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Background  Carbapenems are broadly used for the treatment of ESBL-producing  Enterobacterales  isolates. The use of these agents led to an increase of carbapenem resistance among  Enterobacterales . Monitoring isolates that carry β-lactamases is important to understand their prevalence and susceptibility to clinically available antimicrobial agents. We evaluated the prevalence of β-lactamases and the activity of antimicrobial agents against 1,209 isolates collected in 69 US hospitals.    Methods  A total of 9,686  Enterobacterales  isolates collected during 2019 were susceptibility (S) tested by reference broth microdilution methods. Isolates submitted to whole genome sequencing were: (1)  Escherichia coli  (EC) and  Klebsiella pneumoniae  (KPN; n=817) displaying MIC values ≥2 mg/L for at least 2 of the following β-lactams: ceftazidime, ceftriaxone, aztreonam, or cefepime; (2)  Enterobacter cloacae  (ECL) and  Citrobacter  spp. (CIT; n=351) displaying MIC values ≥16 mg/L for ceftazidime and/or ≥2 mg/L for cefepime; and (3)  Enterobacterales  (n=118) displaying elevated carbapenem (meropenem and/or imipenem) MIC results at >1 mg/L.    Results  A total of 723 isolates harbored ESBL genes but did not carry carbapenemases. The most common ESBL gene was  bla  CTX-M-15  (n=516), followed by  bla  CTX-M-14  (n=153). Most of these isolates were EC (278/147 for  bla  CTX-M-15 / bla  CTX-M-14 ), but 220 KPN harbored  bla  CTX-M-15 . A total of 302 EC and KPN isolates carried  bla  OXA-1 . Among ECL and CIT,  bla  CTX-M-15  and SHV genes encoding ESBLs were noted among 18 and 18 isolates. Carbapenemase genes were noted among 77 isolates, including 65  bla  KPC , 3  bla  SME , 6  bla  OXA-48 -like, and 3  bla  NDM . Ceftazidime-avibactam (CAZ-AVI) was the only agent active against all ESBL-producers that did not carry carbapenemases (Table). CAZ-AVI was active against 90.9% of the isolates producing carbapenemases. Isolates resistant to this combination included 3 NDM-producers and 1 isolate harboring  bla  KPC-31 .    Conclusion    Enterobacterales  isolates carrying ESBLs, mainly  bla  CTX-M-15 , were very prevalent in this collection of US isolates. CAZ-AVI was very active against isolates tested, including isolates producing carbapenemases that displayed resistance to many comparator agents.Disclosures    Mariana Castanheira, PhD ,  AbbVie (formerly Allergan ) (Research Grant or Support) Bravos Biosciences  (Research Grant or Support) Cidara Therapeutics, Inc.  (Research Grant or Support) Cipla Therapeutics  (Research Grant or Support) Cipla USA Inc.  (Research Grant or Support) GlaxoSmithKline  (Research Grant or Support) Melinta Therapeutics, Inc.  (Research Grant or Support) Melinta Therapeutics, LLC  (Research Grant or Support) Pfizer, Inc.  (Research Grant or Support) Qpex Biopharma  (Research Grant or Support) Shionogi  (Research Grant or Support) Spero Therapeutics  (Research Grant or Support)  Mariana Castanheira, PhD , Affinity Biosensors (Individual(s) Involved: Self): Research Grant or Support; Allergan (Individual(s) Involved: Self): Research Grant or Support; Amicrobe, Inc (Individual(s) Involved: Self): Research Grant or Support; Amplyx Pharma (Individual(s) Involved: Self): Research Grant or Support; Artugen Therapeutics USA, Inc. (Individual(s) Involved: Self): Research Grant or Support; Astellas (Individual(s) Involved: Self): Research Grant or Support; Basilea (Individual(s) Involved: Self): Research Grant or Support; Beth Israel Deaconess Medical Center (Individual(s) Involved: Self): Research Grant or Support; BIDMC (Individual(s) Involved: Self): Research Grant or Support; bioMerieux Inc. (Individual(s) Involved: Self): Research Grant or Support; BioVersys Ag (Individual(s) Involved: Self): Research Grant or Support; Bugworks (Individual(s) Involved: Self): Research Grant or Support; Cidara (Individual(s) Involved: Self): Research Grant or Support; Cipla (Individual(s) Involved: Self): Research Grant or Support; Contrafect (Individual(s) Involved: Self): Research Grant or Support; Cormedix (Individual(s) Involved: Self): Research Grant or Support; Crestone, Inc. (Individual(s) Involved: Self): Research Grant or Support; Curza (Individual(s) Involved: Self): Research Grant or Support; CXC7 (Individual(s) Involved: Self): Research Grant or Support; Entasis (Individual(s) Involved: Self): Research Grant or Support; Fedora Pharmaceutical (Individual(s) Involved: Self): Research Grant or Support; Fimbrion Therapeutics (Individual(s) Involved: Self): Research Grant or Support; Fox Chase (Individual(s) Involved: Self): Research Grant or Support; GlaxoSmithKline (Individual(s) Involved: Self): Research Grant or Support; Guardian Therapeutics (Individual(s) Involved: Self): Research Grant or Support; Hardy Diagnostics (Individual(s) Involved: Self): Research Grant or Support; IHMA (Individual(s) Involved: Self): Research Grant or Support; Janssen Research & Development (Individual(s) Involved: Self): Research Grant or Support; Johnson & Johnson (Individual(s) Involved: Self): Research Grant or Support; Kaleido Biosceinces (Individual(s) Involved: Self): Research Grant or Support; KBP Biosciences (Individual(s) Involved: Self): Research Grant or Support; Luminex (Individual(s) Involved: Self): Research Grant or Support; Matrivax (Individual(s) Involved: Self): Research Grant or Support; Mayo Clinic (Individual(s) Involved: Self): Research Grant or Support; Medpace (Individual(s) Involved: Self): Research Grant or Support; Meiji Seika Pharma Co., Ltd. (Individual(s) Involved: Self): Research Grant or Support; Melinta (Individual(s) Involved: Self): Research Grant or Support; Menarini (Individual(s) Involved: Self): Research Grant or Support; Merck (Individual(s) Involved: Self): Research Grant or Support; Meridian Bioscience Inc. (Individual(s) Involved: Self): Research Grant or Support; Micromyx (Individual(s) Involved: Self): Research Grant or Support; MicuRx (Individual(s) Involved: Self): Research Grant or Support; N8 Medical (Individual(s) Involved: Self): Research Grant or Support; Nabriva (Individual(s) Involved: Self): Research Grant or Support; National Institutes of Health (Individual(s) Involved: Self): Research Grant or Support; National University of Singapore (Individual(s) Involved: Self): Research Grant or Support; North Bristol NHS Trust (Individual(s) Involved: Self): Research Grant or Support; Novome Biotechnologies (Individual(s) Involved: Self): Research Grant or Support; Paratek (Individual(s) Involved: Self): Research Grant or Support; Pfizer (Individual(s) Involved: Self): Research Grant or Support; Prokaryotics Inc. (Individual(s) Involved: Self): Research Grant or Support; QPEX Biopharma (Individual(s) Involved: Self): Research Grant or Support; Rhode Island Hospital (Individual(s) Involved: Self): Research Grant or Support; RIHML (Individual(s) Involved: Self): Research Grant or Support; Roche (Individual(s) Involved: Self): Research Grant or Support; Roivant (Individual(s) Involved: Self): Research Grant or Support; Salvat (Individual(s) Involved: Self): Research Grant or Support; Scynexis (Individual(s) Involved: Self): Research Grant or Support; SeLux Diagnostics (Individual(s) Involved: Self): Research Grant or Support; Shionogi (Individual(s) Involved: Self): Research Grant or Support; Specific Diagnostics (Individual(s) Involved: Self): Research Grant or Support; Spero (Individual(s) Involved: Self): Research Grant or Support; SuperTrans Medical LT (Individual(s) Involved: Self): Research Grant or Support; T2 Biosystems (Individual(s) Involved: Self): Research Grant or Support; The University of Queensland (Individual(s) Involved: Self): Research Grant or Support; Thermo Fisher Scientific (Individual(s) Involved: Self): Research Grant or Support; Tufts Medical Center (Individual(s) Involved: Self): Research Grant or Support; Universite de Sherbrooke (Individual(s) Involved: Self): Research Grant or Support; University of Iowa (Individual(s) Involved: Self): Research Grant or Support; University of Iowa Hospitals and Clinics (Individual(s) Involved: Self): Research Grant or Support; University of Wisconsin (Individual(s) Involved: Self): Research Grant or Support; UNT System College of Pharmacy (Individual(s) Involved: Self): Research Grant or Support; URMC (Individual(s) Involved: Self): Research Grant or Support; UT Southwestern (Individual(s) Involved: Self): Research Grant or Support; VenatoRx (Individual(s) Involved: Self): Research Grant or Support; Viosera Therapeutics (Individual(s) Involved: Self): Research Grant or Support; Wayne State University (Individual(s) Involved: Self): Research Grant or Support  Lalitagauri M. Deshpande, PhD ,  AbbVie (formerly Allergan ) (Research Grant or Support) Pfizer, Inc.  (Research Grant or Support)  Timothy B. Doyle ,  AbbVie (formerly Allergan ) (Research Grant or Support) Bravos Biosciences  (Research Grant or Support) GlaxoSmithKline  (Research Grant or Support) Melinta Therapeutics, Inc.  (Research Grant or Support) Pfizer, Inc.  (Research Grant or Support) Shionogi  (Research Grant or Support) Spero Therapeutics  (Research Grant or Support)  Rodrigo E. Mendes, PhD ,  AbbVie  (Research Grant or Support) AbbVie (formerly Allergan ) (Research Grant or Support) Cipla Therapeutics  (Research Grant or Support) Cipla USA Inc.  (Research Grant or Support) ContraFect Corporation  (Research Grant or Support) GlaxoSmithKline, LLC  (Research Grant or Support) Melinta Therapeutics, Inc.  (Research Grant or Support) Melinta Therapeutics, LLC  (Research Grant or Support) Nabriva Therapeutics  (Research Grant or Support) Pfizer, Inc.  (Research Grant or Support) Shionogi  (Research Grant or Support) Spero Therapeutics  (Research Grant or Support)  Helio S. Sader, MD, PhD, FIDSA ,  AbbVie (formerly Allergan ) (Research Grant or Support) Basilea Pharmaceutica International, Ltd.  (Research Grant or Support) Cipla Therapeutics  (Research Grant or Support) Cipla USA Inc.  (Research Grant or Support) Department of Health and Human Services  (Research Grant or Support, Contract no. HHSO100201600002C) Melinta Therapeutics, LLC  (Research Grant or Support) Nabriva Therapeutics  (Research Grant or Support) Pfizer, Inc.  (Research Grant or Support) Shionogi  (Research Grant or Support) Spero Therapeutics  (Research Grant or Support)

open forum infectious diseases

1284. Occurrence of β-Lactamases among <i>Enterobacterales</i> Isolated from United States Hospitals: Results of the INFORM Surveillance Program for Ceftazidime-Avibactam

1284. Occurrence of β-Lactamases among Enterobacterales Isolated from United States Hospitals: Results of the INFORM Surveillance Program for Ceftazidime-Avibactam