A report just published by the UK Health Security Agency has estimated that for the financial year 2023-2024, urinary tract infections (UTIs) cost the NHS in England more than £604 million[1].
Urinary tract infections are caused by bacteria entering the urinary system including the urethra, bladder or kidneys. Some infections will be mild and resolve by themselves, but many infections will require treatment with antibiotics. Some can progress to more serious infections affecting the kidneys, bloodstream infections and sepsis. As well as serious physical symptoms, UTIs can also cause delirium characterised by confusion or agitation.
UTIs disproportionately affect older people and women. In 2023 – 2024, 52.7% of admissions were patients over 70 and 61.8% were female. These admissions resulted in 1.2 million bed days, averaging 6 bed days per infection.
Repeated UTIs treated with antibiotics can also lead to increased antibiotic resistance.
Another report by NHS England documents how serious these infections are for older people. While the overall UTI death rate in hospital is around 4%, this rises to nearly 10% for people aged 95 plus[2].
The report gives a number of ways in which UTIs can be prevented or reduced including washing or showering daily, drinking enough fluids, wiping from front to back after using the toilet and not holding on to urine.
Many campaigners for women’s health, however, have pointed out the lack of any information in the report about the use of low dose vaginal oestrogen (as a cream, gel or pessary) and its role in preventing UTIs in women for which there is increasingly good evidence. One US study published in 2023 studied a cohort of 5638 women, aged a mean of 70.4 years following use of vaginal oestrogen. The study reported a decrease of 51.9% of UTIs in women in the 12 months following prescription of low dose oestrogen[3]. It is also safe for cancer patients as well who cannot take oestrogen. Campaigning journalist Kate Muir has called this ‘The Great UTI Scandal’ – leading to unnecessary suffering for millions of women, hospital admissions, sepsis, antibiotic resistance, delirium (and associated accidents whilst delirious) and deaths from vaginal oestrogen deficiency[4] which doesn’t as yet seem to have filtered through to the UK Health Security Agency.
[1] https://www.gov.uk/government/publications/understanding-the-burden-of-uti-hospitalisations-in-england/understanding-the-burden-of-uti-hospitalisations-in-england
[2] https://www.england.nhs.uk/south/2023/10/12/older-people-across-the-south-west-urged-to-protect-themselves-against-urinary-tract-infections/
[3] Tan-Kim J et al. ‘Efficacy of vaginal oestrogen for recurrent urinary tract infection prevention in hypoestrogenic women’. American Journal of Obstetrics & Gynaecology 2023;229(2):143.
[4] Kate Muir, The Guardian 17 Dec 2023.