Introduction: Scant data are available on the 30-day financial burden associated with incident complicated urinary tract infections (cUTIs) in a cohort of predominately elderly patients. This study sought to examine total and cUTI-related 30-day Medicare spending (MS), a proxy for healthcare costs, among Medicare fee-for-service (FFS) beneficiaries who resided in the community with newly diagnosed cUTIs. Methods: A retrospective multicenter cohort study of adult beneficiaries in the Medicare FFS database with a cUTI between 2017 and 2018 was performed. Patients were included if they were enrolled in Medicare FFS and Medicare Part D from 2016 to 2019, had a cUTI first diagnosis in 2017–2018, no evidence of any UTI diagnoses in 2016, and residence in the community between 2016 and 2018. Results: During the study period, 723,324 cases occurred in Medicare beneficiaries who met the study criteria. Overall and cUTI-related 30-day MS were $7.6 and $4.5 billion, respectively. The average overall and cUTI-related 30-day MS per beneficiary were $10,527 and $6181, respectively. The major driver of cUTI-related 30-day MS was acute care hospitalizations ($3.2 billion) and the average overall and cUTI-related 30-day MS per hospitalizations were $16,431 and $15,438, respectively. Conclusion: Overall 30-day MS for Medicare FSS patients who resided in the community with incident cUTIs was substantial, with cUTI-related MS accounting for 59%. As the major driver of cUTI-related 30-day MS was acute care hospitalizations, healthcare systems should develop well-defined criteria for hospital admissions that aim to avert hospitalizations in clinically stable patients and expedite the transition of patients to the outpatient setting to complete their care.
In this multicenter study of adult patients who presented to the emergency department with an Enterobacterales complicated urinary tract infection (cUTI), high rates of resistance and co-resistance to commonly used oral antibiotics (fluoroquinolones, trimethoprim-sulfamethoxazole, nitrofurantoin, and third-generation cephalosporins) were observed.
Introduction Limited data are available in the United States on the 12-month epidemiology, outpatient (OP) antibiotic treatment patterns, outcomes, and costs associated with complicated urinary tract infections (cUTIs) in adult patients. Methods A retrospective observational cohort study of adult patients with incident cUTIs in IBM® MarketScan® Databases between 2017-2019 was performed. Patients were categorized as OP or inpatient (IP) based on initial setting of care for index cUTI and were stratified by age (<65 years vs ≥65 years). OP antibiotic treatment patterns, outcomes, and costs associated with cUTIs among adult patients over a 12-month follow-up period were examined. Results During study period, 95,322 patients met inclusion criteria. Most patients were OPs (84%) and aged <65 years (87%). Treatment failure (receipt of new unique OP antibiotic or cUTI-related ED visit/IP admission) occurred in 23% and 34% of OPs aged <65 years and ≥ 65 years, respectively. Treatment failure was observed in over 38% of IPs, irrespective of age. Across both cohorts and age strata, >78% received ≥2 unique OP antibiotics, >34% received ≥4 unique OP antibiotics, >16% received repeat OP antibiotics, and >23% received ≥1 intravenous (IV) OP antibiotic. The mean 12-month cUTI-related total healthcare costs were $4,697 for OPs <65 years, $8,924 for OPs >65 years, $15,401 for IPs <65 years, and $17,431 for IPs ≥ 65 years. Conclusion These findings highlight the substantial 12-month healthcare burden associated with cUTIs and underscore the need for new outpatient treatment approaches that reduce the persistent or recurrent nature of many cUTIs.
Background Deleterious outcomes associated with IET are well documented among hospitalized patients with infections. However, scant data exist on the consequences of IET among adult OPs with cUTIs. This study evaluated the association between receipt of IET and 30-day ED/IP visits among adult OPs with cUTIs. Methods Retrospective cohort study among Kaiser Permanente Southern California members from 2017-20. Inclusion criteria were age ≥18 years; cUTI diagnosis during an OP visit; positive urine culture with antibiotic (AB) susceptibility results; receipt of AB ±3 days of index urine culture; and not hospitalized on day of OP visit. For OPs with multiple cUTIs, only the index cUTI was considered. IET was defined as failure to receive an AB with in vitro microbiologic activity against all recovered cUTI pathogens ±3 days of culture collection date. Outcomes included all-cause and cUTI-related ED/IP visits ≥3 days to ≤30 days from index culture date. Logistic regression was used to adjust for baseline differences between appropriateness groups. Results During study period, 25,980 OPs with cUTIs met study criteria. Mean age was 60 years, majority female (57%), and E. coli (66%) was the most common pathogen. IET was noted in 2656 (10%) of patients. Comparison of baseline characteristics between appropriateness groups is shown in Table. Comparison of 30-day all-cause and cUTI-related ED/IP visits between IET and appropriate empiric therapy (AET) is shown in Figure. In the logistic regression, receipt of IET was associated with an increase odds of 30-day all-cause ED/IP visits (adjusted odds ratio (aOR)= 1.3; 95% CI: 1.2-1.4) and 30-day cUTI-related ED/IP visits (aOR=1.5; 95% CI: 1.4-1.7), respectively. Figure Conclusion Thirty-day all-cause and cUTI-related ED/IP visits were significantly higher among adult OPs with cUTI who received IET. As culture and susceptibility results are frequently unknown at the time of empiric therapy selection, the findings highlight the critical need to use institution-specific antibiotic resistance risk stratification tools, in tandem with rapid diagnostic tests, to guide empiric antibiotic decisions among OPs with cUTIs as measures to ensure patients receive AET and maximize chances of a successful clinical outcome. Disclosures Thomas P. Lodise, PharmD, PhD, Spero Therapeutics: Advisor/Consultant Lie Hong H. Chen, DrPH, MSPH, Spero Therapeutics: Grant/Research Support Katia J. Bruxvoort, PhD, MPH, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Seqirus: Grant/Research Support Rong Wei, MA, Spero Therapeutics: Grant/Research Support|Spero Therapeutics: Grant/Research Support Theresa M. Im, MPH, Spero Therapeutics: Grant/Research Support Richard Contreras, MS, Spero Therapeutics: Grant/Research Support Mauricio Rodriguez, PharmD, MS-HEOR, BCPS, BCCCP, BCIDP, Spero Therapeutics: Employee Larry Friedrich, PharmD, Spero Therapeutics: Employee Jennifer Reese, PharmD, Spero Therapeutics: Employee Sara Y. Tartof, PhD MPH, Pfizer: Grant/Research Support|Spero: Grant/Research Support.
Background Antimicrobial resistance (AMR) is a growing threat. ESBL-producing Enterobacterales infections are rising, especially within the community setting. Patients requiring OPAT services will increase based on AMR to oral antibiotic (ABX) options. OPAT adverse events (AEs) are linked to the use of IV catheters, followed by adverse drug events. Complications that arise from OPAT, often necessitate acute care services. We sought to quantify costs associated with OPAT AEs. Methods A multicenter retrospective claims analysis from the state of Utah’s (UT) Public IBIS database was performed for 2020. OPAT AEs as described in the literature were used to query charges. All UT hospitals and common OPAT AE principal diagnosis (PDx) codes were included in the analysis. Estimated inpatient (IP) costs associated with common OPAT AEs were calculated from a charge-to-cost ratio (22.5%) using publicly available data from the Centers for Medicare & Medicaid Services. Event counts reported for UT were scaled proportionally to estimate total events for the U.S. population. Emergency department (ED) incidence rates for OPAT AEs from 2016 to 2020 were also examined. Results During the study period, 248,843 patients met study inclusion for an OPAT AE PDx. Among IV-related complications, catheter phlebitis accounted for highest median cost per IP event at $14,051. Other PDx, included catheter blockage and central line-associated bloodstream infections at $11,237 and $10,103, respectively, followed by $9,371 for complications post injection. Thrombotic events equated to total of $11,915 for the combined costs of deep venous thrombosis and pulmonary embolism. Lastly, C. difficile infections accounted for a median cost of $5,284 (Figure 1). Age-adjusted rates of ED activity related to AEs rose to 17.6 per 10,000 in 2020; this marked an 18% increase from 2016 (Figure 2). Figure 1.Figure 2. Conclusion Give that viable oral ABX treatment options in the community setting are limited, patients will require additional OPAT services as AMR rates continue to escalate. OPAT services are not without added risks of complications, as the average median cost for an OPAT AE was $8,852. These costs may be minimized by the addition of new oral ABXs that overcome AMR, thus improving patient outcomes. Disclosures Mauricio Rodriguez, PharmD, MS-HEOR, BCPS, BCCCP, BCIDP, Spero Therapeutics: Employee Georgia Buscaglia, PhD, Spero Therapeutics: Advisor/Consultant Steven Tolle, BFA, Spero Therapeutics: Advisor/Consultant Darren Michael, PhD, CC, SC, Spero Therapeutics: Advisor/Consultant|Spero Therapeutics: Grant/Research Support.
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