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Background Infection with Escherichia coli after TRUSBP is common, but other Enterobacteriaceae also occur. In the absence of microbiological data, prophylaxis with co-trimoxazole (TMP-SMX) or fluoroquinolones (FQ) is usually prescribed. We estimated the incidence of bacteremia and bacteriuria after TRUSBP with distinct species of Enterobacteriaceae and their rate of resistance to common antibiotics. Methods Using Veterans Healthcare Administration (VHA) databases, we identified patients undergoing TRUSBP between January 1, 2013 and December 31, 2017. We determined the incidence of Enterobacteriaceae isolated from urine and blood cultures obtained within 30 days of TRUSBP. Using microbiology data from VHA, we determined rates of resistance to TMP-SMX, FQ (ciprofloxacin as marker), ESC (ceftriaxone as marker), and carbapenems (Carb) (ertapenem as marker). Results Overall, 377 (0.3%) and 1,739 (1.4%) of 126,761 TRUSBPs were complicated by bacteremia or bacteriuria with Enterobacteriaceae, respectively. E. coli was predominant (91% of blood and 81% in urine). Rates of FQ resistance were low in Klebsiellaand Enterobacter but exceeded 60% in E. coli. In general, TMP-SMX resistance exceeded 30%. Of note, 16.6% of blood and 11% of urine Enterobacteriacaea were resistant to ESC, while Carb-resistance was rare. Conclusion FQ and ESC-resistant Enterobacteriaceae are prevalent in bacteremia and bacteriuria after TRUSBP. Antibiotics used for prophylaxis and empirical treatment are likely to be ineffective. The prevention and management of TRUSBP-related infections should include microbiology-guided approaches. Total ESC-Resistant Carb-Resistant FQ Resistant TMP-SMX Resistant Enterobacteriaceae Blood 377 61 16.4% 2 0.5% 235 62.3% 129 34.2% Urine 1739 192 11.0% 20 1.2% 986 56.7% 607 34.9% Citrobacter Blood 3 1 % 0 – 1 – 1 – Urine 22 5 22.7% 2 9.1% 8 36.4% 7 31.8% Enterobacter Blood 4 0 0 0 0 Urine 46 8 17.4% 2 4.3% 3 6.5% 1 2.2% Escherichia coli Blood 344 57 16.6% 0 0.0% 232 67.4% 123 35.8% Urine 1415 157 11.1% 2 0.1% 934 66.0% 556 39.3% Klebsiella Blood 24 3 12.5% 1 4.2% 2 8.3% 4 16.7% Urine 196 14 7.1% 6 3.1% 15 7.7% 22 11.2% Morganella Blood 2 1 1 0 1 Urine 13 2 15.4% 5 38.5% 5 38.5% 8 61.5% Proteus 33 6 18.2% 3 9.1% 17 51.5% 11 33.3% Providencia 2 0 0 – 1 – 0 – Serratia 11 0 0 2 1 Shigella 1 0 0 1 1 Disclosures All authors: No reported disclosures.

open forum infectious diseases

1179. Incidence of Bacteremia and Bacteriuria With Antibiotic-Resistant Enterobacteriaceae After Transrectal Ultrasound-Guided Biopsy of the Prostate (TRUSBP)