Hospital admission patterns of adult patients with complicated urinary tract infections who present to the hospital by disease acuity and comorbid conditions: How many admissions are potentially avoidable?

• Published in: American journal of infection control Vol. 49; no. 12; pp. 1528 - 1534
• Main Authors: Lodise, Thomas P., Chopra, Teena, Nathanson, Brian H., Sulham, Katherine
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2021
• Subjects: Adolescent; Adult; Epidemiology; Hospitalization; Hospitals; Humans; Inpatients; Male; Morbidity; Outcomes; Retrospective Studies; United States - epidemiology; Urinary tract infection; Urinary Tract Infections - epidemiology; United States; Urinary tract infection; Epidemiology; Outcomes; Morbidity
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2021.05.013

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•Hospital admissions for complicated urinary tract infections (cUTI) are rising.•There is scant information on the clinical acuity of hospitalized cUTI patients.•This study describes the characteristics of hospitalized cUTI patients in the United States.•Approximately 1 in 5 cUTI admissions occurred in patients with low acuity and may be avoidable.•Results highlight need to develop well-defined criteria for cUTI admissions.
Hospital admissions for complicated urinary tract infections (cUTI) in the United States are increasing but there are limited information on the acuity of patients who are admitted.
Describe hospitalization patterns among adult cUTI patients who present to the hospital with cUTI and to determine the proportion of admissions that were of low acuity.
A retrospective multi-center analysis using data from the Premier Healthcare Database (2013-2018) was performed. Inclusion criteria: age ≥ 18 years, cUTI diagnosis, positive blood or urine culture. Hospital admissions were stratified by presence of sepsis, systemic symptoms but no sepsis, and Charlson Comorbidity Index (CCI).
187,789 patients met the inclusion criteria. The mean (SD) age was 59.7 (21.9), 40.4% were male, 29.4% had sepsis, 16.7% had at least 1 systemic symptom (but no sepsis), and 53.9% had no sepsis or systemic symptoms. The median [inter-quartile range] CCI was 1 [0, 3]. Sixty-four percent of patients were admitted to hospital, and 18.9% of admissions occurred in patients with low acuity (no sepsis or systemic symptoms and a CCI ≤ 2). The median [IQR] LOS and costs for low acuity inpatients who were admitted were 3 [2, 5] days and $5,575 [$3,607, $9,133], respectively.
Nearly 1 in 5 cUTI hospital admissions occurred in patients with low acuity, and therefore may be avoidable.