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

Mark H Wilcox; Dave Heaton; Aruni Mulgirigama; Ashish V Joshi; Viktor Chirikov; Daniel C Gibbons; David Webb; Xiaocong L Marston; Myriam Na Alexander; Fanny S Mitrani-Gold

doi:10.3399/BJGPO.2024.0214

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

BJGP Open. 2025 Jul 23;9(2):BJGPO.2024.0214. doi: 10.3399/BJGPO.2024.0214. Print 2025.

Authors

Affiliations

¹ Department of Microbiology, University of Leeds, Leeds, UK.
² Leeds Teaching Hospitals NHS Trust, Leeds, UK.
³ OPEN Health, Marlow, UK.
⁴ GSK, London, UK.
⁵ GSK, Collegeville, PA, US.
⁶ OPEN Health, Bethesda, MD, US.
⁷ GSK, Collegeville, PA, US fanny.s.mitrani-gold@gsk.com.

Abstract

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 (British National Formulary 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 (P<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 (P<0.001). Hospitalisation for acute pyelonephritis, bacteraemia, or sepsis following uUTI was uncommon.

Keywords: community-acquired infections; cystitis; general practice; lower urinary tract symptoms; urinary tract infections.