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?

Abstract

Background: 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.

Objective: 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.

Methods: 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).

Results: 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.

Conclusion: Nearly 1 in 5 cUTI hospital admissions occurred in patients with low acuity, and therefore may be avoidable.

Keywords: Epidemiology; Morbidity; Outcomes; Urinary tract infection.