1672. Eligibility and Outcomes of Conversion to Oral (PO) Therapy in Patients Hospitalized with Enterobacteriaceae (ENT) Urinary Tract Infection (UTI) in the United States (US): A Multicenter Analysis

Abstract

Background

Rising rates of fluoroquinolone resistance (FQ-R) and third-generation cephalosporin resistance/extended-spectrum beta-lactamases (ESBL+) have left patients with urinary tract infections (UTI) few oral options. Here, we evaluate the eligibility of hospitalized UTI patients to take PO medications and estimate the potential impact on hospital cost and length of stay (LOS).

Methods

We analyzed the first positive enterobacteriaceae (ENT) urine culture ≤ 3 days from hospital admission in patients with a primary or secondary UTI ICD10 discharge diagnosis from 68 US hospitals admitted October 1, 2015-2017. Eligibility for PO was classified as: (1) received at least 24 hours intravenous (IV) antimicrobial, (2) ability to tolerate PO drug as evidenced by a pharmacy order for non-antibiotic PO medication, (3) stable/normal white blood count (WBC). Fisher’s exact test was used to test for significance; results were examined by severity quartile, PO conversion and resistance status (FQ-R and ESBL+)

Results

5,842 patients were eligible for PO conversion and analysis; 1,890 (32.5%) actually converted to PO during their hospital stay; 2,199 (37.6%) were either FQ-R, ESBL+, or both. Baseline demographics were similar between groups. Highly resistant patients (FQ-R and ESBL+) were less likely to transition to PO compared to those with neither FQ-R nor ESBL infections (16.7% vs. 37.0%). Among patients who did convert to PO, post-PO-eligible LOS was shorter across all severity strata compared to patients who did not convert (p< 0.0001). For those who did not convert, post PO-eligible LOS was 2.6, 2.9, 3.3, and 4.0 days by severity quartile, respectively. Among patients who did convert to PO, the total cost was $1,043 less (p=0.024) for patients in the 3rd quartile of severity and $1,512 less (p=0.004) for patients in the 4th quartile of severity, compared to the patients who did not convert.

Conclusion

Only ~1/3 of patents eligible for PO therapy are converted during hospitalization. Reduced LOS and substantial cost savings could be recognized by efficient PO conversion and hospital discharge. Lack of PO therapies with activity against resistant pathogens has made this challenging; new PO options may help reduce hospital costs and resources required to treat these UTI patients.

Disclosures

David Melnick, MD, Spero Therapeutics (Employee)Spero Therapeutics (Employee) Akash Jain, PhD, Spero Therapeutics (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)