Dr. Dmochowski on the economic burden of urinary tract infections

Opinion
Video

"The background for this paper stems from the increasingly identified need to do a better job of management of urinary tract infection, not only from a recognition standpoint, but also from a diagnostic and treatment standpoint," says Roger R. Dmochowski, MD, MMHC, FACS.

In this video, Roger R. Dmochowski, MD, MMHC, FACS, describes the background and notable findings from the Neurology and Urodynamics study “Recurrent and complicated urinary tract infections in women: Utility of advanced testing to enhance care.” Dmochowski is professor of urology, surgery and gynecology and vice chair for faculty affairs and professionalism, and associate surgeon in chief at Vanderbilt University Medical Center in Nashville Tennessee.

Transcription:

Please describe the background for this study.

The background for this paper stems from the increasingly identified need to do a better job of management of urinary tract infection, not only from a recognition standpoint, but also from a diagnostic and treatment standpoint. And it's pretty clear from openly available federal data that we as a specialty aren't doing as good a job as potentially we could in terms of identifying and appropriately managing patients with lower urinary tract symptoms that may be compatible with urinary tract infection. And this has led perhaps to overuse of antibiotics, which we know from antibiotic stewardship is a major problem, but also perhaps for not the best use of advanced testing techniques for urinary tract infection.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

The notable findings are really dramatic. First and foremost, I think all of us in urology know that urinary tract infection is a major part of our ambulatory practice. Increasingly, it is becoming a major part of our inpatient and hospital-based practices as well, due to the rapid rise of not only complicated urinary tract infections due to the multiple comorbidities many of our patients have, but also now to the rise of resistant urinary tract infections. Interestingly enough, we're sort of seeing the devolution of a new sort of criteria or hierarchy or taxonomy for the description of urinary tract infections. We're seeing something called uncomplicated urinary tract infections, a term we've used for quite a while—UUI, not urge urinary incontinence, but uncomplicated urinary tract infection. Then, we've also always had complicated UTIs, or CUTIs. Now, we have the emergence of complicated UTIs with antibiotic-resistant UTIs. And so these entities are really affecting our patient population and ourselves. And some of the very interesting findings now are the economic burden associated with this. And the economic burden now associated with complicated urinary tract infection is estimated to be almost $5 billion in 2017. So you can imagine it's more now than ever, and we've got to do a better job of recognizing these patients, appropriately treating those patients with symptoms, and also teaching our colleagues about asymptomatic bacteria and how best to follow...those patients in the absence of symptoms.

This transcription was edited for clarity.

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