Calculation of the optimal structure of antibiotic consumption in a hospital based on the predicted antimicrobial resistance in the treatment of uncomplicated acute pyelonephritis

Abstract

Objective. To select an optimal (in terms of influence on the antibiotic resistance level) and cost-effective structure of antibiotic consumption in a hospital in the management of patients with acute uncomplicated pyelonephritis. Materials and Methods. Based on the literature data as well as a real practice of antibiotic administration, the cost of treatment of an acute uncomplicated pyelonephritis case with different regimens of initial antimicrobial treatment was calculated. Using mathematical modeling, changes in antimicrobial resistance of E. coli taking into consideration the current practice of the antibiotic administration were predicted. The optimal mode of antibiotic consumption in which antimicrobial resistance level would be minimal was predicted. Results. The current mode of antibiotic consumption where fluoroquinolones, 3rd generation cephalosporins, and penicillin/beta-lactamase inhibitor combinations account for more than 60% of consumption will lead to an increase in the proportion of extended-spectrum beta-lactamase (ESBL) producing E. coli by 14% over a 5-year period. At the same time, alternative (optimal) mode of antibiotic consumption (i.e. almost complete withdrawal of penicillin/beta-lactamase inhibitor combinations and fluoroquinolones from the clinical practice with the concomitant increase in consumption of carbapenems by 30% and increase in consumption of 3rd generation cephalosporins by 20%) will lead to a decrease in the proportion of ESBLproducing E. coli by 7% over 5 years. The cost of an acute uncomplicated pyelonephritis case with the current mode of antibiotic consumption will be increasing due to an increase in the proportion of ESBLproducing E. coli. At the same time, the alternative (optimal) mode of antibiotic consumption will lead to a significant reduction in the proportion of ESBL-producing E. coli. Conclusions. Use of mathematical modeling gives the opportunity to calculate changes in antimicrobial resistance of pathogens and choose the optimal mode of antibiotic consumption to reduce resistance levels.