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BMJ Open. 2018 Apr 12;8(4):e020251. doi: 10.1136/bmjopen-2017-020251.

Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study.

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UCL Department of Applied Health Research, University College London, London, UK.
Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
Infectious diseases Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
AiCuris Anti-infective Cures GmbH, Wuppertal, Germany.
Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain.
Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel.



Complicated urinary tract infections (cUTIs) impose a high burden on healthcare systems and are a frequent cause of hospitalisation. The aims of this paper are to estimate the cost per episode of patients hospitalised due to cUTI and to explore the factors associated with cUTI-related healthcare costs in eight countries with high prevalence of multidrug resistance (MDR).


This is a multinational observational, retrospective study. The mean cost per episode was computed by multiplying the volume of healthcare use for each patient by the unit cost of each item of care and summing across all components. Costs were measured from the hospital perspective. Patient-level regression analyses were used to identify the factors explaining variation in cUTI-related costs.


The study was conducted in 20 hospitals in eight countries with high prevalence of multidrug resistant Gram-negative bacteria (Bulgaria, Greece, Hungary, Israel, Italy, Romania, Spain and Turkey).


Data were obtained from 644 episodes of patients hospitalised due to cUTI.


The mean cost per case was €5700, with considerable variation between countries (largest value €7740 in Turkey; lowest value €4028 in Israel), mainly due to differences in length of hospital stay. Factors associated with higher costs per patient were: type of admission, infection source, infection severity, the Charlson comorbidity index and presence of MDR.


The mean cost per hospitalised case of cUTI was substantial and varied significantly between countries. A better knowledge of the reasons for variations in length of stays could facilitate a better standardised quality of care for patients with cUTI and allow a more efficient allocation of healthcare resources. Urgent admissions, infections due to an indwelling urinary catheterisation, resulting in septic shock or severe sepsis, in patients with comorbidities and presenting MDR were related to a higher cost.


cost of illness; health economics; urinary tract infections

[Indexed for MEDLINE]
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Conflict of interest statement

Competing interests: Within the IMI project, AiCuris provided support for the institutions of the following Researchers: LVT, MP, ES, JMV, MS, SG, JG, NC, LH, NE-R, JC, AM, TB, LL and SM. IW, ChV, CuV and IA are employees of AiCuris Anti-infective Cures GmbH, an EFPIA (European Federation of Pharmaceutical Industries and Association) member in the IMI JU. Costs related to the research contribution by IW, ChV, CuV and IA are borne by AiCuris Anti-infective Cures GmbH and considered in-kind contribution under the IMI JU scheme.

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