Abstract
Urinary tract infections (UTIs) are considered to be the most common bacterial infection.
According to the 1997 National Ambulatory Medical Care Survey and National Hospital
Ambulatory Medical Care Survey, UTI accounted for nearly 7 million office visits and
1 million emergency department visits, resulting in 100,000 hospitalizations. Nevertheless,
it is difficult to accurately assess the incidence of UTIs, because they are not reportable
diseases in the United States. This situation is further complicated by the fact that
accurate diagnosis depends on both the presence of symptoms and a positive urine culture,
although in most outpatient settings this diagnosis is made without the benefit of
culture.
Women are significantly more likely to experience UTI than men. Nearly 1 in 3 women
will have had at least 1 episode of UTI requiring antimicrobial therapy by the age
of 24 years. Almost half of all women will experience 1 UTI during their lifetime.
Specific subpopulations at increased risk of UTI include infants, pregnant women,
the elderly, patients with spinal cord injuries and/or catheters, patients with diabetes
or multiple sclerosis, patients with acquired immunodeficiency disease syndrome/human
immunodeficiency virus, and patients with underlying urologic abnormalities. Catheter-associated
UTI is the most common nosocomial infection, accounting for >1 million cases in hospitals
and nursing homes. The risk of UTI increases with increasing duration of catheterization.
In noninstitutionalized elderly populations, UTIs are the second most common form
of infection, accounting for nearly 25% of all infections.
There are important medical and financial implications associated with UTIs. In the
nonobstructed, nonpregnant female adult, acute uncomplicated UTI is believed to be
a benign illness with no long-term medical consequences. However, UTI elevates the
risk of pyelonephritis, premature delivery, and fetal mortality among pregnant women,
and is associated with impaired renal function and end-stage renal disease among pediatric
patients. Financially, the estimated annual cost of community-acquired UTI is significant,
at approximately $1.6 billion.
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