Abstract
Background: Antibiotic resistance hinders treatment of patients with severe urinary tract infections (UTI) and urosepsis. The incidence of urosepsis and impact of antimicrobial resistance(AMR) in these patients is unclear. We estimated the incidence of urosepsis/severe UTIs resistant to first line empirical treatment in 2017. The impact of antibiotic stewardship scenarios on the incidence of urosepsis/severe UTIs that are resistant to first line empirical treatment were tested. Methods: We developed a decision tree model and populated this with two parameters (chances of coverage of antibiotics and number of patients with severe UTIs). Two data sets were used. First, the Global Burden for disease project that was used to estimate the incidence of urosepsis/severeUTIs. Second, the ATLAS surveillance data from 17 countries to estimate the Bayesian Weighted Incidence Syndromic Antibiogram (WISCA), which represents the chances of coverage for each antibiotic. Findings: In 2017 incidence of urosepsis/severe UTIs ranged from 35(uncertainty interval (UI):26 to 46-Turkey) to 242(UI:201 to 287-Portugal) per 100,000 population. Incidence of urosepsis/severe UTIs resistant to first line empirical antibiotic ranged between 5(Turkey-UI:4.9-5.1) to 87(Portugal-UI:84.1-89.5). Amongst 1000 patients with severe UTIs the resistant cases ranged between 174(Netherlands-UI:174-177) to 359(Portugal-UI:347-369). Suspension of quinolones decreased the proportion to 135(Netherlands-UI:132-136) to 334(Portugal-UI:321-337). Interpretation: A substantial improvement in the empirical treatment of severe UTIs were achieved by excluding certain classes of antibiotic from the choices and this showed difference between countries. Each country needs to adopt its own antibiotic armamentarium for empirical antibiotic and in most suspension of quinolones can be useful. Funding: This study was not funded. Declaration of Interest: There are no competing interest. Ethical Approval: The study was not subject to ethical approval.
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