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. 2022 Mar 17;3(2):e12694.
doi: 10.1002/emp2.12694. eCollection 2022 Apr.

Descriptive epidemiology and outcomes of emergency department visits with complicated urinary tract infections in the United States, 2016-2018

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

Descriptive epidemiology and outcomes of emergency department visits with complicated urinary tract infections in the United States, 2016-2018

Marya D Zilberberg et al. J Am Coll Emerg Physicians Open. .

Abstract

Objective: There are >1 million emergency department visits and 100,000 admissions with urinary tract infection (UTI) annually in the United States. A fraction of total UTI volume, complicated (cUTI) costs the health care system over $3.5 billion per year. We evaluated the contemporary annual burden of emergency department (ED) visits with cUTI.

Methods: We conducted a cross-sectional multicenter study within the National Emergency Department database, a 20% stratified sample of all US hospital-based EDs, 2016-2018, to explore characteristics of visits with a cUTI. We compared cUTI as the principal (PD) versus secondary diagnosis (non-PD). We applied survey methods to develop national estimates.

Results: Among 2,379,448 ED cUTI visits (44.8% PD), 40.1% were female (45.1% PD; 36.9% non-PD) and 62.2% were ≥ 65 years (52.5% PD; 70.2% non-PD). Mean Charlson score was 2.3 (3.0 PD; 2.1 non-PD); end-stage renal disease prevalence was 2.3% (1.4% PD; 3.0% non-PD). Whereas pyelonephritis occurred in ∼10% of both groups, severe sepsis (7.2% vs 2.0%) and septic shock (7.1% vs 1.8%) were ∼4 times more prevalent among those with cUTI-non-PD than cUTI-PD. Overall, two thirds of all visits ended in hospitalization (44.9% PD; 85.5% non-PD). Despite similar numbers of visits, the annual national ED bill for cUTI rose from $2.8 billion in 2016 to $3.2 billion in 2018.

Conclusion: There were over 2 million ED visits with cUTI in 2016-2018. Although <10% met criteria for severe sepsis/septic shock, ∼two thirds were admitted. The aggregate cost for cUTI visits rose by 15% without a substantial increase in volume.

Keywords: UTI; complicated UTI; costs; emergency department; hospitalization.

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Conflict of interest statement

Marya D. Zilberberg is a consultant to Spero Therapeutics. Her employer, EviMed Research Group, LLC, has received research grant support from Spero Therapeutics. Brian H. Nathanson's employer, OptiStatim, LLC, has received support from EviMed Research Group, LLC. Kate Sulham was an employee of and stockholder in Spero Therapeutics during the conduct of this study. She currently serves as a consultant to Spero. Andrew F. Shorr is a consultant to and has received research grant support from Spero Therapeutics. Marya D. Zilberberg and Andrew F. Shorr have received grant support and/or have served as consultants to Merck, Melinta, Tetraphase, Pfizer, Astellas, Shionogi, The Medicines Company, Lungpacer, and Theravance.

Figures

FIGURE 1
FIGURE 1
Seasonal variation in cUTI ED visitsa. aValues missing in 13% cUTI‐PD and 12% cUTI‐non‐PD. cUTI, complicated urinary tract infection; cUTI‐non‐PD, cUTI secondary diagnosis; cUTI‐PD, principal diagnosis; ED, emergency department
FIGURE 2
FIGURE 2
Annual cUTI ED visits and aggregate costs. cUTI, complicated urinary tract infection; cUTI‐non‐PD, cUTI secondary diagnosis; cUTI‐PD, principal diagnosis; ED, emergency department; N, number of ED visits
See this image and copyright information in PMC

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