P-292. Epidemiology of <i>Escherichia coli</i> from Urine Sources at Three U.S. Sites, August 2023

Abstract Background Escherichia coli is the most frequent cause of urinary tract infections (UTIs) in the US, but surveillance for urinary E. coli (uEC) is often limited to multidrug-resistant strains. The CDC’s Emerging Infections Program piloted one month of active population- and laboratory-based surveillance for uEC of any phenotype in 3 U.S. sites (representing &amp;gt;3.4 million people) to better characterize its epidemiology and burden. Methods We defined an incident uEC case as the first E. coli isolated from urine in a resident of the surveillance area during August 2023. Demographic data were obtained for all incident cases. Approximately 400 cases per site were randomly selected for chart review. One-month incidence rates were generated using 2022 US census data for participating surveillance areas. Cases were classified as community-associated (CA; no healthcare risk factors); hospital-onset (HO; urine obtained ≥ 3 days after hospital admission), or healthcare-associated, community onset (HACO; urine obtained in a non-hospital setting or &amp;lt; 3 days after hospital admission with healthcare exposures in the prior year). Results Of 5241 uEC patients, 86.1% were female; median age was 60 years (IQR 37–76). The 1-month incidence rate was 151.7 per 100,000 population and greater among those aged ≥ 60 vs &amp;lt; 60 years (362.7 vs 94.0). Of 1197 patients with data from chart review, 1104 (92.2%) had cultures collected as an outpatient; 732 (61.2%) had an underlying comorbidity reported; 1113 (93.0%) had a documented UTI diagnosis; 269 (22.5%) reported recurrent UTI; and 43 (3.6%) developed E. coli bacteremia. No signs or symptoms associated with uEC were reported for 372 (31.1%) patients. In total, 287 (24%) were hospitalized within 30 days after urine culture collection; 51/287 (17.8%) had a urinary catheter in place 2 days before culture collection. Most uEC were CA (867; 72.4%), followed by HACO (325; 27.2%) and HO (3; 0.3%). Of 3289 uEC isolates with local testing results, 255 (7.8%) were extended-spectrum β-lactamase producing and 5 (&amp;lt; 1%) were carbapenem-resistant. Conclusion These findings emphasize the high burden of uEC in these communities, notably among older adults and females. Effective prevention strategies are needed to decrease uEC-associated morbidity. Disclosures All Authors: No reported disclosures