Epidemiology and microbiology of recurrent UTI in women in the community in Oxfordshire, UK

Maria D L A Vazquez-Montes; Thomas R Fanshawe; Nicole Stoesser; A Sarah Walker; Christopher Butler; Gail Hayward

doi:10.1093/jacamr/dlad156

Epidemiology and microbiology of recurrent UTI in women in the community in Oxfordshire, UK

JAC Antimicrob Resist. 2024 Jan 10;6(1):dlad156. doi: 10.1093/jacamr/dlad156. eCollection 2024 Feb.

Authors

Maria D L A Vazquez-Montes¹, Thomas R Fanshawe¹, Nicole Stoesser^{2

3}, A Sarah Walker², Christopher Butler¹, Gail Hayward¹

Affiliations

¹ Nuffield Department of Primary Health Care Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
² Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.
³ Modernising Medical Microbiology Consortium, University of Oxford, Experimental Medicine Division, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.

Abstract

Background: Recurrent urinary tract infection (rUTI) contributes to significant morbidity and antibiotic usage.

Objectives: To characterize the age of women experiencing rUTI, the microbiology of rUTIs, and the risk of further rUTIs in Oxfordshire, UK.

Patients and methods: We retrospectively analysed de-identified linked microbiology and hospital admissions data (Infections in Oxfordshire Research Database), between 2008 and 2019, including positive urine cultures from women aged ≥16 years in community settings. We defined rUTI as ≥2 positive urine cultures within 6 months or ≥3 within 12 months.

Results: Of 201 927 women with urine culture performed, 84 809 (42%) had ≥1 positive culture, and 15 617 (18%) of these experienced ≥1 rUTI over a median (IQR) follow-up of 6 (3-9) years. Women with rUTI were 17.0 (95% CI: 16.3-17.7) years older on average. rUTI was commonest (6204; 40%) in those aged 70-89 years. Post-rUTI, the risk of further UTI within 6 months was 29.4% (95% CI: 28.7-30.2). Escherichia coli was detected in 65% of positive cultures. Among rUTIs where the index UTI was E. coli associated, the second UTI was also E. coli associated in 81% of cases.

Conclusions: rUTIs represent a substantial healthcare burden, particularly in women >60 years. One-third of women experiencing rUTI have a further microbiologically confirmed UTI within 6 months.