699. Case-Case Comparison of Exposures among Fluoroquinolone-Resistant and Pan-Susceptible Campylobacter Cases, Tennessee, 2016-2018

Abstract

Abstract Background Campylobacter causes an estimated 1.5 million infections each year in the United States. Of those, approximately 448,400 infections are caused by antimicrobial resistant strains, including strains resistant to fluoroquinolones (e.g., nalidixic acid and ciprofloxacin), which are commonly used to treat campylobacteriosis. Campylobacter infection is commonly attributed to consuming poultry products. We compared exposure data between fluoroquinolone-resistant and pan-susceptible Campylobacter cases reported in 2016-2018 to assess attribution. Methods Broth microdilution was performed on Campylobacter isolates at CDC to determine the minimum inhibitory concentration for nine antimicrobial drugs. Whole genome sequencing (WGS) was performed at the Tennessee (TN) State Public Health Laboratory and the sequence data were analyzed at CDC to determine the genetic resistance determinants. Exposure data was collected through routine case interviews. Exposures among cases with fluoroquinolone-resistant infection and cases with no resistance to antimicrobials were compared. Results A total of 606 Campylobacter isolates from TN were submitted to CDC NARMS. Of those, 123 (20%) isolates were resistant to fluoroquinolones and 304 (50%) isolates were pan-susceptible. The gyr A (86) resistance gene was detected in 46/54 (85%) of resistant isolates. Exposure data were available for 59 (48%) fluoroquinolone-resistant cases and 186 (61%) pan-susceptible cases. Consumption of chicken (OR 2.1, p-value 0.03) and handling raw seafood (OR 3.1, p-value 0.03) were significantly associated with fluoroquinolone-resistance. More fluoroquinolone-resistant cases reported international travel compared to pan-susceptible cases (15% versus 4%) with OR 4.6, and p-value 0.004. Conclusion Fluoroquinolone-resistant Campylobacter infections were acquired domestically and internationally. Exposure to chicken products and handling raw seafood were reported more often among fluoroquinolone-resistant cases. Whole genome sequencing of Campylobacter isolates provides predicted resistance data. Coupling predicted resistance data with exposure data facilitates better understanding of source attribution of different strains. Disclosures All Authors: No reported disclosures