1524. Are Providers Shifting from NTF to Fosfomycin for Inpatient UTI? Big Data Reveals Small Shifts.
Session: Poster Abstract Session: Urinary Tract Infection
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • fosfonitroidsapdf.pdf (570.6 kB)
  • Background: Fosfomycin (FOS) and NTF (NTF) are IDSA guideline approved drugs for acute cystitis in women. However their activity against multi drug resistant gram negatives may be driving increased use among inpatients with more complicated UTI. We evaluated trends in inpatient prescribing of these UTI-specific agents in the predominantly male population of the national VA system over a 7 year period.  

    Methods: All inpatient bar coded administrations for FOS and NTF at every VA facility nationwide from 2011-2017 were captured through a data analytics platform which extracts data from the VA Data warehouse.  Antibiotic days of therapy and rates per 1000 patient days (DOT/1000CD) were extracted by year and compared using Mantel-Haenszel chi square for linear trend (MH OR).  Demographics were captured via administrative data.

    Results: Prescriptions from over 65 million patient days spanning 7 years and all inpatient units in 129 VA facilities were included. Approximately 90% of patients were male with a mean age range of 55-64 years.  FOS use increased from 128 prescriptions in 2011 to a high of 1230 in 2016 and 1003 in 2017 (Figure). At the maximum in 2016, prescription rates increased almost 10 fold compared to 2011 (MH OR 9.8, p<.001).  NTF prescriptions declined from 26,590 in 2011 to 19,343 in 2017. Rates decreased 25% from 2.8 – 2.1, MH OR 0.75, p<.001.  In 2017, FOS and NTF usage rates were highest in Rehabilitation/Spinal Cord Units (Table).

    Conclusion: In this large nationwide cohort, FOS use increased almost 10 fold among predominantly male inpatients while NTF use declined slightly. NTF is still used orders of magnitude more than FOS, even after adjusting for extended days of activity of FOS. Both agents retain activity against many MDR GNRs but differences in efficacy, tissue penetration, familiarity and availability likely influence the choice for oral UTI-specific treatment.

     

    2017 Data

    ICU

    MEDSURG

    NH

    PSYCH

    REHAB/SCI

    FOS DOT/1000CD

    0.06

    0.15

    0.07

    0.03

    0.73

    NTF DOT/1000CD

    0.56

    1.46

    2.41

    2.55

    9.35

    FOS Days

    28

    382

    229

    28

    315

    NTF Days

    251

    3699

    7826

    2634

    4013

     

     

    Kalpana Gupta, MD, MPH, VA Boston Healthcare System, West Roxbury, MA; Boston University School of Medicine, Boston, MA, Matthew B. Goetz, MD, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, Makoto Jones, MD, MS, Ideas Center, VA Salt Lake City Health Care System, Salt Lake City, UT; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT and Judith M. Strymish, MD, Medicine, VA Boston Healthcare System, West Roxbury, MA; Harvard Medical School, Boston, MA

    Disclosures:

    K. Gupta, None

    M. B. Goetz, None

    M. Jones, None

    J. M. Strymish, None

    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.