Epidemiology of urinary tract infections in adults among United States emergency departments from 2016 to 2023

Abstract

Introduction

Infections of the urinary tract, including cystitis and pyelonephritis, are common reasons for presentation to the Emergency Department (ED). However, there are limited recent data on incidence and admission rates. Moreover, with changes in resistance rates, advances in antibiotic options, and increasing antimicrobial stewardship, there is a need to better understand the current management. This study reports the incidence, admission rates, and antibiotic distribution among a nationwide cohort of adult ED patients with cystitis and pyelonephritis over an eight-year period.

Methods

This was a cross-sectional study of adult ED patients with a diagnosis of cystitis or pyelonephritis from 1/1/2016 to 12/31/2023. Using the Epic Cosmos database, ED visits for the above were identified using ICD-10 codes. Outcomes included total ED presentations, admission rates, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients with cystitis or pyelonephritis. Data were analyzed with binary logistic regression models to measure the relationship between time and dependent variables.

Results

There were 205,526,173 total ED encounters, with cystitis occurring in 8,768,481 (4.3 %) and pyelonephritis in 1,044,742 (0.5 %). 23.9 % of those with cystitis were admitted and 33.4 % of those with pyelonephritis were admitted, with a slight rise over time. The most common antibiotics for patients admitted with cystitis and pyelonephritis were third-generation cephalosporins (50.6 % and 55.6 %, respectively). There was a rise in third-generation and fourth-generation cephalosporins, while fluoroquinolone use declined. For discharged patients with cystitis, the most common antibiotics were first-generation cephalosporins (36.4 %), nitrofurantoin (17.9 %), and trimethoprim/sulfamethoxazole (10.7 %). There was a rise in first-generation, second-generation, and third-generation cephalosporins, while nitrofurantoin, trimethoprim/sulfamethoxazole, and ciprofloxacin use declined. For discharged patients with pyelonephritis, the most commonly prescribed antibiotics were first-generation cephalosporins (28.6 %), third-generation cephalosporins (19.5 %), ciprofloxacin (17.0 %), and trimethoprim/sulfamethoxazole (11.5 %). The largest rise was in third-generation cephalosporins, while there was a decline in fluoroquinolones.

Conclusion

Cystitis and pyelonephritis remain common ED presentations with a rise over time. There have been notable shifts in antibiotics, with an overall increase in cephalosporins while fluoroquinolone use has declined. Understanding the current epidemiology can inform public health planning and antibiotic stewardship in the ED.