Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
GlaxoSmithKline, Siena, Italy.
J Infect Dis. 2024 Nov 15;230(5):e1101-e1111. doi: 10.1093/infdis/jiae331.
Urinary tract infections (UTIs) occur commonly and often recur. However, recent data on the epidemiology of recurrent UTI (rUTI) are scarce.
Between 1 January 2016 and 31 December 2020, index uncomplicated UTIs (uUTIs) from office, emergency department, hospital, and virtual care settings were identified from the electronic health records of women at Kaiser Permanente Southern California. We defined rUTI as ≥3 UTIs within 365 days or ≥2 UTIs within 180 days. We determined the proportion of women with cystitis index uUTI who had rUTI, and we examined factors associated with rUTIs using modified multivariable Poisson regression.
Among 374 171 women with cystitis index uUTI, 54 318 (14.5%) had rUTI. A higher proportion of women with rUTI vs those without rUTI were aged 18 to 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 result at index uUTI. In multivariable analyses, characteristics associated with rUTI included younger or older age (48-57 vs 18-27 years: adjusted risk ratio [aRR], 0.83 [95% CI, .80-.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 emergency department encounters, oral antibiotic and oral contraceptive prescriptions, positive culture result at index uUTI, and antibiotic-resistant organisms were also associated with increased risk of rUTI.
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.
尿路感染（UTI）很常见，且常反复发作。然而，目前关于复发性 UTI（rUTI）的流行病学数据很少。
2016 年 1 月 1 日至 2020 年 12 月 31 日，从 Kaiser Permanente Southern California 的女性电子健康记录中确定了门诊、急诊、医院和虚拟护理环境中的单纯性膀胱炎指数 UTI（uUTI）的指数病例。我们将 rUTI 定义为在 365 天内发生≥3 次 UTI 或在 180 天内发生≥2 次 UTI。我们确定膀胱炎指数 uUTI 女性中 rUTI 的比例，并使用修正后的多变量泊松回归分析确定与 rUTI 相关的因素。
在 374171 名患有膀胱炎指数 uUTI 的女性中，54318 名（14.5%）患有 rUTI。与无 rUTI 的女性相比，rUTI 女性在指数 uUTI 时的年龄为 18-27 岁或≥78 岁的比例更高（19.7%比 18.7%和 9.0%比 6.0%），免疫功能低下，或指数 uUTI 时尿液培养阳性。多变量分析显示，与 rUTI 相关的特征包括年龄较小或较大（48-57 岁比 18-27 岁：调整后的风险比 [aRR]，0.83 [95%CI，0.80-0.85]；≥78 岁比 18-27 岁：aRR，1.07 [95%CI，1.03-1.11]）、Charlson 合并症指数（≥3 分比 0 分：aRR，1.12 [95%CI，1.08-1.17]）和糖尿病（aRR，1.07 [95%CI，1.04-1.10]）。既往年度门诊和急诊就诊次数增加、口服抗生素和口服避孕药处方、指数 uUTI 培养阳性、以及抗生素耐药菌也与 rUTI 风险增加相关。
膀胱炎女性 rUTI 的高风险令人担忧，尤其是考虑到之前 UTI 发病率增加的报告。目前对 rUTI 流行病学的评估可能有助于制定预防 UTI 的干预措施。
