2583. Short-term Impact of Antimicrobial Exposure on Fecal Carriage of Resistant Microorganisms

Abstract

BackgroundThe relationship between antimicrobial use and subsequent resistance is complicated; this study assesses the short-term impact of antimicrobial use on fecal carriage of resistant microorganisms. This is a sub-study of an ongoing trial comparing 7 vs. 14 days of antimicrobial treatment for male urinary tract infection. This analysis quantifies the effect of 1–2 weeks of systemic antimicrobial use on the fecal flora within 1 week of completing therapy.MethodsThe parent study has enrolled 216 subjects, with 178 enrolled in the optional resistance sub-study. Subjects received either ciprofloxacin or trimethoprim/sulfamethoxazole (SXT), randomized to 7 vs. 14 days therapy. Subjects provided 2 stool specimens, 1 during treatment and 1 a week after completing study medication. Samples were plated on media for Gram-positive and negative growth, including T-7 plates with ciprofloxacin and SXT added to select for resistant organisms. Resistance to 22 antimicrobials was assessed, with resistance reported by: number of isolates with any antimicrobial resistance, total number of resistant drugs/isolate, and number of isolates with multi-drug resistance (resistance to 3 or more different antimicrobial classes).ResultsOverall, 143 (80%) subjects provided 2 stool samples, with 104 (73%) having growth from at least 1 of the samples. Fifty-one of 143 (36%) had microbial growth from both samples. From these 51 paired samples, there were 255 total strains isolated (117 from the first sample, 138 from the second), with some yielding multiple organisms (range, 1–5). From sample 1, 110/117 (94%) isolates had any antimicrobial resistance, vs. 131/138 (95%) from sample 2 (P = .79). Mean number of resistant drugs/isolate was 7.4 in sample 1 and 5.8 in sample 2 (P = .009). Multi-drug resistance was seen in 102/117 (87%) isolates from sample 1 vs. 85/138 (62%) isolates in sample 2 (P < .001).ConclusionThe fecal flora of patients on antimicrobial therapy for UTI has a significant increase in resistant microorganisms compared with samples obtained shortly after antimicrobial completion. This may reflect repopulation of the fecal flora with less-resistant strains after the selection pressure of therapy has been removed. After unblinding, we will assess if differences in resistance are affected by therapy duration.Disclosures All authors: No reported disclosures.