Treatment patterns and burden of uncomplicated urinary tract infection in England

Background: Uncomplicated urinary tract infections (uUTIs) are common bacterial infections.

Aim: 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.

Design & setting: Retrospective cohort study utilising patient data from the Clinical Practice Research Datalink (CPRD) linked to English Hospital Episodes Statistics.

Method: 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.

Results: 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).

Conclusion: 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.