Recurrent Urinary Tract Infections Research Articles

Efficacy of Electrofulguration for Women with recurrent urinary tract infection on quality of life and sexual function.

Introduction The primary objective of the study was to assess the impact of EF in women with rUTI on quality of life and sexual health. Methods This prospective observational clinical study included 152 patients women who underwent EF because of rUTI and were followed for a minimum of 18 months. The SF-12 questionnaire and the Female Sexual Function Index (FSFI) are used to evaluate quality of life and sexual dysfunction. The Patient Global Impression of Improvement (PGI-I) scale was assessed to evaluate subjective cure. Endoscopic success was defined as complete resolution of previous lesions without new lesions seen during cystoscopy Clinical success was defined as no urinary tract infections at the last follow-up; improvement as 1-2 treated infections/year; and failure as ≥3 treated infections/year. Chi-square test, Wilcoxon, and Student's paired t-test were used. Results Seventy patients (52.6%) were defined as cured at least a 1-year follow-up. The subjective cure rate was 71.4% (N = 95) according to PGI-I scores. Women had significantly higher average FSFI scores (P=0.001) in the one-year postoperative assessment. Overall, pathological mental health and physical health scores were significantly higher after the intervention (P=0.00). Thirty-one (23.3%) patients improved clinically with <3 infections per year, and 32 (24.1%) patients failed with >3 infections per year. A total of 97 (74.4%) patients had endoscopic resolution postoperative evaluation. Conclusion EF resulted in clinical cure and improvement in the large majority of the patients. A significant proportion of the patients demonstrated enhanced sexual function and quality of life.

Stones Unearthed: A Journey to Wellness with Ayurvedic Urolithiasis (Mutraashmasri) Management

Urolithiasis is a prevalent clinical condition impacting over 10% of the population in industrialized nations, causing symptoms like intense renal pain, lower abdominal discomfort, painful urination, and cloudy or foul-smelling urine. Despite various medical treatments, managing renal calculi proves financially burdensome, with recurrent stone formation posing a persistent challenge. Ayurvedic diagnostics, including assessing individual constitution (Prakriti), urine (Mutra), and pulse (Nadi), lay the foundation for understanding Mutraashmari causes. Renal calculi are closely linked to Agni (digestive fire) imbalances and the accumulation of Ama (toxins). Ayurvedic interventions aim to enhance Agni, eliminate Ama, and restore Doshic equilibrium, encompassing dietary changes, lifestyle adjustments, and herbal formulations. This case report presents a 45-year-old male with renal calculi (7.7mm at ureteropelvic junction and 7.4mm at ureter-bladder junction) experiencing severe pain, backache, hematuria, and recurrent urinary tract infections. After ineffective allopathic treatment, the patient sought Ayurvedic care, achieving complete urolithiasis dissolution within one month.

Outpatient flexible cystoscopy in urogynaecology: a tertiary hospital's experience.

This study is a retrospective evaluation of a new outpatient flexible cystoscopy service in a tertiary care hospital in Dublin, Ireland. This is a retrospective observational study. This study has been held at the Department of Gynaecology, Rotunda Hospital, Dublin. This included all women who underwent outpatient flexible cystoscopy in Rotunda Hospital between May 2023 to October 2024. Retrospective data collection included patient demographics, indications for referrals, cystoscopic findings, post-procedural complications, and cost-benefit analysis. A total of 77 women underwent flexible cystoscopy. The mean age was 52.5years ranging from 20 to 85years. Flexible cystoscopy was successfully completed in all patients, and there were no post procedure complications. The most common indications were as follows: recurrent urinary tract infections (36%) and bladder pain syndrome (36%), followed by overactive bladder symptoms (14%). Fifty-five percent of patients had no abnormal findings. The most common abnormality found was trabeculations (39%), followed by glomerulations (9%). A cost-benefit analysis showed an approximate saving of € 1211 per patient leading to a saving of over € 93,000 over a period of 18months. Outpatient cystoscopy is a low-risk, feasible, well tolerated, and safe diagnostic procedure, with no post-procedure complications observed in this study. It avoids the risks of general anaesthesia and is associated with lower procedural costs.

Response to Letter to the editor on:” Extended treatment-dose antibiotic therapy versus low-dose prophylaxis for the management of recurrent uncomplicated urinary tract infections in peri- and postmenopausal women”

Response to Letter to the editor on:” Extended treatment-dose antibiotic therapy versus low-dose prophylaxis for the management of recurrent uncomplicated urinary tract infections in peri- and postmenopausal women”

Recurrent Urinary Tract Infections with Multidrug Resistance Bacteria in a 50-Year-Old Man Living Donor Kidney Transplant Recipient with Adult Polycystic Kidney Disease: The Issues for Native Nephrectomy

A 50-year-old man with polycystic kidney disease had living donor kidney transplant. Simultaneous right sided native nephrectomy was done to give a space for graft kidney. He developed three episodes of urinary tract infections within 2 months after transplant; one episode was associated with septic shock and rise serum creatinine. Two urine culture results taken two weeks apart revealed Klbsiella pneumoniae. It was sensitive to amikacin and resistant to nearly all antibiotics including quinolone, imepenum, colistin, cefepime and tigecycline. The remaining left native kidney was removed as the cysts were nidus to hide bacteria; no more recurrence after second nephrectomy.

Renal scarring in children with febrile urinary tract infection.

The authors aim to evaluate characteristics of children with fUTI and results of renal bladder ultrasonography (RBUS) and late dimercaptosuccinicacid (DMSA) scan. This study is designed as retrospective analysis of RBUS and DMSA reports of children with fUTI. Age, gender, number of fUTI, presence of constipation and vesicouretheral reflux (VUR) were recorded. The study included 160 children with fUTI with a median age of 7 years (6 months 18 years old). The majority of children in this study were girls (86.3 %), older than 60 months (73.1 %) and had one episode of fUTI. The recurrence rates of UTI were similar in both girls and boys. The total rate of constipation was 21.9 %. The rate of renal scarring on DMSA was 16.9 %. The rates of renal scarring were similar at three age groups and both genders. The rate of renal scarring was higher in children with recurrent UTI compared to those with one episode of fUTI (26.4 % and 12.5 %, respectively; p = 0.04). The rate of constipation in children with renal scarring and normal DMSA was similar (p = 0.07). The rate of trabeculation and thick bladder wall was higher in children with renal scarring at DMSA than children with no renal scarring (p = 0.03). The present study demonstrated that 16.9 % of children with fUTI had renal scarring. The rates of renal scarring were similar in both gender and age groups. Children with recurrent UTI and abnormal bladder results at RBUS had higher rates of renal scarring.

Mechanisms of uropathogenic E. coli mucosal association in the gastrointestinal tract.

Urinary tract infections (UTIs) are highly recurrent and frequently caused by Uropathogenic Escherichia coli (UPEC) strains that can be found in patient intestines. Seeding of the urinary tract from this intestinal reservoir likely contributes to UTI recurrence (rUTI) rates. Thus, understanding the factors that promote UPEC intestinal colonization is of critical importance to designing therapeutics to reduce rUTI incidence. Although E. coli is found in high abundance in large intestine mucus, little is known about how it is able to maintain residence in this continuously secreted hydrogel. We discovered that the FimH adhesin of type 1 pili (T1P) bound throughout the secreted mucus layers of the colon and to epithelial cells in mouse and human samples. Disruption of T1P led to reduced association with colon mucus. Notably, this mutant up-regulated flagellar production and infiltrated the protective inner mucus layer of the colon. This could explain how UPEC resists being washed off by the continuously secreted mucus layers of the colon.

P-1573. Methenamine Prophylaxis for Recurrent Urinary Tract Infections

Abstract Background Urinary tract infections (UTIs) are the most common outpatient infection in the United States. Between 50%-60% of women will experience at least one UTI during their life and women over 65 experience UTIs at twice the rate of women overall. Recurrent UTIs are often managed with antimicrobials in clinical practice, which decreases their effectiveness as antimicrobial resistance increases. Methenamine is an antiseptic compound that is converted to formaldehyde under acidic conditions and can prophylactically reduce recurrent UTIs but is seldom used in clinical practice. Our objective is to determine the effectiveness of methenamine for prevention of recurrent UTIs at a large academic medical center in Michigan. Methods In this retrospective observational study, 425 patients with recurrent UTIs who were prescribed methenamine for UTI prophylaxis were screened, and 134 who had at least 12 months of pre- and post-methenamine data were included in this study. Patient demographics, medications, UTI history, and kidney function were analyzed. Results 106 female and 28 male patients with a median age of 80 had 385 UTIs in the year before methenamine prophylaxis and 173 UTIs in the year after methenamine prophylaxis respectively. Methenamine significantly decreased recurrent UTIs across all age groups in both male and female patients. Male patients had an average of 3.4 UTIs in the year prior to methenamine and 1.7 UTIs in the year after methenamine prophylaxis (SD±1.37, p&amp;lt; 0.0001), female patients had an average of 2.7 UTIs in the year prior to methenamine prophylaxis and 1.2 UTIs in the year after methenamine prophylaxis (SD±1.7, p&amp;lt; 0.0001). Methenamine was effective in decreasing recurrent UTIs in patients with chronic kidney disease stages 2, 3a, and 3b. Despite not being indicated for patients with chronic urinary catheters, methenamine decreased UTI recurrence in patients with chronic urinary catheters from 3.5 UTIs in the year before methenamine prophylaxis to 2.1 UTIs in the year after methenamine prophylaxis (SD±1.9, p=0.0004). Conclusion Methenamine can serve as a useful prophylactic agent in patients with recurrent UTIs, across all age groups, in patients with stage 2, 3a, and 3b chronic kidney disease, and unexpectedly in patients with chronic urinary catheters. Disclosures Matthew Sims, MD, PhD, Adaptive Phage Therapeutics: Principal Investigator Clinical Trial|Applied Biocode: Advisor/Consultant|Applied Biocode: Principal Investigator Clinical Trial|Astra Zeneca: Sub-investigator Clinical Trial|Biotest AG: Principal Investigator Clinical Trial|ContraFect: Principal Investigator Clinical Trial|Dompe: Sub-investigator Clinical Trial|Janssen: Principal Investigator Clinical Trial|Leonard-Meron Biosciences: Principal Investigator Clinical Trial|Novozyme: Principal Investigator Clinical Trial|OpGen: Advisor/Consultant|OpGen: Principal Investigator Clinical Trial|Pfizer: Principal Investigator Clinical Trial|Prenosis: Advisor/Consultant|Prenosis: Principal Investigator Clinical Trial|QIAGEN: Principal Investigator Clinical Trial|Seres: Advisor/Consultant|Seres: Principal Investigator Clinical Trial|Venatorx: Advisor/Consultant

P-1551. Prevalence and Risk Factors of Multidrug Resistance in Patients with Complicated Urinary Tract Infections (cUTIs) and all UTIs: A Systematic Literature Review

Abstract Background Gram-negative pathogens frequently implicated in complicated urinary tract infections (cUTIs) include Enterobacterales (Escherichia coli [E. coli], Klebsiella and Proteus species). These can harbor multidrug resistance mechanisms such as extended-spectrum β-lactamases (ESBLs) limiting the effectiveness of first-line antibiotics. We studied the prevalence of, and risk factors for, multidrug resistant (MDR) infections among patients with cUTI and for all UTIs. Methods Systematic searches were conducted in MEDLINE and Embase, supplemented by conference, bibliography, and keyword-based searches (2013–2024). All US studies reporting data on antimicrobial resistance (AMR) in either confirmed or presumed cUTI and UTI involving bacterial isolates of interest were included (Table 1). A data extraction template was developed a priori and calibrated before use. AMR results were summarized for cUTI and UTIs (uncomplicated UTI [uUTI], mixed uUTI/cUTI, cUTI), as some studies reported a mixture of cUTI and uUTI, or UTI severity not specified. Results We included 44 US primary studies in UTI (13 cUTI, 31 all UTIs), with results summarized for all studies identified for cUTI and all UTIs. The median age range across studies was 3.8–69.0 years (Table 2). Most patients were White/Caucasian (median 53.2%); MDR ≥ 3 was the most commonly reported AMR phenotype. Among cUTI studies, MDR ≥ 3 was seen in 9.9% of E. coli and 10.1% of Klebsiella spp.; for all UTIs studies, it was 6.9% and 4.6%, respectively. The MDR ≥ 3 proportion for Enterobacterales was 12.5% and 11.3% among cUTI/all UTIs, respectively (Table 3). Similar estimates were observed when assessing AMR to individual drug classes with a higher proportion of AMR observed among cUTI isolates vs isolates from all UTIs (Table 4). Within individual studies, resistance rates were generally higher in hospital-acquired vs community-acquired infections, in recurrent vs non-recurrent UTI, in catheter-associated vs non-catheter-associated UTI, in cUTI vs uUTI, and in pyelonephritis vs cystitis. AMR was higher among UTI isolates from men and older patients. Conclusion cUTIs had a higher prevalence of MDR uropathogens vs all UTIs. AMR prevalence in cUTI was higher among men, older patients, and patients with recurrent UTI. Funding: GSK study 221807 Disclosures Fanny S. Mitrani-Gold, MPH, GSK: Employee|GSK: Stocks/Bonds (Public Company) Myriam Drysdale, PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Saifuddin Kharawala, DPM, Bridge Medical Consulting Ltd.: Employee of Bridge Medical Consulting Ltd., who received funding from GSK to complete this study|GSK India: Previous employee Pooja Malhotra, MPharm, Bridge Medical Consulting Ltd.: Employee of Bridge Medical Consulting Ltd., who received funding from GSK to complete this study Alanna Farrell-Foster, GSK: Employee|GSK: Stocks/Bonds (Public Company) Jeffrey J. Ellis, PharmD, MS, GSK: Employee|GSK: Stocks/Bonds (Public Company) Emily Lloyd, MSc, GSK: Employee|GSK: Stocks/Bonds (Public Company)

P-1567. Urinary Tract Infections Broadly Impact Quality of Life Among People with Neurogenic Bladder

Abstract Background Although recurrent urinary tract infections (UTI) are common complications in people with neurogenic bladder (NB), limited data exist on the specific ways UTIs impact quality of life (QoL) in this population. These data could help tailor patient-centered approaches to improving UTI care in people with NB. UTI Impacts on Feelings and Emotional Well-being Methods We mailed surveys to 289 Veterans with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis, or Parkinson’s Disease who had at least one in-person encounter associated with a UTI diagnosis at four Veterans Affairs Medical Centers between May 2022-May 2023. The survey was adapted from existing instruments and previously collected qualitative data. An expert panel refined the survey using a Delphi process, followed by cognitive interviews with Veterans with NB (n=8). The QoL section contained 15 survey items with 5-point Likert scale response options (higher values = greater QoL impact) which assessed how UTIs affect feelings, emotional well-being, daily activities, sex life, and social participation. To account for missing and ‘not applicable’ responses, scaled QoL scores were calculated by multiplying total survey score by the ratio of 15 / the number of items answered. Descriptive statistics summarized respondent characteristics and QoL scores. UTI Impacts on Activities Results Respondents (n=71) were older [median age (range) = 72 (36-88)], male (92%), and white (79%). Most had SCI/D (77%) and used urinary catheters (77%). 85% of respondents answered at least 13 items. Other than feeling often or always frustrated or bothered by UTIs (n=22; 31%), most respondents did not report that UTIs frequently impact feelings or emotional well-being (Figure 1). In contrast, UTIs had a strong impact on activities (Figure 2), with many respondents agreeing their UTIs have impacted diet (n=35; 50%), travel (n=37; 53%), and sex life (n=24/40 responses; 60%). Mean [standard deviation (SD)] scaled total QoL score was 40.8 (15.3) out of a possible maximum score of 75, with a mean (SD) per item score of 2.7 (1.0) out of 5. Conclusion People with NB experience substantial QoL impacts from UTIs, particularly on their daily and social activities. Patient-centered interventions focused on reducing negative impacts on QoL from UTIs are urgently needed for this population. Disclosures All Authors: No reported disclosures

P-2216. The characteristics of human microbiome and fecal resistome in patients with recurrent urinary tract infection

Abstract Background While uropathogenic E. coli (UPEC) is recognized as a primary causative agent of recurrent urinary tract infections (rUTIs), the factors contributing to its colonization remain poorly understood. The study aims to elucidate the characteristics of the human microbiome in patients with rUTI. Bacterial proportion in genus level: PCoA (distance: Bray-Curtis dissimilarity) Methods A prospective study was conducted at a tertiary-care hospital (850 beds) in Korea from August 2021 to November 2023. All female adults (aged ≥19 years) hospitalized with upper UTI were screened daily for inclusion if they met the following criteria: i) E. coli was confirmed as causative pathogen, ii) no structural abnormalities in the urinary tract were present, and iii) patients agreed to participate in the study. Individuals diagnosed with UTI after 48 hours of admission or those transferred from other hospitals were excluded. Fresh stool samples were collected after 28 days of completion of antibiotic treatment, and whole metagenome sequences were obtained using Illumina HiSeq sequencing. Patients with a history of UTI within the past year were defined as having rUTI. We analyzed the characteristics of the microbiome in rUTI patients compared with those in non-rUTI patients as well as the healthy population (n=214), which had already been analyzed in other studies. Bacterial proportion in genus level: Top 7 genera in each dataset Results A total of 51 cases were initially enrolled, but three samples failed to pass the quality check. Consequently, 48 cases (including 13 with rUTI) were included in the final analysis. Among UTI patients, the dominant genera observed were Blautia (7.7%), Bacteroides (7.6%), Faecalibacterium (4.3%), and Bifidobacterium (3.5%). Principal coordinates analysis (PCoA) revealed that the overall distribution of the microbiome in rUTI patients exhibited a distinct pattern compared to non-rUTI patients. Additionally, the proportion of Faecalibacterium and Prevotella was lower in rUTI patients compared to non-rUTI patients and the healthy population. Regarding antibiotic resistance genes (ARGs), rUTI patients showed a lower proportion of ACI and CatS compared to non-rUTI patients and the healthy population. ARG abundance (RPKM) in gene family level: PCoA (distance: Bray-Curtis dissimilarity) Conclusion Some differences observed in the distribution of microbiome and resistome between patients with rUTI and non-rUTI or healthy population. ARG abundance (RPKM) in gene family level Disclosures All Authors: No reported disclosures

P-293. Epidemiology of Extraintestinal Invasive Escherichia coli Infections in 9 U.S. Communities, 2023

Abstract Background Extraintestinal invasive Escherichia coli (iEC) is a leading cause of sepsis and hospitalization, but US surveillance for iEC has been frequently limited to multidrug-resistant (MDR) strains and hospitalized cohorts. To describe the incidence and clinical characteristics of MDR and non-MDR iEC and inform prevention and vaccine development, CDC’s Emerging Infections Program piloted active population- and laboratory-based surveillance in 9 US sites. Methods Among surveillance area residents ( &amp;gt; 7.3 million people), an incident iEC case was the first isolation of E. coli in a 30-day period from a normally sterile body site (June–August 2023). Demographic, clinical, and laboratory characteristics were assessed by chart review. Annual incidence rates by surveillance area were estimated by multiplying total case number by 4 and used 2022 US census data for denominators. Results Among 1345 iEC cases in 1334 patients, E. coli was isolated from blood in 1223 (90.9%) and from other sterile sites in 122 (9.1%). Median age was 68 years (IQR 55–79); 766 (57.0%) were female. Overall estimated annual crude incidence rate was 74.5 cases per 100,000 population (range by area 51.3–95.6) and was higher for persons aged ≥ 60 vs &amp;lt; 60 years (228.5 vs 30.4). Cases were most commonly community associated (554, 41.2%) or health care associated community onset (633, 47.1%). Most case-patients (1194, 88.8%) had comorbidities; diabetes was most common (457, 34.0%). Of all cases, 762 (56.7%) were associated with urinary tract infection (UTI), 192 (14.3%) with recurrent UTI, and 213 (15.8%) had a urinary catheter in the 2 days before collection of the iEC-defining specimen. Among 1160 hospitalized cases, median length of stay was 5 days (IQR 3–9), 103 (8.9%) died. Of reported E. coli susceptibilities, 144/500 (28.8%) were fluoroquinolone-resistant, 185/1345 (13.8%) were extended-spectrum β-lactamase producing, and 3/1345 (0.2%) carbapenem-resistant. Conclusion The burden of iEC disease was substantial compared to other invasive pathogens and primarily affected older adults. Over half of infections accompanied UTIs and involved hospitalization. Continued surveillance to monitor trends over time, inform vaccine development and evaluation, and advise prevention efforts are needed. Disclosures All Authors: No reported disclosures

P-1570. D-mannose for Prevention of Recurrent Urinary Tract Infection in Adult Women: An Updated Systematic Review and Meta-analysis

Abstract Background Urinary tract infections (UTIs) are prevalent, especially among women as approximately 50% of all healthy women will encounter at least one episode of UTI during their lifetime. An estimated 25%-35% of them will experience a recurrence within the following year. Prolonged antibiotic therapy for prophylaxis of UTI poses the risk of antimicrobial resistance, alteration of normal flora, and high costs to the patient. D-mannose, a polysaccharide may reduce UTI by preventing the adherence of bacteria to uroepithelium by binding to the type1 pili and saturating the adhesin FimH. D-mannose is commonly marketed for urinary tract health and is touted to contribute to better antimicrobial management within primary care settings. We performed an updated meta-analysis comparing prophylaxis with D-mannose versus placebo or no treatment for prevention of recurrent UTI in adult women. Methods We systematically searched PubMed, Scopus, and Cochrane Central databases for trials comparing D-mannose versus placebo or no treatment for UTI prophylaxis in adult women. Outcomes of interest included one or more episodes of UTI within 6 months of randomization and adverse events. Statistical analysis was performed using R software. Heterogeneity was assessed using I2 statistics. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline (Figure 1). Risk estimation for recurrent UTI Results The systematic review identified three randomized controlled trials including 846 participants. Prophylaxis with D-mannose was given to 428 (50.59%) participants. The risk of recurrent UTI within 6 months of randomization (RR 0.75; 95%CI 0.46-1.23; p=0.259; I2=52%) showed no significant difference between the groups (Figure 2). Adverse events (RR 0.81; 95%CI 0.09-6.91; p=0.847; I2=94%) were also similar between the groups (Figure 3). Risk estimation for adverse events Conclusion In contrast to a previous meta-analysis, our study found that prophylaxis with D-mannose did not reduce the risk of recurrent UTIs in adult women. Adverse events were also comparable between the groups. Disclosures All Authors: No reported disclosures

P-1359. Epidemiology of Carbapenem Resistant Enterobacterales in Monroe County, NY 2016-2023

Abstract Background Carbapenem-resistant Enterobacterales (CRE) infections pose an urgent threat due to the limited treatment options and the potential for resistance spread among carbapenemase producing (CP) CRE strains. Methods We conducted active population-based surveillance for select Enterobacterales species resistant to ≥ 1 carbapenem from a normally sterile site or urine in Monroe County, NY as part of the CDC Emerging Infections Program. Epidemiologic data were collected through medical record abstraction. Cases were classified as hospital onset (HO) if they occurred 72 hours after hospital admission, healthcare-associated community-onset (HACO) cases if they had a prior healthcare risk factor, or community associated (CA). CRE isolates were tested at CDC or Northeast Antimicrobial Resistance Laboratory Network. Results From 2016-2023, CRE incidence increased 135% from 8.8 to 20.7 per 100,000 population with 895 incident CRE cases identified in 745 unique patients. Patients were mostly non-Hispanic (89.2%), White (82.1%) and female (67.8%). Urine was the most common source (92.7%). 58.1% of cases were HACO, 28.6% CA and 13.2% HO. Urinary tract abnormalities (58%) and recurrent UTIs (32.6%) were prevalent. Prior healthcare exposures including hospitalization (57.2%), surgery (28.5%), and skilled nursing home stay (22.1%) were common in healthcare associated cases. Few (2%) had a history of international travel. Hospital onset cases were more likely to have CRE isolated from blood (21.2%), require ICU admission (33.1%), and die within 90 days of their infection (34.4%). 272 CRE isolates underwent carbapenemase testing, of those, 78 (28.7%) were CP-CRE: 71.1% blaKPC, 19.3% blaNDM, and 9.6% blaOXA48 with documented emergence of blaNDM CP in 2021. Only 6 (9.5%) of CA isolates were CP-CRE compared to 18 (40%) of HO, and 54 (33.1%) of HACO. Conclusion The incidence of CRE in Monroe County, NY has significantly increased since 2016 with documented emergence of blaNDM-producing strains. The high proportion of healthcare-associated CRE cases, particularly CP-CRE, underscores the need for enhanced infection control measures and ongoing surveillance. Further investigation is needed into the risk of CP-CRE in CA cases. Disclosures All Authors: No reported disclosures

P-1492. Patient Characteristics Associated with Extended-Spectrum Beta-Lactamase-Producing Uropathogens: Pooled Results from Two Phase 3 Clinical Trials of Gepotidacin for the Treatment of Uncomplicated Urinary Tract Infection

Abstract Background Uncomplicated urinary tract infections (uUTIs), usually caused by Escherichia coli (E. coli), are common infections, affecting ∼50% of women globally in their lifetime. The presence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales limits effective oral treatment options for uUTI. Using uropathogen susceptibility data from two randomized controlled trials (RCTs) in uUTI, we compared baseline characteristics of patients with ESBL-positive (ESBL+) versus non-ESBL uropathogens. Methods EAGLE-2 (NCT04020341) and -3 (NCT04187144) were Phase 3, double-blind RCTs of oral gepotidacin versus nitrofurantoin for uUTI. Patients were female, aged ≥ 12 years, with ≥ 2 uUTI symptoms and urinary nitrite and/or pyuria. Pretreatment clean-catch midstream urine samples were collected for quantitative culture and susceptibility. In this post-hoc exploratory analysis, patients in the intent-to-treat population (all randomized patients), with ≥ 103 colony-forming units/mL E. coli, Klebsiella pneumoniae, Klebsiella oxytoca, and/or Proteus mirabilis, were grouped by ESBL status of their uropathogen(s), per Clinical and Laboratory Standards Institute guidelines. Results Overall, 1423 patients with culture-confirmed uUTI were included in the analysis; 203 (14%) had an ESBL+ uropathogen. Baseline characteristics by ESBL status are presented in the Table, and ESBL+ uropathogen prevalence by subgroup in the Figure. Generally, versus patients with non-ESBL uropathogens, more patients with ESBL+ uropathogens were: of Asian, American Indian or Alaska Native race (though sample sizes were small); of Hispanic/Latinx ethnicity; had milder symptoms; aged &amp;gt; 50 years with history of recurrent urinary tract infection. Conclusion This post-hoc analysis of contemporary uUTI trial data describes baseline characteristics for patients with ESBL+ versus non-ESBL uropathogens. These data could inform future studies to identify clinical risk factors linked to ESBL+ uropathogens and improve patient outcomes. Funding EAGLE-2 was funded in part by GSK and in part with Federal funds from the US Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority (HHSO100201300011C). EAGLE-3 was funded by GSK. Disclosures Jeremy Dennison, MD PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Amanda Sheets, PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Caroline R. Perry, PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Florian Wagenlehner, MD, Astellas: Advisor/Consultant|AstraZeneca: Advisor/Consultant|Bionorica: Advisor/Consultant|DFG (German Research Foundation) funded research group BARICADE (FOR5427/1-466687329): Speaker|GSK: Advisor/Consultant|GSK: Principal investigator in a GSK-sponsored study|Janssen: Advisor/Consultant|Klosterfrau: Advisor/Consultant|MIP Pharma: Advisor/Consultant|OM Pharma: Advisor/Consultant|Spero: Advisor/Consultant|VenatoRX: Advisor/Consultant Mark H. Wilcox, MD, Astra Zeneca: Advisor/Consultant|Debiopharm International S.A.: Advisor/Consultant|Debiopharm International S.A.: Grant/Research Support|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|GSK: Honoraria|Nestle: Advisor/Consultant|Paion: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Phico therapeutics: Advisor/Consultant|QPex Biopharma: Advisor/Consultant|Seres: Advisor/Consultant|Seres: Grant/Research Support|Seres: Lecture Fees|Summit: Advisor/Consultant|Summit: Grant/Research Support|The European Tissue Symposium: Advisor/Consultant|The European Tissue Symposium: Grant/Research Support|Tillotts: Advisor/Consultant|Tillotts: Grant/Research Support|Tillotts: Lecture Fees|Vedanta: Advisor/Consultant Nicole E. Scangarella-Oman, MS, GSK: Employee|GSK: Stocks/Bonds (Public Company) Deborah Butler, PharmD, GSK: Employee|GSK: Stocks/Bonds (Public Company) John Breton, MCM, GSK: Employee|GSK: Stocks/Bonds (Public Company) Helen Millns, PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Aruni Mulgirigama, MBBS, GSK: Employee|GSK: Stocks/Bonds (Public Company) Matthew Helgeson, PharmD, MBA, GSK: Employee|GSK: Stocks/Bonds (Public Company) Salim Janmohamed, MD, GSK: Employee|GSK: Stocks/Bonds (Public Company)

P-1540. Treatment Choices for Carbapenem-Resistant Enterobacterales: An Emerging Infections Network Survey

Abstract Background New antibiotics offer additional treatment options for carbapenem-resistant Enterobacterales (CRE) infections, but data are limited on healthcare provider decision making. Figure 1. Antibiotic selections for urinary tract infection case scenarios. (A) CASE 1: A 57-year-old female with a history of recurrent urinary tract infections (otherwise healthy with good renal function) presented to the hospital with urinary tract infection symptoms. A urine culture grew Klebsiella pneumoniae resistant to meropenem, ertapenem, and the preferred suggested treatment options for uncomplicated cystitis caused by Carbapenem-Resistant Enterobacterales (nitrofurantoin, trimethoprim-sulfamethoxazole, and ciprofloxacin). (B) The same patient with the same organism and susceptibility testing results as in scenario A presented with pyelonephritis. Note: All antibiotic survey options for urinary tract infection case scenarios are shown in the legend and were selected by at least one respondent. Methods We surveyed providers through the Infectious Diseases Society of America (IDSA) Emerging Infections Network (EIN) to understand the current management of CRE infections in the context of new therapeutics. Our survey included four CRE infection scenarios to ascertain antibiotic selection. Selections were classified as suggested, alternative, or not in guidance according to the 2023 IDSA Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections. Respondents were asked about barriers to use of selected antibiotics.Figure 2.Antibiotic selections for intra-abdominal infection case scenarios.(A) CASE 2: A 64-year-old intensive care unit patient with a new fever has peritonitis and an intra-abdominal abscess. Peritoneal fluid culture grows Escherichia coli resistant to meropenem and ertapenem. Blood cultures are negative and carbapenemase testing is pending. Past medical history does not indicate international travel. No respondent selected the antibiotic survey options of meropenem (extended infusion) plus amikacin or meropenem (extended infusion) plus colistin, both of which are not suggested in the guidance.(B) The lab reports that carbapenemase testing detects the presence of New Delhi metallo-beta-lactamase (NDM) for this isolate. All antibiotic survey options for this scenario are shown in the legend and were selected by at least one respondent. Results Overall, 441 (28%) of 1566 EIN members who have ever participated in surveys responded. Among these, 337 (76%) reported treating a CRE infection in the last year. Of the 104 who did not report treating a CRE infection, 93 (89%) did not continue the survey. Among scenarios for treating uncomplicated cystitis with Klebsiella pneumoniae resistant to the IDSA suggested agents (Figure 1), respondents most often chose an agent not in guidance (187, 55%), primarily oral fosfomycin (169, 49%). For pyelonephritis, most selected suggested agents aligned with IDSA expert opinion (325, 95%), mainly ceftazidime-avibactam (CAZ/AVI; 272, 79%). For treatment of a CRE intra-abdominal infection, 244 respondents (73%) chose CAZ/AVI (a suggested approach) when mechanism testing was pending. When the CRE was confirmed to be New Delhi metallo-beta-lactamase-producing, CAZ/AVI with aztreonam (a suggested approach) was favored (197, 59%) (Figure 2). When asked about barriers to use, 57% of respondents indicated there were no barriers for CAZ/AVI, compared to 27% for cefiderocol and 16% for eravacycline (Table 1). Conclusion Most clinicians selected newer antibiotics aligned with the IDSA guidance for serious CRE infections but chose an older agent not in the guidance for uncomplicated cystitis, suggesting that treatment selection is complex. The relative preference for CAZ/AVI among similar agents may reflect its longer time in use and that relatively few clinicians reported barriers such as formulary availability and lack of clinical evidence. Disclosures Philip M. Polgreen, MD, Eli Lily: Advisor/Consultant|Pfizer: Grant/Research Support

P-292. Epidemiology of Escherichia coli from Urine Sources at Three U.S. Sites, August 2023

Abstract Background Escherichia coli is the most frequent cause of urinary tract infections (UTIs) in the US, but surveillance for urinary E. coli (uEC) is often limited to multidrug-resistant strains. The CDC’s Emerging Infections Program piloted one month of active population- and laboratory-based surveillance for uEC of any phenotype in 3 U.S. sites (representing &amp;gt;3.4 million people) to better characterize its epidemiology and burden. Methods We defined an incident uEC case as the first E. coli isolated from urine in a resident of the surveillance area during August 2023. Demographic data were obtained for all incident cases. Approximately 400 cases per site were randomly selected for chart review. One-month incidence rates were generated using 2022 US census data for participating surveillance areas. Cases were classified as community-associated (CA; no healthcare risk factors); hospital-onset (HO; urine obtained ≥ 3 days after hospital admission), or healthcare-associated, community onset (HACO; urine obtained in a non-hospital setting or &amp;lt; 3 days after hospital admission with healthcare exposures in the prior year). Results Of 5241 uEC patients, 86.1% were female; median age was 60 years (IQR 37–76). The 1-month incidence rate was 151.7 per 100,000 population and greater among those aged ≥ 60 vs &amp;lt; 60 years (362.7 vs 94.0). Of 1197 patients with data from chart review, 1104 (92.2%) had cultures collected as an outpatient; 732 (61.2%) had an underlying comorbidity reported; 1113 (93.0%) had a documented UTI diagnosis; 269 (22.5%) reported recurrent UTI; and 43 (3.6%) developed E. coli bacteremia. No signs or symptoms associated with uEC were reported for 372 (31.1%) patients. In total, 287 (24%) were hospitalized within 30 days after urine culture collection; 51/287 (17.8%) had a urinary catheter in place 2 days before culture collection. Most uEC were CA (867; 72.4%), followed by HACO (325; 27.2%) and HO (3; 0.3%). Of 3289 uEC isolates with local testing results, 255 (7.8%) were extended-spectrum β-lactamase producing and 5 (&amp;lt; 1%) were carbapenem-resistant. Conclusion These findings emphasize the high burden of uEC in these communities, notably among older adults and females. Effective prevention strategies are needed to decrease uEC-associated morbidity. Disclosures All Authors: No reported disclosures

P-402. A Seven-Year Analysis of CRAB and CRE Urinary Tract Infections in Tennessee

Abstract Background Urinary tract infections (UTIs) are a prevalent health concern, affecting millions worldwide. The data collected through the Tennessee Multi-site Gram-negative Surveillance Initiative (MuGSI) was analyzed for a comparative study of UTIs caused by Carbapenem-Resistant A. baumannii complex (CRAB) and Carbapenem-Resistant Enterobacterales (CRE). We aimed to evaluate the demographics, prevalence, and clinical characteristics of patients with UTIs caused by CRAB and CRE. Methods Tennessee has participated in the Center for Disease Control and Prevention (CDC) Emerging Infections Program MuGSI project since 2014. An incident case is defined as the first CRE of E. coli, E. cloacae complex, Klebsiella species or CRAB per patient within 30 days. We analyzed CRE and CRAB incident cases of primary or recurrent UTIs reported to MuGSI during 2016–2022. Descriptive analysis and odds ratio were performed using SAS 9.4. Results From 2016–2022, 521 UTI cases were reported: 448 (86.0%) CRE and 73 (14.0%) CRAB. More males (64.4%) had CRAB infections (p&amp;lt; 0.0001); conversely, more females (68.5%) had CRE infections (p&amp;lt; 0.0001). The mean ages of patients with CRAB and CRE were 64 and 67 years, respectively. Incidence of CRAB was 8.6 in non-white and 3.3 in white per 100,000 population (p&amp;lt; 0.0001). CRE was associated with reduced odds (OR=0.17, p&amp;lt; 0.0001) of having indwelling catheters compared to CRAB. CRAB cases were 2.59 times more likely to be admitted to the intensive care unit (ICU) (p=0.0020). CRAB cases had higher odds of neurological conditions (OR=3.44, p&amp;lt; 0.0001), renal conditions (OR=2.27, p=0.0014), and diabetes (OR=1.67, p=0.0412). CRAB mortality was 6.9% compared to CRE at 2.0% (p=0.0178). Most CRAB and CRE cases were healthcare-associated infections (98.6% &amp; 67.2%). Conclusion The study marks the first multi-year evaluation of TN patients with CRE and CRAB UTIs. As expected, CRAB patients frequently needed ICU admission and were more likely to have indwelling catheters, neurological and renal conditions, and diabetes. This could be linked to ICU patient severity, but further studies are required to clarify. Additionally, significant race and sex gaps were noticed between CRAB and CRE-infected patients, prompting further investigation into these disparities. Disclosures All Authors: No reported disclosures

P-1562. Epidemiology, Management, and Outcomes of a Novel Complex Urologic Infections Interdisciplinary Clinic

Abstract Background Urinary tract infections (UTIs) are the most common bacterial infections, yet patients with recurrent infection are often not offered effective preventative therapies, patients with bacterial persistence may have a urologic nidus of infection, and patients with non-infectious syndromes are often over-treated with antibiotics. Methods We developed a Complex Urologic Infections Interdisciplinary Clinic comprised of infectious diseases and urology physicians as well as antimicrobial stewardship pharmacists. We categorized patients as complicated (defined as abnormal urinary tract predisposing to infection) or uncomplicated and describe the first 237 patients seen 16 months after clinic initiation. Results Most of our patients were female (69%) and white (67%) with a mean age of 61 and a mean Charlson score of 3.3 (Table 1). Most (58%) had complicated urologic tracts with overall higher Charlson comorbidity scores. Based on a standardized clinical classification system, most presented with recurrent/reinfection (38%), but we also identified patients with isolated and intermittent infection, bacterial persistence, and non-infectious syndromes (Table 2). We started 75/89 (84%) patients with recurrent infections on prevention therapy, and 14 declined. Vaginal estrogen or methenamine monotherapy had an efficacy of 57% and 70% at a mean follow up of 4.2 and 4.6 months, respectively (Figure 1). All five patients on vaginal estrogen plus continuous prophylaxis were UTI free at a mean follow up of 5 months. We identified 20 patients with urinary bacterial persistence, ordered imaging of the urologic tract, and identified an infected urologic nidus and cured or suppressed the infection in 95%. Thirty-two percent of patients referred for UTI were found to have non-infectious syndromes, including asymptomatic bacteriuria (19%) and lower urinary tract symptoms (10%) (Figure 2). Multi-drug resistant organisms were found in 25%, 30% of which were in patients with non-infectious syndromes. Conclusion Complex Urologic Infections Interdisciplinary Clinics can provide expertise to prevent recurrent UTIs, identify a urologic nidus of infection in patients with persistence, and potentially reduce antimicrobial burden and resistance in patients without true infection. Disclosures All Authors: No reported disclosures

P-1554. Impact of High Predicted Risk of Antimicrobial Resistance on Empiric Treatment Failure in US Females with Uncomplicated Urinary Tract Infections

Abstract Background Antibiotic (ABX) treatment of uncomplicated urinary tract infection (uUTI) is often prescribed empirically which may lead to treatment failure (TF) and antimicrobial resistance (AMR). Suspected AMR may be assessed using a published AMR risk categorization framework. This study aimed to investigate the impact of high predicted risk of AMR on TF in female outpatients with uUTI. Methods Female outpatients aged ≥ 12 years with a uUTI diagnosis (Dx) between Jan 2018 and Sep 2022 were assessed retrospectively using Optum’s de-identified Electronic Health Record dataset. TF was defined as having a second oral ABX prescription (Rx), intravenous ABX, or emergency department/inpatient stay with a primary Dx of UTI ≤ 28 days after the first empiric oral ABX Rx for the uUTI Dx. Four validated AMR risk predictive models categorized patients as low or moderate (L/M) or high risk of isolate non-susceptibility to each of nitrofurantoin, sulfamethoxazole-trimethoprim, fluoroquinolones, and β-lactams, separately. Patients predicted to have high risk of isolate non-susceptibility to ≥ 1 ABX class were categorized as high AMR risk. Risk ratios (RRs) with 95% confidence intervals (CIs) were used to compare TF in patients with L/M AMR risk vs high AMR risk and the effect of recurrent uUTI history on TF in high AMR risk patients was explored. Results Of 376,004 female outpatients with uUTI, 121,802 (32.4%) were categorized as high AMR risk (Table 1). Risk of TF was higher in patients with high AMR risk vs L/M AMR risk (21% vs 15%, adjusted RR [95% CI] = 1.21 [1.20–1.23]; p&amp;lt; 0.001; Table 2). TF risk increased with number of predicted high risk ABX classes, as patients with 1, 2, 3, and 4 predicted high risk ABX classes had unadjusted TF RRs of 1.23, 1.37, 1.71, and 2.01, respectively, vs those with L/M AMR risk (all p&amp;lt; 0.001; Table 2). TF rates were higher in patients with high AMR risk and recurrent UTI history vs L/M AMR risk and non-recurrent UTI (23.1% vs 14.6%, unadjusted RR [95% CI] = 1.58 [1.55–1.62]; Table 3). Conclusion Female uUTI outpatients with high predicted AMR risk to ≥ 1 oral ABX had a significantly greater risk of TF vs those with L/M predicted risk of AMR. These findings underscore the clinical importance of suspected AMR and history of UTI recurrence in empiric treatment decision-making for uUTI. Funding GSK study 219500 Disclosures Debra L. Fromer, MD, GSK: Advisor/Consultant|Johnson &amp; Johnson/Janssen Pharmaceuticals: Advisor/Consultant Meghan Luck, PharmD, BCPS, GSK: Employee|GSK: Stocks/Bonds (Private Company) Malena Mahendran, MS, Analysis Group, Inc.: Employee of Analysis Group, Inc., a consulting company that received funding from GSK to conduct this study Rose Chang, ScD, Analysis Group, Inc.: Employee of Analysis Group, Inc., a consulting company that received funding from GSK to conduct this study Megan Pinaire, MPH, Analysis Group, Inc.: Employee of Analysis Group, Inc., a consulting company that received funding from GSK to conduct this study Dar Alon, MS, Analysis Group, Inc.: Employee of Analysis Group, Inc., a consulting company that received funding from GSK to conduct this study Mei Sheng Duh, MPH, ScD, Analysis Group, Inc.: Employee of Analysis Group, Inc., a consulting company that received funding from GSK to conduct this study Madison T. Preib, MPH, GSK: Employee|GSK: Stocks/Bonds (Public Company) Jeffrey J. Ellis, PharmD, MS, GSK: Employee|GSK: Stocks/Bonds (Public Company)