REF ER EN CE CO DE GDH CER041 | PUBLICAT ION D AT E N OVEMBER 2013

GRAM-NEGATIVE BACTERIAL URINARY TRACT

INFECTION - EPIDEMIOLOGY FORECAST TO 2022
 GRAM-NEGATIVE BACTERIAL URINARY TRACT
INFECTION - EPIDEMIOLOGY FORECAST TO 2022

Executive Summary

Urinary tract infections (UTIs) are among the most This report provides an overview of the risk factors
common bacterial infections acquired in hospitals for UTI in the seven major markets (7MM) (US,
and in the community setting (Foxman, 2010). France, Germany, Italy, Spain, UK, and Japan),
Globally, an estimated 150 million UTIs occur and includes a 10-year epidemiological forecast for
annually, resulting in over six billion dollars in direct incident cases of UTI segmented by age (085
healthcare expenditures (Stamm and Norrby, years), sex, causative pathogen (Escherichia coli,
2001). In the US alone, UTI results in nearly seven Klebsiella, Pseudomonas aeruginosa, Proteus, and
million office visits, and one million emergency Acinetobacter), multidrug resistance, and
department visits each year (Foxman, 2002). A UTI carbapenem resistance in these markets. The
can occur when daily living activities and medical forecast in the US is focused on incident cases
interventions aid in the movement of bacteria into caused by gram-negative bacteria in three sites of
the urethra; however, bacterial colonization does acquisition (nosocomial, healthcare-associated,
not always lead to the development of UTI and community-acquired), the 5EU (France,
symptoms (Foxman, 2010). Although UTIs can be Germany, Italy, Spain, and UK) forecast is focused
caused by bacteria, viruses, or fungi, gram- on healthcare-associated UTI incident cases
negative bacteria are the pathogens most caused by all pathogens, and the forecast in Japan
frequently associated with UTIs (Gaynes et al., includes incident cases caused by all pathogens
2005). Gram-negative bacteria have become that were diagnosed in intensive care units (ICUs).
increasingly resistant to individual antimicrobials,
7MM, Incident Cases of UTI, N, 2012 and 2022
and of particular concern, is the emergence of
US
multidrug-resistant activity in these organisms France

(DAgata, 2004). Although there has been little Germany 2022

Market

Italy 2012
change in the predominant causative pathogens in Spain

the past few decades, individual pathogen UK

Japan
frequency and resistance patterns of gram-
0 20,000 40,000 60,000 80,000 100,000120,000140,000160,000180,000
negative pathogens vary considerably between Incident Cases of UTI (N)

Source: GlobalData; Al-Hasan et al., 2010; ECDC, 2012; ECDC, 2013;

settings, countries, and continents (Gupta et al., Guggenbichler et al., 2011; MHLW, 2008; MHLW, 2011; MHLW, 2013;
USCB, 2012
2001; Ortega et al., 2013; Ronald, 2002; Note: 5EU = France, Germany, Italy, Spain, and UK; 7MM = US, 5EU,
and Japan
Shigemura et al., 2005).

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 GRAM-NEGATIVE BACTERIAL URINARY TRACT
INFECTION - EPIDEMIOLOGY FORECAST TO 2022

Executive Summary

Figure above shows the incident cases of UTI in
the 7MM in 2012 and 2022. According to
GlobalDatas forecast, the number of incident
cases of UTI will increase in the US during the
forecast period. The largest number of cases will
be classified as community-acquired and occur in
women 80 years of age. The 5EU will see a slight
increase in the number of healthcare-associated
incident cases of UTI during the forecast period,
with the highest number of cases occurring among
women in Germany, and among those ages 7079
years. Moreover, the most prevalent causative
pathogen will be E. coli. Japan is forecast to see a
large increase in the number of incident cases of
UTI occurring during the forecast period in ICUs,
with the greatest number of cases occurring
among women and those 80 years. Similar to the
US and the 5EU, GlobalData epidemiologists
expect that E. coli will be the most prevalent
causative pathogen in this market.
A major strength of this analysis is that GlobalData
epidemiologists used country-specific sources for
each market in the analysis and were able to
obtain country-specific national surveillance data
for the 5EU and Japan. The use of country-specific
sources is especially important for antimicrobial
resistance data as the rates of resistance have
been found to vary considerably between
countries. Additionally, because resistance rates
have changed over time, GlobalDatas use of
recent sources for resistance rates ensures that
the estimates for the number of resistant cases of
UTI reflect the most current situation in each
market.

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 GRAM-NEGATIVE BACTERIAL URINARY TRACT
INFECTION - EPIDEMIOLOGY FORECAST TO 2022

Table of Contents

1 Table of Contents

1 Table of Contents .......................................................................................................................... 4

1.1 List of Tables............................................................................................................................ 6

1.2 List of Figures .......................................................................................................................... 7

2 Introduction ................................................................................................................................... 8

2.1 Catalyst .................................................................................................................................... 8

2.2 Related Reports ....................................................................................................................... 9

2.3 Upcoming Reports ................................................................................................................... 9

3 Epidemiology............................................................................................................................... 10

3.1 Disease Background .............................................................................................................. 10

3.2 Risk Factors and Comorbidities.............................................................................................. 11

3.2.1 Women are more likely than men to experience UTI at all ages...................................... 12

3.2.2 The risk of developing UTI increases 3%6% per day of catheterization ........................ 12

3.2.3 Older age is a major risk factor for UTI ........................................................................... 13

3.2.4 Sexual intercourse can increase the relative odds of UTI in women by a factor as high as
60 ................................................................................................................................... 14

3.2.5 Diabetic individuals have an increased incidence of UTI and increased associated
complications .................................................................................................................. 14

3.3 Forecast Methodology............................................................................................................ 15

3.3.1 Sources Used ................................................................................................................. 16

3.3.2 Forecast Assumptions and Methods ............................................................................... 20

3.4 Epidemiological Forecast for UTI (20122022) ...................................................................... 25

3.4.1 US .................................................................................................................................. 25

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Table of Contents

3.4.2 5EU ................................................................................................................................ 30

3.4.3 Japan.............................................................................................................................. 37

3.5 Discussion ............................................................................................................................. 42

3.5.1 Conclusions on Epidemiological Trends ......................................................................... 42

3.5.2 Limitations of the Analysis .............................................................................................. 43

3.5.3 Strengths of the Analysis ................................................................................................ 44

4 Appendix ..................................................................................................................................... 45

4.1 Bibliography ........................................................................................................................... 45

4.2 About the Authors .................................................................................................................. 50

4.2.1 Epidemiologists .............................................................................................................. 50

4.2.2 Reviewers....................................................................................................................... 50

4.2.3 Franka des Vignes, PhD, Global Director of Epidemiology and Health Policy ................. 52

4.2.4 Bonnie Bain, PhD, Global Head of Healthcare ................................................................ 52

4.3 About GlobalData ................................................................................................................... 53

4.4 About EpiCast ........................................................................................................................ 53

4.5 Disclaimer .............................................................................................................................. 54

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 GRAM-NEGATIVE BACTERIAL URINARY TRACT
INFECTION - EPIDEMIOLOGY FORECAST TO 2022

Table of Contents

1.1 List of Tables

Table 1: Risk Factors for Urinary Tract Infection............................................................................................. 12

Table 2: Sources of Incidence Data Used in the Epidemiology Forecast......................................................... 15

Table 3: US, Incident Cases of Gram-Negative UTI, N, by Site of Acquisition, Select Years, 20122022 ........ 26

Table 4: US, Incident Cases of Gram-Negative UTI, by Age and Site of Acquisition, N (Row %), 2012 ........... 27

Table 5: US, Incident Cases of Gram-Negative UTI, by Sex and Site of Acquisition, N (Row %), 2012 ........... 28

Table 6: US, Incident Cases of Gram-Negative UTI, by Pathogen and Site of Acquisition, N (Column %),
2012 .............................................................................................................................................. 29

Table 7: US, Incident Cases of Gram-Negative UTI, by Pathogen and Multidrug* and Carbapenem
Resistance, N, Percentage of Pathogen-Specific Cases, 2012 ......................................................... 30

Table 8: 5EU, Incident Cases of UTI, N, Select Years, 20122022................................................................. 31

Table 9: 5EU, Incident Cases of UTI, by Age, N (Row %), 2012 ..................................................................... 32

Table 10: 5EU, Incident Cases of UTI, by Sex, N (Row %), 2012 ................................................................... 33

Table 11: 5EU, Incident Cases of UTI, by Pathogen, N (Percentage of Total Country-Specific Cases
Caused by Pathogen), 2012........................................................................................................... 34

Table 12: 5EU, Incident Cases of UTI, by Pathogen and Multidrug and Carbapenem Resistance, N, and
Percentage of Pathogen-Specific Cases, 2012 ............................................................................... 36

Table 13: Japan, Incident Cases of UTI, N, Select Years, 20122022 ............................................................ 37

Table 14: Japan, Incident Cases of UTI, by Age, N (Row %), 2012 ................................................................ 38

Table 15: Japan, Incident Cases of UTI, by Sex, N (Row %), 2012 ................................................................ 39

Table 16: Japan, Incident Cases of UTI, by Pathogen, N (Percentage of Total Country-Specific Cases
Caused by Pathogen), 2012........................................................................................................... 40

Table 17: Japan, Incident Cases of UTI, by Pathogen and Antibiotic, Number of Antibiotic-Resistant Cases
(N) and Percentage of Antibiotic-Resistant Pathogen-Specific Cases (%), 2012 ............................. 41

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INFECTION - EPIDEMIOLOGY FORECAST TO 2022

Table of Contents

1.2 List of Figures

Figure 1: US, Incident Cases of Gram-Negative UTI, N, by Site of Acquisition, Select Years, 20122022 ....... 26

Figure 2: US, Incident Cases of Gram-Negative UTI, by Age and Site of Acquisition, N, 2012 ........................ 27

Figure 3: US, Incident Cases of Gram-Negative UTI, by Sex, N, 2012............................................................ 28

Figure 4: US, Incident Cases of Gram-Negative UTI, by Pathogen and Site of Acquisition, N, 2012 ............... 29

Figure 5: 5EU, Incident Cases of UTI, N, Select Years, 20122022 ............................................................... 31

Figure 6: 5EU, Incident Cases of UTI, by Age, N, 2012 .................................................................................. 32

Figure 7: 5EU, Incident Cases of UTI, by Sex, N, 2012 .................................................................................. 33

Figure 8: 5EU, Incident Cases of UTI, by Pathogen, N, 2012 ......................................................................... 35

Figure 9: Japan, Incident Cases of UTI, N, Select Years, 20122022 ............................................................. 37

Figure 10: Japan, Incident Cases of UTI, by Age, N, 2012 ............................................................................. 38

Figure 11: Japan, Incident Cases of UTI, by Sex, N, 2012.............................................................................. 39

Figure 12: Japan, Incident Cases of UTI, by Pathogen, N, 2012..................................................................... 40

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 GRAM-NEGATIVE BACTERIAL URINARY TRACT
INFECTION - EPIDEMIOLOGY FORECAST TO 2022

Introduction

2 Introduction

2.1 Catalyst

Urinary tract infections (UTIs) are among the most common bacterial infections acquired in
hospitals and in community settings (Foxman, 2010). Globally, an estimated 150 million UTIs occur
annually, resulting in over six billion dollars in direct healthcare expenditures (Stamm and Norrby,
2001),

To provide a thorough description of the UTI patient population in the 7MM (US, France,
Germany, Italy, Spain, UK, and Japan), GlobalData epidemiologists segmented the forecast
incident cases of UTI by age (beginning at age 0 years and ending at ages 80 years), sex,
causative pathogen (Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus, and
Acinetobacter), and antibiotic resistance (multidrug and carbapenem resistance). The forecast
in the US provides incident cases caused by gram-negative bacteria in three sites of
acquisition (nosocomial, healthcare-associated, and community-acquired), the 5EU (France,
Germany, Italy, Spain, and UK) forecast provides healthcare-associated UTI incident cases
caused by all pathogens, and the forecast in Japan provides incident cases caused by all
pathogens that were diagnosed in intensive care units (ICUs).

In the US, the highest number of incident cases of gram-negative UTI was classified as
community-acquired with 88,602 incident cases occurring in 2012, and by 2022, GlobalData
epidemiologists expect that number to increase to 96,734 incident cases.

The number of incident cases of UTI is expected to increase during the forecast period in the
5EU. In 2012, the number of UTI incident cases in the 5EU was 384,593 cases, and by 2022,
GlobalData Epidemiologists expect the number of incident cases will increase only slightly to
393,713 cases, with a 10-year growth rate of 0.02%.

Japan will see an almost 20% growth in the number of incident cases of UTI over the next 10
years. In 2012, there were 2,880 incident cases of UTI and by 2022, GlobalData
epidemiologists forecast the number of incident cases will grow to 3,445.

An ageing population, increased catheterization, and diabetes are all expected to be major
drivers of increased incidence of UTI in the 7MM during the forecast period.

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Introduction

A major strength of this analysis is that country-specific sources were used for each market,
and for the 5EU and Japan, country-specific national surveillance data were also used.

2.2 Related Reports

GlobalData (2013). EpiCast Report: Gram-Negative Bacterial Pneumonia Epidemiology

Forecast to 2022, October 2013, GDHCER033

2.3 Upcoming Reports

GlobalData (2013). EpiCast Report: Breast Cancer Epidemiology Forecast to 2022, November,
2013, GDHCER039

GlobalData (2013). EpiCast Report: Parkinsons Disease Epidemiology Forecast to 2022,

November, 2013, GDHCER043

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Appendix

4.3 About GlobalData

GlobalData is a leading global provider of business intelligence in the healthcare industry.

GlobalData provides its clients with up-to-date information and analysis on the latest developments
in drug research, disease analysis, and clinical research and development. Our integrated business
intelligence solutions include a range of interactive online databases, analytical tools, reports, and
forecasts. Our analysis is supported by a 24/7 client support and analyst team.

GlobalData has offices in New York, Boston, London, India, and Singapore.

4.4 About EpiCast

EpiCast is a series of premier epidemiology reports written and developed by Masters-

and PhD-level epidemiologists.

EpiCast Reports are in-depth, high quality, transparent, and market-driven, providing expert
analysis of epidemiological trends and forecasting of patient populations for major markets.
Specifically, the reports identify disease trends over a 10-year forecast period in six to seven major
markets (US, France, Germany, Italy, Spain, UK, Japan). Additional countries, such as Canada,
Brazil, China, and India, are covered in these reports if their markets are highly relevant.

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Appendix

4.5 Disclaimer

All Rights Reserved.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any
form by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior
permission of the publisher, GlobalData.

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