1439. Epidemiology and 12- Month Antibiotic Use in the Outpatient Setting among Adult Patients with Complicated Urinary Tract Infections: A Retrospective Database Analysis

Abstract Background Complicated urinary tract infections (cUTI) are one of the most common bacterial infections and represent substantial burden to the health care system. Here, we examine the epidemiology and treatment patterns associated with cUTI in a large US database containing longitudinal inpatient (IP) and outpatient (OP) patient-level data. Methods We conducted a retrospective cohort study of adult patients in the IBM MarketScan® Commercial or Medicare Supplemental Databases with at least 1 IP or non-diagnostic OP claim with a diagnosis for cUTI between January 1, 2017 and June 30, 2019. Patients meeting the following criteria were included for analysis: (1) ≥18 years of age on the index date, (2) ≥6 months of continuous enrollment (CE) with medical and pharmacy benefits prior to the index date, (3) ≥12 months of CE following the index date or evidence of death, and (4) no evidence of a prior cUTI during the 6-month baseline period. Demographics and clinical characteristics were quantified. Patients were classified as IP if they were hospitalized during 30-day post index date; remaining patients were classified as OP. Antibiotics received in the OP setting in the 12-months post index date were examined. Results 95,423 patients met study criteria. Most (86.4%) patients were Commercially insured, mean (SD) age was 53.6 (18.1) and 70.4% were female. Mean baseline Charlson Comorbidity Index was 0.77. During the 30-day post index date, 22.2% were treated as IP and 77.8% were strictly treated as OP. In the 12-month OP follow-up period among index IP, 78.2% required ≥ 2 antibiotics, 38.2% required ≥4 antibiotics, and 41.6% received an IV antibiotic. In the 12-month OP follow-up period among index OP, 81.8% required ≥2 antibiotics, 38.2% required ≥4 antibiotics, and 46.8% received an IV antibiotic. For both IP and OP, fluoroquinolones were the most common oral antibiotic class (57.7%), followed by cephalosporins (39.2%), penicillins (30.3%), trimethoprim-sulfamethoxazole (29.8%), and nitrofurantoin (25.2%). Cephalosporins were the most common IV antibiotic class (38.5%). Conclusion Regardless of index treatment setting, approximately 40% of all cUTI patients required ≥4 antibiotic therapy and almost half with receive an IV antibiotic in the outpatient setting in the 12-months post index date. Disclosures Thomas Lodise, Jr., PharmD, PhD, Astra-Zeneca (Consultant)Bayer (Consultant)DoseMe (Consultant, Advisor or Review Panel member)ferring (Consultant)genentech (Consultant)GSK (Consultant)Melinta (Consultant)merck (Consultant, Independent Contractor)nabriva (Consultant)paratek (Consultant, Advisor or Review Panel member, Speaker’s Bureau)shionogi (Consultant, Advisor or Review Panel member, Speaker’s Bureau)Spero (Consultant)tetraphase (Consultant)Venatrox (Consultant) Thomas Lodise, Jr., PharmD, PhD, Melinta Therapeutics (Individual(s) Involved: Self): Consultant; Merck (Individual(s) Involved: Self): Consultant, Scientific Research Study Investigator; Paratek (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant, Speakers’ bureau; Spero (Individual(s) Involved: Self): Consultant; Tetraphase Pharmaceuticals Inc. (Individual(s) Involved: Self): Consultant Janna Manjelievskaia, PhD, MPH, IBM Watson Health (Employee)Spero Therapeutics (Consultant) Matthew Brouillette, MPH, Spero Therapeutics, Inc. (Other Financial or Material Support, I am an employee of IBM Watson Health, who received funds from Spero Therapeutics, Inc. to conduct this analysis.) Kate Sulham, MPH, Spero Therapeutics (Consultant)

Background. Complicated urinary tract infections (cUTI) are one of the most common bacterial infections and represent substantial burden to the health care system. Here, we examine the epidemiology and treatment patterns associated with cUTI in a large US database containing longitudinal inpatient (IP) and outpatient (OP) patient-level data.
Methods. We conducted a retrospective cohort study of adult patients in the IBM MarketScan® Commercial or Medicare Supplemental Databases with at least 1 IP or non-diagnostic OP claim with a diagnosis for cUTI between January 1, 2017 and June 30, 2019. Patients meeting the following criteria were included for analysis: (1) ≥18 years of age on the index date, (2) ≥6 months of continuous enrollment (CE) with medical and pharmacy benefits prior to the index date, (3) ≥12 months of CE following the index date or evidence of death, and (4) no evidence of a prior cUTI during the 6-month baseline period. Demographics and clinical characteristics were quantified. Patients were classified as IP if they were hospitalized during 30-day post index date; remaining patients were classified as OP. Antibiotics received in the OP setting in the 12-months post index date were examined.

Conclusion.
Regardless of index treatment setting, approximately 40% of all cUTI patients required ≥4 antibiotic therapy and almost half with receive an IV antibiotic in the outpatient setting in the 12-months post index date.
Disclosures. Thomas Lodise, Jr., PharmD, PhD, Astra-Zeneca Background. Many studies have been conducted worldwide to estimate Herpes Zoster (HZ) incidence rates and temporal trends. We systematically reviewed and synthesized studies of HZ incidence rates in the general population using meta-analysis models.
Methods. A random-effects meta-analysis was conducted to estimate HZ incidence from a published worldwide systematic literature review (SLR) including only individuals aged 50 years and older. Meta-regression was used to explore if variability in incidence rates could be explained by a combination of study-specific characteristics in the base model: age, gender, continent and year of data collection. The impact of adding additional covariates: case detection, case definition, study design, incidence type, patient type and latitude to the base model was also assessed.
Results. 65 out of 69 studies from the SLR, were included in the analysis: 27 from Europe, 20 from North America, 11 from Asia and 7 from Oceania. There was much variability in study methodology and outcomes. Heterogeneity of incidence rates was greatest across studies conducted in Asia. Meta-analysis results showed that: incidence increased with age; was lower in males compared to females; was lower in Europe and North America compared to Asia and Oceania; and increased from the period prior to 2003 to the period after 2003. The final meta-regression model included continent, year of data collection, gender, age, cubic and quadratic terms for age, as well as an age x gender interaction term. The age x gender interaction suggests that the difference in incidence between males and females is greater in younger ages (e.g. 50-59), whereas in older age groups (e.g. 80+) incidence rates are similar between males and females. None of the additional covariates contributed significantly to the model. It was estimated that 15.5 million HZ cases occurred in 2020 worldwide in individuals aged 50 years and older, which in the absence of vaccination, is projected to increase to 19.8 million by 2030.
Conclusion. The model allows for trends in incidence data to be explored based on influential covariates. Incidence rates were shown to vary by age, gender, continent, and over time.