Differences in the Incidence of Urinary Tract Infections between Neurogenic and Non-Neurogenic Bladder Dysfunction Patients Performing Intermittent Catheterization - An Analysis of MarketScan Data

Welk B1, Lenherr S2, Santiago-Lastra Y3, Teague T4, Norman H4, Elliott C5

Research Type

Clinical

Abstract Category

Continence Care Products / Devices / Technologies

Abstract 135
On Demand Continence Care Products / Devices / Technologies
Scientific Open Discussion Session 15
On-Demand
Infection, Urinary Tract Retrospective Study Incontinence Neuropathies: Central
1. Western University, 2. University of Utah, 3. University of San Diego, 4. Coloplast Corp, 5. Stanford Univeristy
Presenter
B

Blayne Welk

Links

Abstract

Hypothesis / aims of study
Urinary tract infections (UTI) are thought to account for approximately 20% of all hospitalizations in the first year after a diagnosis of neurogenic lower urinary tract dysfunction (NLUTD).[1] This study aims to characterize the incidence and severity of UTI (i.e., UTI-related hospitalizations) among intermittent catheter (IC) users with neurogenic and non-neurogenic diagnoses.
Study design, materials and methods
Health insurance claims data from the IBM MarketScan Database between January 1, 2015 – December 31, 2019 was retrospectively analyzed. MarketScan is a health insurance claim database, which includes commercial Preferred-Provider Organization (PPO) and Medicare supplemental claims, including drug coverage benefits. Three comparator groups were created: (a) IC users with NLUTD, (b) IC users without neurogenic bladder (non-NLUTD), and (c) age-and-sex-matched members of the general population with no IC use (GEN). Claims were followed for one year following initiation of IC utilization, or one year following a randomly selected index date for the general population comparator group. UTI claims were identified based on primary or secondary diagnosis codes. UTI incidence, hospitalizations and length of hospital stay were compared using Chi Square analysis. Kaplan Meier curves were further used to analyze time to UTIs, comparing all patients in the NLUTD and Non-NLUTD groups to 1:1000 general population data. Analysis was also stratified based on the number of UTI claims (0 UTI, 1 UTI, 2 UTI, 3+ UTI).
Results
Claims were identified for 6,944 IC using NLUTD patients, 5,102 non-NLUTD IC using patients, and 4,715,1055 members of the general population who did not use IC.  The annualized incidence of UTI in those performing self-catheterization was 54.94% in NLUTD patients and 38.93% in non- NLUTD patients as compared to 9.8% in the general population not performing IC (p<0.001 between each of the three groups).  Of all patients with UTI, 20.63% of the NLUTD patients were hospitalized for UTI treatment, compared to 10.32% non-NLUTD patients and 6.77% general population (p <0.001 for each of the comparisons between groups). Average length of stay in the hospital (in days) was greater for those with NLUTD compared to non-NLUTD (2.22± 3.63 days versus 1.54± 2.05 days, p<0.001). Seventeen percent of NLUTD patients experienced 3+ UTIs compared to 9.56% non-NLUTD patients (p<0.001) and NLUTD patients made up 70.85% of all IC users experiencing 3+ UTIs. The figure shows incidence of inpatient hospitalization requiring UTI treatment during the first year after initiation of IC utilization in NLUTD patients (compared to general population; HR = 18.189, 95% CIs [16.934, 19.538]) and non-NLUTD patients (compared to general population; HR = 6.172, 95% CIs [5.377, 7.084]).
Interpretation of results
NLUTD and non-NLUTD patients experienced approximately 5.5- and 4-times higher rate of UTIs during the first year of using ICs compared to the general population not using ICs, respectively. Both NLUTD and non-NLUTD patients that use IC have a very high risk of hospitaliation for UTIs compared to the general population. NLUTD patients are twice as likely to be hospitalized for UTI treatment than non-NLUTD patients and the average length of stay was 42% greater in NLUTD patients. NLUTD patients were approximately twice as likely to experience 3 or more UTIs comparing to non-NLUTD patients. These results point towards a higher burden of UTI among IC users, and particularly those with NLUTD.
Concluding message
The rate of UTIs in IC users is significantly higher than the general population, and the rate of UTIs is higher in the NLUTD patients than the non-NLUTD. Due to the known impact of IC use on clinical outcomes, it is important patients receive education on proper IC technique and have access to IC catheters with advanced technology to decrease known risk factors of UTIs.[2] In addition, other risk factors that increase infection risk in those performing IC require continued evaluation and management.
Figure 1
References
  1. Manack, A., Motsko, S. P., Haag-Molkenteller, C., Dmochowski, R. R., Goehring, E. L., Nguyen-Khoa, B.-A., & Jones, J. K. (2011). Epidemiology and healthcare utilization of neurogenic bladder patients in a us claims database. Neurourology and Urodynamics, 30(3), 395–401. https://doi.org/10.1002/nau.21003
  2. Kennelly M, Thiruchelvan N, Averbeck MA, Konstatinidis C, Chartier-Kastler E, Trojgaard P, Vaabengaard R, Krassioukov A, Jakobsen BP. Adult Neurogenic Lower Urinary Tract Dysfunction and Intermittent Catheterization in a Community Setting: Risk Factors Model for Urinary Tract Infections. Adv Urol. 2019:2757862. doi: 10.1155/2019/2757862. eCollection 2019.
Disclosures
Funding This abstract was supported by Coloplast. Clinical Trial No Subjects None
18/01/2022 10:39:24