1458. Burden of Illness in Patients with Urinary Tract Infections With or Without Bacteremia Caused by Carbapenem-Resistant Gram-Negative Pathogens in US Hospitals (2014 to 2018)

Abstract

BackgroundUrinary tract infections (UTIs) are the most frequent infections caused by Gram-negative (GNB) bacteria in the USA. We aimed to characterize the burden of UTIs caused by carbapenem-resistant (CR) or -susceptible (CS) GNB in hospitalized patients with or without bacteremia.MethodsData from the Premier Healthcare Database of adult patients hospitalized between January 1, 2014 and June 30, 2018 with UTIs (defined as positive urine culture and receipt of GN antibiotics within −2 to 3 days of the index urine culture) with bacteremia (defined as positive blood culture with the same pathogen from the urine) or without bacteremia caused by CR or CS GNB were analyzed retrospectively. Stenotrophomonas maltophilia were presumed to be CR but rarely tested. Patient characteristics and outcomes (mortality, different types of length of hospital stay [LOS], ICU admission, discharge status and hospitalization charges) were compared.ResultsA total of 46,076 UTI patients were included. 11,212 patients with bacteremia were significantly more likely to have UTI index culture on the day of the admission vs. 34,864 patients without bacteremia (82.0% vs. 65.9%, P < 0.001, respectively). The same results were seen when stratified by CR status (CR: 68.59% vs. 61.23%, P < 0.047; CS: 82.29% vs. 66.19%, P < 0.001, respectively). UTI patients with bacteremia were also more likely to have a positive blood culture for the same pathogen on the same day of index urine culture (CR: 85.86%; CS: 95.45%). Pseudomonas aeruginosa was the most frequent CR pathogen (50.03%), followed by K. pneumoniae (14.28%) and Stenotrophomonas maltophilia (10.76%), and CR patients with bacteremia were more likely to die in the hospital and less likely to be discharged home than other groups. They also had longer median overall and infection-associated LOS, were more likely to be admitted to the ICU and had higher hospitalization charges (table).ConclusionUTIs complicated by bacteremia exacerbates the burden of illness in patients hospitalized with UTIs, increasing mortality, LOS, and hospitalization charges. The presence of CR pathogens further exacerbates this burden. Disclosures All authors: No reported disclosures.