Treatment patterns and burden of uncomplicated urinary tract infection in England: a retrospective cohort study.

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

Aim: To 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) healthcare burden and economic costs.

Design & Setting: Retrospective cohort study utilising patient data (January 2017-February 2020) from the Clinical Practice Research Datalink (CPRD) linked to English Hospital Episode Statistics.

Method: Female patients aged ≥12 years with a new uUTI between 2018 and 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 or without disease progression (hospitalisation for acute pyelonephritis, bacteraemia, or sepsis). Treatment non-concordance with current English guidelines was assessed. Burden (all-cause and urinary tract infection-related healthcare resource use [HCRU] and costs) was evaluated in a 1:1 age and 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 uUTI home consultation, prior hospitalisation, and medications prescribed for comorbid conditions in the prior 12 months ( classes: cardiovascular system, eye, and other drugs and preparations). 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 and comorbidity-matched controls (<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 patients with uUTI versus matched controls (<0.001). Hospitalisation for acute pyelonephritis, bacteraemia, or sepsis following uUTI was uncommon.