UTI incidence high, urine culture-directed care underutilized

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Greater use of culture-directed care represents an opportunity to improve management of women with uncomplicated UTIs, researchers say.

New Orleans-It is well recognized that uncomplicated recurrent urinary tract infections (UTIs) are a common and costly problem in the community. Research presented at the AUA annual meeting in New Orleans is a step toward better understanding the magnitude of the problem, practice patterns for patient evaluation, and their effect on downstream resource utilization.

Searching the nationwide MarketScan database for the years 2003 to 2011, the study identified 28,545 women with incident uncomplicated recurrent UTIs, defined as three office or ER visits with an ICD-9 code for UTI associated with a prescription for antibiotics during a 12-month period in the absence of a UTI in the year preceding the first UTI and any complicating factors.

The workup included at least one urine culture in 61% of women, imaging in 6.9%, and cystoscopy in 2.8%. Overall, 33.2% of women were identified as having culture-directed care defined by having a urine culture associated with >50% of their UTIs. Relative to a propensity score-matched control group of women who did not receive culture-directed care, women who did have such care had significantly fewer UTI-related hospitalizations and a significantly lower rate of treatment with intravenous antibiotics.

Dr. Suskind“Guidelines on management of uncomplicated recurrent UTI, which are available from the Canadian Urological Association and European Association of Urology, recommend obtaining a urine culture with each UTI and discourage the routine use of cystoscopy and urinary tract imaging,” said first author Anne Suskind, MD, MS, assistant professor of urology at the University of California, San Francisco.

“While there are many examples today of overutilization of testing in medicine, our findings indicate that is not the case for cystoscopy and imaging in women with uncomplicated recurrent UTI. However, our study indicates that urine culture-directed care is being underutilized and that its greater use represents an opportunity to improve the care of women with this common condition.”

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Highest incidence seen in ages 55-64

The 28,500+ women identified with an uncomplicated recurrent UTI represented an incidence of 102 per 100,000 women overall. Further analyses with women stratified by age showed the incidence had a J-shaped age-related distribution, with the highest rate occurring among women ages 55 to 64 years (189 per 100,000) followed by the group ages 18 to 34 years (105 per 100,000).

“The MarketScan database was an excellent resource for our study, as it contains comprehensive information for a large, nationally representative patient population,” said Dr. Suskind.

“However, as a health care administrative claims database, we recognize it does not capture all cases. Therefore, we believe that our findings provide a conservative estimate of the true incidence of uncomplicated recurrent UTI among community-dwelling women.”

For the analyses to examine the impact of urine culture-directed care, women were matched by propensity score analysis based on age, geographic region, type of insurance, history of pelvic organ prolapse and urinary incontinence, and use of antibiotic prophylaxis. The groups that did and did not receive urine culture-directed care were also compared with respect to emergency room visits, office visits, and pyelonephritis rate. Significant findings in those analyses included a slightly higher frequency of office visits and a higher rate of pyelonephritis in women receiving urine culture-directed care compared with controls.

“We believe these findings probably reflect slightly higher intensity of care and a higher acuity of the problem among women who received urine culture-directed care,” Dr. Suskind said.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases as part of the Urologic Disease of America Project.