1504. Patient demographics and comorbidity profiles associated with hospitalized patients admitted with resistant vs. susceptible urinary tract infections (UTI): A multicenter analysis
Session: Poster Abstract Session: Urinary Tract Infection
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Spero IDWeek 2018 Poster v2092018.jpg (127.6 kB)
  • Background:  A significant percentage of patients admitted to the hospital with UTI are infected with ESBL positive and quinolone resistant (FQ NS) enterobacteriaceae (ENT) that can complicate patient outcomes due to potentially inadequate antibiotic therapy.  We used a large national multicenter database to ascertain the demography associated with susceptible and resistant UTI and the underlying comorbidities.

    Methods: We analyzed the first positive ENT urine culture ≤ 3 days from admission in those with a discharge primary or secondary UTI ICD10 code from 68 US hospitals from October 1, 2015-2017 (BD Insights, Franklin Lakes, NJ).  Patient demographics were identified using AHRQ classifications to assess for specific risk factors and categorized by ESBL and FQ resistance status.  Healthcare-associated (HCA) episodes was defined as admissions from another care facility, admission in the prior 30 days, and presence of dialysis or cancer comorbidity.  The Fisher’s exact test was used to test for significance.

    Results:  Of 16,022 adults (mean age 69.5 years; 77.7% female) with culture positive ENT UTI were identified; 11.0% (n=1763) were ESBL +, 31.3% (n=5017) were FQ NS & 8.9% (n=1433) being both ESBL + and FQ NS.  Admissions with ESBL + /FQ NS were significantly more likely to be male, admitted with HCA risk factors and with higher important comorbidities.

    Demographic

    ESBL - /FQ S

    FQ NS

    ESBL + /FQ NS

    N (%)

    10,784 (67.3%)

    5,017 (31.3%)

    1,433 (8.9%)

    % Male

    2,252 (20.9%)

    1,284 (25.6%) ¥

    401 (28.0%)*

    %HCA

    2,716 (25.2%)

    1,505 (30.3%) ^¥

    489 (34.1%)*

    Deficiency anemias

    2,840 (26.3%)

    1,563 (31.2%) ^¥

    508 (35.5%)*

    Renal failure

    2,196 (20.4%)

    1,227 (24.5%) ^¥

    402 (28.1%)*

    Chronic pulmonary disease

    2,009 (18.6%)

    1,191 (23.7%) ¥

    345 (24.1%)*

    Diabetes

    1,947 (18.1%)

    1,095 (21.8%) ¥

    318 (22.2%)*

    Diabetes w/ chronic complications

    1,872 (17.4%)

    979 (19.5%) ¥

    313 (21.8%)*

    Congestive heart failure

    1,648 (15.3%)

    1,011 (20.2%) ¥

    292 (20.4%)*

    * p < .0002 vs ESBL-/FQ S; ^ p < .0032 FQ NS vs. ESBL+/FQ NS; ¥ p <.0012 FQ NS vs. ESBL-/FQ S

    Conclusion: About 1 in 11 admissions with UTI are ESBL + /FQ NS and are more likely to be male, with HCA risk factors and other important comorbidities.  Current oral antibiotic therapy is limited in such episodes and oral treatment alternatives are needed.

    Jon Bruss, MD, MSPH, MBA1, David Melnick, MD2, Akash Jain, PhD2, John Murray, MPH3, Ian Critchley, PhD2, Stephen Kurtz, MS3 and Vikas Gupta, PharmD, BCPS3, (1)Alarus Development International, LLC, Pagosa Springs, CO, (2)Spero Therapeutics, Cambridge, MA, (3)Becton, Dickinson and Company, Franklin Lakes, NJ

    Disclosures:

    J. Bruss, Alarus Development International: Employee , Salary . Spero Therapeutics: Consultant , Consulting fee .

    D. Melnick, Spero Therapeutics: Employee , Salary .

    A. Jain, Spero Therapeutics: Employee , Salary .

    J. Murray, Becton Dickinson and Company: Employee , Salary .

    I. Critchley, Spero Therapeutics: Employee , Salary .

    S. Kurtz, Becton Dickinson and Company: Employee , Salary .

    V. Gupta, Becton Dickinson and Company: Employee , Salary .

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