Presentation (CTI)

OBJECTIVES: To perform the cost of illness analysis for urinary tract infections (UTIs) caused by resistant Gram-negative pathogens from both the hospital and payer perspectives.
METHODS: The macrocosting approach was used to calculate inpatient costs from payer and hospital perspectives over a 1-year time horizon. Information on the antimicrobial resistance (AMR) rates for Escherichia coli, Klebsiella pneumoniae, and Acinetobacter spp., as well as medicine prices, hospital stay, and therapy standards were obtained from officially published national databases and guidelines.
RESULTS: The AMR rate of the selected microorganisms was very high to extended-spectrum antibiotics, ranging from 20% to 90% of isolates. For infections caused by Escherichia coli and Klebsiella pneumoniae, the inpatient treatment costs paid by hospitals were €38 for initial treatment with third- or fourth-generation cephalosporins, €117 when switching to piperacillin-tazobactam therapy, and €72 for treatment with fluoroquinolones. Acinetobacter spp is not typical uropathogen and was rarely isolated, but it shows very high level of resistance to antibacterial agents. The therapy costs with meropenem are €122.3, switch to cefepime is €134, and €85.23 when colistin was added. The total cost of a completed inpatient course of treatment is €593. If extending a hospital stay is considered, the costs to the National Health Insurance Fund could double.
CONCLUSIONS: UTIs caused by resistant Gram-negative pathogens in Bulgaria lead to significant hospital and payer burden. These findings highlighted the need for optimizing antimicrobial stewardship programmes, improving surveillance, and the introduction of a national policy.