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Title: 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
Authors: Vallejo Torres, Laura 
Pujol, Miquel
Shaw, Evelyn
Wiegand, Irith
Miquel Vigo, Joan
Stoddart, Margaret
Grier, Sally
Gibbs, Julie
Vank, Christiane
Cuperus, Nienke
Van den Heuvel, Leo
Eliakim-Raz, Noa
Carratala, Jordi
Vuong, Cuong
MacGowan, Alasdair
Babich, Tanya
Leibovici, Leonard
Addy, Ibironke
Morris, Stephen
RESCUING Study Group and Study Sites
UNESCO Clasification: 531207 Sanidad
Keywords: Care
Patterns, et al
Issue Date: 2018
Publisher: 2044-6055
Journal: BMJ Open 
Abstract: Objective 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). Design 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. Setting 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). Participants Data were obtained from 644 episodes of patients hospitalised due to cUTI. Results 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. Conclusions 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.
ISSN: 2044-6055
DOI: 10.1136/bmjopen-2017-020251
Source: BMJ Open [ISSN 2044-6055], v. 8 (4), article number e020251
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