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Background: In the United States, antibiotic resistance complicates serious infections in over 2 million people a year, leading to health and economic impacts. Because 80% of antibiotics are sold for animal production, concern is growing over livestock’s contribution to antibiotic resistance in humans. Although many bacterial species that cause pneumonia are found in livestock facilities, the potential impact of livestock production on antibiotic resistant pneumonia has been largely unexplored. This study aims to determine the antibiotic resistance rate in bacterial pneumonia (BP) in the US vulnerable population and its spatio-temporal pattern, focusing on Streptococcus pneumoniae (ICD9CM: 481) and Pseudomonas spp. (ICD9CM: 482.1) and resistance to the top antibiotic classes in livestock production, tetracyclines and penicillins. Methods: We Abstracted all hospitalization records related to pneumonia (ICD9-CM Codes 480-488) from the Centers for Medicare and Medicaid Services (CMS) dataset for years 19912006 in adults aged 65 and older. Each record contains information on 10 diagnostic codes, including laboratory-confirmed resistance, residence zip code, average length of stay, and direct charges. Findings: Out of 16,363,215 hospitalizations related to pneumonia, 3,231,256 (19.7%) cases were due to BP. S. pneumoniae and Pseudomonas spp. were the most common causes of BP and responsible for 516,634 (15.9%) and 465,295 (14.3%) cases, respectively, of which 0.65% and 1.54% of cases were resistant. Of these, 3.4% and 6.8% were multi-drug resistant, respectively. A resistance rate of 4.3% among BP hospitalizations was driven by Staphylococcus aureus, associated with over 20% of resistant cases. The proportion of resistant BP cases increased by 0.5% per year. In 5 states (CT, WV, KY, CA, NC) the proportion of resistant BP exceeded the national average by 20%. Interpretation: Although S. pneumoniae is not common to farms, it may derive antibiotic resistance from emissions, such as through horizontal gene transfer. Pseudomonas spp. have been detected in livestock facilities and show potential for zoonotic transmission. Many risk factors may contribute to the high rate of resistant BP, including high human antibiotic use (as in KY and WV), high animal productions (as in NC and CA, top swine and dairy producers, respectively), or regulations that influence the extent contaminants enter the environment (as CA’s weak requirements for NPDES permits). Such risk factors must be further explored. We are now correlating this dataset spatially to the county level livestock density derived from the USDA NASS Annual Surveys and Agricultural Census. As developed previously by Jagai et al, the livestock data combined with human population census allows creation of four exposure categories to compare rates of antibiotic resistance across counties with high/ low livestock and high/ low human density. The results of the analysis will be presented. Funding: Research partly supported by NIEHS GEWEL Project (NIEHS ES 013171)). Abstract #: 01SEDH015

High uptake of a women-only and sex work-specific drop in centre: independently linked to sexual and reproductive health care for sex workers