Defining recurrent urinary tract infection and reinfection risk: electronic health record study

Vazquez-Montes, Maria D.L.A., Fanshawe, Thomas R., Smith, Margaret C., Ahmed, Haroon ORCID: https://orcid.org/0000-0002-0634-8548, Stoesser, Nicole, Walker, A. Sarah, Butler, Christopher and Hayward, Gail 2026. Defining recurrent urinary tract infection and reinfection risk: electronic health record study. British Journal of General Practice Open , BJGPO.2025.0239. 10.3399/BJGPO.2025.0239

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Abstract

Background: There is limited evidence to support the current standard recurrent urinary tract infection (rUTI) definition of ≥2 UTIs within 6 months or ≥3 within 12 months. Information about reinfection risk after meeting criteria for rUTI may aid decisions on the value of prophylactic approaches. Aim: To estimate the risk of subsequent UTI associated with different rUTI definitions. Design and setting: Electronic health record study using Infections in Oxfordshire Research Database (IORD, 2008-2019) and the Clinical Practice Research Datalink (CPRD, 2009-2019). Method: We identified community-acquired UTIs, separated by 28 days, in non-pregnant women aged 16+years. We created candidate rUTI definitions varying the time window from 3-9 months, and the number of UTIs required to meet the definition from 2-3 episodes. For each definition, we calculated Kaplan-Meier risk estimates of subsequent UTIs within 6 and 12 months after meeting rUTI criteria. Results: Of eligible women with at least one UTI, 18% (15,617/84,809) in IORD and 20% (334,487/1,703,088) in CPRD experienced ≥1 rUTI (current definition). The risk of at least two subsequent UTIs within 12 months after meeting the current rUTI definition rose from 17% (IORD) and 16% (CPRD) to 33% (IORD) and 32% (CPRD) under a rUTI definition of ≥3 UTIs within 6 months. Risk of subsequent UTI also increased with age. Conclusion: Risk estimates of subsequent UTIs after a rUTI vary according to the definition of rUTI adopted. Estimates provided here could support shared decision making around UTI prophylaxis and stratification of populations included in future rUTI research.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Medicine
Publisher:	Royal College of General Practitioners
ISSN:	2398-3795
Date of First Compliant Deposit:	4 February 2026
Date of Acceptance:	11 November 2025
Last Modified:	04 Feb 2026 10:00
URI:	https://orca.cardiff.ac.uk/id/eprint/184388

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