Improvement of Adequacy of Empirical Antimicrobial Therapy in Escherichia coli Bacteremia of Urinary Source in Catalonia (VINCat-PROA)

Background: The antibiotic use optimization program (PROA) in Catalonia (Spain) is part of the surveillance program for nosocomial infections in hospitals in Catalonia (VINCat). Despite the existence of guidelines for the treatment of urinary tract infections in hospitals, adherence to them is not guaranteed. Objective: Our objective was to evaluate the adequacy of empirical antimicrobial therapy to local guidelines in bacteremia caused by Escherichia coli of urinary source within the PROA-VINCat program during a 3-year period. The impact of a voluntary survey asking for evaluating local results and implementing correction measures was also analyzed. Methods: Multicentric prospective observational study including all episodes of E. coli bacteremia of urinary source between May 2017 and September 2019, in adult hospitalized patients in 45 Catalan hospitals. Adequacy of the empirical therapy to local guidelines was one of the prospectively recorded items. A survey evaluating local results of 2017–2018 and asking for possible correcting measures was sent to the participating centers at the end of 2018. Percentages of adequacy of empirical antimicrobial therapy in 2017, 2018, and 2019 were compared by means of χ2 test. Results: Overall, 3,804 episodes of bacteremia were recorded: 845 in 2017, 1,861 in 2018 and 1,098 until September 30, 2019. Globally, adequacy of empirical therapy to guidelines increased from 73.7% in 2017 to 78.2% in 2019 (P = .06). Interestingly, in the 24 hospitals that responded to the voluntary survey, the adequacy of empirical therapy increased significantly from 72.9% in 2017 to 79.9% in 2019 (P = .009). In hospitals that did not respond, adequacy remained the same over the years (76.7% in 2017, 75.1% in 2019; P = .90). Correction measures applied were: meeting with the antimicrobial stewardship team to evaluate the results (100%), review of local resistance rates (62%), review of local guidelines (58.3%), improving guidelines dissemination (75%), sessions for improving guidelines adherence (58%), and analysis of adherence to guidelines after education (65%). Conclusions: In the empirical treatment of E. coli bacteremia of urinary source, adequacy to local antimicrobial therapy guidelines improved from 2017 to 2019, but only in hospitals answering a voluntary survey regarding correcting measures for improving adequacy. Adherence to antimicrobial stewardship proposals improves indicators at local and regional level.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.

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Bloodstream Infections Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae: Risk Factors for Mortality and Treatment Outcome, with Special Emphasis on Antimicrobial Therapy

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.48.12.4574-4581.2004 ◽

2004 ◽

Vol 48 (12) ◽

pp. 4574-4581 ◽

Cited By ~ 180

Author(s):

Cheol-In Kang ◽

Sung-Han Kim ◽

Wan Beom Park ◽

Ki-Deok Lee ◽

Hong-Bin Kim ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Treatment Outcome ◽

Klebsiella Pneumoniae ◽

Antimicrobial Therapy ◽

Bloodstream Infections ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Extended Spectrum ◽

Empirical Antimicrobial Therapy

ABSTRACT This study was conducted to evaluate risk factors for mortality and treatment outcome of bloodstream infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK). ESBL production in stored K. pneumoniae and E. coli blood isolates from Jan 1998 to Dec 2002 was phenotypically determined according to NCCLS guidelines and/or the double-disk synergy test. A total of 133 patients with ESBL-EK bacteremia, including 66 patients with ESBL-producing K. pneumoniae and 67 with ESBL-producing E. coli, were enrolled. The overall 30-day mortality rate was 25.6% (34 of 133). Independent risk factors for mortality were severe sepsis, peritonitis, neutropenia, increasing Acute Physiology and Chronic Health Evaluation II score, and administration of broad-spectrum cephalosporin as definitive antimicrobial therapy (P < 0.05 for each of these risk factors). In 117 of the 133 patients, excluding 16 patients who died within 3 days after blood culture sample acquisition, the 30-day mortality rates according to definitive antibiotics were as follows: carbapenem, 12.9% (8 of 62); ciprofloxacin, 10.3% (3 of 29); and others, such as cephalosporin or an aminoglycoside, 26.9% (7 of 26). When patients who received appropriate definitive antibiotics, such as carbapenem or ciprofloxacin, were evaluated, mortality in patients receiving inappropriate empirical antimicrobial therapy was found not to be significantly higher than mortality in those receiving appropriate empirical antimicrobial therapy (18.9 versus 15.5%; P = 0.666). Carbapenem and ciprofloxacin were the most effective antibiotics in antimicrobial therapy for ESBL-EK bacteremia. A delay in appropriate definitive antimicrobial therapy was not associated with higher mortality if antimicrobial therapy was adjusted appropriately according to the susceptibility results. Our data suggest that more prudent use of carbapenem as empirical antibiotic may be reasonable.

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Effect of nanoparticles on Escherichia coli growth dynamics

10.36811/ijbm.2019.110014 ◽

2019 ◽

pp. 107-113

Author(s):

Laith B Alhusseini

Keyword(s):

Escherichia Coli ◽

Titanium Dioxide ◽

Urinary Tract ◽

Iron Oxide ◽

Titanium Dioxide Nanoparticles ◽

Growth Dynamics ◽

Inhibition Zone ◽

E Coli ◽

Tract Infections ◽

The Impact

Background: Nanoparticles (iron oxide and titanium dioxide nanoparticles) are another kind of critical materials that are produced for use in various research and different purposes. The bacteriology field being so critical seek to the intrinsic understanding on the effect of nanoparticles on bacterial growth and functions. Our investigation was planned to detect the impact of iron oxide (Fe3O4), titanium dioxide (TiO2) nanoparticles on growth of Escherichia coli (Iraqi isolate). Methods: Fifty urine samples of patients, who are suffering Urinary Tract Infections (UTIs) in Iraqi hospitals, were collected. Our study was included three parts: the 1st part was isolated and diagnosed the bacteria that cause the urinary tract infection, the 2nd part was sensitivity to antibiotics, and the 3rd has used the nanomaterials and study their impacts on the growth of E. col isolates. Result: The results showed that 30 E. coli isolates depending on the properties of biochemical and molecular detect. Five common types of antibiotics were examined for the treatment of infections of the urinary tract. Most E. coli were resistant to antibiotics, the ratios of ampicillin, amikacin and augmentin found to be 90%, 82% and 80% respectively. It concluded that bacteria were sensitive to imipenem and meropenem of about 50 %. So, the effect of iron oxide and titanium dioxide nanoparticles were studied for the growth of bacteria using the agar. The effectiveness against bacteria (diameters of the inhibition zone rate) found to be 18 mm for the 1st substance and 21 mm for 2nd substance. Conclusion: Our current study indicates that there is an effect of nanoparticles at the cellular level that can be used for beneficial biological application such as antibacterial. Keywords: Escherichia coli; Inhibition zone; Antibiotics; Nanoparticles

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Molecular Characterization of Uropathogenic Escherichia coli Reveals Emergence of Drug Resistant O15, O22 and O25 Serogroups

Medicina ◽

10.3390/medicina55110733 ◽

2019 ◽

Vol 55 (11) ◽

pp. 733 ◽

Cited By ~ 3

Author(s):

Ruta Prakapaite ◽

Frederic Saab ◽

Rita Planciuniene ◽

Vidmantas Petraitis ◽

Thomas J. Walsh ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Asymptomatic Bacteriuria ◽

Empirical Therapy ◽

Uropathogenic Escherichia Coli ◽

Phylogenetic Groups ◽

E Coli ◽

Tract Infections ◽

Resistance Rates

Background and Objectives: Uropathogenic Escherichia coli (UPEC) are common pathogens causing urinary tract infections (UTIs). We aimed to investigate the relationship among clinical manifestation, serogroups, phylogenetic groups, and antimicrobial resistance among UPEC. Materials and Methods: One-hundred Escherichia coli isolates recovered from urine and ureteral scrapings were used for the study. The prevalence of antimicrobial resistance was determined by using European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations. E. coli serogroups associated with UTI, as well as phylogenetic diversity were analyzed using multiplex PCR reactions. Results: Eighty-seven strains (87%) were isolated from females, while 13 (13%) from males. A high frequency of resistance to cephalosporins (43%) and fluoroquinolones (31%) was observed. Among UTI-associated serogroups O15 (32.8%), O22 (23.4%), and O25 (15.6%) were dominant and demonstrated elevated resistance rates. The E. coli phylogenetic group B2 was most common. These observations extended to pregnant patients with asymptomatic bacteriuria. Conclusions: Due to high rates of resistance, strategies using empirical therapy of second-generation cephalosporins and fluoroquinolones should be reconsidered in this population.

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Avaliação do Perfil de Sensibilidade aos Antibióticos na Infeção Urinária da Comunidade

Acta Médica Portuguesa ◽

10.20344/amp.5352 ◽

2014 ◽

Vol 27 (6) ◽

pp. 737 ◽

Cited By ~ 2

Author(s):

Rui Passadouro ◽

Raquel Fonseca ◽

Felícia Figueiredo ◽

Andreia Lopes ◽

Cristina Fernandes

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Clavulanic Acid ◽

Urinary Tract Infections ◽

Antibiotic Susceptibility ◽

Empirical Therapy ◽

Activity Level ◽

E Coli ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections

Introduction: The urinary tract infections, after respiratory infections, are the most common in the community. The knowledge about the prevalence of microbial strains and their antibiotic susceptibility is crucial to establish an effective empirical therapy. The aim of this study was to determine the antibiotic susceptibility patterns of bacterial strains isolated from positive urine cultures performed in patients from the central region of Portugal. Material and Methods: We carried out a documental analysis of 6008 urine bacteriological exams, to be made available to physicians, most of which run through the automated system VITEK 2, bioMérieux. The majority (80%) of the urine bacteriological exams were from female. Escherichia coli was the most prevalent bacterial pathogen (65.9%), followed by Klebsiella spp (12%). Results: Nitrofurantoin showed high levels of activity (96%) for Escherichia coli, as well as Fosfomycin (96.6%). Amoxicillin-clavulanic acid presents an activity level of only 81.1% for the same germ. Quinolones exhibit efficacy to only 78% of the strains of Escherichia coli, below the Fosfomycin and Nitrofurantoin. Nitrofurantoin showed high levels of activity (96%) for E. coli as well as Fosfomycin (96.6%). Amoxicillin-Clavulanic Acid presents a level of activity of only 81.1% for the same germ. The quinolones have a efficacy for only 78% of strains of E. coli, lower than Fosfomycin. Discussion: Escherichia Coli was the most prevalent uropathogen (65.9%). High efficacy against this pathogenic agent was found for Fosfomycin (96.6%) and Nitrofurantoin (96%). Conclusion: Further antimicrobial surveillance studies should be developed, in order to formulate local empirical therapy recommendations for optimized therapeutical choices. Keywords: Urinary Tract Infections; Drug Resistance, Bacterial; Anti-Bacterial Agents; Community-Acquired Infections.

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Impact of antibiotic usage on extended-spectrum β-lactamase producing Escherichia coli prevalence

Scientific Reports ◽

10.1038/s41598-021-91332-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jeong Yeon Kim ◽

Yunjin Yum ◽

Hyung Joon Joo ◽

Hyonggin An ◽

Young Kyung Yoon ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antibiotic Usage ◽

Transfer Model ◽

Free Text ◽

E Coli ◽

Extended Spectrum ◽

Hospital Acquired ◽

The Impact

AbstractAn increase in antibiotic usage is considered to contribute to the emergence of antimicrobial resistance. Although experts are counting on the antimicrobial stewardship programs to reduce antibiotic usage, their effect remains uncertain. In this study, we aimed to evaluate the impact of antibiotic usage and forecast the prevalence of hospital-acquired extended spectrum β-lactamase (ESBL)—producing Escherichia coli (E. coli) using time-series analysis. Antimicrobial culture information of E. coli was obtained using a text processing technique that helped extract free-text electronic health records from standardized data. The antimicrobial use density (AUD) of antibiotics of interest was used to estimate the quarterly antibiotic usage. Transfer function model was applied to forecast relationship between antibiotic usage and ESBL-producing E. coli. Of the 1938 hospital-acquired isolates, 831 isolates (42.9%) were ESBL-producing E. coli. Both the proportion of ESBL-producing E. coli and AUD increased over time. The transfer model predicted that ciprofloxacin AUD is related to the proportion of ESBL-producing E. coli two quarters later. In conclusion, excessive use of antibiotics was shown to affect the prevalence of resistant organisms in the future. Therefore, the control of antibiotics with antimicrobial stewardship programs should be considered to restrict antimicrobial resistance.

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The Burden of Antimicrobial Resistance among Urinary Tract Isolates of Escherichia coli in the United States in 2017

10.1101/703199 ◽

2019 ◽

Author(s):

Ian A Critchley ◽

Nicole Cotroneo ◽

Michael J Pucci ◽

Rodrigo Mendes

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Hospital Setting ◽

Clonal Expansion ◽

The United States ◽

Cross Resistance ◽

E Coli ◽

Oral Agents ◽

Tract Infections ◽

The Impact

AbstractUrinary tract infections (UTIs) caused by Escherichia coli have been historically managed with oral antibiotics including the cephalosporins, fluoroquinolones and trimethoprim-sulfamethoxazole. The use of these agents is being compromised by the increase in extended spectrum β-lactamase (ESBL)-producing organisms, mostly caused by the emergence and clonal expansion of E. coli multilocus sequence typing (ST) 131. In addition, ESBL isolates show co-resistance to many of oral agents. Management of UTIs caused by ESBL and fluoroquinolone-resistant organisms is becoming increasingly challenging to treat outside of the hospital setting with clinicians having to resort to intravenous agents. The aim of this study was to assess the prevalence of ESBL phenotypes and genotypes among UTI isolates of E. coli collected in the US during 2017 as well as the impact of co-resistance to oral agents such as the fluoroquinolones and trimethoprim-sulfamethoxazole. The national prevalence of ESBL phenotypes of E. coli was 15.7% and was geographically distributed across all nine Census regions. Levofloxacin and trimethoprim-sulfamethoxazole-resistance rates were ≥ 24% among all isolates and this co-resistance phenotype was considerably higher among isolates showing an ESBL phenotype (≥ 59.2%) and carrying blaCTX-M-15 (≥ 69.5%). The agents with the highest potency against UTI isolates of E. coli, including ESBL isolates showing cross-resistance across oral agents, were the intravenous carbapenems. The results of this study indicate that new oral options with the spectrum and potency similar to the intravenous carbapenems would address a significant unmet need for the treatment of UTIs in an era of emergence and clonal expansion of ESBL isolates resistant to several classes of antimicrobial agents, including oral options.

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Molecular Characterisation of Uropathogenic Escherichia coli Reveals Emergence of Drug Resistant O15, O22, and O25 Serogroups

10.21203/rs.2.11385/v1 ◽

2019 ◽

Author(s):

Ruta Prakapaite ◽

Frederic Saab ◽

Rita Planciuniene ◽

Vidmantas Petraitis ◽

Thomas J. Walsh ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Asymptomatic Bacteriuria ◽

Empirical Therapy ◽

Uropathogenic Escherichia Coli ◽

Phylogenetic Groups ◽

E Coli ◽

Tract Infections ◽

Resistance Rates ◽

The Relationship

Abstract Background Uropathogenic Escherichia coli (UPEC) are common pathogens causing urinary tract infections (UTIs). We aimed to investigate the relationship among clinical manifestation, serogroups, phylogenetic groups, and antimicrobial resistance among UPEC. Methods One-hundred Escherichia coli isolates recovered from urine and ureteral scrapings were used for the study. The prevalence of antimicrobial resistance was determined by using EUCAST recommendations. E. coli serogroups associated with UTI, as well as phylogenetic diversity was analysed using multiplex PCR reactions. Results Eighty-seven strains (87%) were isolated from females, while 13 (13%) from males. A high frequency of resistance to cephalosporins (43%) and fluoroquinolones (31%) was observed. Among UTI-associated serogroups, O15 (32.8%), O22 (23.4%), and O25 (15.6%) were dominant and demonstrated elevated resistance rates. The E. coli phylogenetic group B2 was most common. These observations extended to pregnant patients with asymptomatic bacteriuria. Conclusions Due to high rates of resistance, strategies using empirical therapy of second-generation cephalosporins and fluoroquinolones for treatment of UPEC infections should be reconsidered.

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Phenotypic detection of extended spectrum ?-lactamase and AmpC ?-lactamase in urinary isolates of Escherichia coli at a tertiary care referral hospital in Northeast India

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v8i3.8682 ◽

2013 ◽

Vol 8 (3) ◽

pp. 22-29 ◽

Cited By ~ 1

Author(s):

A Bora ◽

GU Ahmed ◽

NK Hazarika

Keyword(s):

Escherichia Coli ◽

Drug Resistance ◽

Tertiary Care ◽

Northeast India ◽

Referral Hospital ◽

E Coli ◽

Extended Spectrum ◽

Tract Infections ◽

The Impact ◽

Urinary Isolates

Objective Urinary tract infections (UTIs) are the most prevalent infections worldwide, mostly caused by Escherichia coli. Emerging antibiotic resistance due to extended spectrum â-lactamase (ESBL) and AmpC β- lactamase production limit the use of β-lactam antibiotics against the infections caused by E. coli. We detected the production of ESBL and AmpC β-lactamase in urinary isolates of E. coli, recovered from a tertiary care referral hospital in Northeast India. Materials and Methods A total of 140 E. coli urinary isolates were recovered during October 2008 to January 2009. Antibiotic susceptibility testing and ESBL detection were carried out according to Clinical Laboratory and Standards Institute (CLSI) guidelines. Phenotypic detection of AmpC β-lactamase was carried out by AmpC disc method. Results Among the 140 urinary isolates, 112 isolates (80%) were multi-drug resistance (MDR). ESBL was detected in 67.14% (94/140) of E. coli isolates. AmpC β-lactamase was detected in 22.34% of ESBL producing E. coli isolates. Conclusions Routine testing for ESBL and AmpC β-lactamase in E. coli urinary isolates with conventional antibiogram would be useful for strict antibiotic policy implementation in hospitals, to estimate the impact of increased drug resistance and to take steps for reducing their resistance. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-3, 22-29 DOI: http://dx.doi.org/10.3126/jcmsn.v8i3.8682

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49. Impact of a Rapid Genotypic Platform for Gram-negative Bloodstream Infections, Paired with an Antimicrobial Stewardship Intervention, on Time to Optimal Antimicrobial Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.251 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S145-S145

Author(s):

Madison Donnelly ◽

Jennifer Walls ◽

Katlyn Wood ◽

Aiman Bandali

Keyword(s):

Length Of Stay ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Intervention Group ◽

Bloodstream Infections ◽

Post Intervention ◽

Gram Negative ◽

E Coli ◽

Optimal Therapy ◽

The Impact

Abstract Background Gram-negative bacteremia is associated with significant morbidity and mortality. Development of an algorithm for antimicrobial selection, using institution-specific antibiogram data and rapid diagnostics (RDT), achieves timely and appropriate antimicrobial therapy. The objective of this study is to assess the impact of a pharmacy-driven antimicrobial stewardship initiative in conjunction with ePlex® BCID on time to optimal antimicrobial therapy for patients with gram-negative bloodstream infections. Methods This retrospective, observational, single-center study included adult patients with a documented gram-negative bloodstream infection in whom the ePlex® BCID was employed. A pharmacist-driven antimicrobial stewardship intervention was initiated on December 1, 2020; pre-intervention (December 2019 – March 2020) was compared to the post-intervention (December 2020 – February 2020) period. The following organisms were included: Citrobacter spp., Escherichia coli, Klebsiella aerogenes/pneumoniae/oxytoca, Proteus spp, Enterobacter spp., Pseudomonas aeruginosa, and Acinetobacter baumannii. Polymicrobial bloodstream infections or those who had an ePlex® panel performed prior to admission were excluded. The following clinical outcomes were assessed: time to optimal antimicrobial therapy, length of stay (LOS), and inpatient-30-day mortality. Results One hundred and sixty-three met criteria for inclusion; 98 patients in the pre-intervention group and 65 patients in the post-intervention group. The mean Pitt Bacteremia Score was 1 in both groups (p=0.741). The most common organism identified by ePlex® BCID was E. coli (65.3% vs 70.8%; p=0.676). Eight E. Coli isolates were CTX-M positive; no other gene targets were detected. The most common suspected source of bacteremia was genitourinary (72.5% vs 72.3%; p=1.0). Time to optimal therapy was reduced by 29 hours [37 (31 – 55) vs. 8 (4 – 28); p=0.048). Length of stay and mortality was similar between groups. Conclusion Implementation of a rapid blood culture identification panel along with an antimicrobial stewardship intervention significantly reduced time to optimal therapy. Further studies are warranted to confirm these results. Disclosures All Authors: No reported disclosures

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1465. Resistance to Oral Antibiotics Among Urinary Tract Infection Isolates of Escherichia coli from the United States and Europe in 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1329 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S534-S535

Author(s):

Ian A Critchley ◽

Nicole Cotroneo ◽

Kate Sulham ◽

David Melnick ◽

Rodrigo E Mendes

Keyword(s):

United States ◽

Escherichia Coli ◽

Urinary Tract ◽

Unmet Need ◽

The United States ◽

Surveillance Program ◽

Oral Antibiotics ◽

Oral Agents ◽

Tract Infections ◽

The Impact

Abstract Background Clinical guidelines have recommended oral antibiotics such as the cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of urinary tract infections (UTI’s) caused by Escherichia coli (EC). The utility of these agents continues to be eroded by increased prevalence of expanded spectrum β-lactamase (ESBL) genes and concomitant resistance determinants to other antimicrobial classes. This study assessed the prevalence of ESBL phenotypes among EC from UTIs in the United States and 11 countries in Europe (EU) in 2017 and the impact of co-resistance to oral agents used to treat UTIs. Methods 2422 unique EC from UTIs in the United States and EU in the SENTRY Surveillance program were evaluated for susceptibility to various agents. All isolates were consecutively collected and centrally tested by CLSI methods and interpretive criteria. Isolates that met ESBL MIC screening criteria were characterized for the presence of β-lactamase genes. Results Among the 2422 isolates of EC from UTI’s in the United States and EU the resistance (R) rates for cefuroxime (CEF), levofloxacin (LEV) and TMP-SMX were 17.9%, 25.6% and 33.2%, respectively. The overall prevalence of ESBL phenotypes was 18.2% (18.7% in the United States and 21.0% in EU). Among the 411 ESBL phenotypes, R to CEF, LEV and TMP-SMX were: 94.3%, 70.6%, and 61.6%, respectively. In contrast, <0.1% of all EC or 0.2% of ESBL EC were meropenem (MER)-R. Only two carbapenemase-producing organisms were identified, an NDM-5- and a KPC-2-producing EC from Turkey and Greece, respectively. The CTX-M-15 was the most prevalent ESBL and identified among 167 isolates; with co-resistance to CEF, LEV and TMP-SMX noted in 100%, 82.6% and 70.7%, respectively. All CTX-M-15 isolates were susceptible to MER. Conclusion Oral agents such as CEF, LEV, and TMP-SMX exhibit R rates ≥17.9%. Co-resistance to CEF, LEV, and TMP-SMX were considerably higher among ESBL phenotypes (>61.1%) and confirmed blaCTX-M-15 genotypes (70.7%). In contrast, the carbapenems remained active against ESBL phenotypes and genotypes, such as blaCTX-M-15. New oral agents with the spectrum and potency of the carbapenems would address an unmet need for new options to treat multi-drug-resistant EC UTIs. Disclosures All authors: No reported disclosures.

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