2833. Multi-drug resistance of Escherichia coli from outpatient uncomplicated urinary tract infections in a large U.S. integrated health care organization

BACKGROUND: Urinary tract infections (UTIs) cause significant disease and economic burden. Uncomplicated UTIs (uUTIs) occur in otherwise healthy individuals without underlying structural abnormalities, with uropathogenic Escherichia coli (UPEC) accounting for 80% of cases. With recent transitions in healthcare toward virtual visits, data on multi-drug resistance (MDR) (resistant to ≥3 antibiotic classes) by care setting are needed to inform empiric treatment decision-making. METHODS: We evaluated UPEC resistance over time and by care setting (in-person vs. virtual), in adults who received outpatient care for uUTI at Kaiser Permanente Southern California between January 2016 and December 2021. RESULTS: We included 174,185 individuals who had ≥1 UPEC uUTI (233,974 isolates), who were 92% female, and 46% Hispanic with a mean age 52 years (standard deviation 20). Overall, UPEC MDR decreased during the study period (13 to 12%) (Figure 1) both in virtual and in-person settings (p-for trend < 0.001). Resistance to penicillins overall (29%), co-resistance to penicillins and trimethoprim-sulfamethoxazole (TMP-SMX) (12%), and MDR involving penicillins and TMP-SMX plus ≥1 antibiotic class were common (10%) (Figure 2). Resistance to 1, 2, 3, and 4 antibiotic classes was found in 19%, 18%, 8%, and 4% of isolates, respectively; 1% were resistant to ≥5 antibiotic classes, and 50% were resistant to none. Similar resistance patterns were observed over time, and by care setting. [Figure: see text] [Figure: see text] CONCLUSION: We observed a slight decrease in both class-specific AMR and MDR of UPEC overall, most commonly involving penicillins and TMP-SMX, and consistent over time and by care setting. Virtual healthcare may expand access to UTI care without increased risk for MDR and the need for setting-specific antibiograms. DISCLOSURES: Jennifer H. Ku, PhD MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Katia J. Bruxvoort, PhD, MPH, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Sara Y. Tartof, PhD MPH, Genentech: Grant/Research Support|GSK: Grant/Research Support|Pfizer: Grant/Research Support|SPERO: Grant/Research Support