Defining the Clinical and Economic Burden of Complicated UTI

Welcome back to another AJMC Peer Exchange series. In "Defining the Clinical and Economic Burden of Complicated UTI," moderator Kalpana Gupta, MD is joined by Keith Kaye, MD, MPH, Zachary Nelson, PharmD, MPH, and Jason Pogue, PharmD to open the series by unpacking the true scope of complicated urinary tract infection.

Dr. Gupta opens the panel by introducing her co-panelists and framing the discussion around complicated urinary tract infection, a condition long managed with limited options. She turns first to Dr. Nelson, asking him to size up the economic burden clinicians face. Dr. Nelson notes that complicated UTI drives well over a million emergency department visits and roughly 100,000 hospitalizations each year in the United States. Associated costs likely reach into the billions, largely attributable to hospitalization itself. Clinicians have historically struggled to move patients off intravenous antibiotics and onto oral therapy, or to avoid admission altogether when reasonable oral options exist. He frames critically assessing who truly needs hospitalization as one of the field's biggest unmet needs. Dr. Gupta then turns to Dr. Kaye for the access barriers patients and providers most commonly encounter. Dr. Kaye starts with a diagnostic caution: distinguishing a genuine, symptomatic urinary tract infection from a simple positive urine culture, since treating asymptomatic bacteriuria remains common and unnecessary. For confirmed complicated infections, he identifies antimicrobial resistance and the limited efficacy of standard empiric therapy as the biggest emerging challenges, though familiarity with local guidelines can help optimize that empiric choice. Even after susceptibility results return, outpatient and nursing-home settings often lack effective oral options. That gap pushes patients toward emergency departments and, ultimately, hospital admission for intravenous antibiotics alone. On the discharge side, Dr. Kaye points to duration as a second major barrier, describing a long-standing mantra favoring extended intravenous courses. He argues that shifting toward earlier oral transitions can help patients leave the hospital sooner without compromising care. That shift depends on growing clinician awareness of newer, resistant-pathogen-active oral agents now entering the treatment landscape.

The next episode in this series, "What Payers Need to See From New Complicated UTI Therapies," has the panel turning from clinical burden to the financial case new therapies must make.