248. Antimicrobial Therapy for Suspected Urinary Tract Infection in Advanced Cancer Patients Transitioning to Comfort Measures
Session: Poster Abstract Session: Antimicrobial Stewardship: Special Populations
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Poster_IDWeek_20180921_TW.pdf (313.9 kB)
  • Background: Antimicrobials for suspected urinary tract infection (UTI) in advanced cancer patients transitioning to comfort measures (CM) may benefit from stewardship intervention.

    Methods: We identified adults ≥ 65 years with advanced cancer who had ≥1 urine culture obtained during admission to Yale New Haven Hospital from 7/2014 to 10/2016 that involved transition to CM.  We evaluated whether patients met 2017 National Healthcare Safety Network criteria for symptomatic urinary tract infection (UTI). Antimicrobials for suspected UTI and total calendar days of therapy including post-discharge days were evaluated. Factors associated with antimicrobial use were assessed using x2 or Fisher’s exact testing and fitted in a modified multivariable Poisson regression model.

    Results: We identified 327 adults with advanced cancer and ≥1 urine culture obtained during admission involving transition to CM.  Median age was 74 years (range, 65-99), 48% (N=157) were male, and 73% (N=239) had solid tumors, 21% (N=70) had liquid tumors, and 6% (N=18) had unknown primary tumors. Overall, 306 (94%) patients with suspected UTI did not meet criteria for symptomatic UTI. Of these, 14% (N=43/306) received antimicrobials for suspected UTI resulting in 273 total calendar-days of therapy.  Antimicrobial use for suspected UTI was associated with asymptomatic or symptomatic bacteriuria or candiduria (Table 1).  In a multivariable model adjusted for gender, length of stay, liquid tumor, and UTI signs or symptoms, antimicrobial use remained associated with bacteriuria or candiduria (RR=29.0, 95% CI 11.6, 72.6).

    Conclusion: In advanced cancer patients transitioning to CM, inappropriate antimicrobial use for suspected UTI is independently associated with bacteriuria or candiduria but not with UTI signs or symptoms. These findings highlight a potential target for diagnostic (i.e., restricting urine culture orders) and antimicrobial stewardship in this population to promote comfort at the end of life.

    Table 1. Antimicrobial use for suspected UTI according to urine culture and associated signs or symptoms 

     

    Antimicrobial Use

    P value

    Urine Culture

    Yes (N=43)

    No (N=263)

     

         Growtha

    38

    30

    <.001

         No Growth

    5

    233

     

    UTI Signs or Symptoms

     

     

     

         Present

    6

    28

    0.60

         Absent

    37

    235

     

    a Bacterial or fungal growth

     

    Tianyun Wang, BS1, Rupak Datta, MD PhD2, Mojun Zhu, MD3, Vincent Quagliarello, MD, FIDSA2, Louise Marie Dembry, MD, MS, MBA, FSHEA2 and Manisha Juthani-Mehta, MD, FIDSA, FSHEA2, (1)Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, (2)Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, (3)Department of Internal Medicine, Yale School of Medicine, New Haven, CT

    Disclosures:

    T. Wang, None

    R. Datta, None

    M. Zhu, None

    V. Quagliarello, None

    L. M. Dembry, None

    M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor , Consulting fee .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.