title: Empirical therapies among adults hospitalized for community-acquired upper urinary tract infections: A decision-tree analysis of mortality, costs, and resistance.
abstract: Poor outcomes occur when patients with serious infections receive antibiotics to which the organisms are resistant.
  
  
  
  Decision trees simulated in-hospital mortality, costs, incremental cost-effectiveness ratio per life year saved, and carbapenem resistance according to 3 empirical antibiotic strategies among adults hospitalized for community-acquired (CA) upper urinary tract infections (UTIs): ceftriaxone (CRO) plus gentamicin (GM) in the intensive care unit (ICU), imipenem (IMP), and individualized choice (IMP or CRO) based on clinical risk factors for CA- extended-spectrum β-lactamase (ESBL).
  
  
  
  The estimated prevalence of CA-ESBL on admission was 5% (range, 1.3%-17.6%); 3% and 97% were admitted to the ICU and medical ward (MW), respectively. In the ICU, CRO plus GM was dominated; IMP was cost-effective (incremental cost-effectiveness ratio: €4,400 per life year saved compared with individualized choice). In the MW, IMP had no impact on mortality and was less costly (-€142 per patient vs CRO, -€38 vs individualized choice). The dominance of IMP was consistent in sensitivity analyses. Compared with CRO, colonization by carbapenem-resistant pathogens increased by an odds ratio of 4.5 in the IMP strategy.
  
  
  
  Among the ICU patients, empirical IMP therapy reduces mortality at an acceptable cost. Among MW patients, individualized choice or CRO is preferred to limit carbapenem resistance at a reasonable cost.
authors.affiliation: Action Thématique et Incitative sur Programme AVENIR, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche 1137, Team DeSCID (Decision Sciences in Infectious Disease Prevention, Control and Care), Univ Paris Diderot, Sorbonne Paris Cité, Paris, France; Biostatistics and Clinical Research Department, Côte de Nacre University Hospital, Caen, France. Electronic address: parienti-jj@chu-caen.fr.
authors.forename: J J
authors.initials: JJ
authors.lastname: Parienti
authors.affiliation: Action Thématique et Incitative sur Programme AVENIR, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche 1137, Team DeSCID (Decision Sciences in Infectious Disease Prevention, Control and Care), Univ Paris Diderot, Sorbonne Paris Cité, Paris, France; Hygiene and Infection Control Unit, Bichat - Claude Bernard Hospital, Paris, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Lucet
authors.affiliation: Internal Medicine Department, Beaujon Hospital, Clichy, France.
authors.forename: A
authors.initials: A
authors.lastname: Lefort
authors.affiliation: Action Thématique et Incitative sur Programme AVENIR, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche 1137, Team DeSCID (Decision Sciences in Infectious Disease Prevention, Control and Care), Univ Paris Diderot, Sorbonne Paris Cité, Paris, France; Bacteriology Laboratory, Bichat - Claude Bernard Hospital, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Armand-Lefèvre
authors.affiliation: Critical Care and Infectious Disease Department, Bichat - Claude Bernard Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Wolff
authors.affiliation: Infectious Diseases Department, Charles Nicolle University Hospital, Rouen, France.
authors.forename: F
authors.initials: F
authors.lastname: Caron
authors.affiliation: Bacteriology Laboratory, Côte de Nacre University Hospital, Caen, France.
authors.forename: V
authors.initials: V
authors.lastname: Cattoir
authors.affiliation: Action Thématique et Incitative sur Programme AVENIR, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche 1137, Team DeSCID (Decision Sciences in Infectious Disease Prevention, Control and Care), Univ Paris Diderot, Sorbonne Paris Cité, Paris, France; Infectious Diseases Department, Assistance Publique Hôpitaux de Paris, Bichat - Claude Bernard University Hospital, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Yazdanpanah
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D024881:Drug Resistance, Bacterial; D036262:Empirical Research; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents
keywords: Carbapenem; Cost-effectiveness; Empirical therapy; Urinary tract infection