1669. Antimicrobial Resistance Patterns of Uropathogenic Escherichia coli: Comparison of Infection Setting and Community Classification

Background This study describes antibiotic resistance rates for Escherichia coli (E. coli) urinary tract infections (UTIs) and assesses differences in resistance patterns based on setting and community classification. Methods A cross-sectional study design was used to analyze antibiotic resistance patterns of E. coli isolates from 12,600 urine cultures processed at a large hospital system in North Carolina from 2016 to 2018. Overall 3-year and annual resistance rates of uropathogenic E. coli to routinely tested first-line antibiotics were determined. Antibiotic resistance rates per 1000 patients were compared based on setting of infection acquisition (hospital vs. community) and community classification (urban vs. rural). T-test and chi-square tests were used to compare extended spectrum beta-lactamases (ESBLs) by demographic factors and setting. Analyses were performed using SAS Version 9.3 (SAS Institute, Cary, NC) at alpha=0.05. Results Three-year resistance rates were highest to ampicillin (42.2%), ampicillin-sulbactam (24.7%), ciprofloxacin (21.8%), trimethoprim-sulfamethoxazole (21.6%), and levoflaxacin (21.4%). Resistance was lowest for amikacin (0.06%), meropenem (0.08%), piperacillin-tazobactam (1.3%), nitrofurantoin (1.4%), and tobramycin (1.8%). Overall resistance rates were significantly higher in hospital- compared to community-acquired UTIs (p< 0.05) with the exception of amikacin, gentamicin, and meropenem. Significant differences in E. coli resistance rates were observed for patients from rural compared to urban counties for these antibiotics: levoflaxacin (233.6 vs. 208.3, p=0.003), ciprofloxacin (239.3 vs. 211.8, p=0.002), and nitrofurantoin (19.6 vs. 12.2, p=0.003). Prevalence of ESBL-producing E. coli was significantly higher among the elderly (p< 0.001), males (p< 0.001), inpatients (p< 0.001), and catheterized patients (p< 0.001). Conclusion Resistance to first-line fluoroquinolones and nitrofurantoin was more prevalent in patients from rural compared to urban areas. Resistance rates and ESBL prevalence were significantly higher for hospital-acquired UTIs. Our findings have important implications for the empirical treatment of UTIs based on geographical area and setting. Disclosures All Authors: No reported disclosures