Lodise Thomas P, Manjelievskaia Janna, Marchlewicz Elizabeth Hoit, Rodriguez Mauricio
Albany College of Pharmacy and Health Sciences, Albany, New York, USA.
IBM Watson Health, Cambridge, Massachusetts, USA.
Open Forum Infect Dis. 2022 Jun 20;9(7):ofac307. doi: 10.1093/ofid/ofac307. eCollection 2022 Jul.
Limited data are available in the United States on the 12-month epidemiology, outpatient (OP) antibiotic treatment patterns, outcomes, and costs associated with complicated urinary tract infections (cUTIs) in adult patients.
A retrospective observational cohort study of adult patients with incident cUTIs in IBM MarketScan Databases between 2017 and 2019 was performed. Patients were categorized as OP or inpatient (IP) based on initial setting of care for index cUTI and were stratified by age (<65 years vs ≥65 years). OP antibiotic treatment patterns, outcomes, and costs associated with cUTIs among adult patients over a 12-month follow-up period were examined.
During the study period, 95 322 patients met inclusion criteria. Most patients were OPs (84%) and age <65 years (87%). Treatment failure (receipt of new unique OP antibiotic or cUTI-related ED visit/IP admission) occurred in 23% and 34% of OPs aged <65 years and ≥65 years, respectively. Treatment failure was observed in >38% of IPs, irrespective of age. Across both cohorts and age strata, >78% received ≥2 unique OP antibiotics, >34% received ≥4 unique OP antibiotics, >16% received repeat OP antibiotics, and >33% received ≥1 intravenous (IV) OP antibiotics. The mean 12-month cUTI-related total health care costs were $4697 for OPs age <65 years, $8924 for OPs age >65 years, $15 401 for IPs age <65 years, and $17 431 for IPs age ≥65 years.
These findings highlight the substantial 12-month health care burden associated with cUTIs and underscore the need for new outpatient treatment approaches that reduce the persistent or recurrent nature of many cUTIs.
在美国，关于成年患者复杂性尿路感染（cUTI）的12个月流行病学、门诊（OP）抗生素治疗模式、治疗结果及相关费用的数据有限。
对2017年至2019年IBM MarketScan数据库中成年初发cUTI患者进行回顾性观察队列研究。根据首次cUTI的初始护理地点将患者分为门诊或住院患者，并按年龄（<65岁与≥65岁）分层。研究了成年患者在12个月随访期内与cUTI相关的门诊抗生素治疗模式、治疗结果及费用。
在研究期间，95322例患者符合纳入标准。大多数患者为门诊患者（84%）且年龄<65岁（87%）。年龄<65岁和≥65岁的门诊患者中，治疗失败（接受新的独特门诊抗生素治疗或因cUTI相关的急诊就诊/住院）的发生率分别为23%和34%。无论年龄大小，超过38%的住院患者出现治疗失败。在两个队列和年龄层中，超过78%的患者接受了≥2种独特的门诊抗生素治疗，超过34%的患者接受了≥4种独特的门诊抗生素治疗，超过16% 的患者接受了重复门诊抗生素治疗，超过33%的患者接受了≥1种静脉（IV）门诊抗生素治疗。年龄<65岁的门诊患者12个月cUTI相关的总医疗费用平均为4697美元，年龄>65岁的门诊患者为8924美元，年龄<65岁的住院患者为15401美元，年龄≥65岁的住院患者为17431美元。
这些发现凸显了与cUTI相关的12个月医疗负担之重，并强调需要新的门诊治疗方法来减少许多cUTI的持续性或复发性。
