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Burden of Uncomplicated UTIs
Uncomplicated but Not Insignificant: The Burden of Uncomplicated UTIs

Released: October 05, 2023

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Key Takeaways
  • Although uncomplicated UTIs often are not seen as a major illness, they still are a significant burden and can have a significant impact on quality of life.
  • Access to treatment is a major issue for many patients, whether it be the inability to obtain an appointment or feeling uncomfortable with requesting further treatment for recurrent UTIs.
  • Antibiotic resistance is increasing among the common pathogens for UTIs, making it even more important to individualize treatment based on cultures for some patients, such as those with recurrent UTIs.

In this commentary, Richard Colgan, MD, discusses the burden of uncomplicated urinary tract infections (UTIs) with a patient with lived experience.

Delayed Diagnosis and a Burden to Bear

Richard Colgan, MD:
UTIs are among the most common infections seen by ambulatory care healthcare professionals (HCPs). At times, the impact of UTIs on patients may be minimized by HCPs, at least if the UTIs are simple, acute uncomplicated cystitis—but they certainly are not minimized by the patients who experience them. Patients who experience UTIs incur a lot of discomfort and lost opportunities in their daily activities.

I participated in a study several years back that assessed the quality of life of patients who have UTIs, and the study resulted in a couple of interesting observations. One was that, on average, patients experience a delay of approximately 1 week from the onset of symptoms to when they are seen by an HCP. That's 1 week of suffering with symptoms.

The other key finding was that the quality of life of a patient with a simple, acute uncomplicated UTI is significantly impaired. Examples include postponing sexual interactions or missing work for approximately 1 week. So, although we may not think of UTIs as being a major illness, the truth is that those with UTIs know that it significantly impairs their quality of life. If you couple that with the fact that patients typically are not seen until 1 week after the onset of symptoms, this is quite a burden to bear.

Patient Advocate:
Yes, having UTIs has been a burden. It has limited my activities with my grandchildren and my kids. It has prevented me from going to see my grandkids’ ballgames and traveling on vacations with them. At times, I’ve been in so much pain that I couldn’t walk. There have been days that I just stayed in bed because I didn’t feel like getting up and doing anything. It has been very debilitating. It is very stressful and very painful.

Access to HCPs

Richard Colgan, MD:
A major cause of delayed diagnosis is the difficulty of accessing an HCP. These days, it is much less common for a patient to call up their doctor’s office with an acute complaint and have the HCP say, “Come right over.” It would be ideal if a patient could come in and be seen by their HCP as soon as symptoms develop, but that is not often available to them. Often, they are asked to go to the clinic’s urgent care, or if it is a weekend, they may be asked to go to an urgent care center even farther away. This can be a problem for patients who cannot access transportation to a clinic.

Another issue is whether an HCP is comfortable prescribing antibiotics over the phone. When I was on call for our private practice group, I would note more frequent calls from out-of-town patients saying that they had a UTI. Back then, I felt hesitant to prescribe antibiotics over the phone, thinking it was not good medical care. Subsequent research has shown that if the patient is known to the HCP, has a history of UTIs, and is informing the HCP that they have UTI symptoms, the HCP can feel comfortable prescribing antibiotic therapy over the phone. In fact, now with telemedicine here in the wake of COVID-19, we are providing this service even more often than before.

Patient Advocate:
I think my providers did everything possible that they knew to do. I think my primary care provider finally got to the point where she was just tired of seeing me come into the clinic. I had good doctors, but there were times when I did feel like they thought I was just seeking attention. So, I sometimes felt uncomfortable seeking treatment.

Challenges Related to Therapy Selection

Patient Advocate:
I wish my providers knew more about UTIs and didn’t treat them like every UTI is the same. In my case, I wish they would have dug deeper. I wish they had not just treated me like a regular patient with a UTI. If they had paid more attention to me as an individual who has recurrent UTIs and who has received multiple courses of antibiotics, maybe I could have had some relief sooner.

I would go in and do a urine test, and my provider would give me an antibiotic because we knew it was a UTI. But after culturing the urine, they would call and say, “The medicine we gave you is not going to work—you’re resistant,” and then I’d have to return to the pharmacy to pick up a different antibiotic 7 days later. Over time, I have become more resistant to the initial antibiotic.

Richard Colgan, MD:
Yet another challenge is the selection of antimicrobial therapy. Many times, patients are prescribed antibiotics for their UTIs that are not ideal. The guidelines recommend 3 antibiotics as drugs of choice, unless there are other overriding concerns or restrictions: trimethoprim/sulfamethoxazole, nitrofurantoin, and fosfomycin (in no order of preference).

However, in the past 20 years, antibiotic resistance in the bacteria causing UTIs has drastically increased, making it even more critical for HCPs to make informed decisions when prescribing antibiotics for patients with UTIs.

To prescribe the right treatment, HCPs must be aware of the risk factors for antibiotic resistance. HCPs should consider a multidrug-resistant infection if they have had the following risk factors in the past 3 months.

  • Urinary culture results with multidrug-resistant gram-negative bacteria or fluoroquinolone-resistant Pseudomonas aeruginosa
  • A recent stay at an inpatient facility such as a hospital, long-term acute care, or other nursing facility
  • Recent use of a broad-spectrum β-lactam, fluoroquinolone, or trimethoprim/sulfamethoxazole
  • History of recent travel to an area with high rates of multidrug-resistant organisms (eg, India, Mexico, Spain)

If a patient has a known history of recurrent UTIs, HCPs must be diligent in obtaining new cultures for each symptomatic episode. The benefits here are 2-fold: Individualizing treatment this way both enables selection of more effective antibiotics and lowers rates of overtreatment, thereby lowering the risk of developing antibiotic resistance.

Join Our Discussion!
To learn more about these important issues of patient burden, diagnosis, and treatment, I am excited to invite you to join upcoming in-person or virtual sessions where I will discuss optimizing the management of uncomplicated UTIs with my colleagues Lillian Abbo, MD, MBA, FIDSA, and Lilly C. Lee, MD, SM, FACEP, FAAEM. Our multidisciplinary panel will explore best practices from family medicine, infectious disease, and emergency medicine perspectives, and we will hear first-hand patient testimony.

Your Thoughts?
How do you approach treatment for patients with uncomplicated UTIs? Leave a comment below to join the discussion.