect Dis 2017; 4:XXX–XX. - PMC - PubMed
    1. Zilberberg MD, Nathanson BH, Sulham K, Shorr AF.. Antimicrobial susceptibility and cross-resistance patterns among common complicated urinary tract infections in U.S. hospitals, 2013 to 2018. Antimicrob Agents Chemother 2020; 64:e00346–20. - PMC - PubMed
    1. Zilberberg MD, Nathanson BH, Sulham K, et al. . Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis. BMC Infect Dis 2017; 17:279. - PMC - PubMed
    1. Zilberberg MD, Nathanson BH, Sulham K, et al. . 30-day readmission, antibiotics costs and costs of delay to adequate treatment of Enterobacteriaceae UTI, pneumonia, and sepsis: a retrospective cohort study. Antimicrob Resist Infect Control 2017; 6:124. - PMC - PubMed