Abstract：
BACKGROUND: Urinary tract infections (UTIs) occur commonly and often recur. However, recent data on the epidemiology of recurrent UTI (rUTI) are scarce.
METHODS: Between 01/01/2016-31/12/2020, index uncomplicated UTIs (uUTI) from office, emergency department (ED), hospital, and virtual care settings were identified from electronic health records of women at Kaiser Permanente Southern California. We defined rUTI as ≥3 UTI within 365 days or ≥2 UTI within 180 days. We determined the proportion of women with cystitis index uUTI who had rUTI and examined factors associated with rUTIs using modified multivariable Poisson regression.
RESULTS: Among 374,171 women with cystitis index uUTI, 54,318 (14.5%) had rUTI. A higher proportion of women with rUTI compared to those without rUTI were age 18-27 or ≥78 years at index uUTI (19.7% vs 18.7% and 9.0% vs 6.0%, respectively), were immunocompromised, or had a positive urine culture at index uUTI. In multivariable analyses, characteristics associated with rUTI included younger or older age (48-57 vs 18-27 years aRR=0.83 [95% CI: 0.80-0.85]; ≥78 vs 18-27 years aRR=1.07 [95%CI=1.03-1.11]), Charlson Comorbidity Index (≥3 vs 0, aRR=1.12 [95%CI:1.08-1.17]), and diabetes mellitus (aRR=1.07 [95%CI:1.04-1.10]). More frequent prior year outpatient and ED encounters, oral antibiotic prescriptions, oral contraceptive prescriptions, positive culture at index uUTI, and antibiotic resistant organisms were also associated with increased risk of rUTI.
CONCLUSIONS: The high risk of rUTI among women with cystitis is concerning, especially given previous reports of increasing UTI incidence. Current assessment of the epidemiology of rUTI may guide the development of preventive interventions against UTI.
METHODS: Between 01/01/2016-31/12/2020, index uncomplicated UTIs (uUTI) from office, emergency department (ED), hospital, and virtual care settings were identified from electronic health records of women at Kaiser Permanente Southern California. We defined rUTI as ≥3 UTI within 365 days or ≥2 UTI within 180 days. We determined the proportion of women with cystitis index uUTI who had rUTI and examined factors associated with rUTIs using modified multivariable Poisson regression.
RESULTS: Among 374,171 women with cystitis index uUTI, 54,318 (14.5%) had rUTI. A higher proportion of women with rUTI compared to those without rUTI were age 18-27 or ≥78 years at index uUTI (19.7% vs 18.7% and 9.0% vs 6.0%, respectively), were immunocompromised, or had a positive urine culture at index uUTI. In multivariable analyses, characteristics associated with rUTI included younger or older age (48-57 vs 18-27 years aRR=0.83 [95% CI: 0.80-0.85]; ≥78 vs 18-27 years aRR=1.07 [95%CI=1.03-1.11]), Charlson Comorbidity Index (≥3 vs 0, aRR=1.12 [95%CI:1.08-1.17]), and diabetes mellitus (aRR=1.07 [95%CI:1.04-1.10]). More frequent prior year outpatient and ED encounters, oral antibiotic prescriptions, oral contraceptive prescriptions, positive culture at index uUTI, and antibiotic resistant organisms were also associated with increased risk of rUTI.
CONCLUSIONS: The high risk of rUTI among women with cystitis is concerning, especially given previous reports of increasing UTI incidence. Current assessment of the epidemiology of rUTI may guide the development of preventive interventions against UTI.
摘要：
背景：尿路感染（UTI）常有且经常复发。然而,关于复发性UTI（rUTI）流行病学的最新数据很少。
方法：在01/01/2016-31/12/2020之间，从办公室索引不复杂的UTI（uUTI），急诊科（ED），医院,从南加州KaiserPermanente妇女的电子健康记录中确定了虚拟护理环境。我们将rUTI定义为365天内≥3UTI或180天内≥2UTI。我们确定了患有膀胱炎指数uUTI的女性患有rUTI的比例，并使用改进的多变量Poisson回归检查了与rUTI相关的因素。
结果：在374,171名患有膀胱炎指数uUTI的女性中，54318（14.5%）有rUTI。与没有rUTI的女性相比，患有rUTI的女性比例更高，在uUTI指数为18-27岁或≥78岁（19.7％vs18.7％和9.0％vs6.0％，分别)，免疫功能受损，或在指数uUTI时尿液培养阳性。在多变量分析中，与rUTI相关的特征包括年龄较小或较大（48-57岁vs18-27岁，RR=0.83[95%CI：0.80-0.85]；≥78岁vs18-27岁，RR=1.07[95CI=1.03-1.11]），Charlson合并症指数（≥3vs0，RR=1.12[95CI：1.08-1.17]），和糖尿病（RR=1.07[95CI：1.04-1.10]）。上一年更频繁的门诊和ED遭遇，口服抗生素处方，口服避孕药处方，UUTI指数阳性培养，抗生素耐药菌也与rUTI风险增加相关。
结论：膀胱炎女性患rUTI的风险较高，特别是考虑到以前关于UTI发病率增加的报道。当前对rUTI流行病学的评估可能会指导针对UTI的预防性干预措施的发展。
方法：在01/01/2016-31/12/2020之间，从办公室索引不复杂的UTI（uUTI），急诊科（ED），医院,从南加州KaiserPermanente妇女的电子健康记录中确定了虚拟护理环境。我们将rUTI定义为365天内≥3UTI或180天内≥2UTI。我们确定了患有膀胱炎指数uUTI的女性患有rUTI的比例，并使用改进的多变量Poisson回归检查了与rUTI相关的因素。
结果：在374,171名患有膀胱炎指数uUTI的女性中，54318（14.5%）有rUTI。与没有rUTI的女性相比，患有rUTI的女性比例更高，在uUTI指数为18-27岁或≥78岁（19.7％vs18.7％和9.0％vs6.0％，分别)，免疫功能受损，或在指数uUTI时尿液培养阳性。在多变量分析中，与rUTI相关的特征包括年龄较小或较大（48-57岁vs18-27岁，RR=0.83[95%CI：0.80-0.85]；≥78岁vs18-27岁，RR=1.07[95CI=1.03-1.11]），Charlson合并症指数（≥3vs0，RR=1.12[95CI：1.08-1.17]），和糖尿病（RR=1.07[95CI：1.04-1.10]）。上一年更频繁的门诊和ED遭遇，口服抗生素处方，口服避孕药处方，UUTI指数阳性培养，抗生素耐药菌也与rUTI风险增加相关。
结论：膀胱炎女性患rUTI的风险较高，特别是考虑到以前关于UTI发病率增加的报道。当前对rUTI流行病学的评估可能会指导针对UTI的预防性干预措施的发展。
