P-1466. Prevalence of Antimicrobial Resistance among Invasive Escherichia coli Disease Patients in the United States
Authors: Basu Sanjukta , Wei Ziyan (Jenny) , Laor Atara , Bennetts Liga , El Khoury Antoine , Ahmad Nina , Geurtsen Jeroen , Neary Maureen P 
Published: January 2025

Abstract

Background
Invasive E. coli disease (IED) poses a substantial public health concern globally. Anti-microbial resistance (AMR) displayed by some E. coli strains further limits the treatment options. We sought to identify and synthesize evidence on prevalence of AMR among adult IED patients in the United States.
Figure 1.
PRISMA flowchart

Methods
A systematic literature review was conducted in EMBASE, MEDLINE, and MEDLINE In-Process databases to identify studies of prevalence of AMR E. coli among adult IED patients, published January. 2010–September. 2023.
Figure 2.
Antimicrobial resistance of E. coli isolates to antibiotics across patient groups

Results
Seventeen publications met eligibility criteria and were included (Fig. 1). The review reports study-specific prevalence from these included studies. Variation in AMR was observed across study designs (retrospective: 12; cross-sectional: 1; prospective: 4) with varying population characteristics, and 19-year time period (2002–2020) (Fig. 2). Four studies had high prevalence (≥50%) of ampicillin-resistant E. coli. Extended-spectrum cephalosporin resistance (ESC-R) increased over time in two studies (2003–2007: 4.1% & 2008–2013: 7.9% among veterans with bacteremia; and 2009: 5.4% & 2016: 12.9% for IED-related visits). One study reported higher prevalence of E. coli AMR among older as opposed to younger patients for ESC-R (18-49 years: 6%; &gt; 65 years: 10%) and FQ-R (18-49 years: 18%; &gt; 65 years: 31%). Similar trends were observed for E. coli multidrug resistance (≤69 years: 10% vs &gt; 69 years: 19%) in one study. FQ/ESC co-resistance increased over time, from 11% in 2013 to 14% in 2017 (p &lt; .0001). In one study, AMR rates were lower during Summer for amoxicillin/clavulanic acid (17% vs 29%; p=.02), cefazolin (6% vs 19%; p &lt; .001), trimethoprim/sulfamethoxazole (9% vs 27%; p &lt; .001) and ceftriaxone (2% vs 6%; p=.04). Prevalence of ampicillin resistance was not seasonal. Regional variation in AMR was observed, with FQ-R varying between 10.5% in Denver Health Clinic to 28.9% in Cleveland Clinic. Prevalence of FQ/ESC co-resistance varied geographically; highest prevalence ( &gt; 13%) occurred in several regions.

Conclusion
Prevalence of AMR E. coli in the US increased overall, in certain high-risk groups, over time, with also regional and seasonal variation. There is an unmet need for additional data on AMR prevalence in IED, and a critical need for preventive measures.

Disclosures
Sanjukta Basu, Ph.D, Amaris Consulting: Advisor/Consultant Ziyan (Jenny) Wei, Msc, Amaris Consulting: Advisor/Consultant Atara Laor, BSc., Amaris Consulting: Advisor/Consultant Liga Bennetts, PhD, Amaris Consulting: Advisor/Consultant Antoine El Khoury, PhD, Janssen Global Services: Advisor/Consultant|Janssen Global Services, LLC: Employee of Janssen Global Services, LLC Nina Ahmad, MD, Janssen Global Services, LLC: Employee of Janssen Global Services, LLC Jeroen Geurtsen, PhD, Janssen Vaccines & Prevention BV: Advisor/Consultant|Janssen Vaccines & Prevention BV: Employee of Janssen Vaccines & Prevention BV Maureen P. Neary, PhD, MS, Janssen Global Services, LLC: Employee of Janssen Global Services, LLC