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J Infect. 2015 Dec;71(6):667-74. doi: 10.1016/j.jinf.2015.08.012. Epub 2015 Sep 14.

Clinical and economic impact of urinary tract infections caused by ESBL-producing Escherichia coli requiring hospitalization: A matched cohort study.

Author information

1
Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain. Electronic address: esteve.erika@gmail.com.
2
Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
3
Pharmacy Service, Hospital del Mar, Barcelona, Spain.
4
Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERES, Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Electronic address: jhorcajada@parcdesalutmar.cat.

Abstract

OBJECTIVE:

To analyze the clinical and economic impact of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli requiring hospitalization.

METHODS:

Matched cohort study including adults with UTI caused by ESBL-producing E. coli admitted to a tertiary care hospital in Barcelona, Spain, between August 2010 and July 2013. Demographic, clinical and economic data were analyzed.

RESULTS:

One hundred and twenty episodes of UTI were studied: 60 due to ESBL-producing E. coli and 60 due to non-ESBL-producing E. coli. Bivariate analysis showed that prior antimicrobial treatment (p = 0.007) and ESBL production (p < 0.001) were related to clinical failure during the first 7 days. Multivariate analysis selected ESBL as the sole risk factor for clinical failure (p = 0.002). Regarding the economic impact of infections caused by ESBL-producing E. coli, an ESBL-producing infection cost more than a non-ESBL-producing E. coli infection (mean €4980 vs. €2612). Looking at hospital expenses separately, the total pharmacy costs and antibiotic costs of ESBL infections were considerably higher than for non-ESBL infections (p < 0.001), as was the need for outpatient parenteral antibiotic therapy (OPAT) and its related costs. Multivariate analysis performed for the higher costs of UTI episodes found statistically significant differences for males (p = 0.004), chronic renal failure (p = 0.025), ESBL production (p = 0.008) and OPAT (p = 0.009).

CONCLUSION:

UTIs caused by EBSL-producing E. coli requiring hospital admission are associated with worse clinical and economic outcomes.

KEYWORDS:

ESBL; Economic impact; OPAT; Urinary tract infection

PMID:
26380898
DOI:
10.1016/j.jinf.2015.08.012
[Indexed for MEDLINE]

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