2848. Spatial Distribution of Community-Acquired Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Infections and its Association with Sewer Overflows in Middle Georgia

BACKGROUND: Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) were described first in relation to hospital-acquired infections. However, infections by these organisms acquired in the community have become a public health problem. There are no well-known risk factors for acquisition of these bacteria in the community. Surface waters and sanitation conditions may serve as reservoir and transmission. METHODS: We conducted a retrospective study over 12 months of patients who had positive cultures with ESBL-PE in our laboratory. We excluded patients with hospitalization in the previous 3 months, those in skilled nursing facilities, and those whose culture was taken 3 or more days after hospitalization. Geographic Information System analysis was performed based on patient’s residence, population, and sewer overflow public data. RESULTS: Among 485 patients with cultures positive for ESBL-PE in 2018, 64 were included in the study. Mean age was 54, and 68.7% were females. Organisms isolated were E. coli (78.2%) and K. pneumoniae ESBL (21.8%). These were isolated from urine 47 (73.4%), blood 5 (7.8%), abscess 6 (9.3%), ulcers 5 (7.8%), and sputum 1 (1.5%). Antibiotic exposure in the preceding 3 months was noted in 12 patients (18.7%). Spatial distribution of patients in the community was not random based on nearest neighbor analysis (Z score = −2.6). Kernel density estimation showed clustering of cases. Infection rates were calculated per census tracts. There was poor correlation between infection rate and mean family income (R2 = 0.18, P = 0.017). Analysis of Kernel density estimations showed that sewer overflow distribution explained over 50% of the variance of distribution of cases with ESBL-PE (R2 = 0.51, P < 0.001). CONCLUSION: Patients presenting with infections due to ESBL-PE acquired in the community did not have a random spatial distribution. Other factors besides prior antibiotic use and financial status should be investigated. Proximity to sanitary sewer overflows may be a contributing factor. Location of residence within a community may aid in identifying patients at risk for acquisition of ESBL-PE. [Image: see text] [Image: see text] DISCLOSURES: All Authors: No reported Disclosures.