Economic analysis of empirical antibiotic treatment in urinary infection by multiresistant gram-negative in a Hospital of medium complexity in Colombia.

Abstract

Objectives: Generate data related to costs and effectiveness in a medium complexity hospital in Colombia, which allows to the hospital care staff to choose the best therapeutic option, at a reasonable cost in the management of urinary tract infections caused by extended spectrum beta-lactamases (ESBL) agents. Materials and Methods: It was performed an observationalanalytical retrospective study considering medical records and costs in the management of patients with UTI in which is isolated BLEE producing strains as etiologic agent in two health institutions of Duitama, Colombia, during the period from 01 January 2010 to August 31 2015, where they were analyzed and were compared costs of patients who received nitrofurantoin, beta-lactams and quinolones, which were evaluated according to cost-effectiveness, cost treatment failure, cost according hospital stay, cost according index severity of charlson and cost according staggering antibiotic. Results: Of the 154 patients found, 49 received beta-lactams, 55 quinolones, 18 nitrofurantoin and 32 received no treatment. Nitrofurantoin was found to be the most cost-effective treatment ($ 12,575), followed by beta-lactams ($ 16,588) and quinolones ($ 25,331). In terms of cost according to therapeutic failure, the most economical treatment is with beta-lactams ($ 505,688), followed by quinolones ($ 535,465) and lastly nitrofurantoin ($801,656). The hospital stay indicated that in patients with a stay of less than 7 days the most economical treatment is with nitrofurantoin, and when it is greater than 7 days, the lowest costs are quinolones. This behavior was similar to Charlson’s severity and comorbidities index. Conclusions: Nitrofurantoin is the most cost-effective antibiotic; it also has low levels of therapeutic failure and bacterial resistance in the region; This type of research is recommended to institutionally adjust the appropriate empirical therapy in the management of UTI, which reduces mortality, hospital stay and increases the measure off cost-effective use.