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. 2022 Jun 14;11(1):84.
doi: 10.1186/s13756-022-01121-y.

Economic burden of antibiotic-not-susceptible isolates in uncomplicated urinary tract infection: Analysis of a US integrated delivery network database

Jason Shafrin  1 , Alen Marijam  2 , Ashish V Joshi  3 , Fanny S Mitrani-Gold  2 , Katie Everson  4 , Rifat Tuly  1 , Peter Rosenquist  5 , Michael Gillam  6 , Maria Elena Ruiz  6
Affiliations

Economic burden of antibiotic-not-susceptible isolates in uncomplicated urinary tract infection: Analysis of a US integrated delivery network database

Jason Shafrin et al. Antimicrob Resist Infect Control. .

Abstract

Background: Uncomplicated urinary tract infections (uUTIs) are one of the most common bacterial infections in the United States (US). Contemporary data are important for understanding the health economic impact of antimicrobial-resistant uUTIs. We compared the economic burden among patients with uUTI isolates susceptible or not-susceptible to the initial antibiotic prescription.

Methods: This retrospective cohort study utilized electronic health record data (1 July 2016-31 March 2020) from a large Mid-Atlantic US integrated delivery network database. Patients were females aged ≥ 12 years with a uUTI, who received oral antibiotic treatment and had ≥ 1 urine culture within ± 5 days of diagnosis. The primary outcome was the difference in healthcare resource use and costs (all-cause, urinary tract infection [UTI]-related) among patients with susceptible versus not-susceptible isolates during the 6 months after the index uUTI diagnosis. Secondary outcomes included: pharmacy costs, hospital admissions and emergency department visits, as well as the probability of uUTI progressing to complicated UTI (cUTI) between patients with susceptible and not-susceptible isolates. Patient outcomes were compared using 1:1 propensity score matching. Winsorized costs were adjusted to 2020 quarter 1 US dollars ($).

Results: A total of 2565 patients were eligible for analysis. The propensity score-matched sample comprised 2018 patients, with an average age of 44.0 and 41.0 years for the susceptible and not-susceptible populations, respectively. In the 6 months post-index uUTI event, patients with not-susceptible isolates had significantly more all-cause prescriptions orders (+ 1.41 [P = 0.001]), UTI-related prescriptions orders (+ 0.26 [P < 0.001]) and a higher probability of all-cause inpatient (+ 1.4% [P = 0.009]), outpatient (+ 6.1% [P = 0.006]), or UTI-related outpatient (+ 3.7% [P = 0.039]) encounters. Patients with a uUTI and an antibiotic-not-susceptible isolate were significantly more likely to progress to cUTI than those with susceptible isolates (odds ratio: 2.35 [confidence interval: 1.66-3.33; P < 0.001]). Over 6 months, patients with not-susceptible versus susceptible isolates had significantly higher all-cause costs (+ $426 [P = 0.031]) and UTI-related costs (+ $157 [P = 0.034]).

Conclusions: Patients with a uUTI caused by antibiotic-not-susceptible isolates had higher healthcare resource usage, costs, and increased likelihood of progressing to cUTI than those with antibiotic-susceptible isolates.

Keywords: Antibiotic resistance; Costs; Healthcare resource use; Urinary tract infection.

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Conflict of interest statement

JS is a former employee of Precision Medicine Group, which received funding from GlaxoSmithKline plc. to conduct this study. AM is an employee of and shareholder in GlaxoSmithKline plc. AVJ is an employee of and shareholder in GlaxoSmithKline plc. FSM-G is an employee of and shareholder in GlaxoSmithKline plc. KE is an employee of Precision Medicine Group, which received funding from GlaxoSmithKline plc. to conduct this study. RT is an employee of Precision Medicine Group, which received funding from GlaxoSmithKline plc. to conduct this study. PR is a former employee of Precision Medicine Group, which received funding from GlaxoSmithKline plc. to conduct this study. MG is a contractor for MedStar Health and received funding from GlaxoSmithKline plc. through Precision Medicine Group to conduct this study. MER is an employee of MedStar Health and received funding from GlaxoSmithKline plc. through Precision Medicine Group to conduct this study.

Figures

Fig. 1
Fig. 1
Overview of study design (uUTI patients with susceptible or not-susceptible isolates). uUTI uncomplicated urinary tract infection
Fig. 2
Fig. 2
Patients identified with UTI and applied exclusion criteria. AIDS acquired immunodeficiency syndrome; CFU colony forming units; cUTI complicated urinary tract infection; I intermediate; IV intravenous; R resistant; S sensitive; UTI urinary tract infection
Fig. 3
Fig. 3
Probability of inpatient, outpatient, and emergency department visits during follow-up in the 6 months or 180 days post-index. Susceptible/not-susceptible refers to the initial antibiotic prescribed. *Statistically significant value (P < 0.05). ED emergency department; UTI urinary tract infection
Fig. 4
Fig. 4
Probability of uUTI–cUTI progression from uncomplicated to complicated UTI among patients with uUTI the 6 months or 180 days post-index. CI: 1.66–3.33. J Shafrin. Progression of an Uncomplicated Urinary Tract Infection Among Female Patients with Susceptible and Non-Susceptible Urine Isolates: Findings from an Integrated Delivery Network. [Paper/Poster/Talk] presented at IDWeek; September 29–October 3, 2021; Virtual Event. https://idweek.org. CI confidence interval; cUTI complicated urinary tract infection; OR odds ratio; UTI urinary tract infection; uUTI uncomplicated urinary tract infection
Fig. 5
Fig. 5
Winsorized and non-winsorized total all-cause/UTI-related costs in the 6 months or 180 days post-index. UTI urinary tract infection
Fig. 6
Fig. 6
Winsorized and non-winsorized total all-cause/UTI-related costs by medical and pharmacy categories in the 6 months or 180 days post-index. UTI urinary tract infection
See this image and copyright information in PMC

References

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