Descriptive epidemiology and outcomes of emergency department visits with complicated urinary tract infections in the United States, 2016–2018

OBJECTIVE: There are >1 million emergency department visits and 100,000 admissions with urinary tract infection (UTI) annually in the United States. A fraction of total UTI volume, complicated (cUTI) costs the health care system over $3.5 billion per year. We evaluated the contemporary annual burden of emergency department (ED) visits with cUTI. METHODS: We conducted a cross‐sectional multicenter study within the National Emergency Department database, a 20% stratified sample of all US hospital‐based EDs, 2016–2018, to explore characteristics of visits with a cUTI. We compared cUTI as the principal (PD) versus secondary diagnosis (non‐PD). We applied survey methods to develop national estimates. RESULTS: Among 2,379,448 ED cUTI visits (44.8% PD), 40.1% were female (45.1% PD; 36.9% non‐PD) and 62.2% were ≥ 65 years (52.5% PD; 70.2% non‐PD). Mean Charlson score was 2.3 (3.0 PD; 2.1 non‐PD); end‐stage renal disease prevalence was 2.3% (1.4% PD; 3.0% non‐PD). Whereas pyelonephritis occurred in ∼10% of both groups, severe sepsis (7.2% vs 2.0%) and septic shock (7.1% vs 1.8%) were ∼4 times more prevalent among those with cUTI‐non‐PD than cUTI‐PD. Overall, two thirds of all visits ended in hospitalization (44.9% PD; 85.5% non‐PD). Despite similar numbers of visits, the annual national ED bill for cUTI rose from $2.8 billion in 2016 to $3.2 billion in 2018. CONCLUSION: There were over 2 million ED visits with cUTI in 2016–2018. Although <10% met criteria for severe sepsis/septic shock, ∼two thirds were admitted. The aggregate cost for cUTI visits rose by 15% without a substantial increase in volume.