2479. Trends and Regional Differences in Extended Spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, 2012–2017

Abstract

BackgroundExtended spectrum β-lactamase-producing Enterobacteriaceae (ESBLs) have been identified as a serious antibiotic-resistant threat. Studies have shown that ESBL infection rates were increasing through 2014. Our objective was to examine more recent ESBL trends and to evaluate differences across regions in the United States.MethodsWe measured the incidence of positive clinical cultures from inpatient encounters in a cohort of hospitals submitting data to the Premier Healthcare Database and Cerner Health Facts from 2012 through 2017. We included Escherichia coli and Klebsiella spp. cultures and defined ESBL as non-susceptibility to cefotaxime, ceftriaxone, ceftazidime, or cefepime. Cultures collected on days 1, 2, or 3 of hospitalization were considered community-onset (CO); cultures from day 4 or later were considered hospital onset (HO). We developed weights using a raking procedure to match the American Hospital Association distribution for acute care hospitals based on US census division, bed size category, teaching status, and urban/rural designation. We used weighted multivariable logistic regression adjusting for hospital characteristics to examine trends and regional differences in ESBL rates.ResultsIn 2017, the estimated rate of ESBLs was 40.3 per 10,000 discharges for CO and 6.4 per 10,000 discharges for HO; 86% of all ESBLs were CO. The percent that were ESBLs among all included cultures increased for CO (8.2% in 2012 to 11.6% in 2017) and HO (13.1 to 16.8%) cultures. From 2012 – 2017, adjusted ESBL rates increased for CO (7.9% annually, P < 0.0001), while HO rates did not change significantly over time (P = 0.39, Figure 1). We found significant regional differences in the rates of ESBL (P < 0.0001) across US census divisions in 2017 (Figure 2). Estimated rates for 2017 varied 5-fold from 15.3 ESBLs per 10,000 discharges in the Northwest Central to 82.4 ESBLs in the Mid-Atlantic.ConclusionWe estimated a 40% increase in the rate of CO-ESBLs among hospitalized patients from 2012 to 2017, but no increase in HO rates. ESBL rates varied greatly by region of the country and are estimated as much as 5× higher in some areas. A better understanding of factors contributing to community transmission and regional variation is necessary in order to inform ESBL prevention efforts. Disclosures All authors: No reported disclosures.