Epidemiology
Lifetime incidence of UTIs is 50% to 60% in adult women. The prevalence of UTI increases with age, and in women aged over 65 is approximately double the rate seen in the female population overall.[9]
UTIs are among the most common conditions encountered in primary care, hospitals, and extended care facilities, and in the US are responsible for 7 million surgery visits and 1 million hospital admissions each year.[10] Total direct costs of UTI treatment (without cultures) have been estimated at US $25.5 billion annually.[11] Despite an exceptionally high prevalence of bacteriuria in the population, these infections rarely cause significant renal damage.
Risk factors
The absence of oestrogen (consistent with urogenital atrophy, vaginal atrophy, and also known as genitourinary syndrome of menopause) is a risk factor for UTIs.[26]
Topical intra-vaginal oestrogen treatment reduces UTIs in post-menopausal women;[20][27][28] oestrogenisation of the vaginal mucosa promotes lactobacilli colonisation, which reduces the presence of uropathogens and thus the risk of UTIs. Conversely, systemic oral oestrogen therapy is not associated with benefit related to reduction of recurrent UTIs,[28] and is not recommended over the use of topical oestrogen therapy.[29]
Sexual activity in post-menopausal women is less strongly associated with UTIs than in younger women.
Urinary incontinence and oestrogen supplementation have also been associated with UTI in older women, although the reasons for this are incompletely understood.[30]
Having a mother with a history of UTIs is associated with a two- to fourfold increase in risk of recurrent UTI.[22]
A well-established risk factor.[31]
Any indwelling catheter or any foreign body (stone, suture, surgical material, or exposed polypropylene mesh from pelvic surgery) significantly increases risk for UTI.
Foreign bodies serve as nidus for UTIs and interfere with a person's ability to clear a UTI.
Bacteriuria occurs in the presence of indwelling or intermittent catheters, and asymptomatic bacteriuria does not require treatment. When a symptomatic UTI is present in a patient with a catheter or stent, catheter or stent change should be strongly considered.[1]
Considered a more predominant risk factor in older women.[32]
Considered a more predominant risk factor in older women.[32]
Due to either poor detrusor muscle contraction or bladder outlet obstruction (e.g., secondary to pelvic organ prolapse or a prior anti-incontinence procedure), can lead to urinary stasis, interfering with a person's intrinsic ability to clear bacteriuria.
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