Introduction: Urinary tract infection is one of the leading causes of bacterial infections in adults, with an annual incidence of 3% for males and 12.6% for females. Annual cost of UTI care is in excess of $3 billion dollars in the US alone, and with abundant outpatient antibiotic prescriptions written for cystitis despite a lack of evidence that this improves outcomes. We aimed to evaluate the incidence of presentation for cystitis at a tertiary academic medical center, associated rate of culture confirmed urinary tract infections, and rate of progression to sepsis based on initial visit type. We hypothesized a higher positive culture rate and progression to sepsis for patients initially presenting in the hospital setting.
Methods: We queried the Discovery Data Mart administered by the UCLA Office of Health Informatics and Analytics to identify direct patient encounters for acute cystitis based on corresponding ICD code from January 1, 2013 through July 1, 2021. Encounters were characterized as outpatient (office or telemedicine), or hospital-based encounters. Corresponding urinalysis and culture data was obtained in addition to patient demographics. Encounters were screened for subsequent outpatient encounters, hospital admissions, or sepsis diagnosis within seven days of initial visit.
Results: We identified 511,622 encounters for acute cystitis, of which 181,568 met inclusion criteria. The majority of encounters were office visits (74.5%) compared to hospital-based (21.9%) or telemedicine (3.6%) visits. Only 32,326 (17.8%) were associated with a positive urine culture. A urinalysis was not ordered in 67,386 (37.1%) of encounters, with telemedicine having a significantly lower rate of UA orders (3% vs 78% hospital and 61% office, p < 0.00001). 42,772 patients had a follow up encounter within 7 days, of which only 6,411 were hospital encounters. Only 946 patients (0.5%) progressed to sepsis within 7 days, the majority of which were hospital encounters (1% vs 0.3 office and telemedicine, p < 0.00001).
Conclusions: Overall rate of progression to sepsis within one week following diagnosis of acute cystitis is low. Initial encounter in a hospital setting showed higher rate of progression compared to outpatient office or telemedicine visits. Risk of empiric antibiotic therapy and antibiotic stewardship must be considered given low rate of positive cultures and overall risk of progression to sepsis.
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