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.
“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.”
Also from AUA 2015