1670 - Clinical Characteristics and Demographics of Patients with Complicated Urinary Tract Infections (cUTI) and Antibiotic Resistance or Treatment Failure: A Retrospective Database Analysis

Background: The incidence of complicated urinary tract infection (cUTI) in the United States estimated to be approximately 1%; however, the majority of published literature focuses on characterizing hospitalized cUTI patients. Limited data exists detailing the clinical characteristics and demographics of cUTI patients more generally; in particular, those experiencing antibiotic resistance and/or treatment failure, many of whom currently lack effective oral treatment options in the outpatient setting, yet may not have severe enough disease to warrant hospitalization. Here, we examine the clinical and demographic characteristics of this patient group.

Methods: A retrospective study was performed in partnership with Komodo Health, Inc., using aggregate data from the Komodo Healthcare Map™ for cUTI-related events. Inclusion criteria: (1) 2+ UTI-related encounters within 35 days, beginning in 2017-2018, (2) clinical/coding features indicative of recurrence, treatment failure or antibiotic resistance, or treatment with carbapenem or piperacillin/tazobactam. Clinical and demographic characteristics were examined.

Results: 3,334,497 cUTI patients were identified; 1,889,216 patients with evidence of treatment failure and/or antibiotic resistance were eligible for analysis. 76.7% were female, and 40.2% were >65 years of age. 61.8% of patients had hypertension, 42.5% had hyperlipidemia, and 32.3% had uncomplicated type 2 diabetes. 38.7% had concomitant gastroesophageal reflux disease; 17.0% had mild renal impairment and 29.5% had moderate/severe renal impairment. Most common treatments were nitrofurantoin (21.8%), trimethoprim-sulfamethoxazole (19.2%), and cephalexin (14.4%). Approximately half (48.9%) of patients had an inpatient hospital stay during the study period.

Conclusion: cUTI patients with antibiotic resistance and/or treatment failure are predominantly female and present with a variety of common comorbidities, the most common being hypertension. Approximately half of patients in this cohort were treated successfully in outpatient settings and did not require hospitalization during the study period.