2.4 Kidney infections and urinary tract infections

Kidney infections and urinary tract infections (UTIs) are a common cause of hospitalisations that could be prevented. People who go to hospital for a UTI are often given antibiotics called ‘broad-spectrum antimicrobials’. This type of antimicrobial can increase antimicrobial resistance, which is a problem around the world. It can also make treatment for any future UTIs in that person more difficult.

In 2017–18:

• There were 76,854 hospitalisations for kidney infections and UTIs, representing 281 hospitalisations per 100,000 people of all ages (the Australian rate)
• The rate of hospitalisation for Aboriginal and Torres Strait Islander people (581 per 100,000 people) was around double the rate for other Australians
• Rates of hospitalisation varied across Australia, from 212 per 100,000 people in Tasmania to 559 per 100,000 people in the Northern Territory
• Hospitalisation rates were higher in remote areas
• Rates were also higher in areas of socioeconomic disadvantage in remote and inner regional areas.

Between 2014–15 and 2017–18:

• The national rate of kidney infection and UTI hospitalisation decreased by 1%
• For Aboriginal and Torres Strait Islander people, the national rate of kidney infection and UTI hospitalisation increased by 3.6%.

Rates are standardised to remove age and sex differences between populations.

Variation in kidney infection and UTI hospitalisation rates is likely to be due to differences in:

• Clinical factors – clinicians may be over-diagnosing or under-diagnosing kidney infection and UTI
• Access to services – people in some areas may not have good access to services and clinicians. Aboriginal and Torres Strait Islander people may not have good access to culturally appropriate care
• Patient factors – some groups of people have a higher chance of getting a UTI, such as people aged over 65, people with type 2 diabetes and people with social and economic disadvantages.

Ensure more accurate diagnosis and early detection of kidney infections and UTIs to:

• reduce the impact of the infection on the patient
• reduce hospitalisation rates
• limit the use of broad-spectrum antimicrobials.

Improve accurate diagnosis of UTIs in elderly people, especially those in aged care homes. It is common for older people to have bacteria in their urine, but this does not mean they have a UTI, and they may not have any symptoms.

Ensure access to community continence services and education for people who need to manage their own catheters.

Improve access to health care and provide appropriate services for people who are vulnerable to UTIs, such as people aged over 65, women, Aboriginal and Torres Strait Islander people, and people with type 2 diabetes.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

2a. Consistent with the commitments made under the National Health Reform Agreement and building on the activities set out in the 2017 Bilateral Agreement on Coordinated Care, Local Hospital Networks, Primary Health Networks and the Aboriginal Community Controlled Health Service sector to implement the following principles in developing chronic disease management programs consistent with the National Strategic Framework for Chronic Conditions:



i. Patients, families and carers as partners in care, where patients are activated to maximise their knowledge, skills and confidence to manage their health, aided by technology and with the support of a healthcare team



ii. A risk stratification approach that supports identification of patients with high coordination and multiple provider needs, to ensure personalisation of service provision 



iii. Flexible service delivery and team-based care that supports integrated patient care across the continuum of the health system through shared information and care planning



iv. A commitment to care that is of high quality and safe, including care planning and clinical decisions that are guided by evidence-based patient healthcare pathways, appropriate to the patient’s needs

v. Data collection and sharing by patients and their healthcare teams to measure patient health outcomes and improve performance.

2b. The Commission, the Independent Hospital Pricing Authority and the Administrator of the National Health Funding Pool to identify and develop alternative approaches to funding for chronic disease and infection that could be applied to the National Health Reform Agreement Pricing and Funding model so that pricing and funding are aligned with best-practice guidelines. The alternative models could include bundled payments, capitation payments or regionally coordinated service responses.

Download the kidney infections and urinary tract infections section of the Atlas to read more about context, data, key findings, interpretation and addressing variation:

Contents:

Context

• Asymptomatic bacteriuria
• Kidney infections and UTIs among Aboriginal and Torres Strait Islander people
• Kidney infections and UTIs among older people

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by Aboriginal and Torres Strait Islander status
• Trends over time

Interpretation

Addressing variation

• Over-diagnosis of UTI
• Reducing over-diagnosis in elderly people
• Healthcare-associated UTIs
• Impact of antimicrobial-resistant bacteria
• Reducing UTIs among Aboriginal and Torres Strait Islander people
• Preventing recurrent UTIs

Resources

References