Extended-spectrum Beta-lactamase Infections Research Articles

Thematic description of factors linked with extended-spectrum beta-lactamase-producing Enterobacteriaceae in humans.

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are associated with serious antimicrobial-resistant infections in Canadians. Humans are exposed to ESBL-producing Enterobacteriaceae through many interconnected pathways. To better protect Canadians, it is important to generate an understanding of which sources and activities contribute most to ESBL exposure and infection pathways in Canada. The aims of this scoping review were to thematically describe factors potentially associated with ESBL-producing Enterobacteriaceae colonization, carriage and/or infection in humans from countries with a very high human development index and describe the study characteristics. Four databases (PubMed, CAB Direct, Web of Science, EBSCOhost) were searched to retrieve potentially relevant studies. Articles were screened for inclusion, and factors were identified, grouped thematically and described. The review identified 381 relevant articles. Factors were grouped into 13 themes: antimicrobial use, animals, comorbidities and symptoms, community, demographics, diet and substance use, health care, household, occupation, prior ESBL colonization/carriage/infection, residential care, travel, and other. The most common themes reported were demographics, health care, antibiotic use and comorbidities and symptoms. Most articles reported factors in hospital settings (86%) and evaluated factors for ESBL-producing Enterobacteriaceae infections (52%). This scoping review provided valuable information about which factor themes have been well described (e.g., health care) and which have been explored less frequently (e.g., diet or animal contact). Themes identified spanned human, animal and environmental contexts and settings, supporting the need for a diversity of perspectives and a multisectoral approach to mitigating exposure to antimicrobial resistance.

Effect of UV-C disinfection and copper plating on healthcare-associated infections in a NICU with high ESBL infections

IntroductionHealthcare-associated infections (HCAIs) in neonates are frequent and highly lethal, in particular those caused by extended spectrum beta-lactamase (ESBL) producing bacteria. We evaluated the beneficial effects of ultraviolet C (UV-C) disinfection and copper adhesive plating on HCAIs in the Neonatal Intensive Care Unit (NICU) of a third level paediatric hospital in Mexico City, both in combination of hand-hygiene (HH) and prevention bundles. MethodsAll NICU patients were included. There were 4 periods (P): P1: HH monitoring and prevention bundles; P2: P1+UV-C disinfection; P3: P2+Copper adhesive plating on frequent-contact surfaces and P4: Monitoring of P3 actions. Results552 neonates were monitored during 15,467 patient days (PD). HCAI rates decreased from 11.03/1000 PD in P1 to 5.35/1000 PD in P4 (p=0.006). HCAIs with bacterial isolates dropped from 5.39/1000 PD in PI to 1.79/1000 PD in P4 (p=0.011). UV-C and copper were associated with significant HCAI prevention (RR 0.49, CI95% 0.30–0.81, p=0.005) and with lesser HCAIs with bacterial isolates (RR 0.33, CI95% 0.14–0.77, p=0.011). ConclusionsCopper adhesive plating combined with UV-C disinfection were associated with a drop in HCAI rates and with the elimination of ESBL-caused HCAIs. Hence, we propose that these strategies be considered in MDRO proliferation preventions.

Extended Spectrumbeta-Lactamase Bacteria and Multidrug Resistance in Jordan are Predicted Using a New Machine-Learningsystem.

The incidence of microorganisms with extended-spectrum beta-lactamase (ESBL) ison the rise, posing a significant public health concern. The current application of machine learning (ML) focuses on predicting bacterial resistance to optimize antibiotic therapy. This study employs ML to forecast the occurrence of bacteria that generate ESBL and demonstrate resistance to multiple antibiotics (MDR). Six popular ML algorithms were initially trained on antibiotic resistance test patient reports (n = 489)collected from Al-Hussein/Salt Hospital in Jordan. Trained outcome models predict ESBL and multidrug resistance profiles based on microbiological and patients' clinical data. The results were utilized to select the optimal ML method to predict ESBL's most associated features. Escherichia coli (E. coli, 82%) was the most commonly identified microbe generating ESBL, displaying multidrug resistance. Urinary tract infections (UTIs) constituted the most frequently observed clinical diagnosis (68.7%). Classification and Regression Trees (CART) and Random Forest (RF) classifiers emerged as the most effective algorithms. The relevant features associated with the emergence of ESBL include age and different classes of antibiotics, including cefuroxime, ceftazidime, cefepime, trimethoprim/ sulfamethoxazole, ciprofloxacin, and gentamicin. Fosfomycin nitrofurantoin, piperacillin/tazobactam, along with amikacin, meropenem, and imipenem, had a pronounced inverse relationship with the ESBL class. CART and RF-based ML algorithms can be employed to predict the most important features of ESBL. The significance of monitoring trends in ESBL infections is emphasized to facilitate the administration of appropriate antibiotic therapy.

Risk Factors for Bloodstream Infections Due to ESBL-Producing Escherichia coli, Klebsiella spp., and Proteus mirabilis.

(1) Background: Risk factors for extended-spectrum beta-lactamase (ESBL) infections could vary geographically. The purpose of this study was to identify local risk factors for ESBL production in patients with Gram-negative bacteremia. (2) Methods: This retrospective observational study included adult patients admitted from January 2019 to July 2021 and had positive blood cultures for E. coli, K. pneumoniae, K. oxytoca, and P. mirabilis. Patients with ESBL infection were matched to a non-ESBL-producing infection with the same organism. (3) Results: A total of 150 patients were included: 50 in the ESBL group and 100 in the non-ESBL group. Patients in the ESBL group had a longer length of stay (11 vs. 7 days, p < 0.001), but not increased mortality (14% vs. 15%, p = 0.87) Multivariate analysis identified the receipt of >1 antibiotic in the last 90 days as a risk factor for ESBL infection (OR = 3.448, 95% CI = 1.494-7.957; p = 0.004); (4) Conclusions: Recent antimicrobial use was identified as an independent risk factors for ESBL-producing Enterobacterales infections. Knowledge of this risk may improve empirical therapy and reduce inappropriate use.

Analysis of infections among patients with historical culture positive for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae: Is ESBL-targeted therapy always needed?

Among patients with a history of ESBL infection, uncertainty remains regarding whether all of these patients require ESBL-targeted therapy when presenting with a subsequent infection. We sought to determine the risks associated with a subsequent ESBL infection to help inform empiric antibiotic decisions. A retrospective cohort study of adult patients with positive index culture for Escherichia coli or Klebsiella pneumoniae (EC/KP) receiving medical care during 2017 was conducted. Risk assessments were performed to identify factors associated with subsequent infection caused by ESBL-producing EC/KP. In total, 200 patients were included in the cohort, 100 with ESBL-producing EC/KP and 100 with ESBL-negative EC/KP. Of 100 patients (50%) who developed a subsequent infection, 22 infections were ESBL-producing EC/KP, 43 were other bacteria, and 35 had no or negative cultures. Subsequent infection caused by ESBL-producing EC/KP only occurred when the index culture was also ESBL-producing (22 vs 0). Among those with ESBL-producing index culture, the incidences of subsequent infection caused by ESBL-producing EC/KP versus other bacterial subsequent infection were similar (22 vs 18; P = .428). Factors associated with subsequent infection caused by ESBL-producing EC/KP include history of ESBL-producing index culture, time ≤180 days between index culture and subsequent infection, male sex, and Charlson comorbidity index score >3. History of ESBL-producing EC/KP culture is associated with subsequent infection caused by ESBL-producing EC/KP, particularly within 180 days after the historical culture. Among patients presenting with infection and a history of ESBL-producing EC/KP, other factors should be considered in making empiric antibiotic decisions, and ESBL-targeted therapy may not always be warranted.

Hubungan ESBL dengan Lama Rawat Inap pada Pasien Ulkus Kaki Diabetes

Diabetic Foot Ulcer (DFU) is a condition of foot ulcers caused by neuropathy disorders. The prevalence of DFU in Indonesia is around 15% with an amputation rate of 30% and a mortality rate of 32%. DFU is known as a chronic wound with a long healing time. Infection with Extended-Spectrum Beta-Lactamase (ESBL) is an important predictor in determining the optimal antibiotic regimen. The study aim was to determine the association between ESBL infection with length of stay in DFU patients at Abdoel Wahab Sjahranie Hospital, Samarinda. This study used analytical observational method with a cross-sectional study approach. The research data were gathered from the medical records of DFU patients at Abdoel Wahab Sjahranie Hospital Samarinda from the period of 2020–2022 with a purposive sampling method. There were 108 patients selected as samples through inclusion and exclusion criteria. The statistical bivariate analysis was performed using Chi-Square test. The results showed that there was no association between ESBL (p=0.676) towards length of stay in DFU patients at Abdoel Wahab Sjahranie Hospital Samarinda.&#x0D;

2040. Healthcare-Associated Infection Surveillance During the COVID-19 Pandemic in New Mexico

Abstract Background The COVID-19 pandemic changed accessibility of care and practices within healthcare environments. This period has been associated with healthcare-associated infection outbreaks and shifts in healthcare-associated infectious disease epidemiology. This study’s objective is to describe changes in rates and characteristics of antimicrobial-resistant gram negative and Clostridioides difficile (CD) infections during the COVID-19 pandemic in Bernalillo County, New Mexico. Methods The NM EIP, a collaboration between University of New Mexico and the NM DOH, conducts ongoing laboratory- and population-based surveillance of infectious disease including Clostridium difficile, extended-spectrum beta lactamase (ESBL-E) and carbapenemase-producing gram negative bacteria (CRE). Stata statistical software was used for retrospective analysis of rates and characteristics on NM EIP data from Bernalillo county, NM between 2016 and 2021. Results Reported C. difficile rates decreased from 76 to 49 cases/month and ESBL-producing Enterobacterales decreased from 145 to 86 cases/month during the pandemic period from March-December 2020 compared with the prior 14 months. Monthly case counts for 2020 are lowest during initial public health orders for the state of New Mexico. Rates of CRE remained constant between 2018-2021. The proportion of CDI cases originating from long-term care facilities decreased significantly from 17.2% to 10.4% (p=0.006) while the proportion attributable to hospital inpatient and community populations remained constant. The proportion of ESBL-E cases from sterile sample sites increased from 3.1% to 4.9% (p=0.05) and the proportion of patients who died within 30 days or prior to discharge increased from 2.2% to 3.2% (p=0.019). Conclusion Rates and characteristics of CD and ESBL-E infections in Bernalillo county NM changed significantly during the COVID-19 pandemic, while rates of CRE remained constant. It is still unclear whether this is related to changes in actual disease rates due to risk factor exposure (healthcare), or if this trend reflects changes in care-seeking behavior and/or reporting of cases. Disclosures All Authors: No reported disclosures.

Cost of Care and Impact on Quality of Life of Upper Urinary Tract Infections in South India with a Focus on Diabetics and Extended-Spectrum Beta-Lactam Producing Organisms

Background and Objectives: Upper urinary tract infections (UTIs) that require in-patient care can be expensive. Comorbid conditions such as diabetes as well as UTI due to extended-spectrum beta-lactamase (ESBL) producing bacteria may affect costs. The quality of life of patients with this condition has not been described. Methods: This was a cost of illness study that prospectively evaluated patients admitted with upper UTI to a medical ward in a tertiary care hospital. Direct medical and nonmedical costs, indirect costs were collected to make the total cost per admission. Quality of life was assessed using the World Health Organization Quality of Life-BREF score. We also compared costs between those with and without diabetes or ESBL infection. Results: Between March 2016 and July 2017, 92 eligible patients were included in the study. The average age was 55.8 years; two thirds were diabetics. The mean overall cost of a single admission for upper UTI was INR.88, 330.2 (1370.4 USD). This was INR.96, 193.0 (1492.6 USD) and INR.1, 03,154.9 (1600.4 USD) among those with diabetes mellitus and ESBL infection, respectively. The cost was higher among those with diabetes and ESBL than those without; this difference reached statistically significance for the ESBL group. The quality of life was affected in all domains; the psychological being most affected among diabetics and ESBL infected. Conclusions: The mean total cost of admission for an upper UTI in a tertiary care hospital in South India was INR 88,330 (1370.4 USD). This is higher if the patient has diabetes or ESBL organism causing the UTI. Quality of life is clearly reduced especially in the psychological domain.

Mortality and its predictors among hospitalized patients with infections due to extended spectrum beta-lactamase (ESBL) Enterobacteriaceae in Malaysia: a retrospective observational study

BackgroundExtended spectrum beta-lactamase (ESBL) pathogens are associated with morbidity and mortality. There is a paucity of data describing the treatments and outcomes of ESBL infections in Malaysia. This study evaluated the treatments, mortality and associated factors among patients hospitalized with infections due to ESBL positive enterobacteriaceae. This is a retrospective study conducted in a tertiary hospital from January 2018 to June 2020. Hospitalized patients with ESBL-positive enterobacteriaceae infections were included. A clinical pharmacist collected data by reviewing the patients’ electronic medical records. The data were analysed using both descriptive and inferential analyses.ResultsThis analysis included 110 patients with a mean age of 62.1 ± 14.4 years. Klebsiella pneumoniae (53.6%) and Escherichia coli (40.9%) were the most prevalent pathogens among the 110 infections. Bacteremia (42.7%) was the most frequent diagnosis. The isolates were resistant to majority of penicillins and cephalosporins. However, over a third (39.3%) were susceptible to piperacillin–tazobactam, while carbapenem susceptibility was extremely high (≥ 99%). The most frequently used empiric and definitive antibiotics was piperacillin–tazobactam and meropenem, respectively. Less than a third (28.2%) of patients received active empiric antibiotics, and the mean duration before active antibiotics was 3.9 ± 2.7. Overall, hospital mortality rate was 13.6%, and mortality was significantly associated with ICU admission (AOR 8.75; 95% CI 1.05–72.75; P = 0.045) and diabetes mellitus (AOR 9.85; 95% CI 1.04–93.09; P = 0.046).ConclusionsCarbapenems are the major antibiotics used to treat ESBL-positive enterobacteriaceae infections. Hospital mortality rate is relatively high and is significantly associated with in patients admitted to ICU and those with diabetes mellitus. Antibiotic stewardship interventions are necessary to promote early administration of active antibiotics and to reduce overuse of carbapenem antibiotics.

349 Utilization of an Antibiogram and a Pathway for Urinary Tract Infections in a Pediatric Emergency Department to Improve Empiric Antimicrobial Treatment: A Quality Improvement Project

Escherichia coli is the most common cause of pediatric urinary tract infections (UTI). Antimicrobial resistance including extended spectrum beta-lactamase (ESBL) has increased alarmingly since the early 2000s, leaving antibiotics such as penicillins and cephalosporins ineffective. Overutilization of third generation cephalosporins (3GC) can add selective pressure and serve as a risk factor for development of an ESBL infection. An antibiotic review at our institution demonstrated children with community-acquired UTIs were receiving a 3GC as a part of treatment from the emergency department (ED). A UTI-specific antibiogram demonstrated good susceptibility to first generation cephalosporins (1GC). Our primary objective was to provide education based on our antibiogram and implement a UTI pathway in the ED to decrease the overall use of 3GC while maintaining clinical outcomes. This was a prospective study in a freestanding urban academic pediatric medical system consisting of an ED with an annual census of 60, 000 patients (Site A) as well as a small satellite non-academic campus ED (Site B). Data was collected from July 2019 to June 2020 and included patients 60 days to 18 years of age with a positive urine culture and a diagnosis of UTI who were discharged from the ED, excluding those with concurrent urologic conditions and non-UTI infections. Data was collected pre-implementation (July 2019 - October 2019) and post-implementation (December 2019 - June 2020) of our interventions at Site A. (See Figure 1) Interventions included provider huddles, education, and pathway implementation. Site B acted as a control group where the pathway was available but the education and provider huddles were not implemented. The primary outcome was comparing the frequency that the proposed empiric treatment pathway was followed pre- and post-interventions, and was analyzed using the Binomial Test. The secondary outcome was comparing the antibiotic treatment days, and was analyzed using the Mann-Whitney U Test. 309 pediatric patient encounters (194 from Site A and 115 from Site B) were included; 122 pre- and 187 post-intervention. 286 (93%) were female, and 139 (45%) were Caucasian. Mean age (years) was 6.86 (range 0.2-18). 271 (87%) urine cultures grew E. coli. Of all gram-negative pathogens isolated, 88% were susceptible to 1GC. For Site A, the correct drug based on pathway was improved from 36% to 69.2% post-intervention (p = <0.001) with a median of 81%. Median duration of antimicrobial therapy at Site A pre-intervention was 11 days and post-intervention was 10 days (p = 0.004). Site B showed no change in correct drug or duration. The most common initial antibiotic prescribed at Site A was 3GC (59%) pre-intervention and 1GC (60%) post-intervention. 3GC was most common at Site B both pre- (72%) and post-intervention (55%). Our data demonstrates that a pathway alone will not change practice. Education at different levels (attendings and trainees) and provider huddles along with a pathway improved antimicrobial prescribing patterns in pediatric patients with a community-acquired UTI. Overall, this study is generalizable to other populations and will be expanded to include other clinical settings in an effort to continue improving antimicrobial usage in children.

Urinary Tract Infection (UTI) caused by Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae: a case series

Introduction: A urinary tract infection (UTI) is an infection in any part of the urinary system, occurring in the kidneys, bladder, ureters, and urethra. UTI incidence in Indonesia was high enough. The prevalence of UTI in the community enhances in line with the increase of age. 40-60 years had a prevalence rate of 3.2%, while at the age of ≥65, a UTI had a prevalence rate of 20%. UTIs are among the most common infections in humans. Enterobacteria that produce extended-spectrum beta-lactamase (ESBL) is one of the most frequent causes. Prevalence of the ESBL bacterial infection is developing due to the widespread prescription of antibiotics around the world. Thus, our articles established several UTI cases of various ages and their antibiotic susceptibility. Case Description: This case report series presents eight cases describing a UTI caused by Enterobacteriaceae producing ESBL in various ages. Data were collected retrospectively from secondary sources of laboratory results. Patient baby-child mostly had a history of sepsis. Other than that patient had hydronephrosis kidney, seizure, fever. On the other hand, the patient's old man and woman had a history of fever, shock spinal and fracture, malignancy. All patients were tested for antibiotic susceptibility and mostly still sensitive with amikacin, meropenem, nitrofurantoin, and fosfomycin. Conclusions: Our case series established that patients with UTI were mainly still sensitive to amikacin, meropenem, nitrofurantoin, and fosfomycin. We should implement and maintain contact precautions throughout the hospital wards to prevent the transmission of ESBL infections.

Microbiological Profile of Orthopaedic Implant Associated Infections: A Prospective Study

Introduction: The incidence of orthopaedic implantation and implantation associated infections were correspondingly increasing among the elderly and trauma patients. The resistance among the pathogens pose a unique challenge to the clinicians in the management of the infection. Extended-Spectrum Beta-Lactamase (ESBL), AmpC beta-lactamases (AmpC), Metallo Beta-Lactamases (MBL) and Methicillin-Resistant Staphylococcus aureus (MRSA) producing bacterial pathogens are responsible for a high rate of relapsing infections and outbreaks of nosocomial infections. Aim: To focus on accounting the incidence of ESBL, AmpC, MBL and MRSA and its antibiogram for effective management of implant associated infection. Materials and Methods: The present study was a prospective observational study which was conducted using various samples like pus, wound swab, serous discharge. These samples were collected under aseptic precautions in sterile containers for the period of one year (February 2015-February 2016). A total of 200 samples were inoculated on Blood agar and McConkey agar and identified. The isolates were tested for detection of ESBL, AmpC, MBL and MRSA as per standard protocol. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 20.0 Chicago, USA. Results: Most commonly used implants were intramedullary interlocking nail 138 (65.7%) followed by dynamic compression plates 23 (11.0%) and anatomical plates 18 (8.6%). Of the total of 200 samples, 190 (95%) samples yielded monomicrobial isolates and 10 (5%) samples yielded polymicrobial isolate. gram negative isolates 108 (51.4%) were marginally higher than gram positive isolates 102 (48.6%). The predominant isolate was S. aureus 81 (38.5%) followed by Klebsiella spp. 28 (13.3%) and Pseudomonas aeruginosa 21 (10.0%). In gram negative isolates, 76 (70.4%) were ESBL and/or AmpC producers. Of which, 48 (44.4%) were ESBL and AmpC co-producers. There were no MBL producing isolates. In gram positive isolates, majority were S. aureus 81 (79.4%) followed by Coagulase-negative Staphylococcus 21 (20.6%). Out of 81 S. aureus isolates, 46 (56.8%) were MRSA. Out of 21 CoNS, majority 17 (81%) isolates were methicillin-resistant. Implant failures were observed in 28 (14%) cases. Out of 28, majority 12 (42.8%) of the implant failures were MRSA. Conclusion: High rates of ESBL, AmpC and MRSA infections associated with implant surgeries indicate the necessity to formulate antibiotic policies and control measures. ESBL and AmpC producing strains were found to show higher rates of resistance to the various class of antibiotics when compared to non-ESBL and non-AmpC producers. MRSA isolates were found to show higher rates of resistance to various classes of antibiotics when compared to MSSA

71. Impact of Prospective Audit and Feedback on Fluoroquinolone Use: A Large Academic Medical Center Experience

BackgroundFluoroquinolones are an effective class of antimicrobials; however, their use is not without consequence. Recent warnings have resulted in the FDA recommending to reserve this class for infections lacking alternative options. Antimicrobial stewardship significantly reduces targeted antimicrobial use, improves susceptibility patterns, decreases rates of Clostridium difficile infection (CDI), and reduces healthcare-associated costs. Literature on fluoroquinolone stewardship by antimicrobial stewardship programs report similar outcomes in addition to reductions in rates of extended-spectrum beta-lactamase (ESBL)-producing and methicillin-resistant S. aureus (MRSA) infection.MethodsThis study was a retrospective cohort study of adult patients receiving at least 3 days of a fluoroquinolone for an indication of pneumonia or urinary tract infection. Retrospective orders were assessed for prescribing patterns, duration of therapy, and antibiotic choice by indication. The primary outcome was reduction of fluoroquinolone consumption as a result of a prospective audit and feedback intervention, determined with days of therapy (DOT) and DOT per 1000 patient days. Secondary outcomes included hospital length-of-stay (LOS), 3-month post-exposure incidence of CDI, ESBL and MRSA infections, percentage of interventions accepted, and QT prolongation events. Mann-Whitney U was used to determine statistical significance for DOT and LOS, unpaired student t-test was used for DOT per 1000 patient days.Results333 patients were reviewed. Fluoroquinolone median days-of-therapy (DOT) was significantly reduced in the intervention phase (7 vs. 4 days, P < 0.001). Median LOS was 8 days for the cohort and did not differ between groups. After adjusting for identifiable alternative causes, no difference in QT prolongation, CDI or ESBL infection was observed. However, these results were limited by lack of diagnostic testing for QT prolongation and inability to assess for other contributing factors related to infection control.ConclusionAntimicrobial stewardship is an effective intervention to reduce fluoroquinolone use. An increased LOS was not observed despite patients switching to parenteral therapies. More data is needed to assess differences related to adverse events.Disclosures All Authors: No reported disclosures

1564. Activity of bacteriophage against multidrug resistant Klebsiella pneumoniae

BackgroundThe prevalence of extended-spectrum beta-lactamase (ESBL) producing and carbapenem resistant (CR) Klebsiella pneumoniae (KP) has significantly risen in all geographic regions. Infections due to these bacteria are associated with high mortality across different infection types. Even with newer options, there remains an unmet need for safe and effective therapeutic options to treat infections caused by ESBL and CR KP. Phage therapy offers a novel approach with an unprecedented and orthogonal mechanism of action for treatment of diseases caused by pathogenic bacterial strains that are insufficiently addressed by available antibiotics. Phage-based therapies confer a high strain-level specificity and have a strong intrinsic safety profile. Here we describe the identification of novel phages that can effectively target antibiotic resistant KP strains.Host range of the 21 phages on 33 strain KP panel via solid culture infectivity assays. Red marks resistance to infection while sensitivity to phage is marked in green Methods KP clinical strains were isolated from human stool specimens preserved in glycerol. Selective culturing was carried, followed by testing of individual colonies for motility, indole and urease production, sequenced and analyzed by Kleborate tool to determine antibiotic resistant genes. Natural phages were isolated from plaques that developed on susceptible bacterial targets, sequenced and characterized.ResultsAntibiotic-resistant KP strains encoding beta lactamase genes or a carbapenemase (n=33) were isolated from healthy individuals (n=3), and patients with inflammatory bowel disease (n=26) or primary sclerosing cholangitis (n=3). Isolates sequencing revealed bla CTX-M15 and/or bla SHV encoding strains and carbapenamase KPC-2. A panel of 21 phages targeting the beta-lactamase- and carbapenemase-producing KP strains were identified. Phage sequencing revealed that all phages belong to the Caudovirales order and include 6 Siphoviridae, 14 Myoviridae, and 1 Podoviridae. In vitro lytic activity of the phages was tested on the isolated bacteria and revealed a coverage of 70% of the 33 isolated antibiotic resistant strains, >50% of which were targeted by multiple phages.ConclusionCollectively, these results demonstrate the feasibility of identifying phage with potent activity against antibiotic resistant KP strains, and may provide a novel therapeutic approach for treatment of ESBL and CR KP infections.Disclosures All Authors: No reported disclosures

1668. Clinical Risk Score Model for Predicting Extended Spectrum Beta Lactamase (ESBL)-Positive Urinary Tract Infection among Hospitalized Filipino Patients: a Retrospective Single-Center Study

BackgroundInfections caused by Extended-Spectrum B-lactamases (ESBL) organisms are an emerging health concern worldwide. In the background of progressive rise of antibiotic resistant organisms, efforts should be started to minimize antibiotic resistance. The development of clinical risk score models to predict the possibility of infection with these drug resistant organisms will bridge the gap between treating too late and treating too early and too much.MethodsThis is a single-center cross-sectional study of ESBL positive urinary tract infection (UTI) among patients admitted at St Luke’s Medical Center - Global City from January 2018 to December 2018. A total of 93 patients positive for ESBL-positive UTI and 186 patients with ESBL-negative UTI were included in the study. Clinical characteristics, medical and medication histories were obtained from the computerized medical database. To develop the risk score, clinical risk indicators measured at the time of recruitment were built by logistic regression. Regression coefficients were transformed into item scores and added up to a total score. A risk-scoring scheme was developed from clinical predictors.ResultsThe following factors were observed to be predictive of ESBL UTI: hospital-acquired or healthcare-associated infection, prior ESBL infection, cardiac comorbidity and history of carbapenem intake. Scoring for the predictive model is as follows: having age at least 50 years old=1.5, hospital-acquired or healthcare-associated infection=1, having prior ESBL infection=2, having cardiac comorbidity (NYHA I-II)=1, having cardiac comorbidity (NYHA III-IV)=2.5, and history of carbapenem intake=3. ROC analysis showed that the optimum cut point in the model predictive of ESBL is 3.5/10. The risk prediction model for ESBL had high sensitivity of 87%, medium specificity of 68%, and good predictive accuracy of 0.78.ConclusionA simple and non-invasive scoring scheme of three predictors provides good prediction indices for presence of ESBL organisms in patients diagnosed with UTI. However, a large sample study is needed to improve the power of the study. Validation studies are also needed.Disclosures All Authors: No reported disclosures

Extended-spectrum beta-lactamase Escherichia coli and Klebsiella pneumoniae urinary tract infections.

The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae urinary tract infections (UTIs) is increasing worldwide. We investigated the prevalence, clinical findings, impact and risk factors of ESBL E. coli/K. pneumoniae UTI through a retrospective review of the medical records of children with UTI aged <15 years admitted to Prince of Songkla University Hospital, Thailand over 10 years (2004-2013). Thirty-seven boys and 46 girls had ESBL-positive isolates in 102 UTI episodes, compared with 85 boys and 103 girls with non-ESBL isolates in 222 UTI episodes. The age of presentation and gender were not significantly different between the two groups. The prevalence of ESBL rose between 2004 and 2008 before plateauing at around 30-40% per year, with a significant difference between first and recurrent UTI episodes of 27.3% and 46.5%, respectively (P = 0.003). Fever prior to UTI diagnosis was found in 78.4% of episodes in the non-ESBL group and 61.8% of episodes in the ESBL group (P = 0.003). Multivariate analysis indicated that children without fever (odds ratio (OR) 2.14, 95% confidence interval (CI) 1.23-3.74) and those with recurrent UTI (OR 2.67, 95% CI 1.37-5.19) were more likely to yield ESBL on culture. Congenital anomalies of the kidney and urinary tract were not linked to the presence of ESBL UTI. In conclusion, ESBL producers represented one-third of E. coli/K. pneumoniae UTI episodes but neither clinical condition nor imaging studies were predictive of ESBL infections. Recurrent UTI was the sole independent risk factor identified.

The association between extended-spectrum β-lactamase and increasing usage of 3rd generation cephalosporin in pediatric ward of Saiful Anwar Hospital

Background: The increasing consumption of antibiotic can increase the incidence of Extended-Spectrum Beta-Lactamase (ESBL) infection, especially the consumption of 3rd generation cephalosporin. The consumption of 3rd generation cephalosporin can affect the treatment, length of stay, and mortality of patient. This research is performed to know the association between the increasing consumption of 3rd generation cephalosporin and incidence of ESBL infection. Methods and materials: The subjects of this research are medical records from 2017–2018 year at Pediatric ward of Saiful Anwar Hospital. This research is an analytical research which uses cross sectional design. It used Pearson-chi square test to compare between consumption of 3rd generation cephalosporin and incidence of ESBL infection in 2017 and 2018. Results: The total antibiotic usage in 2017 were 38 (47.5%) and no antibiotic usage were 42 (52.5%). In 2018, total antibiotic usage were 42 (53.8%) and no antibiotic usage were 36 (46.2%). The number of ESBL infection in 2017 was 5 (6.4%) and 2018 was 15 (16.8%). The number of 3rd generation cephalosporin usage in 2017 was 7 (9.09%) and 2018 was 19 (21.3%). From the pearson-chi square test, the p was 0.157, it means no significant difference. Conclusion: The increasing utilization of 3rd generation cephalosporin was asociated with a clinically significant increased incidence of ESBL infection, but statistically it is not associated in this research.

Molecular characterization of bla TEM and bla CTX-M in Multi-Drug Resistance E. coli isolated from Country Chicken and Country Chicken Eggs in Poultry Farms of Malaysia

Over the years, multidrug-resistant Escherichia coli has contributed to the development of extended-spectrum beta-lactamase (ESBLs), which evolved primarily from poultry in every corner of the world. The unregulated use of antibiotics commonly administered to poultry products to prevent any subclinical infections that lead to multidrug resistance (MDR) that is due to acquired bacteria resistance. The main aim of this study is to investigate the prevalence in Malaysia of multidrug-resistant, extended-spectrum beta-lactamase (ESBL) producing E.coli from poultry country chicken and country eggs. In several states of Malaysia, fifty samples from country chicken and country chicken eggs were extracted randomly from chosen poultry. The sample was taken from May to June 2019. The samples were tested using traditional microbiological techniques for the presence of E. coli. Antibiotics susceptibility test using 5 forms of β-lactam antibiotics was used using the double-disk diffusion screening, and confirmation of the test is performed by a combination disk diffusion process to establish the strains generating the ESBL. Although, the phenotypic characterization of bla TEM and bla CTX-M ESBL was carried out using PCR and SDS methods. Twenty of the fifty samples collected were classified as E.coli (20/50), suggesting 40%. The results of the distribution of the β-lactamases genes were reported as bla TEM, bla CTX-M with results of 75% (3/4), and 100% (4/4), respectively. The findings indicate a high prevalence of multidrug resistance as the most prevalent of all ESBL genes in ESBL infections with CTX-M genes. Consequently, effective monitoring of MDR infections, in particular resistance to β-lactamases in poultry chicken, can predict the potential for ESBL infections in humans and animals.

Multidrug-Resistant Bacterial Infections in U.S. Hospitalized Patients, 2012–2017

BackgroundMultidrug-resistant (MDR) bacteria that are commonly associated with health care cause a substantial health burden. Updated national estimates for this group of pathogens are needed to inform public health action.MethodsUsing data from patients hospitalized in a cohort of 890 U.S. hospitals during the period 2012–2017, we generated national case counts for both hospital-onset and community-onset infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum cephalosporin resistance in Enterobacteriaceae suggestive of extended-spectrum beta-lactamase (ESBL) production, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant acinetobacter species, and MDR Pseudomonas aeruginosa.ResultsThe hospital cohort in the study accounted for 41.6 million hospitalizations (>20% of U.S. hospitalizations annually). The overall rate of clinical cultures was 292 cultures per 1000 patient-days and was stable throughout the time period. In 2017, these pathogens caused an estimated 622,390 infections (95% confidence interval [CI], 579,125 to 665,655) among hospitalized patients. Of these infections, 517,818 (83%) had their onset in the community, and 104,572 (17%) had their onset in the hospital. MRSA and ESBL infections accounted for the majority of the infections (52% and 32%, respectively). Between 2012 and 2017, the incidence decreased for MRSA infection (from 114.18 to 93.68 cases per 10,000 hospitalizations), VRE infection (from 24.15 to 15.76 per 10,000), carbapenem-resistant acinetobacter species infection (from 3.33 to 2.47 per 10,000), and MDR P. aeruginosa infection (from 13.10 to 9.43 per 10,000), with decreases ranging from −20.5% to −39.2%. The incidence of carbapenem-resistant Enterobacteriaceae infection did not change significantly (from 3.36 to 3.79 cases per 10,000 hospitalizations). The incidence of ESBL infection increased by 53.3% (from 37.55 to 57.12 cases per 10,000 hospitalizations), a change driven by an increase in community-onset cases.ConclusionsHealth care–associated antimicrobial resistance places a substantial burden on patients in the United States. Further work is needed to identify improved interventions for both the inpatient and outpatient settings. (Funded by the Centers for Disease Control and Prevention.)

Prevalence of Extended Spectrum Beta-Lactamase Producing Escherichia coli and Klebsiella pneumoniae Isolated from Urinary Tract Infected Patients Attending Tertiary Care Hospital of Central Nepal

Background: Urinary tract infection (UTI) is one of the major health problems in Nepal. Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are two important bacteria associated with UTI. This study was designed to assess the prevalence of extended spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae in urinary isolates at College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal.&#x0D; Methods: We aseptically received 5564 mid-stream urine samples of suspected UTI patients from September 2016 to August 2018. The randomly collected 5564 urine samples were processed by standard Microbiological guidelines as recommended by Clinical and Laboratory Standards Institute (CLSI). All isolates including E. coli and K. pneumoniae were identified using the specific biochemical and sugar fermentation tests. Antibiotic sensitivity test was performed for all the isolates against all commonly used antibiotics by modified Kirby-Bauer disk diffusion method and interpreted following CLSI guidelines. First performed initial screening method then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT).&#x0D; Results: Out of 5,564 urine specimens investigated, E. coli was isolated in 1219 (63.99%) and K. pneumoniae in 223 (11.70%) cases. Initial screening revealed 615 (50.45%) isolates of E. coli and 127 (56.95%) K. pneumoniae to be resistant. Further testing by PCDDT method confirmed 102 (16.58%) E. coli and 25 (19.68%) K. pneumoniae isolates to be ESBL producers. These ESBL producers’ uropathogens revealed high degree of resistance to cephalosporins (100%) and quinolones (52%-92%) group of antibiotics.&#x0D; Conclusions: In our study the prevalence of ESBL producing K. pneumoniae was found to be 19.68%, those of E. coli was to be 16.58% by PCDDT. In this study, all ESBL producing K. pneumoniae isolates were sensitive (100%) to meropenem and E. coli showed 98.04% sensitive to meropenem. Hence, for the treatment of these ESBL infections, currently, carbapenems are the recommended drug of choice.