Search

Background Multidrug resistance (MDR) in Enterobacterales is common; the impact of socioeconomic status (SES) on MDR prevalence is unclear. Methods Data from 2014–2021 was obtained from UNC Hospitals for all cultures with Enterobacterales growth (N=90129). ZIP-code level socioeconomic data for North Carolina was sourced from the 2020 5-Year American Community Survey and combined into an SES factor score assigned to each ZIP code (N=790). Prevalence ratios from generalized linear models were used to compare the relative MDR occurrence between SES quartiles. Results A significant inverse relationship between MDR and SES was observed (16%, 16.5%, 19.5%, and 20.7% MDR in the highest, medium-high, medium-low, and lowest quartiles, respectively; Table 1). The prevalence of MDR in Enterobacterales from patients residing in lowest-quartile ZIP codes was 32% higher (Table 1) relative to those from the highest quartile. This effect was significant across all measured antibiotic classes, with the largest absolute difference in penicillins (40.1% and 50.6% in the highest and lowest quartiles, respectively), and the smallest in aminoglycosides (5.6% and 7.3%; Figure 1). Temporally, the lowest quartile had the highest prevalence of MDR in all measured years. Conclusion Our findings show that in North Carolina from 2014–2021, MDR was consistently more prevalent in Enterobacterales from patients residing in lowest-quartile ZIP codes. These data emphasize the need to address the societal causes for disparities in clinical outcomes and can inform further study of the relationship between SES and MDR. Disclosures David van Duin, MD, PhD, Achaogen: Advisor/Consultant|Actavis: Advisor/Consultant|Allergan: Advisor/Consultant|Astellas: Advisor/Consultant|Entasis: Advisor/Consultant|Karius: Advisor/Consultant|MedImmune: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Neumedicine: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Qpex: Advisor/Consultant|Roche: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|T2Biosystems: Advisor/Consultant|Tetraphase: Advisor/Consultant|Utility: Advisor/Consultant|Wellspring: Advisor/Consultant.

Patients with burn injuries are at high risk for infectious complications, and infections are the most common cause of death after the first 72 h of hospitalization. Hospital-acquired infections caused by multidrug resistant (MDR) Gram-negative bacteria (GNB) in this population are concerning. Here, we evaluated carriage with MDR GNB in patients in a large tertiary-care burn intensive care unit. Twenty-nine patients in the burn unit were screened for intestinal carriage. Samples were cultured on selective media. Median time from admission to the burn unit to first sample collection was 9 days (IQR 5 – 17 days). In 21 (72%) patients, MDR GNB were recovered; the most common bacterial species isolated was Pseudomonas aeruginosa, which was found in 11/29 (38%) of patients. Two of these patients later developed bloodstream infections with P. aeruginosa. Transmission of KPC-31-producing ST22 Citrobacter freundii was detected. Samples from two patients grew genetically similar C. freundii isolates that were resistant to ceftazidime-avibactam. On analysis of whole-genome sequencing, bla(KPC-31) was part of a Tn4401b transposon that was present on two different plasmids in each C. freundii isolate. Plasmid curing experiments showed that removal of both copies of bla(KPC-31) was required to restore susceptibility to ceftazidime-avibactam. In summary, MDR GNB colonization is common in burn patients and patient-to-patient transmission of highly resistant GNB occurs. These results emphasize the ongoing need for infection prevention and antimicrobial stewardship efforts in this highly vulnerable population.

Background People with HIV (PWH) may be at increased risk for MDR Enterobacterales (MDR-E) infection or colonization, relative to individuals without HIV, due to a greater burden of comorbidities as well as HIV-related intestinal inflammation and microbiota alterations. Objectives To characterize antibiotic susceptibility of enteric Enterobacterales and risk factors for antimicrobial-resistant bacterial infections in a sample of PWH attending routine clinic visits. Methods Participants provided self-administered rectal swabs and completed questionnaires regarding healthcare, travel and occupational exposures for the prior 12 months. Rectal samples were processed to identify Enterobacterales species, and susceptibility testing was performed. Results Among 82 participants, 110 Enterobacterales isolates were obtained. Non-susceptibility was common for penicillins, sulphonamides and first-generation cephalosporins. MDR-E was present in 20% of participants. HIV-related characteristics, including current or nadir CD4 cell count, viral suppression, or AIDS-defining clinical conditions, were not associated with MDR-E. Conclusions MDR-E colonization is common in this population of PWH. Further research evaluating risk factors for MDR-E in PWH may inform infection prevention approaches to better protect at-risk populations from these difficult-to-treat infections.

Background: Symptoms associated with SARS-CoV-2 infection remain incompletely understood, especially among ambulatory, non-hospitalized individuals. Objective: Identify symptom and patient factors associated with detection of SARS-CoV-2 in outpatients. Design: Retrospective cohort analysis. Setting: An outpatient testing program in North Carolina. Patients: 20,177 individuals presenting between March 16 and September 3, 2020 for nasopharyngeal SARS-CoV-2 RNA RT-PCR testing. Measurements: Self-reported symptoms, demographic characteristics, and exposure and travel histories. Results: Among 20,177 tested individuals, the proportion positive was 9.4% (95% CI, 9.0-9.8) and was higher for men, younger individuals, and racial/ethnic minorities (all P