1420. Descriptive Epidemiology of UTI Hospitalizations in the US, 2018

Abstract Background In parallel with an increase in antimicrobial resistance, urinary tract infections (UTI), one of the most common diagnoses among hospitalized patients in the US, have been on the rise. Though mostly emphasized as a hospital-acquired complication among patients with an indwelling catheter, quantification of the full contemporary burden of UTI-associated hospitalizations is limited. Methods We conducted a cross-sectional multicenter study within the National Inpatient Sample (NIS) database, a 20-percent stratified sample of discharges from US community hospitals, from 2018, to explore characteristics of patients discharged with a UTI diagnosis. We divided UTI into mutually exclusive categories of complicated (cUTI), uncomplicated (uUTI), and catheter-associated (CAUTI). We applied survey methods to develop national estimates. Results Among 2,837,385 discharges with a UTI code, 77.9% were uUTI, 17.6% cUTI, and 4.4% CAUTI. Compared to patients with uUTI (mean age 69.0 years), those with CAUTI and cUTI were older (70.1 and 69.7 years), but had same comorbidity burden (mean Charlson 4.3) as cUTI (4.3) and lower than CAUTI (4.6). Compared to other geographic regions, the Northeast had the lowest proportion of uUTI (74.6%) and highest of cUTI (20.8%) while the South had highest uUTI (80.2%) and lowest cUTI (15.7%). Over 60% of all UTI, regardless of type, were in large, and nearly ½ in urban teaching, institutions, and >80% came through the emergency department. Antimicrobial resistance codes were infrequent, but extended spectrum beta-lactamase organisms were more common in CAUTI (2.7%) and cUTI (2.1%) than in uUTI (1.6%). Among the 83.0% of discharges whose UTI was a secondary diagnosis, sepsis was the most common principal diagnosis, ranging from 17.7% in uUTI to 22.3% in cUTI. Although relatively low across the board, hospital mortality was lowest in cUTI (2.8%) and highest in uUTI (3.9%). Discharges to a chronic care facility were most common in CAUTI (46.7%) and least common in cUTI (33.3%). Conclusion There are nearly 3 million hospital admissions with a UTI, comprising fully 8% of all annual admissions in the US. Though most are considered uncomplicated, there are few differences in characteristics or outcomes across the categories. Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Kate Sulham, MPH, Spero Therapeutics (Consultant)

Background. In parallel with an increase in antimicrobial resistance, urinary tract infections (UTI), one of the most common diagnoses among hospitalized patients in the US, have been on the rise. Though mostly emphasized as a hospital-acquired complication among patients with an indwelling catheter, quantification of the full contemporary burden of UTI-associated hospitalizations is limited.
Methods. We conducted a cross-sectional multicenter study within the National Inpatient Sample (NIS) database, a 20-percent stratified sample of discharges from US community hospitals, from 2018, to explore characteristics of patients discharged with a UTI diagnosis. We divided UTI into mutually exclusive categories of complicated (cUTI), uncomplicated (uUTI), and catheter-associated (CAUTI). We applied survey methods to develop national estimates.
Results. Among 2,837,385 discharges with a UTI code, 77.9% were uUTI, 17.6% cUTI, and 4.4% CAUTI. Compared to patients with uUTI (mean age 69.0 years), those with CAUTI and cUTI were older (70.1 and 69.7 years), but had same comorbidity burden (mean Charlson 4.3) as cUTI (4.3) and lower than CAUTI (4.6). Compared to other geographic regions, the Northeast had the lowest proportion of uUTI (74.6%) and highest of cUTI (20.8%) while the South had highest uUTI (80.2%) and lowest cUTI (15.7%). Over 60% of all UTI, regardless of type, were in large, and nearly ½ in urban teaching, institutions, and >80% came through the emergency department. Antimicrobial resistance codes were infrequent, but extended spectrum beta-lactamase organisms were more common in CAUTI (2.7%) and cUTI (2.1%) than in uUTI (1.6%). Among the 83.0% of discharges whose UTI was a secondary diagnosis, sepsis was the most common principal diagnosis, ranging from 17.7% in uUTI to 22.3% in cUTI. Although relatively low across the board, hospital mortality was lowest in cUTI (2.8%) and highest in uUTI (3.9%). Discharges to a chronic care facility were most common in CAUTI (46.7%) and least common in cUTI (33.3%).
Conclusion. There are nearly 3 million hospital admissions with a UTI, comprising fully 8% of all annual admissions in the US. Though most are considered uncomplicated, there are few differences in characteristics or outcomes across the categories.
Disclosures Background. Understanding outpatient antibiotic prescribing practices for urinary tract infections (UTIs) is vital in guiding future stewardship initiatives. Focusing on fluoroquinolones (FQs) is of value as FQs are commonly prescribed, but not recommended as first line therapy by the Infectious Diseases Society of America (IDSA) cystitis treatment guidelines and are also associated with multiple adverse effects. Boxed warnings state FQs should be reserved for patients with no alternative treatment options, due to risk of aortic dissection, C. difficile infection, antimicrobial resistance as well as tendon, joint, muscle, and nervous system damage.
Methods. This descriptive study assessed rates of guideline concordant empiric FQ prescribing from March 1 to June 30, 2019. Adult women prescribed an oral FQ for acute uncomplicated cystitis at a primary care clinic were included. Men, pregnant or breastfeeding women, and patients with pyelonephritis, urologic abnormality, or antibiotic use in the past 30 days were excluded. The primary outcome was the incidence of IDSA guideline concordance among FQs empirically prescribed. Guideline concordant empiric FQ therapy was defined as correct drug, dose, duration and frequency per IDSA guidelines when no first line drug is indicated due to allergy, adverse effect, previous treatment failure or most recent previous urine culture showing bacterial resistance. Secondary outcomes were mean dose (mg), mean duration (days) and incidence of adverse effects.
Results. Of 95 FQ prescriptions included, none met the primary outcome definition. Rates of guideline concordance for each component of the primary outcome definition were 6% for drug selection, 38% for dose, 37% for duration, and 99% for frequency. Mean daily doses exceeded guideline recommended doses by 62% and 100% for ciprofloxacin and levofloxacin, respectively. Mean duration was 5 days, 66% longer than 3 days as recommended by IDSA guidelines. Of 66 patients with documented follow up within 30 days, 3 (5%) experienced an adverse effect, and none developed C. difficile infection.
Conclusion. Current outpatient FQ prescribing for acute uncomplicated cystitis does not align with IDSA guidelines. Multifaceted antimicrobial stewardship initiatives are required to improve appropriate FQ use.
Disclosures. All Authors: No reported disclosures Table 1. High-risk cohorts identified in the study Results. IA/SO AB RX was highest in the elderly cohort (94.3%, likely influenced by renal impairment/no NFT RX in this group) and > 90% in other cohorts; AP&OP AB RX was highest in the postmenopausal cohort (9.0%). IA/SO AB RX in all cohorts was associated with significantly higher uUTI-related HRU (outpatient visits and pharmacy