Risk Factor Analysis for Extended-Spectrum Beta-Lactamase Producing Enterobacterales Colonization or Infection: Evaluation of a Novel Approach to Assess Local Prevalence as a Risk Factor

Objective To explore an approach to identify the risk of local prevalence of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) on ESBL-E colonization or infection, and reassess known risk factors. Design Case-control study. Setting Johns Hopkins Health System emergency departments (EDs) in the Baltimore-Washington, D.C. region. Patients Patients aged ≥18 years with a culture growing Enterobacterales between 4/2019-12/2021. Cases had a culture growing an ESBL-E. Methods Addresses were linked to Census Block Groups and placed into communities using a clustering algorithm. Prevalence in each community was estimated by the proportion of ESBL-E among Enterobacterales isolates. Logistic regression was used to determine risk factors for ESBL-E colonization or infection. Results ESBL-E were detected in 1167 of 11,229 patients (10.4%). Risk factors included a history of ESBL-E in the prior year (OR, 15.62; 95% CI, 11.25-21.68), and exposure to a skilled nursing or long term care facility (OR, 1.66; 95% CI, 1.39-1.99), 3rd generation cephalosporin (OR, 1.83; 95% CI, 1.50-2.23), carbapenem (OR, 2.01; 95% CI, 1.46-2.78) or trimethoprim-sulfamethoxazole (OR, 1.53; 95% CI, 1.05-2.22) within the prior 6 months. Patients were at lower risk if their community had a prevalence <25th percentile in the prior 3 months (OR, 0.84; 95% CI, 0.71-0.98), 6 months (OR, 0.84; 95% CI, 0.71-0.99) or 12 months (OR, 0.81; 95% CI, 0.69-0.96). There was no association between being in a community >75th percentile and the outcome. Conclusions This method of defining the recent local prevalence of ESBL-E may partially capture differences in the likelihood of a patient having an ESBL-E. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by the Modeling Infectious Diseases in Healthcare Network (awards U01CK000589) and by the Centers for Disease Control and Preventions Prevention Epicenters Program (grant number U54CK000617-01-00). This work was also supported by the National Institute of Health T32 AI007291 to J.C. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of Johns Hopkins University School of Medicine gave ethical approval for this work with a waiver of informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Mobile phone mobility data from SafeGraph is freely available for research purposes through the SafeGraph COVID-19 Data Consortium. The other data are not publicly available given they are HIPPA protected and were approved for limited use by the Johns Hopkins University School of Medicine Institutional Review Board.