248. Antimicrobial Therapy for Suspected Urinary Tract Infection in Advanced Cancer Patients Transitioning to Comfort Measures

BACKGROUND: Antimicrobials for suspected urinary tract infection (UTI) in advanced cancer patients transitioning to comfort measures (CM) may benefit from stewardship intervention. METHODS: We identified adults ≥65 years with advanced cancer who had ≥1 urine culture obtained during admission to Yale New Haven Hospital from July 2014 to October 2016 that involved transition to CM. We evaluated whether patients met 2017 National Healthcare Safety Network criteria for symptomatic urinary tract infection (UTI). Antimicrobials for suspected UTI and total calendar days of therapy including postdischarge days were evaluated. Factors associated with antimicrobial use were assessed using χ(2) or Fisher’s exact testing and fitted in a modified multivariable Poisson regression model. RESULTS: We identified 327 adults with advanced cancer and ≥1 urine culture obtained during admission involving transition to CM. Median age was 74 years (range, 65–99), 48% (N = 157) were male, and 73% (N = 239) had solid tumors, 21% (N = 70) had liquid tumors, and 6% (N = 18) had unknown primary tumors. Overall, 306 (94%) patients with suspected UTI did not meet criteria for symptomatic UTI. Of these, 14% (N = 43/306) received antimicrobials for suspected UTI resulting in 273 total calendar-days of therapy. Antimicrobial use for suspected UTI was associated with asymptomatic or symptomatic bacteriuria or candiduria (Table 1). In a multivariable model adjusted for gender, length of stay, liquid tumor, and UTI signs or symptoms, antimicrobial use remained associated with bacteriuria or candiduria (RR = 29.0, 95% CI 11.6, 72.6). CONCLUSION: In advanced cancer patients transitioning to CM, inappropriate antimicrobial use for suspected UTI is independently associated with bacteriuria or candiduria but not with UTI signs or symptoms. These findings highlight a potential target for diagnostic (i.e., restricting urine culture orders) and antimicrobial stewardship in this population to promote comfort at the end of life. DISCLOSURES: M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor, Consulting fee