Around half of all women will suffer from at least one urinary tract infection (UTI) in their lifetime, and it is the most common bacterial infection treated by General Practitioners (GPs). Up to 800000 women in the UK suffer from frequent UTIs each year. Such recurrent UTI causes painful and distressing symptoms, difficulty in managing daily activities, and problems with sexual relationships. Multiple antibiotic courses or even continuous antibiotics are often prescribed, which can result in bacteria becoming resistant to some antibiotics, making infections harder to treat. GPs find recurrent UTI challenging to treat for the following reasons
1) It is unclear which women are most likely to benefit from preventative treatment
2) We dont know how helpful preventative antibiotics really are in this condition
3) We dont know who is at risk of bad outcomes from their recurrent UTI
To help GPs to more accurately determine which women are likely to suffer from recurrent UTI in the future, and therefore should try preventative treatment, we will use a large database of patient contacts with GP services for UTI. We will explore whether a womans medical history, age and pattern of previous infections relate to their risk of further UTIs. We will look at women who have been prescribed daily antibiotics for UTI to see if these worked in the short or long term. Finally, we will see if there are any features of the patient or how often they get UTIs which are associated with a greater risk of bad outcomes such as hospital admission with complications of UTI.
Recurrent Urinary Tract Infections (RUTIs), currently defined as ?2 UTIs in 6 months or 3 in a year, affect ~800000 women in the UK annually, causing pain, fever and urinary frequency. Many women are prescribed antibiotics for RUTI, which cause side-effects and drive antibiotic resistance. GPs find managing this condition challenging, because there is insufficient evidence indicating which women will benefit from preventative treatment.
Aim
To characterise women at greatest risk of RUTI and women to whom GPs should consider offering prophylactic treatment
Objectives:
1. Describe the burden of women with UTI contacting UK primary care
2. Develop a new definition of RUTI based on the frequency of clinical recurrence
In women with RUTI:
3. Describe the demographic (age, socioeconomic group) and clinical features (comorbidities, patterns of presentation, duration of antibiotics) associated with increased risk of subsequent UTI
4. In those receiving prophylactic antibiotics, explore features associated with successful prophylaxis (i.e. 25% or 50% reduction, no medically attended infections/hospital admissions with UTI, no pyelonephritis/sepsis during prophylaxis)
5. Explore patient and disease factors associated with UTI-related hospital attendance
Methods
Data will be women aged 16+ with ?1 UTI episode. GP contacts within 28 days of one another will be considered as the same episode. Proportion of UTI-related consultations will be calculated for all UTIs and for RUTIs. Cox regression will be used to investigate 1) patterns of RUTI, censoring at exit from a participating practice, end of study, or death (if >5%, competing risks methods will be investigated); 2) factors associated with RUTI risk, including number of previous UTIs, time since last UTI, and prophylaxis; 3) factors associated with success of prophylaxis for RUTI; and 4) patient/disease characteristics associated with complications, linking with HES Admitted Patient Care and Accident and Emergency databases to determine UTI-related hospital attendance.
The outcome is UTI episodes, defined as contacts with a UTI related symptom or a UTI-specific antibiotic code list: Contacts within 28 days of an index contact will be assumed to be related to the index infection, in line with previous studies (38), although a sensitivity analysis will explore contacts within 14 days as a less restrictive definition.
Gail Hayward - Chief Investigator - University of Oxford
Maria Vazquez Montes - Corresponding Applicant - University of Oxford
Christopher Butler - Collaborator - University of Oxford
Clare Bankhead - Collaborator - University of Oxford
Harry Ahmed - Collaborator - Cardiff University
Joshua Fieggen - Collaborator - University of Oxford
Margaret Smith - Collaborator - University of Oxford
Sarah Lay-Flurrie - Collaborator - University of Oxford
Thomas Fanshawe - Collaborator - University of Oxford
HES Accident and Emergency;HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Pregnancy Register