1438. Prevalence and Risk Factors for Extended Spectrum Betalactamases Among Hospitalized Patients with Community Acquired Pyelonephritis in Colombia

Abstract Background Urinary tract infections (UTI) are the most frequent bacterial infection in hospitalized patients. Extented spectrum betalactamases (ESBL) producing bacteria causing UTI have become more prevalent. Escherichia coli (E. coli) is the most frequent ESBL producing bacteria isolated in UTI. This drug resistant organisms are associated with poorer outcomes for patients. In low income countries, approaching to and treating ESBL E. coli, represent a major challenge for health care centers. Methods A retrospective cohort of adult patients with community acquired pyelonephritis caused by Escherichia coli was identified in a tertiary hospital in Colombia. Susceptibility was performed with Vitek (BioMerieux, France); extended spectrum beta lactamase (ESBL) production was defined phenotypically. Inclusion criteria were adult patients hospitalized with a positive urine culture for E. coli. Demographic and clinical characteristics were searched in electronic records. Risk factors associated with ESBL production were identified by using a multivariate logistic regression analysis. Results During 7 years 817 patients with pyelonephritis caused by E. coli were identified. 79 (9.7%) of them were caused by ESBL producers. Women were 66% and 408 (74.8% of them) had menopause. Mean age was 64.2 years (standard deviation of 19.1). Of the cohort, 481 (561.1%) had at least some comorbidity and was frequent to find diabetes (18.5%), immunosuppression due to oncologic disease or medications (18.4%), urolithiasis or previous surgical procedures (17%). After logistic regression, risk factors identified to predict ESBL production, were: being a man (aOR 5.4, 2.1-18.2), a woman with menopause (aOR 2.9, 1.3 -9.9), and the Charlson score (aOR 0.83, 0.73 – 0.96). Previous antibiotic use was not related to ESBL infection. Conclusion In this relatively large cohort of patients with pyelonephritis caused by E. coli, ESBL production risk factors were not clearly identified other than sex and menopause. Curiously, Charlson score predicted a lower risk of resistance. Other factors (food consumptions and others) might be driving the resistance in the community in E. coli. Disclosures Jorge Cortes, MD, Pfizer (Research Grant or Support)

Background. Complicated urinary tract infections (cUTI) are one of the most common bacterial infections and represent substantial burden to the health care system. Here, we examine the epidemiology and treatment patterns associated with cUTI in a large US database containing longitudinal inpatient (IP) and outpatient (OP) patient-level data.
Methods. We conducted a retrospective cohort study of adult patients in the IBM MarketScan® Commercial or Medicare Supplemental Databases with at least 1 IP or non-diagnostic OP claim with a diagnosis for cUTI between January 1, 2017 and June 30, 2019. Patients meeting the following criteria were included for analysis: (1) ≥18 years of age on the index date, (2) ≥6 months of continuous enrollment (CE) with medical and pharmacy benefits prior to the index date, (3) ≥12 months of CE following the index date or evidence of death, and (4) no evidence of a prior cUTI during the 6-month baseline period. Demographics and clinical characteristics were quantified. Patients were classified as IP if they were hospitalized during 30-day post index date; remaining patients were classified as OP. Antibiotics received in the OP setting in the 12-months post index date were examined.

Conclusion.
Regardless of index treatment setting, approximately 40% of all cUTI patients required ≥4 antibiotic therapy and almost half with receive an IV antibiotic in the outpatient setting in the 12-months post index date.
Disclosures. Thomas Lodise, Jr., PharmD, PhD, Astra-Zeneca Background. Many studies have been conducted worldwide to estimate Herpes Zoster (HZ) incidence rates and temporal trends. We systematically reviewed and synthesized studies of HZ incidence rates in the general population using meta-analysis models.
Methods. A random-effects meta-analysis was conducted to estimate HZ incidence from a published worldwide systematic literature review (SLR) including only individuals aged 50 years and older. Meta-regression was used to explore if variability in incidence rates could be explained by a combination of study-specific characteristics in the base model: age, gender, continent and year of data collection. The impact of adding additional covariates: case detection, case definition, study design, incidence type, patient type and latitude to the base model was also assessed.
Results. 65 out of 69 studies from the SLR, were included in the analysis: 27 from Europe, 20 from North America, 11 from Asia and 7 from Oceania. There was much variability in study methodology and outcomes. Heterogeneity of incidence rates was greatest across studies conducted in Asia. Meta-analysis results showed that: incidence increased with age; was lower in males compared to females; was lower in Europe and North America compared to Asia and Oceania; and increased from the period prior to 2003 to the period after 2003. The final meta-regression model included continent, year of data collection, gender, age, cubic and quadratic terms for age, as well as an age x gender interaction term. The age x gender interaction suggests that the difference in incidence between males and females is greater in younger ages (e.g. 50-59), whereas in older age groups (e.g. 80+) incidence rates are similar between males and females. None of the additional covariates contributed significantly to the model. It was estimated that 15.5 million HZ cases occurred in 2020 worldwide in individuals aged 50 years and older, which in the absence of vaccination, is projected to increase to 19.8 million by 2030.
Conclusion. The model allows for trends in incidence data to be explored based on influential covariates. Incidence rates were shown to vary by age, gender, continent, and over time.