Abstract
Background
Low socioeconomic status has been shown to contribute to an increase in mortality and intensive care unit (ICU) admission in patients with sepsis. The role of homelessness on outcomes of gram-negative sepsis is currently unknown. The primary objective was to evaluate the impact of homelessness on presentation and outcomes compared with low socio-economic status patients with housing.
Methods
Single-center, retrospective cohort study of hospitalized adults with Enterobacteriaceae infections between 2015 and 2017. Medical charts were reviewed for pertinent data. Patients were grouped as homeless (H) vs. non-homeless (NH) and compared for patient characteristics, clinical presentation, and course. Primary outcome was 30-day mortality. Secondary outcomes were 30-day re-admission and hospital length of stay (LOS).
Results
198 patients were included; 68 in H group vs. 130 in NH group. H group were younger (mean 51 years vs. 57 years, P = 0.01), more likely to be male (71% vs. 37%, P < 0.01) and non-Hispanic White (57% vs. 21%, P < 0.01). Two groups had similar comorbidities, except H group had more liver dysfunction (16% vs. 7%, P = 0.05); however, less heart failure (7% vs. 18%, P = 0.03). H group had a more severe presentation with higher rate of ICU admission (57% vs. 41%, P = 0.04) although initial SOFA score (median 6 vs. 4, P = 0.14) and need for vasopressors (16% vs. 18%, P = 0.19) were similar. Urinary tract infection (37% vs. 45%, P = 0.36) and bacteremia (38% vs. 42%, P = 0.76) were the most common sources. Total antibiotic duration was similar (median 7d, P = 0.61); H group received more empirical vancomycin (16% vs. 7%, P = 0.05) and fluoroquinolones as definitive therapy (13% vs. 8%, P = 0.05). 30d mortality was similar (13% vs. 8%, P = 0.21); however, H group had significantly prolonged LOS by 4d (median 9 days vs. 5 days, P < 0.01) and higher 30 days re-admission (41% vs. 18%, P < 0.01).
Conclusion
Within a medically underserved population, homeless patients with gram-negative sepsis were younger and had more liver disease compared with patients with housing. As this group had increased utilization of healthcare resources including need for ICU-level care, prolonged LOS, and 30-day re-admission, additional targeted interventions to prevent and optimally treat Enterobacteriaceae infections in homeless patients may be needed.
Disclosures
All authors: No reported disclosures.
Session: 157. Urinary Tract Infections
Friday, October 4, 2019: 12:15 PM