PHARMACOECONOMIC STUDY OF THE USE OF FOSFOMYCIN AND FLUOROQUINOLONES FOR URINARY TRACT SANITATION IN ORTHOPAEDIC PATIENTS


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Аннотация

Urinary tract (UT) infections are among the most common bacterial diseases worldwide and the most common cause of antibiotic prescriptions and infection-related hospitalizations. The aim of the study: to perform a clinical and economic evaluation of the implementation of a local UT sanitation protocol based on the analysis of the spectrum dynamics and sensitivity to fosfomycin and fluoroquinolones of leading microorganisms isolated from the urine of patients admitted for elective hip (THA) or knee (KJ) arthroplasty during the period 2018-2020. Material and methods. A retrospective analysis of urine microbiological findings in patients admitted for elective hip or knee arthroplasty between 2018 and 2020 was performed. All positive results without regard to the obtained bacterial titer were included in the study. Leading pathogens included microorganisms with a proportion of more than 5%. Pharmacoeconomic modeling of fosfomycin and fluoroquinolones use for UT sanitation of was performed. Medical costs for a course of UT sanitation with these antibiotics were calculated, efficiency of each strategy was calculated, cost-effectiveness ratio was calculated, cost-minimization analysis was carried out. Results. During the study period 872 positive urine cultures were obtained and 1266 microorganisms were isolated. E coli (43%), K pneumoniae (16%), E faecalis (15%) were leading in the spectrum of uropathogens. The proportion of ESBL producers, among E colisolates, was 32,2%, K pneumoniae -37,7%. The majority of E coli, K pneumoniae strains retain sensitivity to fosfomycin (99 and 79%), sensitivity to fluoroquinolones is much lower (53 and 46%), the proportion of E. faecalis strains sensitive to ciprofloxacin was 76,5%. Direct medical costs for a course of UT sanitation with fluoroquinolones are 32% higher than with fosfomycin. The strategy efficiency of using fosfomycin (EF) was 70%, and fluoroquinolones - 47%; the cost-effectiveness ratio (CER) for fluoroquinolones was 2,2 times higher than for fosfomycin. Conclusion. Taking into account the spectrum of pathogens of UT infection, their sensitivity to antibacterial agents, data of the pharmacoeconomic study, we can conclude that it is reasonable to include fosfomycin in the local protocol for UT sanitation in orthopaedic patients.

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Olga Tufanova

R.R. Vreden National Medical Research Centre of Traumatology and Orthopedics of the Ministry of Healthcare of Russia

Email: katieva@mail.ru
clinical pharmacologist 195427, Saint Petersburg, 8 Akademika Baykova Str

Alina Kasimova

R.R. Vreden National Medical Research Centre of Traumatology and Orthopedics of the Ministry of Healthcare of Russia; Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia

Email: kasi-alina0yandex.ru
PhD in Medicine, clinical pharmacologist; associate professor of the Department of clinical pharmacology and evidence-based medicine 195427, Saint Petersburg, 8 Akademika Baykova Str

Ekaterina Gordina

R.R. Vreden National Medical Research Centre of Traumatology and Orthopedics of the Ministry of Healthcare of Russia

Email: emgordina@win.rniito.ru
PhD in Medicine, senior researcher at the Scientific Department of prevention and treatment of wound infection 195427, Saint Petersburg, 8 Akademika Baykova Str

Anna Rukina

R.R. Vreden National Medical Research Centre of Traumatology and Orthopedics of the Ministry of Healthcare of Russia

Email: anrukina@win.rnnto.ru
head of the Central Clinical Diagnostic Laboratory, junior researcher at the Scientific Department for the prevention and treatment of wound infection 195427, Saint Petersburg, 8 Akademika Baykova Str

Svetlana Bozhkova

R.R. Vreden National Medical Research Centre of Traumatology and Orthopedics of the Ministry of Healthcare of Russia

Email: clinpharm-rniito@yandex.ru
Dr. med. habil., associate professor, head of Scientific Department for the prevention and treatment of wound infection 195427, Saint Petersburg, 8 Akademika Baykova Str

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