Epidemiology and economics of adult patients hospitalized with urinary tract infections

Cardwell, Sophia M.; Crandon, Jared L.; Nicolau, David P.; McClure, Mitchell H.; Nailor, Michael D

doi:10.1080/21548331.2016.1133214

Cited by 35 publications

(24 citation statements)

References 27 publications

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“…The presence of catheter on admission and the Charlson comorbidity index have also been found in the literature to increase costs of adult patients hospitalised with UTI, together with time to appropriate therapy. 13 Another study found males, patients with chronic renal failure, ESBL production and outpatient parenteral antibiotic therapy to be associated with higher costs in patients with UTI admitted to hospital. 15 …”

Section: Discussionmentioning

confidence: 99%

“…Some papers have measured the cost of community-acquired UTIs 7–10 and nosocomial UTIs, 11 12 or both. 13 Most of these studies were conducted in the USA, 7 8 11–13 while studies undertaken in European countries have mainly focused on women visiting primary care settings with suspected UTIs. 9 10 Some papers have estimated the impact of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli on the cost of UTI episodes requiring hospitalisation.…”

Section: Introductionmentioning

confidence: 99%

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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

Vallejo-Torres¹,

Pujol

Shaw

et al. 2018

BMJ Open

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ObjectiveComplicated 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).DesignThis 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.SettingThe 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).ParticipantsData were obtained from 644 episodes of patients hospitalised due to cUTI.ResultsThe 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.ConclusionsThe 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Vallejo-Torres¹,

Pujol

Shaw

et al. 2018

BMJ Open

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“…Urinary tract infections (UTI), ranging from uncomplicated cystitis to urosepsis, are amongst the most prevalent bacterial infections worldwide and are accountable for a large number of emergency consultations and hospitalizations [ 1 , 2 ]. The direct and indirect costs for all urinary tract infections in the Unites States of America in 2010 were estimated to be about 2.3 billion dollars [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The development and validation of different decision-making tools to predict urine culture growth out of urine flow cytometry parameter

et al. 2018

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ObjectivePatients presenting with suspected urinary tract infection are common in every day emergency practice. Urine flow cytometry has replaced microscopic urine evaluation in many emergency departments, but interpretation of the results remains challenging. The aim of this study was to develop and validate tools that predict urine culture growth out of urine flow cytometry parameter.MethodsThis retrospective study included all adult patients that presented in a large emergency department between January and July 2017 with a suspected urinary tract infection and had a urine flow cytometry as well as a urine culture obtained. The objective was to identify urine flow cytometry parameters that reliably predict urine culture growth and mixed flora growth. The data set was split into a training (70%) and a validation set (30%) and different decision-making approaches were developed and validated.ResultsRelevant urine culture growth (respectively mixed flora growth) was found in 40.2% (7.2% respectively) of the 613 patients included. The number of leukocytes and bacteria in flow cytometry were highly associated with urine culture growth, but mixed flora growth could not be sufficiently predicted from the urine flow cytometry parameters. A decision tree, predictive value figures, a nomogram, and a cut-off table to predict urine culture growth from bacteria and leukocyte count were developed, validated and compared.ConclusionsUrine flow cytometry parameters are insufficient to predict mixed flora growth. However, the prediction of urine culture growth based on bacteria and leukocyte count is highly accurate and the developed tools should be used as part of the decision-making process of ordering a urine culture or starting an antibiotic therapy if a urogenital infection is suspected.

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“…UTI is second commonest cause of bacterial infection in Europe [9,10], and has financial implications, which are annually estimated to 1.6 billion US $ around the world [4,11,12]. A pre-test Urinary tract infection diagnosed clinically or on dipsticks was exclusion criteria for the test.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

UNOAJ

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Introduction: Urodynamic pressure flow study is invasive investigation to assess lower urinary tract symptoms. We evaluated risk of UTI after the procedure. Patients and Methods: We conducted prospective evaluation of patients coming for urodynamic study. Patients with symptomatic and dipstick test positive UTI were excluded. Patients were assessed by post procedure MSU and symptom questionnaire. Results: Rate of infection was 5.6% with no significant relationship to other parameters. Conclusion: Data is comparable and routine antibiotics are not recommended.

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Epidemiology and economics of adult patients hospitalized with urinary tract infections

Abstract: Changes in antimicrobial susceptibility are evident with exposure to healthcare, the presence of a FC, and a history of resistant pathogens. Risk-based empirical prescribing and rapid de-escalation may improve care and reduce costs.

Cited by 35 publications

References 27 publications

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

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

The development and validation of different decision-making tools to predict urine culture growth out of urine flow cytometry parameter

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