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1418. Single Center Treatment Patterns for Asymptomatic Bacteriuria and UTIs in Kidney Transplant Recipients: Are We Still Overtreating?

1418. Single Center Treatment Patterns for Asymptomatic Bacteriuria and UTIs in Kidney Transplant... study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny 1418. Single Center Treatment Patterns for Asymptomatic Bacteriuria and UTIs S.  Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Jonathon in Kidney Transplant Recipients: Are We Still Overtreating? 1 2 3 Wright, BSc, Kantar Health (Employee, Employee of Kantar Health, which received Meena Azeem, M.D. ; Kelsie Cowman, MPH ; Cindy Pynadath, D.O. ; 3 1 2 funding from GlaxoSmithKline plc. to conduct this study) Ashish V.  Joshi, PhD, Rachel Bartash, MD ; Montefiore Medical Center, Bronx, New York; Montefiore GlaxoSmithKline plc. (Employee, Shareholder) Medical Center and Albert Einstein College of Medicine, New York, NY; Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York Session: P-81. UTIs 1416. Medicare Spending on Urinary Tract Infections: A Retrospective Database Analysis Background. In February 2019, the American Society of Transplantation (AST) 1 2 1 Kate Sulham, MPH ; Eric Hammelman, MBA ; Spero Therapeutics, Cambridge, MA; published guidelines on the management of asymptomatic bacteriuria (AB) and Health Management Associates, Chicago, Illinois urinary tract infections (UTIs) in kidney transplant (KT) recipients. These recommen - dations include avoiding treatment of AB > 2 months post-transplant and outline the Session: P-81. UTIs duration of treatment (DT) for uncomplicated and complicated UTIs. We reviewed Background. Medical visits for UTIs represent 1%-6% of all healthcare visits (~7 management of these syndromes and guideline concordance at our institution. million visits) and are estimated to cost the United States (US) healthcare system at Methods. We conducted a single-center, retrospective cohort study of KT recipients least $1.6 billion annually. UTIs are associated with significant morbidity; particularly age > 18 years who underwent transplantation between June 2016 - June 2020. Patients among the elderly, where UTIs are most prevalent. Little is known about the specific were obtained through query of our electronic medical record for documented UTI syn- costs to Medicare of UTI; here, we seek to examine overall Medicare spending on UTI. dromes and included if a diagnosis was confirmed between March 2019 - December 2020 Methods. We conducted a retrospective multicenter cohort study of the Medicare upon chart review. Definitions of AB, complicated UTI, and uncomplicated UTI were fee-for-service (FFS) data. Patients were included for analysis if the following criteria based on AST definitions. Patients with AB < 2 months post-transplant were excluded. were met: (1) enrolled in Medicare FFS from January 1, 2016 through December 31, Outcomes included treatment of AB, DT, 30-day hospital admission and re-admission, 2019, (2) not enrolled in Medicare Advantage during that time period, (3) did not and 30-day mortality. Bivariate analysis was conducted using chi square and t test.  have any UTI diagnoses in 2016, and (4) enrolled in Medicare Part D. Individuals were Results. Seventy-four patients (mean age 55.4 years, 62.0% female) were included. categorized as having uncomplicated UTI (uUTI), complicated UTI (cUTI), or those Twenty-one patients had AB, 90% of whom received antibiotics. Distribution of diag- who first had a uUTI that progressed to a cUTI (uUTI to cUTI). Medicare spending in noses and median DT among those treated with antibiotics is outlined in Table 1.  the 12 months post-diagnosis was calculated, and patients were stratified by home- or Overall DT was similar in patients whose care included infectious disease (ID) institutionally-based (eg, nursing home, long-term care facility, etc.). input and those who did not (10.0 vs. 10.0 days, p=0.12), although ID involvement was Results. 2,330,123 patients were included for analysis; 92% were home-based, more common in complicated UTIs. There was no difference in 30-day admission rates 8% were institutionally-based. Mean Charlson Comorbidity Index (CCI) across all for those receiving < 7 days vs. > 7 days of antibiotics (p=0.53) (Table 2) including those patients was 2.16. In the 12 months aer ini ft tial diagnosis, average Medicare spend was with complicated UTIs (5/15 in < 7  days (33%) vs. 4/18 in > 7  days (22%) p=0.49). $33,984, $9,941 of which was UTI-related. Annual UTI-related costs were approxi- er Th e were no deaths within 30 days of diagnoses. mated $9,000 for home-based vs. $21,444 for institutionally-based patients. Mean drug spend per patient on antibiotics was $872. Broadly, uUTI patients were least expensive, followed by cUTI patients, with uUTI to cUTI patients being most expensive. Higher costs for were observed for institutionally-based patients, largely due to more frequent acute hospitalizations and more Part A-paid skilled nursing stays. Conclusion. UTI-related spending represents approximately one-third of total annual Medicare spend for patients diagnosed with a UTI. Given average Medicare spending of approximately $12,000 per person in 2019, UTI is associated with sub- stantially increased per patient cost and represents a significant source of spending for Medicare. Disclosures. Kate Sulham, MPH, Spero Therapeutics (Consultant) Eric Hammelman, MBA, AbbVie Pharmaceuticals (Consultant)Edwards Lifesciences (Consultant)Genentech (Consultant)Spero Therapeutics (Consultant)Vertex Pharmaceuticals (Consultant) 1417. Fosfomycin Use in the Treatment of Complicated Urinary Tract Infections at a Veterans Affairs Medical Center 1 2 3 1 Ryan Lee, Pharm.D. ; Thuong  Tran, Pharm.D ; Susanna Tan, MD ; VA Long Beach, Rancho Palos Verdes, California; Veterans Affairs Long Beach Medical Center, Long Beach, California; VA Long Beach Healthcare System, Long Beach, California Session: P-81. UTIs Background. e p Th revalence of multidrug resistant gram-negative urinary tract infections (UTIs) is increasing, oen r ft equiring intravenous antimicrobial therapy. Oral fosfomycin is a recommended alternative agent for the treatment of cystitis caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli). The primary objective of this study is to evaluate the efficacy of fosfomycin in the treatment of UTIs at the Veterans Affairs Long Beach Healthcare System. The secondary objective is to assess the incidence of adverse drug reactions associated with fosfomycin.  Methods. This is a retrospective, single-center, cohort study. Patients who st th received fosfomycin between June 1 , 2015  – June 30 , 2020 were included. Data collection was completed by chart review through the Computerized Patient Record System (CPRS). Descriptive analysis was used to evaluate data. Treatment outcomes were analyzed using a composite of clinical and microbiological cure. Clinical cure was defined as resolution of UTI symptoms. Microbiological cure was defined as urine ster - ilization within 1 month aer co ft mpleting treatment course with fosfomycin. Conclusion. Despite guidelines, treatment of AB is common and uncomplicated Results. A total of 62 unique patients were evaluated in this study. The mean age UTIs oen r ft eceive prolonged courses of antibiotics. There was no increased risk of was 71.9 years. 56 patients (90.3%) were male, 31 patients (50.0%) had an indwelling admission or mortality with shorter DT, though these results should be interpreted catheter present at the time of treatment, and 48 patients (77.4%) had the presence of cautiously given the small sample size. Greater stewardship efforts are needed in this genitourinary tract pathology that may increase the risk of developing UTIs. Majority high-risk population. of patients (50%) had a urine culture result positive for E.  coli prior to treatment, of Disclosures. Kelsie Cowman, MPH, Merck (Research Grant or Support) which 43.5% were ESBL-producing. 60 patients (96.8%) received more than 1 dose of Fosfomycin. Out of 29 patients who were eligible to be evaluated for clinical outcomes, 20 patients (68.9%) met a positive composite outcome of either microbiological cure, 1419. High Prevalence of Fluoroquinolone-Resistant Urinary Tract Infection clinical cure, or both. 4 patients (6.5%) experienced an adverse drug reaction of diar- Among US Emergency Department Patients Diagnosed with UTI, 2018-2020 rhea that was self-limited.  1 2 Brett Faine, PharmD ; Megan A. Rech, PharmD, MS, BCCCP, FCCM ; Conclusion. Fosfomycin is an effective and well-tolerated antimicrobial agent 1 3 1 Priyanka Vakkalanka, PhD ; David A. Talan, MD ; University of Iowa, Iowa City, that may be considered for treatment of complicated UTIs without evidence of py- 2 3 Iowa; Loyola University Medical Center, Maywood, Illinois; Olive View-UCLA elonephritis or bacteremia caused by multi-drug resistant organisms in the veteran Medical Center, Sylmar, CA population. Emergency Medicine PHARMacy Research NETwork (EMPHARM-NET) Disclosures. All Authors: No reported disclosures Abstracts • OFID 2021:8 (Suppl 1) • S793 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Open Forum Infectious Diseases Oxford University Press

1418. Single Center Treatment Patterns for Asymptomatic Bacteriuria and UTIs in Kidney Transplant Recipients: Are We Still Overtreating?

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Oxford University Press
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© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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2328-8957
DOI
10.1093/ofid/ofab466.1610
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Abstract

study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny 1418. Single Center Treatment Patterns for Asymptomatic Bacteriuria and UTIs S.  Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Jonathon in Kidney Transplant Recipients: Are We Still Overtreating? 1 2 3 Wright, BSc, Kantar Health (Employee, Employee of Kantar Health, which received Meena Azeem, M.D. ; Kelsie Cowman, MPH ; Cindy Pynadath, D.O. ; 3 1 2 funding from GlaxoSmithKline plc. to conduct this study) Ashish V.  Joshi, PhD, Rachel Bartash, MD ; Montefiore Medical Center, Bronx, New York; Montefiore GlaxoSmithKline plc. (Employee, Shareholder) Medical Center and Albert Einstein College of Medicine, New York, NY; Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York Session: P-81. UTIs 1416. Medicare Spending on Urinary Tract Infections: A Retrospective Database Analysis Background. In February 2019, the American Society of Transplantation (AST) 1 2 1 Kate Sulham, MPH ; Eric Hammelman, MBA ; Spero Therapeutics, Cambridge, MA; published guidelines on the management of asymptomatic bacteriuria (AB) and Health Management Associates, Chicago, Illinois urinary tract infections (UTIs) in kidney transplant (KT) recipients. These recommen - dations include avoiding treatment of AB > 2 months post-transplant and outline the Session: P-81. UTIs duration of treatment (DT) for uncomplicated and complicated UTIs. We reviewed Background. Medical visits for UTIs represent 1%-6% of all healthcare visits (~7 management of these syndromes and guideline concordance at our institution. million visits) and are estimated to cost the United States (US) healthcare system at Methods. We conducted a single-center, retrospective cohort study of KT recipients least $1.6 billion annually. UTIs are associated with significant morbidity; particularly age > 18 years who underwent transplantation between June 2016 - June 2020. Patients among the elderly, where UTIs are most prevalent. Little is known about the specific were obtained through query of our electronic medical record for documented UTI syn- costs to Medicare of UTI; here, we seek to examine overall Medicare spending on UTI. dromes and included if a diagnosis was confirmed between March 2019 - December 2020 Methods. We conducted a retrospective multicenter cohort study of the Medicare upon chart review. Definitions of AB, complicated UTI, and uncomplicated UTI were fee-for-service (FFS) data. Patients were included for analysis if the following criteria based on AST definitions. Patients with AB < 2 months post-transplant were excluded. were met: (1) enrolled in Medicare FFS from January 1, 2016 through December 31, Outcomes included treatment of AB, DT, 30-day hospital admission and re-admission, 2019, (2) not enrolled in Medicare Advantage during that time period, (3) did not and 30-day mortality. Bivariate analysis was conducted using chi square and t test.  have any UTI diagnoses in 2016, and (4) enrolled in Medicare Part D. Individuals were Results. Seventy-four patients (mean age 55.4 years, 62.0% female) were included. categorized as having uncomplicated UTI (uUTI), complicated UTI (cUTI), or those Twenty-one patients had AB, 90% of whom received antibiotics. Distribution of diag- who first had a uUTI that progressed to a cUTI (uUTI to cUTI). Medicare spending in noses and median DT among those treated with antibiotics is outlined in Table 1.  the 12 months post-diagnosis was calculated, and patients were stratified by home- or Overall DT was similar in patients whose care included infectious disease (ID) institutionally-based (eg, nursing home, long-term care facility, etc.). input and those who did not (10.0 vs. 10.0 days, p=0.12), although ID involvement was Results. 2,330,123 patients were included for analysis; 92% were home-based, more common in complicated UTIs. There was no difference in 30-day admission rates 8% were institutionally-based. Mean Charlson Comorbidity Index (CCI) across all for those receiving < 7 days vs. > 7 days of antibiotics (p=0.53) (Table 2) including those patients was 2.16. In the 12 months aer ini ft tial diagnosis, average Medicare spend was with complicated UTIs (5/15 in < 7  days (33%) vs. 4/18 in > 7  days (22%) p=0.49). $33,984, $9,941 of which was UTI-related. Annual UTI-related costs were approxi- er Th e were no deaths within 30 days of diagnoses. mated $9,000 for home-based vs. $21,444 for institutionally-based patients. Mean drug spend per patient on antibiotics was $872. Broadly, uUTI patients were least expensive, followed by cUTI patients, with uUTI to cUTI patients being most expensive. Higher costs for were observed for institutionally-based patients, largely due to more frequent acute hospitalizations and more Part A-paid skilled nursing stays. Conclusion. UTI-related spending represents approximately one-third of total annual Medicare spend for patients diagnosed with a UTI. Given average Medicare spending of approximately $12,000 per person in 2019, UTI is associated with sub- stantially increased per patient cost and represents a significant source of spending for Medicare. Disclosures. Kate Sulham, MPH, Spero Therapeutics (Consultant) Eric Hammelman, MBA, AbbVie Pharmaceuticals (Consultant)Edwards Lifesciences (Consultant)Genentech (Consultant)Spero Therapeutics (Consultant)Vertex Pharmaceuticals (Consultant) 1417. Fosfomycin Use in the Treatment of Complicated Urinary Tract Infections at a Veterans Affairs Medical Center 1 2 3 1 Ryan Lee, Pharm.D. ; Thuong  Tran, Pharm.D ; Susanna Tan, MD ; VA Long Beach, Rancho Palos Verdes, California; Veterans Affairs Long Beach Medical Center, Long Beach, California; VA Long Beach Healthcare System, Long Beach, California Session: P-81. UTIs Background. e p Th revalence of multidrug resistant gram-negative urinary tract infections (UTIs) is increasing, oen r ft equiring intravenous antimicrobial therapy. Oral fosfomycin is a recommended alternative agent for the treatment of cystitis caused by extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli). The primary objective of this study is to evaluate the efficacy of fosfomycin in the treatment of UTIs at the Veterans Affairs Long Beach Healthcare System. The secondary objective is to assess the incidence of adverse drug reactions associated with fosfomycin.  Methods. This is a retrospective, single-center, cohort study. Patients who st th received fosfomycin between June 1 , 2015  – June 30 , 2020 were included. Data collection was completed by chart review through the Computerized Patient Record System (CPRS). Descriptive analysis was used to evaluate data. Treatment outcomes were analyzed using a composite of clinical and microbiological cure. Clinical cure was defined as resolution of UTI symptoms. Microbiological cure was defined as urine ster - ilization within 1 month aer co ft mpleting treatment course with fosfomycin. Conclusion. Despite guidelines, treatment of AB is common and uncomplicated Results. A total of 62 unique patients were evaluated in this study. The mean age UTIs oen r ft eceive prolonged courses of antibiotics. There was no increased risk of was 71.9 years. 56 patients (90.3%) were male, 31 patients (50.0%) had an indwelling admission or mortality with shorter DT, though these results should be interpreted catheter present at the time of treatment, and 48 patients (77.4%) had the presence of cautiously given the small sample size. Greater stewardship efforts are needed in this genitourinary tract pathology that may increase the risk of developing UTIs. Majority high-risk population. of patients (50%) had a urine culture result positive for E.  coli prior to treatment, of Disclosures. Kelsie Cowman, MPH, Merck (Research Grant or Support) which 43.5% were ESBL-producing. 60 patients (96.8%) received more than 1 dose of Fosfomycin. Out of 29 patients who were eligible to be evaluated for clinical outcomes, 20 patients (68.9%) met a positive composite outcome of either microbiological cure, 1419. High Prevalence of Fluoroquinolone-Resistant Urinary Tract Infection clinical cure, or both. 4 patients (6.5%) experienced an adverse drug reaction of diar- Among US Emergency Department Patients Diagnosed with UTI, 2018-2020 rhea that was self-limited.  1 2 Brett Faine, PharmD ; Megan A. Rech, PharmD, MS, BCCCP, FCCM ; Conclusion. Fosfomycin is an effective and well-tolerated antimicrobial agent 1 3 1 Priyanka Vakkalanka, PhD ; David A. Talan, MD ; University of Iowa, Iowa City, that may be considered for treatment of complicated UTIs without evidence of py- 2 3 Iowa; Loyola University Medical Center, Maywood, Illinois; Olive View-UCLA elonephritis or bacteremia caused by multi-drug resistant organisms in the veteran Medical Center, Sylmar, CA population. Emergency Medicine PHARMacy Research NETwork (EMPHARM-NET) Disclosures. All Authors: No reported disclosures Abstracts • OFID 2021:8 (Suppl 1) • S793

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Open Forum Infectious Diseases – Oxford University Press

Published: Dec 4, 2021

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