Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

David Brett-Major

Second Committee Member

Abraham Mengist

Third Committee Member

Ishrat Kamal-Ahmed


Background: Extended spectrum beta-lactamase (ESBL)-producing Enterobacterales are considered a serious public health threat by the United States Centers for Disease Control and Prevention. However, surveillance of ESBL-producing Enterobacterales is currently limited to select states and the epidemiology of these antibiotic-resistant bacteria in Nebraska is still not well understood.

Objective: To describe the incidence of ESBL-producing Enterobacterales across local health department (LHD)-jurisdictions as well as at the state-level over time and assess population-specific factors associated with infection or colonization with these pathogens in Nebraska.

Methods: A retrospective, cross-sectional analysis of public health surveillance data reported to the Nebraska Department of Health and Human services between 1 January 2018 and 31 December 2021 was conducted. The first ESBL-producing and non-ESBL-producing Enterobacterales of each species per patient in a 30-day period were eligible as incident cases. Specimen source, LHD-jurisdiction, and demographic features such as patient race, ethnicity, sex, and age were assessed for an association with isolation of an ESBL-producing Enterobacterales via multiple logistic regression.

Results: From January 2018 to December 2021, there were a total of 87,853 incident cases and 65,314 individuals with an Enterobacterales isolate that met the inclusion criteria. The estimated annual incidence of ESBL-producing Enterobacterales per 100,000 population was 45.22 in 2018, increased to 60.04 in 2019 and decreased to 43.97 in 2021. Population-level factors significantly associated with an ESBL-producing Enterobacterales included male sex, older age, and race/ethnicity. In addition, there was a higher likelihood of isolating an ESBL-producing Enterobacterales from sterile specimen sites and among certain rural LHD jurisdictions.

Conclusion: The burden of ESBL-producing Enterobacterales remains overall low in Nebraska, but various LHD-jurisdictions have higher incidence rates. Continuing to evaluate the incidence of ESBL-producing Enterobacterales across LHDs over time will help inform these public health agencies on the degree of prioritization of surveillance and prevention activities aimed at these multidrug-resistant microorganisms.