Demography and burden of care associated with patients readmitted for urinary tract infection
Shawn H. MacVane, Lindsay O. Tuttle, David P. Nicolau
Received: March 12, 2014 Revised: April 2, 2014 Accepted: April 3, 2014
David P. Nicolau, Corresponding author. Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
Background and purpose:
Urinary tract infection (UTI) is one of the most prevalent admission diagnoses in hospital-based clinical practice. Despite its frequency, few data are available regarding its demographics and economic implications.
To describe the demography, epidemiology, and burden of care of patients admitted to hospital with UTI and compare these characteristics depending on admission status.
A retrospective cohort study using an administrative database of patients admitted to Hartford Hospital (September 2011–August 2012) with UTI. Patient demographics, hospital characteristics, and total costs of care were examined.
A total of 2345 unique patients were included. The mean age of the patients was 78 years and 71% were female. Median length of stay and total cost were 5 days and $8326 (interquartile range $5388–$14,179), respectively. A total of 359 patients (16.4%) were readmitted within 30 days, of which 111 patients (5.1%) had UTI on readmission. Only 16.3% of readmitted patients were infected with the same causative pathogen. A significant increase in the incidence of Enterococcus faecalis (1.2% vs. 9.3%; p = 0.046) occurred upon readmission, whereas occurrence of Enterobacteriaceae infection decreased in the readmission group (50.0% vs. 25.6%; p = 0.006), including a lower proportion of Escherichia coli (32.5% vs. 11.6%; p < 0.001). A higher proportion of readmission pathogens were nonsusceptible, including significant changes to cefazolin (24.4% vs. 63.6%; p = 0.004) and cefepime (8.7% vs. 27.6; p = 0.05).
UTI is highly prevalent and is associated with significant utilization of health-care resources among hospitalized patients. These findings, coupled with considerable rates of 30-day readmission, stress the importance of proper diagnosis and treatment.
demography, economics, readmission, urinary tract infection