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1ISG-022 Financial impact of third-generation cephalosporines resistance in hospital settings – an example with ceftriaxone
  1. M Kamusheva1,
  2. M Amerikova2,
  3. G Petrova1,
  4. I Pencheva2
  1. 1Faculty of Pharmacy- Medical University – Sofia, Department of Organisation and Economics, Sofia, Bulgaria
  2. 2Faculty of Pharmacy- Medical University – Sofia, Department of Pharmaceutical Chemistry, Sofia, Bulgaria


Background Despite the availability of a national antibiotic stewardship programme, antibiotic resistance (AR) in local hospital settings has been increasing in recent years. The consumption of third-generation cephalosporins in national hospitals increased from 0.2 in 2006 to 0.8 in 2016 defined daily doses (DDD) per 1000 patients/day.

Purpose The goal is to estimate the financial impact of cephalosporin resistance in patients with lower respiratory tract infections (LRTI) and to calculate the savings in case of regular application of antibiograms from the hospital perspective.

Material and methods A cost-benefit analysis was applied to evaluate the benefits from the introduction of compulsory antibiograms in hospitals in case of LRTI. Information about the AR towards ceftriaxone was gathered from the National Reference Microbiology Centre. The cost of ceftriaxone and antibiotics commonly applied as alternatives (linezolid, vancomycin, teicoplanin) in the case of AR was calculated based on hospital prices. Cost per bed day and length of stay in hospitals were taken from the National Centre of Public Health and Analyses and the cost of antibiogram from the National Health Insurance Fund. Savings from the avoided hospital stay, cost of therapy and antibiogram for a cohort of 200 patients with LRTI were calculated.

Results The level of ceftriaxone resistance is 8% (Pseudomonas aeruginosa) and 14% (Klebsiella pneumonia). The price per DDD of ceftriaxone is €1.93, its alternatives €22.54, the number of hospital days for treatment of LRTI is 9.94, the extension of hospital stays due to AR is five, the price of one hospital bed per day is €64.83 and the unit price of antibiogram is €2.25. Thus, the total costs for treatment of LTRI patients are €99,256.57 with and €101,888.07 without antibiogram. The performing of antibiogram provides savings of €2,631.49 for the treatment course. The availability of resistant isolates is associated with additional costs of €3698.39.

Conclusion The application of efficient national antibiotic policy, use of defensins and regular provision of antibiogram tests in hospitals could decrease the costs of LRTI treatment. Further studies revealing the economic consequences of the use of defensins as a special class of antimicrobial peptides should be performed.

References and/or acknowledgements

No conflict of interest.

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