1440. Prevalence and Regional Variation of in ESBLs and CRE Enterobacteriaceae (ENT) among Adult, Hospitalized Patients with ENT on a Urine Culture: A Multicenter Evaluation

Background Despite increased public health awareness of ESBLs and CRE, limited data exist regarding the true frequency of these resistant bacteria in urine cultures collected from adult patients in US hospitals. This study sought to quantify the prevalence and rates of ESBLs and CRE from urine cultures in adult hospitalized patients with ENT. Methods All hospitalized adults with a urine culture (first urine isolate of a species per 30-day period) from 377 hospitals in 2018 were evaluated (BD Insights Research Database, Becton, Dickinson & Company). ESBL was defined as an ENT that was ESBL-positive per commercial panels or intermediate or resistant (non-susceptible, [NS]) to a third-generation cephalosporin; CRE was defined as an ENT that was NS to imipenem, meropenem, doripenem or ertapenem. Urine isolates were classified as community-onset (CO: < 3 days of an inpatient admission and no previous admission within 14 days) or hospital-onset (HO: ≥ 3 days post-admission or within 14 days of discharge) period. Prevalence and rates per 100 admissions were calculated overall, by onset location (CO vs. HO), and by US Department of Health and Human Services (HHS) geographic region. Results In 2018, there were 193,476 non-duplicate ENT urine isolates across 4,623,333 admissions; 63.6% were E. coli (EC), 19.5% were K. pneumoniae/oxytoca (KPO), and 8.7% were P. mirabilis (PM). Overall, 12.6% were ESBL and 0.9% were CRE. Rate per 100 admissions was 0.484 and 0.037 for ESBL and CRE, respectively. Among CO, 11.8% were ESBLs and ESBL rates per 100 admissions were 0.358; 0.7% were CRE and CRE rates per 100 admissions was 0.024. Among HO, 15.7% were ESBLs and ESBL rates per 100 admissions was 0.126; 1.5% were CRE and CRE rates per 100 admissions was 0.013. Regional differences in both ESBL and CRE ENT were noted (table). Conclusion The prevalence of ESBLs/CRE among adult hospitalized patients with ENT in a urine culture was 13% and 1%, respectively. The % ESBL/CRE was higher among patients HO urine isolates whereas ESBL/CRE rates per 100 admissions were higher among patients with CO urine isolates. Considerable geographic variations were observed. Region and site of onset differences in ESBL/CRE epidemiology should be considered when making empiric antibiotic treatment decisions. Disclosures All authors: No reported disclosures.