1436. Overview of ESBL Enzyme Producing Infections and UTIs

Abstract

Background. Extended-spectrum beta lactamase (ESBL) enzymes are plasmid-mediated, rapidly emerging and complex thereby posing a major therapeutic challenge in the management of urinary tract infections (UTIs) in community and hospital settings. In 2017, there were an estimated 197,400 cases of ESBL-producing Enterobacterales among hospitalized patients and 9,100 estimated deaths in the United States. Methods. We conducted a retrospective cohort study using a publicly accessible National Inpatient Sample (NIS) database from October 2015 to December 2017. Adult patients (age >/= 18 years old) with UTI as a principal diagnosis were included. SAS 9.4 was used for univariate and multivariate linear. Logistic regression statistical analyses were used to compare mean age at the time of admission, length of stay, in-hospital mortality, hospitalization costs, and Elixhauser comorbidity indices. Results. Of the total 5,776,156 patients included in the study, 52,765 patients had ESBL-enzyme induced UTIs. 66% were females and 34% were males. 63.3% were Caucasian, 11.6% were African-American, 18.8% were Hispanic, and 4.4% were Asian or Pacific Islander. The most common comorbidities were renal failure (22.8%), diabetes mellitus with complications (20.8%), congestive heart failure (20.5%), chronic lung disease (20.0%), neurological diseases (17.8%), obesity (12.6%), paralysis (12.5%), and depression (11.5%). In-hospital mortality was 2.5% (p< 0.0001), which was most likely due to the underlying co-morbidities. In patients without ESBL-enzyme induced UTIs, average length of stay was 7.8±8.5 days, and economic burden was $16,166.8 ± $21,183.5 USD. In comparison, patients with ESBL-enzyme induced UTIs had in-hospital mortality of 3.9%, average length of stay of 7.0 ± 9.7 days, and economic burden of $15,793.3 ± $29,268.6 USD. Conclusion. We found that ESBL-enzyme-producing UTIs have statistically significant prolonged length of stay and economic burden, though in hospital mortality rate is low. This could be due to judicious use of antimicrobial therapy. There is a need for further research, as well as increased antimicrobial stewardship for UTIs, a globally recognized major cause of nosocomial acquired infections.