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Background: There are numerous ways to measure social markers of health. One reliable method for predicting health outcomes is the social vulnerability index (SVI) which assesses multiple themes, including housing insecurity, socioeconomic status, and minority status. As a part of Multi-site Gram Negative Surveillance Initiative (MuGSI), surveillance of Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacterales was conducted in four Tennessee counties (Maury, Marshall, Wayne, and Lewis). This study examines the association between social vulnerability and infection rates for ESBL-producing Enterobacterales within the surveillance area. Method: ESBL incident cases reported from July 2019 to December 2023 were analyzed. Cases were defined as the first isolation of Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca resistant to at least one extended-spectrum cephalosporin (ceftazidime, cefotaxime or ceftriaxone) and non-resistant to all carbapenem antibiotics from urine or normally sterile sites in residents of the surveillance area within a 30-day period. Pearson correlation analysis was conducted to evaluate the association between SVI scores and ESBL infection rates per 1,000 residents at the census tract level, as well as the four SVI ranking variables (socioeconomic status, household characteristics, racial & ethnic minority status, and housing type & transportation). Analysis was conducted using SAS 9.4. Geospatial analysis in ArcGIS Pro v2.9.7 produced a bivariate choropleth map, illustrating the interaction between SVI and ESBL infection rates. Result: From 2019–2023, 2,166 ESBL cases were reported. Cases were 21% male and 79% female, with mean age of 66 years. Incidence rates ranged from 0.19 to 19.5 per 1,000 population. The analysis revealed a significant positive relationship between SVI and tract-level ESBL infection rates. Higher vulnerability scores are associated with higher infection rates, as evidenced by the positive correlation coefficient (ℝ? = 0.38427, ℝ? = 0.0272). Pearson correlation analysis revealed that household type and transportation demonstrated statistically significant positive correlation with ESBL infection rates (ℝ? = 0.431, ℝ? = 0.0121). Conclusion: Information from geocoding surveillance data can be used to identify social groups at increased risk of infections with drug resistant pathogens. In this study, ESBL infection rate is significantly associated with SVI. Among the four themes, only household type & transportation status is found to be significantly associated with ESBL infection rates. Further research is needed to understand the role housing plays in the spread of ESBL infection, especially looking at both urban and rural populations. Using SVI scores as a risk assessment tool, infection preventionists and antibiotic stewards can prioritize high risk areas for intervention.

Background: Group B Streptococcus (GBS) is one of the most common causes of bacterial sepsis in newborns. In 2002, the Center for Disease Control and Prevention (CDC) recommended universal screening of all pregnant women for GBS colonization and administering intrapartum prophylaxis to colonized pregnant women to prevent GBS infection in newborns. To identify racial disparities in GBS infections in Tennessee, we compared the incidence of early-onset GBS infection among Black and White infants from 2005-2021. Methods: GBS infections identified from normally sterile sites are reportable in Tennessee. We analyzed GBS data reported to surveillance systems from 2005 to 2021. We linked the surveillance data with the population data to calculate incidence rates. We excluded cases with unknown race status (9%) and other races (0.2%) as we do not have denominator data to calculate the incidence rate. Database linkage and data analyses were performed in SAS V.9.4. Results: A total of 399 early-onset GBS cases were reported from 2005–2021; 150 (37.59%) were Black, 212 (53.13%) were White, and 36 (9.02%) were of unknown race, and one (0.20%) reported as Other for race. While the incidence rates of early-onset GBS for all races declined from 0.23 per 1000 live births in 2005 to 0.18 per 1000 live births in 2021, Blacks experienced the largest decline in incidence from 0.6 per 1000 live births in 2005 to 0.37 in 2021. Among Whites, there was a slight decline in 2021 (0.13/1000 live births) compared to the rate in 2005 (0.21/1000 live births). The mean incidence rate of early onset GBS among Blacks (0.52 per 1000 live births) is significantly higher than the mean rates among Whites (0.20 per 1000 live births) (p value < 0 .001) from 2005 to 2021. Shelby County, one of the 95 counties in Tennessee, is predominantly Black (54.6%) and reported 27.8% of all early-onset GBS. Conclusion: There was a significant decline in early-onset GBS infections among Blacks and some reductions among Whites, indicating the effectiveness of the prevention strategies. However, Blacks have significantly higher rates than their White counterparts. In addition, 27.8% of the cases are reported from one county, signaling geographic disparities as well. Further investigation is warranted to identify risk factors and causes of observed racial and geographic disparities to help reduce the infection rate among vulnerable populations and high-risk geographic areas.

Background: Clinical antibiotic susceptibility testing (AST) interpretations based on minimum inhibitory concentrations (MIC) breakpoints are important for both clinical decision making and some reportable condition criteria. Standardization of MIC breakpoints across clinical laboratories is lacking; AST instruments are often validated for outdated Clinical and Laboratory Standards Institute (CLSI) MIC breakpoint guidelines. In this study, we analyzed the agreement between the reported clinical laboratory AST interpretations and the guideline CLSI interpretation. Methods: Clinical laboratory AST data collected from the Multisite Gram-Negative Surveillance Initiative (MuGSI) carbapenem-resistant Enterobacterales (CRE) surveillance program in Tennessee between 2019 and 2021 were utilized. MIC values from the clinical instrument were used to calculate CLSI standard interpretations following the 2019–2021 CLSI M100 guidelines. Agreement between the clinical laboratory and CLSI interpretations of the reported MIC values were measured using a weighted Cohen κ calculated in SAS version 9.4 software. Total matches were isolates with identical CLSI and clinical laboratory interpretations. Results: In total, 14 antibiotics were assessed. Of those, 9 antibiotics had at least moderate agreement (κ > 0.41) between interpretations. Agreement between the clinical laboratory and the CLSI interpretations were near perfect (κ > 0.81) for 3 antibiotics. Agreement between the clinical laboratory and the CLSI interpretations were poor for cefazolin (0.06) and ertapenem (0.14). Cefotaxime (−0.07) was the only antibiotic that suggested no agreement. Conclusions: Of the antibiotics included in the analysis, 36% had less than moderate agreement between clinical laboratory and CLSI AST interpretations. Given the increases in antimicrobial resistance globally and the emphasis placed on antibiotic stewardship, standardization across clinical AST panels should be prioritized. Inconsistencies have the potential to contribute to inappropriate antibiotic use in addition to under- or overidentification of reportable conditions, including CRE. Disclosures: None

Background: On March 5, 2020, the Tennessee Department of Health (TDH) announced the first case of COVID-19 in the state. Since then, hospitals have been overwhelmed by the spike in respiratory infections. Several studies have attempted to describe the impact of the pandemic on antibiotic prescriptions. The NHSN Antimicrobial Use Option offers a platform for hospitals to report their antibiotic usage. The TDH has established access to hospital antibiotic usage data statewide through an existing NHSN user group. We compared the change in the volume of inpatient antibiotic prescriptions before and during the pandemic. Methods: An ecological study was conducted from January 2019 to December 2021. Aggregated facility-level data from the NHSN Antimicrobial Use Option were used to describe antibacterial use among Tennessee hospitals. Data from facilities that had reported at least 1 month of data during the study period were included in this study. The antimicrobial use rate was calculated by dividing the antimicrobial days of therapy (DOT) by the number of 1,000 days present. Overall antimicrobial use rates as well as specific antimicrobial use rates for azithromycin, ceftriaxone, and piperacillin–tazobactam were compared across years. Results: In total, 55 hospitals reported at least 1 month of data into the NHSN Antimicrobial Use Option during the study period. These hospitals had a median bed size of 140 (range, 12–689). Conclusions: We observed a modest increase in overall antibiotic use during the COVID-19 pandemic in Tennessee facilities. This trend appeared to be primarily attributed to agents used for community-acquired respiratory infections, such as azithromycin and ceftriaxone, earlier in the pandemic. However, both of these agents have fallen to prepandemic use levels during 2021. The fact that overall use increased in 2021 suggests that other agents not analyzed may have contributed to this effect. Further analysis may help determine which agents are responsible for this increase in 2021. Funding: None Disclosures: None

Background: The NHSN Antibiotic Resistance (AR) Option can serve as a useful tool for tracking antibiotic-resistant infections and can aid in the development of inpatient antibiograms. We recently described the frequency of antibiotic suppression in NHSN AR Option data. In this analysis, we describe the effects of suppression on practical uses of the NHSN AR Option, specifically selected agent antibiogram development, and detection of reportable conditions. Methods: Antibiotic susceptibility data were collected from the NHSN AR Option and commercial automated antimicrobial susceptibility testing instruments (cASTI) from 3 hospital networks. Data were obtained from January 1, 2017, to December 31, 2018. The clinical susceptibility data for third-generation cephalosporins and carbapenems against carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa , and Acinetobacter baumannii were included. Susceptibility results were defined as suppressed when susceptibility results were observed from the laboratory instrument but not from NHSN data. For the overall percentage susceptibility estimation, isolates with <30 susceptibility results were excluded. Percentage susceptibility of NHSN results were compared to their counterparts from cASTI. Results: Of the 852 matched isolates in the primary analysis, 804 had at least 1 suppressed result. Of the 804 isolates, 16.9% were P. aeruginosa , 67.3% by E. coli , and 11.1% by Klebsiella spp. The following pathogen–drug combinations had no difference observed in the percentage susceptible between the 2 systems: ceftazidime tested against P. aeruginosa , ceftriaxone tested against Klebsiella spp, ertapenem tested against Klebsiella spp, imipenem tested against E. coli and P. aeruginosa , and meropenem tested against P. aeruginosa . Significant differences were observed for the following drugs tested against E. coli : ceftazidime (11.1%), cefotaxime (8.6%), and ceftriaxone (8.3%). In the NHSN AR Option, the following isolates showed suppressed results related to their phenotypic case definition: 17 (3%) CRE isolates, 7 (28%) carbapenem-resistant Acinetobacter baumannii (CRAB) isolates, 511 (93.2%) extended spectrum β-lactamase (ESBL) isolates, and 94 (66.7%) carbapenem-resistant Pseudomonas aeruginosa (CRPA) isolates. Conclusions: For select isolates, notably E. coli , we observed a large difference in the percentage of susceptible isolates reported into the NHSN AR Option compared to the cASTI data. This difference significantly limits the ability of the AR Option to create valid antibiograms for select pathogen–drug combinations. Moreover, significant numbers of CRAB, ESBL, and CRPA isolates would not be identified from NHSN AR Option because of suppression. This finding warrants the need for antimicrobial stewardship teams to regularly assess the impact of selective reporting in identifying pathogens of public health importance. Funding: None Disclosures: None

Background: Carbapenem-resistant Enterobacterales (CRE) have become an increasing public health challenge in the United States over the past two decades. Carbapenemase-producing CREs (CP-CREs) significantly contribute to the spread of antimicrobial-resistant pathogens in healthcare settings. Tennessee has been conducting surveillance of CRE since 2011. As part of the Emerging Infections Program (EIP), the state has participated in population-based surveillance in Davidson and seven surrounding counties, collaborating with the Centers for Disease Control and Prevention (CDC) since 2014. Methods: The data collected through the Muti-site Gram-negative Surveillance Initiative (MuGSI) project, a collaboration between Tennessee and CDC as part of EIP, was used for this study. The analysis was performed on a subset of CRE isolates tested for carbapenemase production (CP) among all incident CRE cases collected from 2016 to 2022. Incident CRE cases are defined as the identification of carbapenem-resistant E. coli, Enterobacter cloacae complex, and Klebsiella species (K. aerogenes, K. oxytoca, K. pneumoniae, and K. variicola) from urine or normally sterile specimens (e.g., blood) from the residents of the surveillance area in a 30-day period. The mortality data was obtained from the Tennessee Vital Registry and merged with the surveillance data. Cox regression analysis was performed to evaluate if there is a difference in the 90-day survival rate based on the CP status of the pathogen, gender, age group, and the Charlson comorbidity index (CCI) score. Data analysis was done using SAS version 9.4. Results: There were 570 CRE cases reported during the study period (2016-2022). Of these, 406 were tested for carbapenemase production and 87 (21.4%) were positive for CP. There were 269 (66.3%) females and 137 (33.7%) males. Patients with higher Charlson comorbidity index score (> = 5) have significantly higher hazard ratios compared to those with low scores (HR 4.17; p-value) Conclusion: This study indicates that patients infected with CP-CRE, females, and those with high Charlson comorbidity index score have a significantly higher probability of dying within 90 days. These factors are worth considering when conducting a risk assessment of patients infected with drug-resistant gram-negative bacilli. The significantly increased risk of death among patients infected with CP-CRE highlights the need for timely carbapenemase testing and use of the test result for appropriate antimicrobial therapy and infection prevention.

Nitrogen is the major plant nutrient that limits common bean production throughout sub-Saharan Africa. Four experimental trials were conducted at four areas namely Babillae, Fedis, Haramaya, and Hirna experimental sites to determine if various inherent soil fertility status and soil total N might affect the N use efficiency of common bean var. Dursitu. Six levels of N application and two inoculation treatments were factorially combined and laid out in randomized complete block design with three replications. The agronomic efficiency of N (AE-N) by common bean obtained from different locations displayed significant difference at p ≤ 0.05. The highest AE-N was obtained from Babillae site, while the lowest from Hirna site. In general, overall AE-N declined with increase in rates of N application. Slight increase of AE-N was observed in Babillae and Hirna sites when 20 kg N ha −1 was applied. Haramaya and Hirna sites had the highest of all investigated growth parameters, except 100 seeds weight and harvest index. The regression analysis indicated strong and negative association (R 2  = 0.498 and R 2  = 0.390 at p ≤ 0.05) between AE-N and N rates of application in Babillae site followed by Fedis site, respectively. A stronger and significant association (R 2  = 0.276, p ≤ 0.05) of AE-N and grain yield was observed only in Hirna site. In general, this study indicated the remarkable effect of soil inherent fertility and soil total N content on N use efficiency of common bean in the study sites.

Background: Infections lead to high mortality among patients on chronic dialysis; knowledge of multi-drug resistant infections is limited. The Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) conducts laboratory- and population-based surveillance for carbapenem-resistant Enterobacterales (CRE) in 10 U.S. sites and carbapenem-resistant Acinetobacter baumannii (CRAB) in 9 U.S. sites. We investigated clinical characteristics, healthcare exposures, and outcomes of CRE and CRAB cases in persons on chronic dialysis from 2016-2021. Methods: Among EIP catchment-area residents on chronic dialysis, we defined a CRE case as the first isolation of Escherichia coli, Enterobacter cloacae complex, Klebsiella aerogenes (formerly Enterobacter aerogenes), Klebsiella oxytoca, Klebsiella pneumoniae, or Klebsiella variicola resistant to any carbapenem, from a normally sterile site or urine in a 30-day period. A CRAB case was defined as the first isolation of Acinetobacter baumannii complex resistant to any carbapenem (excluding ertapenem), from a normally sterile site or urine (or lower respiratory tract or wound since 2021) in a 30-day period. Medical records were reviewed. A case was considered colonized if the case culture had no associated infection type or colonization was documented in the medical record. Descriptive analyses, including analyses stratified by pathogen, were conducted. Results: Among 426 cases, 314 were CRE, and 112 were CRAB; most cases were male (235, 55.2%), Black (229, 53.8%), and 51-80 years old (320, 75.1%) (Table). An infection was associated with 363 (85.2%) case cultures; bloodstream infections (148; 40.8%), urinary tract infections (134; 36.9%), and pneumonia (17; 4.7%) were the most frequent. Overall, most cases had documented healthcare exposures (excluding outpatient dialysis) in the year before incident specimen collection, including: 366 (85.9%) hospitalizations, 235 (55.2%) surgeries, 209 (49.1%) long-term care facility stays, 54 (12.7%) long-term acute care facility stays. Additionally, 125 (29.3%) had an intensive care unit admission within the 7 days before incident specimen collection. Compared to CRE cases, a higher proportion of CRAB cases (a) had a long-term care facility stay (82/112 [73.2%] versus 127/314 [40.5%], P<.0001) or hospitalization (103/112 [92%] versus 263/314 [83.8%], P = .03) within the preceding year and (b) died within 30 days of incident specimen collection (40/112 [35.7%] versus 64/314 [20.4%], P = .001). Discussion: Among CRE and CRAB cases in persons on chronic dialysis, healthcare exposures were common, and mortality was high. Additional efforts to better describe the burden of these organisms and associated risk factors in the dialysis population are needed for tailoring infection prevention strategies to this vulnerable.

Background Effectiveness of Rhizobium inoculation is determined by common bean genotypes. Environmental factors also affect common bean genotypes- Rhizobium -symbiosis. The effect of common bean genotypes- Rhizobium strains-environment interaction on nodulation and common bean production is not well studied. Three genotypes (Dursitu, Gofta, and Kufanzik) and eight selected isolates of common bean nodulating-rhizobia with N-fertilized and control check were used for field experiments at four locations (Babile, Fedis, Haramaya, and Hirna) to evaluate the effect of genotypes- Rhizobium strains-environment interaction on the nodulation, yield and yield traits of common bean. The treatments were laid out in a randomized complete block design with three replications. Results This study revealed that Rhizobium inoculation, the genotypes, environment and their interaction significantly (P ≤ 0.05) affected all investigated traits of common bean. Common bean genotypes Rhizobium inoculation and experimental locations significantly affected nodule number (NN) and nodule dry weight (NDW). The highest NN and NDW as compared to the uninoculated control across locations were recorded with the genotype Dursitu in all inoculation treatments. However, the result revealed the lowest mean total biomass (TBY) and grain yield (GY) over locations with the same genotype Dursitu. The highest mean grain yields of 3358.89, 3257.82, 1499.25 and 2204.82 kg ha −1 across the treatments were recorded at Haramaya, Hirna, Babile and Fedis sites, respectively, with the genotype Gofta, thereby implying that there was none specificity between common bean genotypes × locations in the study locations of eastern Ethiopia with tested common bean genotypes. None of the tested isolates produced statistically better NN, NDW, TBY, GY and total plant N accumulation consistently in all locations with all tested common bean genotypes, indicating the presence of Rhizobium strains × location specificity. Conclusion Therefore, the result showed the need for a specific strain of Rhizobium development for common bean production in different locations.

Objective:The National Healthcare Safety Network (NHSN) Antibiotic Resistance (AR) Option is a valuable tool that can be used by acute-care hospitals to track and report antibiotic resistance rate data. Selective and cascading reporting results in suppressed antibiotic susceptibility results and has the potential to adversely affect what data are submitted into the NHSN AR Option. We describe the effects of antibiotic suppression on NHSN AR Option data.Methods:NHSN AR Option data were collected from 14 hospitals reporting into an existing NHSN user group from January 1, 2017, to December 31, 2018, and linked to commercial automated antimicrobial susceptibility testing instruments (cASTI) that were submitted as part of unrelated Tennessee Emerging Infections Program surveillance projects. A susceptibility result was defined as suppressed if the result was not found in the NHSN AR Option data but was reported in the cASTI data. Susceptibility results found in both data sets were described as released. Proportions of suppressed and released results were compared using the Pearson χ2 and Fisher exact tests.Results:In total, 852 matched isolates with 3,859 unique susceptibilities were available for analysis. At least 1 suppressed antibiotic susceptibility result was available for 726 (85.2%) of the isolates. Of the 3,859 susceptibility results, 1,936 (50.2%) suppressed antibiotic susceptibility results were not reported into the NHSN AR option when compared to the cASTI data.Conclusion:The effect of antibiotic suppression described in this article has significant implications for the ability of the NHSN AR Option to accurately reflect antibiotic resistance rates.