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1510. Treatment of Asymptomatic Bacteriuria prior to Transcatheter Aortic Valve Replacement

Abstract Background Based on large population-based studies, the risk of prosthetic valve endocarditis (PVE) after surgical aortic valve replacement is 0.57% per person year. There is no causal link from asymptomatic bacteriuria (ASB) to PVE; however, antibiotics are often prescribed in an abundance of caution given the catastrophic downside. The risk of PVE is yet to be determined in patients who receive a transcatheter aortic valve replacement (TAVR), but likely lower due to the minimally invasive approach. At our institution, ASB is heterogeneously treated with antibiotics prior to TAVR. Herein we quantified some untoward outcomes of treatment of ASB pre-TAVR. Methods A single-center retrospective study was conducted for patients who underwent TAVR between October 2012 and June 2017. Pre- and post-procedural urinalyses (UA), culture results, antibiotic regimens, development of resistance, symptoms of UTI, 30-day readmission rates, and 30- and 90-day mortality rates were collected. Results A total of 296 patients with median age of 83 (range 49–97) underwent TAVR. Two hundred and sixty UAs with reflex to culture (137 of which reflexed) and eight additional urine cultures (UC) were sent. One hundred and thrity-three of 145 patients cultured had no documented symptoms. There were 44 patients with positive UC, of which nine (20%) had symptoms. Of the 35 with ASB, 27 received antibiotics prior to TAVR (77%). Among those who were treated, there was one case of C. diff, three cases of development of resistance in an organism previously isolated and three cases of newly acquired MDRO. This amounts to a number needed to harm of 3.86. There were no cases of any of these outcomes, 30-day readmission or death within 90 days for the ASB patients who did not receive treatment. In the treatment group, there was one case of bacteremia for which the causative organism was different from the organism isolated in UC. Conclusion In this small cohort of mostly elderly TAVR patients, the rate of ASB was high as expected and most were treated. We documented cases of potential harm associated with antibiotic treatment, and found no such harm episodes in the untreated group. Given the high number needed to harm and the historically low risk of PVE, antimicrobial stewardship experts should continue to encourage avoidance of antibiotics for ASB, including for patients undergoing invasive and minimally invasive cardiac procedures. Disclosures All authors: No reported disclosures.

Background. The clinical significance of Staphylococcus aureus bacteriuria (SABU) is unclear and often presumed to represent hematogenous spread of occult S. aureus bacteremia (SAB). The aim of this study was to evaluate the clinical significance of SABU by assessing factors associated with the development of invasive S. aureus disease and 12-month mortality. We also describe the proportion of patients with methicillin-resistant S. aureus (MRSA), symptomatic urinary tract infection (UTI), asymptomatic bacteriuria, concomitant SAB, and calculate Charlson comorbidity scores.
Methods. This is a retrospective cohort study of all SABU isolates in a tertiary care hospital from 1 January 2007 to 31 December 2016. Cases were identified by screening specimens processed in the microbiology laboratory with records in the Phoenix/BG data system. Demographic data, Charlson comorbidity score, antimicrobial susceptibility profiles, urinary catheter use, residence in a long-term care facility, and UTI symptoms were obtained through chart review.
Results. A total of 356 patients with SABU were identified and 237 met inclusion criteria. Seventeen patients had concurrent invasive S. aureus infections and 220 patients had SABU without invasive infection or SAB. Of the 220 patients with SABU and no invasive S. aureus infection, none developed invasive disease. The 12-month mortality rate was 6.8% in those without concurrent SAB and 52.9% in those with invasive infection. In those without concurrent invasive S. aureus infection, male sex (P = 0.033), MRSA (P = 0.008), collection of blood cultures (P = 0.005), and Charlson comorbidity score (P ≤ 0.001) were identified as risk factors for 12-month mortality. Race, inpatient status, specimen type, pyuria, UTI symptoms, and urologic instrumentation were not significantly associated with mortality.
Conclusion. Patients without evident invasive S. aureus infection at the time of urine culture were not observed to present with invasive disease in the following year. Mortality increases with Charlson score and invasive infection in patients with SABU. Clinicians may consider isolated UTI, contamination, and colonization before embarking on extensive searches for occult staphylococcal infection in patients who present without obvious invasive infection, particularly in those without comorbid disease.
Disclosures. All authors: No reported disclosures. Background. Based on large population-based studies, the risk of prosthetic valve endocarditis (PVE) after surgical aortic valve replacement is 0.57% per person year. There is no causal link from asymptomatic bacteriuria (ASB) to PVE; however, antibiotics are often prescribed in an abundance of caution given the catastrophic downside. The risk of PVE is yet to be determined in patients who receive a transcatheter aortic valve replacement (TAVR), but likely lower due to the minimally invasive approach. At our institution, ASB is heterogeneously treated with antibiotics prior to TAVR. Herein we quantified some untoward outcomes of treatment of ASB pre-TAVR.

Methods.
A single-center retrospective study was conducted for patients who underwent TAVR between October 2012 and June 2017. Pre-and post-procedural urinalyses (UA), culture results, antibiotic regimens, development of resistance, symptoms of UTI, 30-day readmission rates, and 30-and 90-day mortality rates were collected.
Results. A total of 296 patients with median age of 83 (range 49-97) underwent TAVR. Two hundred and sixty UAs with reflex to culture (137 of which reflexed) and eight additional urine cultures (UC) were sent. One hundred and thrity-three of 145 patients cultured had no documented symptoms. There were 44 patients with positive UC, of which nine (20%) had symptoms. Of the 35 with ASB, 27 received antibiotics prior to TAVR (77%). Among those who were treated, there was one case of C. diff, three cases of development of resistance in an organism previously isolated and three cases of newly acquired MDRO. This amounts to a number needed to harm of 3.86. There were no cases of any of these outcomes, 30-day readmission or death within 90 days for the ASB patients who did not receive treatment. In the treatment group, there was one case of bacteremia for which the causative organism was different from the organism isolated in UC.
Conclusion. In this small cohort of mostly elderly TAVR patients, the rate of ASB was high as expected and most were treated. We documented cases of potential harm associated with antibiotic treatment, and found no such harm episodes in the untreated group. Given the high number needed to harm and the historically low risk of PVE, antimicrobial stewardship experts should continue to encourage avoidance of antibiotics for ASB, including for patients undergoing invasive and minimally invasive cardiac procedures.
Disclosures. All authors: No reported disclosures.