Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States

OBJECTIVE: To determine the incidence and characteristics of women with uncomplicated recurrent UTIs and to explore whether the use of culture-driven treatment affects rates of UTI-related complications and resource utilization. METHODS: Using MarketScan claims from 2003 to 2011, we identified UTI naive women ages 18-64 with incident uncomplicated recurrent UTIs. Recurrent UTIs were defined as 3 UTI visits associated with antibiotics during a 12-month period. Cases were excluded if they had a UTI in the preceding year, or if they had any complicating factors (e.g. abnormality of the urinary tract, neurologic condition, pregnancy, diabetes, or currently taking immunosuppression). We next assessed use of urine cultures, imaging, and cystoscopy and performed propensity score matching with logistic regression to determine whether having a urine culture associated with >50% of UTIs affected rates of complications and downstream resource utilization. RESULTS: We identified 48,283 women with incident uncomplicated recurrent UTIs, accounting for an overall incidence of 102 per 100,000 women, highest among women ages 18-34 and 55-64. 61% of these women had at least 1 urine culture, 6.9% had imaging, and 2.8% had cystoscopy. Having a urine culture >50% of the time was associated with fewer UTI-related hospitalizations and lower rates of IV antibiotic use, while demonstrating higher rates of UTI-related office visits and pyelonephritis. CONCLUSIONS: The incidence of uncomplicated recurrent UTIs increases with age. Urine culture directed care is beneficial in reducing high cost services including UTI related hospitalizations and IV antibiotic use, making them a valuable component to management of these patients.