1675 - Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections.  There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States.  This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting.

Methods: We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study.  Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities.  Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization.

Results: There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older.  The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%.  The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin.  Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization.  Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively.

Conclusion: E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common.