161. Epidemiology and Management of Complicated Urinary Tract Infections (cUTI) in Hospitalized Adults: Opportunities for Carbapenem Stewardship
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDweek 42.161 cUTI.pdf (146.0 kB)
  • Background: cUTI is a common indication for hospital admission and antimicrobial therapy and is often complicated by drug-resistant Gram-negative pathogens necessitating use of carbapenems. To avoid overuse of group 2 carbapenems (e.g. meropenem) and subsequent increased emergence and spread of extensively drug-resistant pathogens, we sought to identify characteristics of patients warranting empiric carbapenem therapy for cUTI for whom ertapenem would be appropriate.

    Methods: Retrospective cohort analysis of adult patients admitted for cUTI caused by pan-sensitive enterobacteriaceae (S) (for which non-carbapenem alternatives are appropriate), Pseudomonas aeruginosa (PA) (for which group 2 carbapenems but not ertapenem are appropriate) or enterobacteriaceae resistant to both cephalosporins and fluroroquinolones (ESBL) (for which ertapenem would be appropriate, as an alternative to group 2 carbapenems). A case-case-control study was performed in order to identify risk factors unique to ESBL cUTI, and to evaluate the impact of resistance on therapeutic choices and outcomes.

    Results: 399 patients were included: 134 S, 149 ESBL and 116 PA. Mean age of the cohort was 68 ± 17 years, 53% were male, and 70% were African American. Characteristics unique to ESBL cUTI were higher Charlson scores and history of multi drug-resistant organisms (MDROs) (Table). Frequency of empiric (5% vs 7%; p = 0.59) and definitive (11% vs 12%, p > 0.99) treatment with meropenem were similar in the ESBL and PA groups.

    Conclusion: Compared to patients with cUTI caused by S or PA, patients with ESBL had higher Charlson scores and were more likely to have had past infection with an MDRO, including ESBL..  Patients with these characteristics represent a potential target group for empiric therapy with ertapenem. Additionally, in patients with ESBL cUTI, opportunities exist to decrease use of group 2 carbapenems.

     

    ESBL

    n=149

    S

    n=134

    PA

    n=116

    OR (95% CI)

    ESBL vs S

    ESBL vs PA

    PA vs S

    Charlson score, mean ± SD

    5.2 ± 2.8

    3.2 ± 2.4

    3.2  ± 2.3

    p < 0.01

    p < 0.01

    p = 0.90

    Past >1 MDRO, n (%)

    24 (16%)

    1 (0.1%)

    0

    25.5 (3.4, 191.6)

     

    50.0 (2.7, 769.0)

     

    0.4 (0.01, 9.5)

     

    Past ESBL, n (%)

    45 (30%)

    3 (2%)

    8 (7%)

    18.9 (5.7, 62.5)

     

    5.0 (2.5, 10.0)

     

    3.2 (0.8, 12.5)

     

    Leah Molloy, Pharm D1, Jason Pogue, PharmD2, Alhusain Alsagahyer, MD, MPH3, Madiha Salim, MD4, Bakht Nishan, MD5, Hamadullah Shaikh, MD5, Niveditha Mudegowdra, MD, MBBS6 and Keith Kaye, MD, MPH, FIDSA, FSHEA7, (1)Pharmacy, Children's Hospital of Michigan, Detroit, MI, (2)Detroit Medical Center/Wayne State University, Detroit, MI, (3)Internal Medicine/Infectious Disease, Wayne State Univeristy - Detroit Medical Center, Detroit, MI, (4)Detroit Medical Center / Wayne State University, Detroit, MI, (5)Detroit Medical Center, Detroit, MI, (6)Internal Medicine, Sinai Grace Hospital, Detroit, MI, (7)Medicine, Wayne State University, Detroit, MI

    Disclosures:

    L. Molloy, None

    J. Pogue, None

    A. Alsagahyer, None

    M. Salim, None

    B. Nishan, None

    H. Shaikh, None

    N. Mudegowdra, None

    K. Kaye, Detroit Medical Center and Wayne State University: Consultant and Grant Investigator , Consulting fee and Grant recipient

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.