Abstract
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 were 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 = 1,763) were ESBL +, 31.3% (n = 5,017) were FQ NS and 8.9% (n = 1,433) 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. CONCLUSION: About one 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. 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.