1430. Descriptive Epidemiology of Emergency Department Visits with cUTI in the US, 2012-2018. (4th December 2021)

• Record Type: Journal Article
• Authors: Zilberberg, Marya; Nathanson, Brian; Sulham, Kate; Shorr, Andrew F
• Is Part Of: Open forum infectious diseases. Volume 8(2021)Supplement 1
• Page Start: S797
• Page End: S797
• Publication Date: 2021-12-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofab466.1622
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Urinary tract infections (UTI) represent a substantial burden to the healthcare system. In the early 2000s annual UTI admissions numbered 100, 000, and these infections resulted in over 1 million emergency department (ED) visits. While only a fraction of total UTI volume, the estimated cost of complicated (cUTI) to the healthcare system exceeded &3.5 billion. We set out to evaluate the contemporary burden of cUTI in the US in terms of ED visits annually. Methods: We conducted a retrospective multicenter cohort study within the National Emergency Department (NEDS) database, a 20-percent stratified sample of all US hospital-based EDs, from 2012-2018, to explore characteristics of patients discharged with a cUTI diagnosis. We applied a previously published algorithm to identify cUTI using administrative coding. We applied survey methods to develop national estimates. Results: Among 3, 010, 997 ED visits with cUTI, 43.3% were female, and 59.0% were age 65 years or older. Commensurately, Medicare was the primary payor in 62.8% of the visits. The majority of the patients (59.1%) presented to metropolitan teaching hospitals, and plurality were in the Southern US (39.6%). There was a narrow range in the visits' seasonal variation, from 6.4% occurring in February to 7.9% in October. cUTI was the principal diagnosis in 48.5% of all cUTI visits. In the remaining 51.5%, sepsis was the most common principal diagnosis (33.9%), but severe sepsis and septic shock codes each appeared in 4.9%. Of all cUTI ED visits, 21.4% had catheter-associated UTI. While only 19.8% had a code for pyelonephritis, 2, 050, 548 (68.1%) were admitted to the hospital. Mortality in the ED was 0.02%. Conclusion: During the seven-year span, there were over 3 million ED visits for cUTI. Although fewer than 1 in 10 patients met criteria for severe sepsis/septic shock, approximately 2/3rds of cUTI patients presenting to the ED were subsequently hospitalized. Disclosures: Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Kate Sulham, MPH, Spero Therapeutics (Consultant) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)