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

Objectives.To evaluate the economic and clinical impact of infection with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species (ESBL-EK).Design.A matched-cohort analysis of the cost of illness.Setting.An 810-bed, urban, community hospital in Hartford, Connecticut.Patients.Twenty-one case patients infected with ESBL-EK at a site other than the urinary tract were matched with 21 control subjects infected with a non–ESBL-producing organism on the basis of pathogen species, age, anatomic site of infection, hospitalization in the intensive care unit (ICU) during the time of infection, date of hospitalization, and initial antibiotics received.Results.Mean infection-related costs per patient were significantly greater for case patients than for control patients ($41,353 vs $24,902; P = .034). Infection-related length of stay was the main driver of cost, which was prolonged for case patients, compared with control patients (21 vs 11 days; mean difference, 9.7 days [95% confidence interval {CI}, 3.2-14.6 days] P = .006). The additional cost attributed to the presence of an ESBL-EK infection was $16,450 per patient (95% CI, $965-$31,937). Case patients were more likely than control patients to have clinical failure (P = .027), and the rate of treatment success for case patients whose initial treatment involved antibiotics other than carbapenems was lower than that for their matched control patients (39% vs 83%; P = .013). Treatment was successful in patients for whom initial treatment was with a carbapenem, regardless of the ESBL status of the pathogen.Conclusion.The cost of non–urinary tract infections caused by ESBL-EK was 1.7 times the cost of non–urinary tract infections caused by non-ESBL producers. Prompt recognition and appropriate antimicrobial selection may minimize this ESBL-related impact on hospital costs.

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Treatment duration of pivmecillinam in men, non-pregnant and pregnant women for community-acquired urinary tract infections caused by Escherichia coli: a retrospective Danish cohort study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz211 ◽

2019 ◽

Vol 74 (9) ◽

pp. 2767-2773 ◽

Cited By ~ 4

Author(s):

Jonas Bredtoft Boel ◽

Filip Jansåker ◽

Frederik Boëtius Hertz ◽

Katrine Hartung Hansen ◽

Sara Thønnings ◽

...

Keyword(s):

Escherichia Coli ◽

Cohort Study ◽

Urinary Tract ◽

Treatment Failure ◽

Pregnant Women ◽

Urinary Tract Infections ◽

Treatment Duration ◽

E Coli ◽

Tract Infections ◽

Risk Of Treatment

Abstract Objectives To evaluate the importance of treatment duration for therapeutic efficacy of pivmecillinam for community-acquired urinary tract infections (UTIs) caused by Escherichia coli. Methods A retrospective cohort study was conducted between 1 January 2010 and 30 September 2016 in adults with community-acquired E. coli bacteriuria, treated empirically with pivmecillinam. Regimens of 3, 5 and 7 days were compared using clinical treatment failure (i.e. redemption of a new antibiotic or hospitalization due to UTI) within 14 and 30 days as outcome. HR and risk difference with 95% CI were estimated for treatment failure. Results were stratified by age (18–50, 51–70, >70 years) and sex. Results Of the 21864 cases of E. coli UTI that were analysed, 2524 (11.5%) were in men. In 954 cases (4.4%) E. coli produced ESBL and 125 (13.1%) of the cases were in men. The 3 day regimen increased the risk of treatment failure for all groups. The risk differences between the 3 and 5 day regimens were <10% for women, but >10% for men. Comparing the 7 day and 5 day regimens, only women aged >50 years demonstrated an increased risk of treatment failure within 14 days with the 5 day regimen, but not within 30 days. Conclusions With the current data, where data on clinical classification of the E. coli UTI were missing, a 5 day treatment with pivmecillinam at 400 mg three times daily seems to be the rational recommendation for lower UTI in men, pregnant women and women >50 years old. A 3 day regimen seems sufficient for non-pregnant women <50 years old.

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Clinical and Economic Impact of Community-Onset Urinary Tract Infections Caused by ESBL-Producing Klebsiella pneumoniae Requiring Hospitalization: An Observational Cohort Study

10.20944/preprints202103.0528.v1 ◽

2021 ◽

Author(s):

Dawid Rozenkiewicz ◽

Erika Esteve-Palau ◽

Mar Arenas-Miras ◽

Santiago Grau ◽

Xavier Duran ◽

...

Keyword(s):

Multivariate Analysis ◽

Cohort Study ◽

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Economic Impact ◽

Urinary Tract Infections ◽

Esbl Production ◽

Adequate Treatment ◽

Tract Infections ◽

Community Onset

Objective: To analyze the clinical and economic impact of community-onset urinary tract infections (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae requiring hospitalization. Methods: A retrospective cohort study included all adults with UTI caused by K. pneumoniae admitted to a tertiary care hospital in Barcelona, Spain, between 2011 and 2015. Demographic, clinical and economic data were analyzed. Results: One hundred and seventy-three episodes of UTI caused by K. pneumoniae were studied; 112 were non-ESBL-producing and 61 ESBL-producing. Multivariate analysis identified ESBL production, acute confusional state associated with UTI, shock, and time to adequate treatment as risk factors for clinical failure during the first 7 days. Economic analysis showed differences between ESBL-producing and non-ESBL-producing K. pneumoniae for the total cost of hospitalization per episode (mean 6,718 € vs 3,688 € respectively). Multivariate analysis of the higher costs of UTI episodes found statistically significant differences for ESBL production and time to adequate treatment. Conclusion: UTI caused by ESBL-producing K. pneumoniae requiring hospitalization, and time to adequate antimicrobial therapy are associated with worse clinical and economic outcomes.

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Economic Burden of Urinary Tract Infections From Antibiotic-Resistant Escherichia coli Among Hospitalized Adult Patients in Lebanon: A Prospective Cohort Study

Value in Health Regional Issues ◽

10.1016/j.vhri.2020.01.006 ◽

2021 ◽

Vol 24 ◽

pp. 38-46

Author(s):

Katia Iskandar ◽

Rana Rizk ◽

Roula Matta ◽

Rola Husni-Samaha ◽

Hala Sacre ◽

...

Keyword(s):

Escherichia Coli ◽

Cohort Study ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Prospective Cohort Study ◽

Economic Burden ◽

Prospective Cohort ◽

Adult Patients ◽

Antibiotic Resistant ◽

Tract Infections

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Clinical and Economic Impact of Community-Onset Urinary Tract Infections Caused by ESBL-Producing Klebsiella pneumoniae Requiring Hospitalization in Spain: An Observational Cohort Study

Antibiotics ◽

10.3390/antibiotics10050585 ◽

2021 ◽

Vol 10 (5) ◽

pp. 585

Author(s):

Dawid Rozenkiewicz ◽

Erika Esteve-Palau ◽

Mar Arenas-Miras ◽

Santiago Grau ◽

Xavier Duran ◽

...

Keyword(s):

Multivariate Analysis ◽

Cohort Study ◽

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Economic Impact ◽

Urinary Tract Infections ◽

Esbl Production ◽

Adequate Treatment ◽

Tract Infections ◽

Community Onset

Objective: To analyze the clinical and economic impact of community-onset urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae requiring hospitalization. Methods: A retrospective cohort study that included all adults with a UTI caused by K. pneumoniae that were admitted to a tertiary care hospital in Barcelona, Spain, between 2011 and 2015. Demographic, clinical, and economic data were analyzed. Results: One hundred and seventy-three episodes of UTIs caused by K. pneumoniae were studied; 112 were non-ESBL-producing and 61 were ESBL-producing. Multivariate analysis identified ESBL production, acute confusional state associated with UTI, shock, and the time taken to obtain adequate treatment as risk factors for clinical failure during the first seven days. An economic analysis showed differences between ESBL-producing and non-ESBL-producing K. pneumoniae for the total cost of hospitalization per episode (mean EUR 6718 vs EUR 3688, respectively). Multivariate analysis of the higher costs of UTI episodes found statistically significant differences for ESBL production and the time taken to obtain adequate treatment. Conclusion: UTIs caused by ESBL-producing K. pneumoniae requiring hospitalization and the time taken to obtain adequate antimicrobial therapy are associated with worse clinical and economic outcomes.

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