Risk-stratified epidemiology and global burden of urinary tract infections across healthcare and high-risk populations: a systematic review and meta-analysis

Urinary tract infections (UTIs) remain a major global healthcare-associated infection, yet current evidence is fragmented across healthcare settings and high-risk populations. We searched PubMed, Scopus, and Web of Science for studies published since 2014 to estimate pooled incidence and prevalence across healthcare settings. Subgroup analyses were performed based on infection setting, geography, and host risk profiles. Fifty-one studies involving 969,476 participants were included. Hospital-acquired UTIs (HAUTIs) (incidence proportion 0.17, 95% CI 0.13–0.22 and prevalence 0.21, 0.16–0.25) showed a greater burden than community-acquired UTIs (0.08, 0.06–0.10), with catheter-associated UTIs having a high risk. HAUTI burden was highest in Asia, Africa, and South America. Gram-negative bacteria, particularly Escherichia coli, were predominant. Risk factors included gender, age, comorbidities, and disease history. Kidney transplant recipients with delayed graft function (risk ratio 1.63, 1.19–2.22) and lower-educated pregnant women had elevated UTI risk (0.40, 0.16–0.63). This study comprehensively compared the burden of UTIs in hospitalized patients and in different high-risk subgroups. The observed population and regional variations highlight the shortcomings of a uniform prevention approach. Key vulnerable groups include the elderly, people with diabetes, kidney transplant recipients, and pregnant women. These findings support the development of risk-stratified infection control protocols for specific vulnerable populations and healthcare settings. Registration PROSPERO: CRD42025648170.