Betsy Foxman

Urinary Tract Infection

PURPOSE To estimate the annual incidence, cumulative probability of presumed urinary tract infection (UTI) by age, and the social costs. METHODS Analysis of a random digit dialing survey of 2000 women in the United States. RESULTS 10.8 percent (95% CI: 9.4, 12.1%) of women aged 18 and older reported at least one presumed UTI during the past 12 months, with the majority of the cases occurring among women with a history of two or more UTI episodes in their life. We estimate that by age 24, one-third of women will have at least one physician-diagnosed UTI that was treated with prescription medication. Overall, an estimated 11.3 million women in the United States had at least one presumed UTI treated with antibiotics in 1995. We estimate the annual cost of UTI cases with prescriptions to be

The epidemiology of urinary tract infection

1.6 billion in 1995. If the costs occurring after 1995 are discounted at 5% annually, the total cost over 20 years has a present value of

Urinary tract infection: self-reported incidence and associated costs.

25.5 billion. CONCLUSION If a vaccine were developed that would prevent either initial or recurrent UTI the net benefits to society would be substantial, even at a developmental cost of one billion dollars.

VULVOVAGINAL CANDIDIASIS: EPIDEMIOLOGIC, DIAGNOSTIC, AND THERAPEUTIC CONSIDERATIONS

Urinary tract infections (UTIs) are among the most common bacterial infections acquired in the community and in hospitals. In individuals without anatomical or functional abnormalities, UTIs are generally self limiting, but have a propensity to recur. Uropathogens have specialized characteristics, such as the production of adhesins, siderophores and toxins that enable them to colonize and invade the urinary tract, and are transmitted between individuals both through person-to-person contact and possibly via food or water. Although generally self limiting, treatment of UTIs with antibiotics leads to a more rapid resolution of symptoms and is more likely to clear bacteriuria, but also selects for resistant uropathogens and commensal bacteria and adversely affects the gut and vaginal microbiota. As uropathogens are increasingly becoming resistant to currently available antibiotics, it may be time to explore alternative strategies for managing UTI.

Epidemiology of urinary tract infections: Transmission and risk factors, incidence, and costs☆

PURPOSE To estimate the annual incidence, cumulative probability of presumed urinary tract infection (UTI) by age, and the social costs. METHODS Analysis of a random digit dialing survey of 2000 women in the United States. RESULTS 10.8 percent (95% CI: 9.4, 12.1%) of women aged 18 and older reported at least one presumed UTI during the past 12 months, with the majority of the cases occurring among women with a history of two or more UTI episodes in their life. We estimate that by age 24, one-third of women will have at least one physician-diagnosed UTI that was treated with prescription medication. Overall, an estimated 11.3 million women in the United States had at least one presumed UTI treated with antibiotics in 1995. We estimate the annual cost of UTI cases with prescriptions to be

Recurring urinary tract infection: incidence and risk factors

1.6 billion in 1995. If the costs occurring after 1995 are discounted at 5% annually, the total cost over 20 years has a present value of

Identification of Risk Factors for Extrapulmonary Tuberculosis

25.5 billion. CONCLUSION If a vaccine were developed that would prevent either initial or recurrent UTI the net benefits to society would be substantial, even at a developmental cost of one billion dollars.

The role of early HIV infection in the spread of HIV through populations

Although it is the second most common vaginal infection in North America, vulvovaginal candidiasis is a non-notifiable disease and has been excluded from the ranks of sexually transmitted diseases. Not surprisingly, vulvovaginal candidiasis has received scant attention by public health authorities, funding agencies, and researchers. Epidemiologic data on risk factors and pathogenic mechanisms remain inadequately studied. Most important, standards of care, including diagnosis and therapy, remain undefined. A conference was held in April 1996 to define and summarize what is known and supported by scientific data in the areas of epidemiology, diagnosis, and treatment of vulvovaginal candidiasis; but, more important, the conference aimed at defining what is not known, poorly studied, and controversial. Guidelines for the treatment and diagnosis of the different forms of vulvovaginal candidiasis are suggested.

Prevalence of Antibiotic Resistance in Drinking Water Treatment and Distribution Systems

Uropathogenic E. coli have special features that allow them to take advantage of the bladder environment. There UPEC can grow to substantial numbers in pure culture that are shed frequently into the environment and have a high probability of transmission to other hosts. A better understanding of the transmission system and the host and bacterial factors influencing transmission is essential for the identification of effective prevention strategies. Although the risk of severe morbidity among otherwise healthy populations is low, the incidence is high. Further, the potential impact of antibiotic treatment on the emergence of increasingly antibiotic-resistant UPEC (the resistant mechanisms that may be transmitted to other bowel inhabitants) is high. The benefits of successfully preventing UTI are substantial.

Urinary Tract Infection Syndromes: Occurrence, Recurrence, Bacteriology, Risk Factors, and Disease Burden

Urinary tract infection (UTI) is a common infection among young women, with a high recurrence rate. This study documents the six-month incidence of second UTI among a cohort of women with one initial UTI and the factors associated with recurrence. Among the cohort of 113 women, 30 (26.6 percent) experienced at least one culture-confirmed recurrence within the six months following initial infection. The presence of hematuria and urgency as symptoms of initial infection were the strongest predictors of second infection. Behavioral factors associated with initial infection (frequency of sexual intercourse, diaphragm use, and voiding after sexual intercourse) did not distinguish between women who would and would not experience a second UTI during the six-month follow-up period.