title: Clinical and economic impact of urinary tract infections caused by ESBL-producing Escherichia coli requiring hospitalization: A matched cohort study.
abstract: OBJECTIVE
  To analyze the clinical and economic impact of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli requiring hospitalization.
  
  
  METHODS
  Matched cohort study including adults with UTI caused by ESBL-producing E. coli admitted to a tertiary care hospital in Barcelona, Spain, between August 2010 and July 2013. Demographic, clinical and economic data were analyzed.
  
  
  RESULTS
  One hundred and twenty episodes of UTI were studied: 60 due to ESBL-producing E. coli and 60 due to non-ESBL-producing E. coli. Bivariate analysis showed that prior antimicrobial treatment (p = 0.007) and ESBL production (p < 0.001) were related to clinical failure during the first 7 days. Multivariate analysis selected ESBL as the sole risk factor for clinical failure (p = 0.002). Regarding the economic impact of infections caused by ESBL-producing E. coli, an ESBL-producing infection cost more than a non-ESBL-producing E. coli infection (mean €4980 vs. €2612). Looking at hospital expenses separately, the total pharmacy costs and antibiotic costs of ESBL infections were considerably higher than for non-ESBL infections (p < 0.001), as was the need for outpatient parenteral antibiotic therapy (OPAT) and its related costs. Multivariate analysis performed for the higher costs of UTI episodes found statistically significant differences for males (p = 0.004), chronic renal failure (p = 0.025), ESBL production (p = 0.008) and OPAT (p = 0.009).
  
  
  CONCLUSIONS
  UTIs caused by EBSL-producing E. coli requiring hospital admission are associated with worse clinical and economic outcomes.
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain. Electronic address: esteve.erika@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Esteve-Palau
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Solande
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Sánchez
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Sorlí
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Montero
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Güerri
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Villar
authors.affiliation: Pharmacy Service, Hospital del Mar, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Grau
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain; CEXS, Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERES, Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Electronic address: jhorcajada@parcdesalutmar.cat.
authors.forename: J P
authors.initials: JP
authors.lastname: Horcajada
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D016527:Drug Costs; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification / Q000502:physiology; D004927:Escherichia coli Infections / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers; D014552:Urinary Tract Infections / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: ESBL; Economic impact; OPAT; Urinary tract infection