ESBL Rates Research Articles

Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in the United States, 2012-2021

Background: The 2022 Special Report: COVID-19 U.S. Impact on Antimicrobial Resistance identified continued increases in the rate of extended- spectrum beta-lactamase producing (ESBL) infections in the United States from 2017 through 2020. Using similar data sources and methodology, we examined the trends of species-specific ESBL infections from 2012-2021. Methods: We identified a cohort of patients from the PINC AI and BD Research Insights databases with a clinical culture yielding a Klebsiella pneumoniae or Escherichia coli isolate with accompanying susceptibility testing. E. coli or K. pneumoniae isolates non-susceptible to ceftriaxone, cefotaxime, ceftazidime, or cefepime were considered suggestive of ESBL production. Isolates from patients with no culture yielding the same resistance phenotype of interest in the previous 14 days were counted as an incident case. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; hospital-onset (HO) cultures were obtained ≥ day 4. We used a raking procedure to determine weights for extrapolating the number of discharges included in our sample to match the distribution of discharges, stratified by bed size, U.S. census division, urban/rural designation, and teaching status, for U.S. hospitals included in the American Hospital Association survey. We evaluated rates over time due to the changes in number of hospitalizations during the COVID-19 pandemic. Results were stratified by HO and CO, and sterile and non-sterile specimen sources. Results: In 2021, there were 48,936 ESBL K. pneumoniae and 153,112 ESBL E. coli infections among approximately 32 million discharges. Overall, most infections were CO and from non-sterile specimens. From 2012-2021, the rate of ESBL K. pneumoniae increased from 9.54 to 15.28 per 10,000 discharges. ESBL E. coli infections increased from 2012-2020 (30.18 to 51.32 per 10,000 discharges), then declined in 2021 (47.81 per 10,000 discharges) (Table 1, Figure 1). The proportion of non-sterile ESBL E. coli declined from 88% in 2012 to 83% in 2021, and the proportion of non-sterile ESBL K. pneumoniae was 85-87% over the study period (Figure 2). Conclusion: ESBL E. coli and K. pneumoniae infections increased from 2012-2021, although the CO ESBL E. coli rate decreased between 2020 and 2021. Understanding changes in culturing practices over time may provide insights into the increased proportion of ESBL E. coli from sterile sites. Additionally, further investigation into differences in organism trends, particularly in 2021, may inform prevention strategies.

Demographic, clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections in Central Australia

We describe the demographics, clinical and molecular epidemiology of extended-spectrum β-lactamase (ESBL) Escherichia coli bloodstream infections (BSI) in Central Australia. All ESBL-producing E.coli bloodstream isolates from January 2018 to December 2020 were retrospectively identified. Demographic and clinical information was extracted by chart review. Whole-genome sequencing was performed for multi-locus sequence typing, antibiotic-resistance genes, and phylogenetic relationships. We identified 41 non-duplicate episodes of ESBL E.coli BSI. Median age was 55 years (IQR 47-63), 78% were female, 93% were Aboriginal, and half came from a remote community. Infections were predominantly urinary (68%, 28/41). In the 12 months prior, 70% (26/37) of identified patients had been hospitalised and 81% (30/37) prescribed antibiotics. Meropenem and piperacillin-tazobactam susceptibility was maintained in 100% and 95% of isolates, respectively. Co-resistance to non-β-lactam antibiotics was 32% to gentamicin, 61% to trimethoprim/sulfamethoxazole, and 68% to ciprofloxacin. For sequenced isolates, 41% (16/35) were sequence type 131 (ST131). Mean acquired antibiotic-resistance genes for each isolate was 12.3 (SD 3.1). Four isolates carried an OXA-1 gene. Only non-ST131 isolates carried AmpC and acquired quinolone-resistance genes. There was some evidence of clustering of closely related strains, but no evidence of community or healthcare admission overlap. ESBL rates are rapidly rising in Central Australia, which is a conducive environment for antibiotic resistance development (e.g., overcrowding, socioeconomic disadvantages, high healthcare exposure and high antibiotic use). Future research is required to explore resistance-transmission dynamics in this unique setting.

Machine-learning-based risk assessment tool to rule out empirical use of ESBL-targeted therapy in endemic areas

Antimicrobial stewardship focuses on identifying patients who require extended-spectrum beta-lactamase (ESBL)-targeted therapy. 'Rule-in' tools have been researched extensively in areas of low endemicity; however, such tools are inadequate for areas with high prevalence of ESBL-producing pathogens, as almost all patients will be selected. To develop a machine-learning-based 'rule-out' tool suitable for areas with high levels of resistance. Gradient-boosted decision trees were used to train and validate a risk prediction model on data from 17,913 (45% ESBL) patients with Escherichia coli and Klebsiella pneumoniae in urine cultures. The predictive power of different sets of variables was evaluated using Shapley values to evaluate the contributions of variables. The model successfully identified patients with low risk of ESBL resistance in ESBL-endemic areas (area under receiver operating characteristic curve 0.72). When used to select the 30% of patients with the lowest predicted risk, the model yielded a negative predictive value ≥0.74. A simplified model with seven input features was found to perform nearly as well as the full model. This simplified model is freely accessible as a web application. This study found that a risk calculator for antibiotic resistance can be a viable 'rule-out' strategy to reduce the use of ESBL-targeted therapy in ESBL-endemic areas. The robust performance of a version of the model with limited features makes the clinical use of such a tool feasible. This tool provides an important alternative in an era with growing rates of ESBL-producing pathogens, where some experts have called for empirical use of carbapenems as first-line therapy for all patients in areas with high prevalence of ESBL-producing pathogens.

Blood-Stream Infections: Causative Agents, Antibiotic Resistance and Associated Factors in Older Patients.

The rate of multi-drug antibiotic resistance in nosocomial bloodstream infections in elderly patients is increasing. This study examined the data for bloodstream infections to gain a better understanding of bacterial antibiotic resistance. This was a retrospective study of 817 patients with the first positive blood culture between January 1, 2016 and December 31, 2019. Moyen's age was 77.4 ± 9.8 years, male (52.4%) and SOFA 5.0 ± 4. ESBL(+) rate was 78/817 (9.5%). ESBL(+) rate for Escherichia coli and Klebsiella pneumoniae was 69/141 (48.9%) and 9/52 (17.3%), respectively. The most common isolates were Escherichia coli (17.3%), Stenotrophomonas maltophilia (13.7%), and Staphylococcus species (23.1%). The rate of septic shock and mortality accounted for 22.3% and 28.9%, respectively. Escherichia coli is highly sensitive to carbapenem, and resistant (>50%) with quinolone and aminoside. Klebsiella pneumoniae and Pseudomonas aeruginosa were highly sensitive to carbapenem. Acinetobacter baumannii was resistant to meropenem (75%). Stenotrophomonas maltophilia was sensitive to quinolone (13.8 %), and highly resistant to remaining antibiotics. Methicillin-resistant Staphylococcus aureus had a low resistance rate for vancomycin, teicoplanin, and linezolid. Multivariate analysis showed that the significant factors associated with mortality were age >75; SOFA >7; respiratory infection; intensive care unit treatment and presentation with septic shock. The mortality rate was still high, especially for antibiotic-resistant agents.

Detection of hypervirulent and classical type of Klebsiella pneumoniae and screening their resistant properties in Erbil city

Background and objective: Klebsiella pneumoniaei s an opportunistic pathogenic bacterium and is considered one of the main causes of nosocomial infection. Hypervirulent K. pneumoniae (hvKp) has emerged as a pathogen of global importance. The current study aimed to determine Extended-spectrum beta-lactamase, carbapenem resistance, and serum bactericidal effect among the clinical isolates and to find the relationship of the above features with antimicrobial resistance. Methods: A total of 90 K. pneumoniae isolates were collected from different clinical specimens. Isolates were diagnosed using routine bacteriological methods and VITEK 2 compact system. Several phenotypic tests including string test, serum resistant, ESBL test, and Modified Carbapenem inactivation method were performed. The antibiotic resistance pattern was compared among ESBL-positive, carbapenem-resistant in both Hypervirulent (hvKp) and classical K. pneumoniae (cKp) isolates. Results: The results revealed that among 90 isolates, 56.7% of the isolates were of classical K. pneumoniae (cKp) type within which 70.6% of them were ESBL positive, 37.3% of them were resistant to carbapenem, and 51% were resistant to serum bactericidal activity. On the other hand, 43.3% were of hvKp type within which 61.5% of them were ESBL positive, 30.8% were carbapenem-resistant and all of the hvKp were resistant to human serum. The rate of antibiotic-resistant among cKp was higher than hvKp isolates. Conclusion: In this study, classical strains were more resistant to antibiotics and the rates of ESBL and Carbapenem resistance were higher compared to hvKp strains. but they were killed by serum bactericidal activities more rapidly.

Update on antibiotic resistance of common pathogenical bacteria isolated in Hue University of Medicine and Pharmacy Hospital

Backgroud: The aim of this study is to update on antibiotic resistance of common pathogenical bacteria isolated in Hue University of Medicine and Pharmacy Hospital (Hue UMP Hospital). Methodology: Use of the agar disk diffusion method to test the susceptibility to antimicrobial agents of 3709 bacterial strains from infected patients hospitalized in Hue UMP Hospital in 2020 - 2022. Results: Among 3709 strains of pathogenical bacteria isolated, S.aureus was found with the rate of 29.9%, followed by E. coli (24.5%), Pseudomonas aeruginasa (17.8%), Enterococcus spp. (11.8%), Klebsiella spp (9.7%) and Acinetobacter spp (4.1%). The proportion of bacterial isolates has changed, but Staphylococcus aureus is still highest rate. S.aureus is resistant to many antibiotics, but MRSA strains have decreased significantly, from 73.3% in 2020 to 62.5% in 2022. Pseudomonas aeruginosa was resistant to some of the group A recommended antibiotics such as ceftazidime, piperacillin-tazobactam with the rate of 56.6% and 48.7%. The percentage of E. coli with ESBL strains (+) was at 28.2% - 30.3%. Enterococus spp strains are still sensitive to vancomycin (83.1% - 91.9%). The rate of Klebsiella ESBL (+) is only 6.9% to 8.2%. The strains of Acinetobacter spp were highly resistant to Piperacillin (100%) and Ceftriaxone (96.5%) but they are still sensitive to imipenems 70 - 71%, highly sensitive to Doxycillin (95.2%) and Cefotaxime (88.4%). Conclusion: Many bacterial strains are resistant to many commonly antibiotics. Providing timely, regular, and effective management of antibiotic resistance patterns for common pathogenic bacteria in hospitals, will help reduce the risk of bacterial resistance. Key words: Hue University of Medicine and Pharmacy Hospital (Hue UMP Hospital), antimicrobial resistance, antimicrobial agents, bacterial infections.

Prevalence of Multidrug-Resistant Enterobacterales Isolated from 2019 to 2020 in a Tertiary Hospital in Dakar-Senegal

Background: Multi-resistant bacteria have emerged as a global threat to human health. In Africa, there are few data on AMR. The objective of this study was to determine antibiotic resistance profile of enterobacteria strains and prevalence of multidrug-resistant bacteria isolated in a university hospital in the suburbs of Dakar.
 Methods: Enterobacterales were isolated from a wide range of clinical specimens (urine, pus, blood, catheter tip and bronchoalveolar fluid) from inpatients and outpatients at Medical Biology Laboratory of National University Hospital Center of Pikine from November 2019 to October 2020. Enterobacterales were identified using API 20E. Antimicrobial susceptibility testing was performed with ATB G-EU (08) (bio Mérieuxs®) on all enterobacterales in accordance with CA-SFM/EUCAST 2020 guidelines.
 Results: Of the 3422 different clinical specimens tested, 623 (17.1%) were culture positive. Enterobacteriaceae accounted for 57.6% (n=359) of the strains; Escherichia coli and Klebsiella pneumoniae were predominant isolates with 53.5% and 20.6% respectively. Seventy-four(%) strains of enterobacterales were ESBL. Antibiotic resistance patterns showed a prevalence of multidrug resistant strains of 32.6%. The most active antibiotics on isolates were imipenem (25%), followed by amikacin (15%), fosfomycin (12%) and piperacillin-tazobactam (10%).
 Conclusion: High rates of ESBL and multidrug-resistant strains were found in both outpatients and inpatients. These results indicate need for an active surveillance system for antimicrobial resistance. Also, the application of good hospital hygiene practices and antibiotic therapy adapted to local data must be adopted.

Antimicrobial susceptibility and integrons detection among extended-spectrum β-lactamase producing Enterobacteriaceae isolates in patients with urinary tract infection.

Integrons are bacterial mobile genetic components responsible for mediating the antibiotic resistance process by carrying and spreading antimicrobial resistance genes among bacteria through horizontal gene transfer. This cross-sectional hospital-based study aimed to find the prevalence of antibiotic resistance patterns and to detect integrons classes (I, II, and III) among bacterial isolates in patients with urinary tract infections (UTI) in Sulaimani, Iraq. Mid-stream urine samples (no. = 400) were collected from patients with UTI at three different Hospitals from Sulaimani, Iraq, between September 2021 to January 2022. Urine samples were cultured on various agar media, and grown bacteria were isolated. Antibiotic susceptibility test (AST) and an extended-spectrum β-lactamase (ESBL) screen were done for isolated bacteria. Then, integrons classes were screened using conventional PCR with gene sequencing and uploaded to the National Center for Biotechnology Information (NCBI). The frequency rate of Enterobacteriaceae was 67.03% among positive urine cultures. E. coli (no. = 86) and Klebsiella pneumoniae (no. = 32) isolates were identified. The most sensitive antibiotics were the carbapenem group (85.3%) and nitrofurantoin (NFN) (64.2%), while the most resistant antibiotics were nalidixic acid (NA) and 3rd generation cephalosporin. The occurrence rate of ESBL was 56.6% with a predominance of class I integron (54.2%), then class II (15.8%) and no positive record for class III integron were observed. Most bacterial isolates from patients with UTI produced class I and II integrons genes with favourable ESBL properties.

Detection of Antibiotic Resistance in Feline-Origin ESBL Escherichia coli from Different Areas of China and the Resistance Elimination of Garlic Oil to Cefquinome on ESBL E. coli.

The development of drug-resistance in the opportunistic pathogen Escherichia coli has become a global public health concern. Due to the share of similar flora between pets and their owners, the detection of pet-origin antibiotic-resistant E. coli is necessary. This study aimed to detect the prevalence of feline-origin ESBL E. coli in China and to explore the resistance elimination effect of garlic oil to cefquinome on ESBL E. coli. Cat fecal samples were collected from animal hospitals. The E. coli isolates were separated and purified by indicator media and polymerase chain reaction (PCR). ESBL genes were detected by PCR and Sanger sequencing. The MICs were determined. The synergistic effect of garlic oil and cefquinome against ESBL E. coli was investigated by checkerboard assays, time-kill and growth curves, drug-resistance curves, PI and NPN staining, and a scanning electronic microscope. A total of 80 E. coli strains were isolated from 101 fecal samples. The rate of ESBL E. coli was 52.5% (42/80). The prevailing ESBL genotypes in China were CTX-M-1, CTX-M-14, and TEM-116. In ESBL E. coli, garlic oil increased the susceptibility to cefquinome with FICIs from 0.2 to 0.7 and enhanced the killing effect of cefquinome with membrane destruction. Resistance to cefquinome decreased with treatment of garlic oil after 15 generations. Our study indicates that ESBL E. coli has been detected in cats kept as pets. The sensitivity of ESBL E. coli to cefquinome was enhanced by garlic oil, indicating that garlic oil may be a potential antibiotic enhancer.

Predominance of Multidrug-Resistant Gram-Negative Bacteria on Contaminated Surfaces at a Tertiary Hospital in Tanzania: A Call to Strengthening Environmental Infection Prevention and Control Measures.

The spreading of multidrug resistance (MDR) strains in the hospital settings via contaminated surfaces have been increasingly reported where Gram-negative bacteria have been implicated in causing most nosocomial infections. This study aimed to determine the rate of contamination with multi-resistant gram-negative bacteria in the hospital environment. A cross-sectional study was conducted at Muhimbili National Hospital paediatric department, between July and August 2020. Non-repetitive surface swab samples were collected from predefined surfaces and medical device surfaces, and cultured on MacConkey agar with and without antibiotics. Isolates were identified using biochemical test and tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method. The rate of hospital contamination with Gram-negative bacteria across the Pediatrics units was 30%, with a high rate observed in oncology units (34.8%) and the malnutrition/diarrhoea ward (32.1%). Sink/washing basin had the highest frequency of bacterial contamination (74.2%). We observed a high rate of ESBL (32.5%), with Acinetobacter baumannii, Klebsiella pneumoniae, and E. coli being the predominant ESBL-producing Gram-negative bacteria, while carbapenemase-producing Gram-negative bacteria was detected at 22.8%. Highest resistance rates (63-100%) were observed against ceftriaxone and trimethoprim-sulfamethoxazole. Up to 51% of the Gram-negative bacteria showed resistant to meropenem. MDR strains were detected in 61.4% of Gram-negative bacteria isolated. In conclusion, we observed a high rate of MDR bacteria contaminating hospital surfaces. The higher rate of MDR calls for a need to strengthen infectious prevention control measures, including cleaning practices in the hospital environment, to reduce the risk of transmission of resistant strains to patients and healthcare workers.

Trends of β-Lactamase Occurrence Among Escherichia coli and Klebsiella pneumoniae in United States Hospitals During a 5-Year Period and Activity of Antimicrobial Agents Against Isolates Stratified by β-Lactamase Type.

The temporal and longitudinal trends of β-lactamases and their associated susceptibility patterns were analyzed for Escherichia coli and Klebsiella pneumoniae isolates consecutively collected in 56 United States hospitals during 2016-2020. Isolates (n = 19 453) were susceptibility tested by reference broth microdilution methods. Isolates that displayed minimum inhibitory concentration (MIC) values ≥2 mg/L for at least 2 of the following compounds-ceftazidime, ceftriaxone, aztreonam, or cefepime-or resistance to the carbapenems were submitted to whole genome sequencing for identification of β-lactamases. Longitudinal and temporal trends were determined by slope coefficient. New CTX-M and OXA-1 variants were characterized. Extended-spectrum β-lactamases (ESBLs) were detected among 88.0% of the isolates that displayed elevated cephalosporin/aztreonam MICs without carbapenem resistance. bla CTX-M-15 was detected among 55.5% of the ESBL producers. ESBL rates were stable over time, but significant increases were noted among bloodstream infection and K pneumoniae isolates, mainly driven by an increase in bla CTX-M. Carbapenem resistance and carbapenemase genes were noted among 166 and 145 isolates, respectively, including 137 bla KPC, 6 bla SME, 3 bla OXA-48-like, and 3 bla NDM. Ceftazidime-avibactam and carbapenems were very active (>99% susceptibility) against ESBL producers without carbapenem resistance. Ceftazidime-avibactam inhibited 97.0% of the carbapenem-resistant isolates. This agent and meropenem-vaborbactam inhibited 96.4% and 85.0% of the 2020 isolates, respectively. Overall, ESBL-producing isolates were stable, but an increase was noted for K pneumoniae isolates driven by CTX-M production. Carbapenem-resistant Enterobacterales rates decreased in the study period. The prevalence of metallo-β-lactamases and OXA-48-like remains low. Continuous surveillance of β-lactamase-producing isolates is prudent.

Mobile resistance determinants, plasmid replicon types and phylogeny among Escherichia coli strains isolated from cats and dogs

Abstract
 Multidrug resistance is a great challenge for the treatment of infectious diseases. We determined antibiotic resistance patterns, integrons, plasmid-mediated ESBL-, AmpC beta-lactamase-, carbapenemase-, colistin resistance genes, plasmid replicon types and phylogeny of fecal E. coli strains isolated from domestic cats and dogs in Turkey.
 A total of 104 fecal samples of healthy 49 cats and 55 dogs were examined. The integrons, plasmid-mediated resistance genes, plasmid replicon types and phylogroups were determined by PCR. Antimicrobial susceptibilities were performed by disc diffusion and microdilution methods.
 
 coli strains were mostly resistant to AMP (56.73%), SXT (39.42%), CTX (38.46%) and CIP (30.77%). Colistin resistance was not detected. ESBL and carbapenemase rates were 35.5 % and 7.69%, respectively. Eighty (76.9%) and 49 (47.1%) strains were harboring class I and class II integrons, respectively. Besides 12 strains were shown to possess class III integrons. The most frequently detected genes were blaCTX-M (48.08%), blaTEM (45.19%) and blaVIM (20.19%). In our study, none of strains were positive for mcr-1 and mcr-2 genes. Integrons were mostly found on plasmids of incompatibility groups IncF (71.25%) and strains bearing CTX-M and TEM carried a wide range of plasmid replicons of which IncF, IncFIB, IncK, and IncN. The majority of the strains were grouped in B2 (31.73%) and B1 (22.12%) and resistant bacteria mostly belonged to phylogroup B2.
 
 We showed an increasing trend in ESBL-producing E. coli among fecal microbiota members. E. coli strains with different plasmid replicon types and phylogroups isolated from cats and dogs can be resistant to various antibiotics which are used in human and veterinary medicine.

Trends in the Rates of Extended-Spectrum-β-Lactamase-Producing Enterobacterales Isolated from Urine Cultures during the COVID-19 Pandemic in Ontario, Canada.

Worldwide, extended-spectrum β-lactamase (ESBL) rates are increasing at an alarming level with increasing rates of health care exposures, international travel, and antibiotic usage. In this study, we investigated whether enhanced social isolation, travel restrictions, and the reduced use of antibiotics in Ontario, Canada during coronavirus disease 2019 (COVID-19) pandemic had an impact on ESBL rates in urine cultures collected from the community and long-term-care (LTC) facilities across the province. Data from a total of 8.6 million urine cultures performed at LifeLabs Ontario from 2016 to 2021 were utilized for analysis. ESBL-producing Escherichia coli (ESBL Escherichia coli) and ESBL Klebsiella pneumoniae were identified using standard operating procedures. Data trends were estimated by interrupted time series (ITS) regression analysis. Among 2.3 million positive urine cultures, 48.9% and 7.2% grew E. coli and K. pneumoniae, of which 5.8% and 3.3% produced ESBLs, respectively. While the overall rate of ESBL isolation was higher in the pandemic period than in the prepandemic period, by ITS regression analysis of the monthly rates of ESBL isolation, decreasing trends were noted for ESBL E. coli in both the community and LTC facilities and for ESBL K. pneumoniae in the community. The ESBL K. pneumoniae rates in LTC facilities continued to increase throughout the COVID-19 period. By subgroup analysis for different genders, age groups, and local health integration network (LHIN) units, similar trends were seen in most cases (P < 0.05), except for a few densely populated LHINs where rate changes were not statistically significant. IMPORTANCE Community-onset urinary tract infections (UTIs) caused by ESBL-producing Enterobacterales, particularly E. coli and K. pneumoniae, are a major public health concern. In this study, we assessed the impact of COVID-19 on ESBL rates in urine cultures in Ontario, Canada. Our results show the recent epidemiology of ESBL-producing Enterobacterales in urine cultures from both the community and LTC facilities in Ontario, Canada, and the impact of COVID-19 restrictions on ESBL trends for the entire province as well as different subgroups of the population based on demographic and geographic characteristics. Our results may have important public health implications in the context of the gradual easing of COVID-19 restrictions.

Clinical and Microbiological Characteristics of Type 2 Diabetes Mellitus Accompanied with Sepsis.

This study was conducted to investigate the clinical and microbiological characteristics of type 2 diabetes mellitus (T2DM) complicated with sepsis and to provide a reasonable basis for early diagnosis and treatment. The clinical material of patients with T2DM complicated with sepsis enrolled from January 2019 to February 2022 in the Endocrinology Department of Sichuan Provincial People's Hospital were retrospectively analyzed. A total of 36 patients were included. T2DM patients with sepsis had bad blood glucose control, long hospital stays, poor nutritional status, severe infection, occult primary infection sites, and high detection rates of ESBL producing Escherichia coli and MRSA. Multiple complex clinical factors made it difficult for T2DM patients with sepsis to be cured or improved and raised great challenges for antibiotic therapy.

BACTERIAL INFECTION MODEL AND ANTIBIOTIC RESISTANCE AT THE NEW PRIVATE HOSPITAL

Objectives: Survey of bacterial pathogens and antibiotic resistance at Tam Anh Hospital in 2021.Material and methods: Retrospective method. Bacteria were isolated from specimens at the Department Microbiology of Laboratory center at Tam Anh Hospital in 2021 which were identified and tested drug susceptibility by Vitek 2. By CLSI standards.Results: Distribution of pathogenic strains: In 2021, 880 strains of bacteria were isolated, 8 types of most common bacteria were Escherichia coli (46%), Staphylococcus aureus (16.8%), Klebsiella pneumoniae (14.3%), Staphylococcus haemolyticus (6%), Pseudomonas aeruginosa (4.3%), Enterococcus faecalis (3.9%), Enterobacter cloacae (2.9%), Acinetobacter baumannii (2.3%). Antibiotic resistance: Escherichia coli was resistant to most second and third generation cephalosporins, trimethoprim/sulfamethoxazole, fluoroquinolone, still sensitive to carbapenems, piperacillin/tazobactam, amikacin, tigecylin, cefepime, ceftazidim, gentamycin, tobramycin, nutrofurantoin. The ESBL rate was 36%. Staphylococcus aureus was resistant &gt; 30% to bezilpenicillin, erythromycin, clindamycin, oxacillin, tetracycline, still sensitive to levofloxacin; rifamycin, Vancomycin; fusidic acid; nitrofurantoin; linezolid; teicoplanin; tigecycline. The MRSA rate is 59.6%. Klebsiella pneumoniae was resistant &gt; 30% to cephalosporin, fluoroquinolone, ampicillin/sulbactam, piperacillin/tazobactam, nitrofurantoin,moxifloxacin. For meropenem were resistant 18%, ertapenem 19%. The ESBL rate was 19%. Staphylococcus heamolyticus was resistant &gt; 30% to fluoroquinolone, bezilpenicillin, erythromycin, fusidic acid, oxacillin, trimethoprim/sulfamethoxazole. Tetracycline, still sensitive to moxifloxacin, rifamycin, nitrofurantoin, gentamicin, linezolid, teicoplanin, tigecycline, vancomycin.Pseudomonas aeruginosa was resistance &gt; 30% to cephalosporin, aminoglycoside, fluoroquinolone, tigecylin, cefepime, was resistance &gt; 20% to meropenem, ceftazidime, imipenem, piperacillin/tazobactam, especially not resistance to colistin. acinetobacter baumannii was resistance &gt; 50% to cephalosporin, aminoglycoside, carbapenem, piperacillin/tazobactam, ticarcillin/clavuclanic acid, trimethoprim/sulfamethoxazole still sensitive to colistin, tigecycline; tobramycin.Conclusion: The common bacteria in at Tam Anh Ho Chi Minh Hospital in 2021 were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Staphylococcus haemolyticus, Pseudomonas aeruginosa, Enterococcus faecalis, Enterobacter cloacae, Acinetobacter baumannii. In the current situation of multidrug resistant bacteria, understanding the distribution of sepsis parthogens and updating their antibiotic resistance will be a great help to clinicians in the antibiotic selection to treat as well as contribute to reduce antibiotic resistance,

2056. Trends in the Rates of Multidrug-resistant Bacteria Commonly Associated with Healthcare in U.S. Acute Care Hospitals, 2019-June 2021

Abstract Background Several studies demonstrated an increase in hospital-onset (HO) infections during the COVID-19 pandemic. We examined trends in the rates of multidrug-resistant (MDR) infections among acute care hospitals in the United States (U.S.) for bacteria commonly associated with healthcare: methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum cephalosporin resistance in Enterobacteriaceae suggestive of extended-spectrum beta-lactamase production (ESBL), vancomycin resistant Enterococcus (VRE), MDR Pseudomonas aeruginosa, carbapenem resistant Enterobacteriaceae (CRE), and carbapenem-resistant Acinetobacter species (CRAB). Methods We measured incidence of clinical cultures yielding the bacterial species of interest among hospitalized patients in a dynamic cohort of hospitals submitting data to the Premier Healthcare Database Special COVID-19 Release during 2019-June 2021. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; HO were obtained ≥ day 4. We determined monthly hospital-specific rates for each species. We used generalized estimating equations (GEE) multivariable negative binomial regression models adjusting for hospital characteristics to examine trends. Results From 2019-June 2021, the overall number of hospitals contributing data was 318. Rates for each pathogen are shown in Figures 1 and 2. All pathogens’ HO rates were significantly higher in 2021 compared with 2019. The rates of ESBL, VRE, and CRE were also significantly higher in 2021 when compared to 2020 (Table 1a). For CO rates, we found that MRSA rates decreased significantly during the study period, while ESBL, VRE, and CRE increased with varying degree of significance (Table 1b). Rates of CO MDR Pseudomonas and CO CRAB did not significantly change. Conclusion Our study confirmed that the rates of several MDR infections increased during the COVID-19 pandemic through June 2021, especially HO infections. CO MRSA was the only pathogen with consistent and significant decline. As infections caused by MDR pathogens represent a serious threat to patient safety, further study of factors contributing to the emerging trends may inform prevention strategies during a pandemic. Disclosures All Authors: No reported disclosures.

930. Weakening the waves: Impact of a syndrome-based antimicrobial stewardship intervention during COVID-19

Abstract Background Lower respiratory tract infections (LRTIs) from SARS-CoV-2 are difficult to distinguish from other viral or bacterial etiologies. This has led to increased antimicrobial use (AU) during the pandemic and concerns for concomitant rise in antimicrobial resistance (AMR). It is crucial for antimicrobial stewardship (ASP) to develop strategies to mitigate excess AU and curve AMR. We leveraged a syndrome-based ASP intervention targeting LRTIs and the use of anti-Pseudomonal beta lactams (APBL) during the COVID-19 pandemic. Methods We incorporated COVID-19 elements into a syndrome-based prospective audit and feedback (PAF) at an urban community hospital. Elements included EMR order sets (Figure 1) that discouraged routine AU for COVID-19 and PAF targeting LRTIs and COVID-19 therapies. Empiric selection discouraging APBL was incorporated during the first COVID-19 wave. Order sets and PAF were then modified to reflect novel COVID-19 therapeutics and AU was strongly discouraged in subsequent waves. Data on AU and AMR from 2018-2022 was reviewed. Figure 1.Electronic medical records COVID-19 antimicrobial order set Results Average quarterly AU increased during the first pandemic year by 8.7%, from 359.5 to 391 days of therapy per 1000 patient days (DOT/1000), with peaks 22.5% above the pre-pandemic average during COVID-19 surges. AU increased each COVID-19 surge, with smaller peaks each subsequent wave. DOT/1000 declined 29% from the first wave to the Omicron wave. AU decreased the second year to 318, an 18.6% decrease from the first pandemic year. Ceftriaxone use increased during surges, reflecting our LRTI guidelines (Figure 2). Peaks declined each subsequent wave, from a peak of 239 in the first wave to 75 during Omicron, a 68% decrease. The average monthly DOT/1000 for APBL decreased from 73.51 to 63.21 (Figure 3). Incidence rate of ESBL and CRE initially rose and then declined (Figure 4). Figure 2.Antimicrobial use (DOT/1000) before and during the COVID-19 pandemicFigure 4.Antipseudomonal beta lactam use before and during the COVID-19 pandemic Figure 5. Incidence of multidrug resistance organisms before and during the COVID-19 pandemic Conclusion ASP successfully incorporated COVID-19 elements and steered AU during the pandemic. Though total AU increased, APBL use declined and AU peaks decreased with each COVID-19 wave, reflecting adherence with ASP recommendations. AMR increased during the first year and subsequently declined. ASP can play a vital role guiding AU during respiratory pandemics. Disclosures All Authors: No reported disclosures.

2174. Development and Validation of a Clinical Prediction Model for Community-Onset Pneumonia caused by Extended-Spectrum Beta-lactamase-Producing Enterobacteriaceae

Abstract Background The study aims to identify specific risk factors associated with developing pneumonia cause by ESBL producing organisms and develop a Clinical scoring model base on the risk factors identified to be able to provide guidance on appropriate empiric antibiotic therapy Methods We conducted a single-center retrospective cohort study in a tertiary hospital on Pasig City, Philippines including 150 patients admitted with Community onset Pneumonia from 2018 to 2019 Baseline Characteristics Independent variables included in the study Results Among 150 patients admitted with Community onset Pneumonia, 70.2% their respiratory isolates were K. Pneumoniae followed be E. coli at 14.57%. The Total ESBL rate among all the respiratory isolate was 45.3%. Univariate analysis of all the risk factors showed significant statistical difference in female Sex (OR 0.49; 5% CI: 0.26-0.96), Charlson Score (OR 26.00; 95% CI: 10.66-63.39), Recent Hospitalization (OR: 29.35; 95% CI: 11.53-74.46), Recent Antibiotic Use (OR 84.49; 95% CI: 28.66 – 251.87), Prior History of ESBL (OR: 57.14; 95% CI: 12.96 – 525.01), and Frequent ED visits (OR:45.88; 95% CI; 15.92 – 132.23). Multivariate analysis was done to generate the final model. The results shows that Charlson Score (OR 11.86, 95%CI: 2.55 – 55.18, p value 0.002), Recent Antibiotic Use (OR: 31.09, 95%CI: 5.36-180.44, p value &amp;lt; 0.001). and Frequent ED visits (OR 6.52; 95% CI 1.04-41.07) were found to be significant predictor of ESBL. The final model of the three risk factors has a performance AU ROC Curve of 0.9780 at distinguishing between the positive and negative samples. Sensitivity, Specificity, PPV, NPV and ROC area of each of the variables included in the final model Conclusion The results of this study suggest a simple and easy-to-use prediction model to predict Community-onset pneumonia caused by ESBL-producing Enterobacteriaceae. Disclosures All Authors: No reported disclosures.

MICROBIOLOGICAL PATTERN IN BILIARY TRACT INFECTION AT CHO RAY HOSPITAL IN 2021

Background: MBiliary tract infection is a common cause of bacteremia with high morbidity and mortality, particularly in older patients with co-morbid disease or when there is a delay in diagnosis and treatment. This study is undertaken to determine the microbiological pattern and antibiotic resistance in biliary tract infection at Cho Ray Hospital in 2021.Subbjects and methods: NA retrospective study was conducted from January 2021 to Demcember 2021 at Cho Ray hospital. Bile samples were cultured on Blood agar, Mac-conkey agar. Bacterial strains were identified by the MALDI-TOF MS system and made susceptibility testing on the VITEK 2-compact system of Biomerieux. The antibiotic susceptibility were determined by mininum inhibitory concentration(MIC) according to CLSI.Results: Out of 595 bile samples sent for aerobic culture and susceptibility testing, 203 (34.1%) weresterile and 392 (65.9%) were found to be culture positive. Of the bile culture positives, 129 (21.7%)were polymicrobial. The most prevalent bacteria isolates were Escherichia coli 33.8% (102), Klebsiella pneumoniae 22.2% (67), Enterococcus spp. 16.6% (50), Pseudomonas aeruginosa 7.9% (24). The ESBL rate of Escherichia coli was 42.2%, while this rate of Klebsiella pneumoniae was 9%. The vancomycin resistant rate of Enterococcus spp. was 8.3%. In Pseudomonas aeruginosa, among beta-lactams, imipenem had the highest resistant rate (45.8%). No resistance to colistin had been reported.Conclusion: In biliary tract infections, about one-third cases had negative-culture results and about onefifth cases had polymicrobial infection. The common pathogens in biliary tract infections were Escherichia coli, Klebsiella pneumoniae, Enterococcus spp. and Pseudomonas aeruginosa. The resistance rate to commonly used antibiotics in treatment was quite high.

Bacterial Isolates and Antibacterial Resistance Patterns in a Patient with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Teaching Hospital, Southwest Ethiopia.

Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. The natural course of COPD is characterized by acute exacerbation. Infectious agents, particularly bacteria, cause exacerbation of COPD in the majority. This study aimed to determine the bacteriology and antibiotic resistance patterns among patients with acute exacerbations of COPD (AECOPD) at Jimma Medical Center. Methods A cross-sectional study was conducted from March to October 2019. Demographic, clinical, and sputa samples were collected from 39 study participants, who were diagnosed with AECOPD. Bacterial pathogens were identified using standard bacteriological techniques, and anti-microbial susceptibility testing was done by Kirby Bauer's disk diffusion method. Extended-spectrum β-lactamase (ESβL) and carbapenemase production were confirmed by MASTTM D68C and MASTTM D73C combination disc sets, respectively. Chi-square and odds ratios were calculated. Results Overall, 69.2% (27/39) of sputum samples were confirmed to be culture-positive. A total of 32 bacterial isolates with 78.1% (25/32) Gram-negative and 21.9% (7/32) Gram-positive bacteria were identified. The predominant bacterial isolates were Pseudomonas aeruginosa 21.9% (7/32), Klebsiella pneumoniae 18.75% (6/32), and Staphylococcus aureus 15.62% (7/32). Overall, 30 (93.8%) of the isolates were multidrug-resistant (MDR). About 48% (12/25) and 8 (32%)of gram negative bacterial isolates were ESBL betalatemase and OXA-48 carbapenemase producers, respectively. Having two or more exacerbation experiences in the previous year were found to be important determinants of the sputum culture positivity. Conclusions High rates of MDR, ESBL, and carbapenemase producer bacteria were isolated from patients with AECOPD. Empiric antibiotic therapy should consider the prevalence of antibiotic-resistant pathogens and the factor that may increase the occurrence of MDR bacterial pathogens.