bluuebunny/crossref_metadata_2025 huggingface dataset:
1399. A Prospective Cohort Study Regarding the Impact of Biofire® FilmArray® Meningitis/Encephalitis (FA) Panel in Children with Suspected Central Nervous System Infection
Authors: Posnakoglou Lamprini , Syriopoulou Vasiliki , Siahanidou Tania , Atmatzidou Eleni , Syriopoulos Triantafyllos , Michos Athanasios
Published: October 2019

Background

Rapid detection of pathogens involved in central nervous system (CNS) infections could be important for the optimal patient management and overall hospitalization cost. The aim of the study was to evaluate the possible benefits with the use of BioFire® FilmArray® meningitis/encephalitis (FA) panel in children with suspected CNS infection.

Methods

A prospective cohort study, was performed on children admitted to a tertiary pediatric hospital, over a period of 1 year (April 2018–April 2019), with possible CNS infection and cerebrospinal fluid (CSF) pleocytosis (>15 cells/mm3). For each child that FA was used for the diagnosis, an age-matched control was selected, and separate molecular CSF microbiological tests were sent according to pediatrician’s discretion. Conventional microbiological procedures were performed in all children. Length of hospital stay, duration of antimicrobials, and total cost of hospitalization were compared between groups. FA enables rapid automated cerebrospinal fluid testing for 14 common viral, bacterial and yeast pathogens that cause CNS infections. The cost was estimated according to ICD-10 diagnosis standard cost, adding additional daily hospitalization cost, FA or other molecular microbiological tests costs.

Results

A total of 142 children were included in the study (71 cases). The median age of cases and controls was 2.5 months (IQR: 1–72) and 2 months (IQR: 0.7–36) respectively (P = 0.157). A pathogen was detected in 38/71 (53.5%) children with the use of FA and in 16/71 (22.5%) in the control group (P < 0.001). In aseptic meningitis cases a virus was detected in 27/60 (45%) and in 11/64 (16.4%) controls (P < 0.001). Length of stay in cases and controls with aseptic meningitis was 5 days (IQR: 4–8) and 8 (IQR: 6–10) respectively (P < 0.001). The median duration of antimicrobials in cases was 4 days (IQR: 2–5.7) and 7 (IQR: 5–10) respectively (P < 0.001). The hospitalization cost was calculated in cases and controls 1,042 (IQR: 932–1372€) and 1,522 (IQR: 1,302–1,742€) respectively (P < 0.001).

Conclusion

The use of FA was able to reduce significantly the hospitalization days and the total cost comparing to the control group in children with suspected CNS infection.

Disclosures

All authors: No reported disclosures.
1400. Impact of a Multiplex Polymerase Chain Reaction Meningitis/Encephalitis Panel and Antimicrobial Stewardship Bundle on Antimicrobial Use in Patients with Suspected Meningitis or Encephalitis
Authors: Woodbury Katelyn , Seddon Megan , McMahon Andre , Kisgen Jamie
Published: October 2019

Background

Optimal treatment of meningitis relies on prompt diagnostic evaluation and initiation of appropriate antimicrobials. The meningitis/encephalitis panel (MEP) is a multiplex rapid polymerase chain reaction, with the ability to detect 14 community-acquired pathogens in 1 hour. The purpose of this study was to evaluate impact of the MEP on de-escalation of antimicrobials in adult inpatients with suspected meningitis at a large community teaching hospital.

Methods

This single-center retrospective quasi-experimental pre/post study included adults admitted for ≥48 hours and initiated on antimicrobial therapy for suspected meningitis. Those with healthcare-associated meningitis, immunosuppression, initiation of antimicrobials >8 hours prior to lumbar puncture (LP), and use of antimicrobials for another indication were excluded. The pre-group included patients admitted prior to MEP introduction. The post-group included patients with the MEP performed. An antimicrobial stewardship bundle consisting of a meningitis order set, provider education, and use of a real-time meningitis alert in clinical decision support software was also implemented in the post-group. The primary outcome was percentage of patients experiencing antimicrobial de-escalation ≤48 hours after LP. Secondary outcomes included time to de-escalation, total duration of antimicrobial therapy (DOT), and hospital length of stay (LOS).

Results

A total of 45 patients were included in the study (23 pre-group and 22 post-group). Baseline characteristics were similar between groups. The percentage of patients experiencing de-escalation of antimicrobials ≤ 48 hours after LP increased by 44% in the post-group (82% vs. 38%, P = 0.005). The overall median time to de-escalation of antimicrobials decreased by 35 hours [11.1 (IQR 5.6, 17.6) vs. 46.1 (IQR 18.4, 66.5); P = 0.002] and the median time to de-escalation after LP decreased by 38 hours [13.6 (IQR 8.3, 20.3) vs. 51.6 (IQR 44.2, 69.8); P < 0.001]. No statistically significant difference in hospital LOS or total DOT was seen.

Conclusion

Implementation of the MEP and antimicrobial stewardship bundle increased the percentage of patients de-escalated in 48 hours and decreased the time to de-escalation. However, this did not impact the total DOT or hospital LOS.

Disclosures

All authors: No reported disclosures.
1406. Steroid-Sparing Agents to Control Inflammation in Complicated Neurocysticercosis: Three Cases
Authors: Anand Pria , Mukerji Shibani , Gunaratne Shauna , Thon Jesse , Cho Tracey , Venna Nagagopal
Published: October 2019

Background

Clinical manifestations of neurocysticercosis (NCC) are primarily due to the inflammatory response against degenerating cysts of the Taenia solium tapeworm. Inflammation can occur when cysts lose their ability to evade the host immune response during their natural life cycle or result from antihelminthic therapy. A subset can develop chronic perilesional edema requiring immunosuppressive therapy. Although guidelines recommend methotrexate (MTX) as an alternative to long-term steroids, limited information is available regarding when to start a steroid-sparing agent (SSA) and alternative SSAs in case of MTX failure or intolerance.

Methods

Retrospective chart review.

Results

Three patients with complicated NCC followed at a single tertiary care center are described in this study: Patient 1 with subarachnoid NCC (age 64, female), patient 2 with subarachnoid and intraventricular NCC (age 48, male) and patient 3 with parenchymal NCC (age 43, male). Patients 1–3 were followed clinically and radiographically for 8, 1.5 and 3 years, respectively. Patient 1 was treated with antihelminthic therapy and steroids for 24 months. She was transitioned to MTX for 1 month, but developed ulcerative stomatitis, leukopenia and transaminitis. She completed a treatment course of steroids, complicated by osteoporosis. Patient 2 was treated with 12 months of antihelminthic therapy and steroids with resolution of a previously positive cysticercal antigen in spinal fluid. Imaging revealed persistent inflammation in spite of adequate antihelminthic therapy. He was started on MTX and has remained on this medication for 5 months. Patient 3 was treated with two courses of antihelminthic therapy. He developed perilesional edema despite treatment with steroids and MTX uptitrated to 20 mg weekly. Adalimumab was added to his regimen and he had a rapid radiographic resolution of edema and clinical improvement in seizures. His seizures returned during an interruption in his adalimumab treatment and again resolved with re-initiation of this medication.

Conclusion

SSAs are beneficial in the long-term treatment of patients with subarachnoid NCC or chronic perilesional edema. The formulation of guidelines that include multiple options for SSAs will be essential in guiding management of complicated NCC.

Disclosures

All authors: No reported disclosures.
1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial
Authors: Larsen Travis M , Campen Natalie , Larsen Robert
Published: October 2019

Background

The therapeutic challenges of neurosyphilis are rooted in its diagnosis and management, with potential for complications arising from asymptomatic, unrecognized, or under-treated disease. Currently, the non-treponemal VDRL testing of cerebrospinal fluid (CSF) samples is used to predict those with CNS invasion by T. pallidum. However, more extensive evaluation of those at any stage of infection demonstrates both that the incidence of CNS invasion is much greater than predicted, and there exists a large proportion of false positives from VDRL testing alone.

Methods

Subjects with suspected neurosyphilis were recruited from the infectious disease clinic after referral to LAC+USC Hospital. Informed consent was obtained and subjects underwent clinical examination, including a standardized neurological and neurocognitive evaluation and CSF sampling. A CSF-specific VDRL, FTAabs, and a T. pallidum particle agglutination index were calculated:

A TPPA Index >2.0 was defined as positive and definitive evidence of neurosyphilis

Results

40 subjects were recruited, 8 were HIV-negative and 32 HIV positive, of which, 1 declined to continue after CSF sampling (Table 1). Employing the CSF TPPA index, 7/31 HIV positive (22.6%) and 1/8 HIV-negative individuals (12.5%) had neurosyphilis (Table 2). Discordant results with the CSF VDRL were common; 4/31 subjects (12.9%) with a positive CSF VDRL had a TPPA Index < 2.0 (0.227, 0.227, 0.315, and 0.400) and 4/31 subjects (12.9%) with a negative CSF VDRL had a positive TPPA index (2.234, 3.333, 3.797, and 4.548, Table 3). Neurocognitive and neurologic abnormalities were commonly encountered in this population both with and without documented neurosyphilis.

Conclusion

Our investigations demonstrate the value of CSF sampling in persons with any stage of syphilis and establish the utility of T. pallidum-specific antibody testing to greatly facilitate clinical decision-making. The diagnostic tools to evaluate the T. pallidum-specific immunological response of the CNS to syphilis are currently widely available, inexpensive, but woefully underutilized

Disclosures

All authors: No reported disclosures.
1416. Nocardia beijingensis: A Rare and Unusual Cause of Intracranial Abscess
Authors: Chauhan Lakshpaul , Vassa Nirali , Henderson Elizabeth , Mubarik Ateeq , Siddiq Danish , Eddib Abdulmagid
Published: October 2019

Background

Nocardia species are thin, aerobic, filamentous, gram-positive bacilli that are ubiquitous in soil worldwide. Nocardia infections are divided into three main categories: pulmonary nocardiosis, disseminated nocardiosis, and cutaneous nocardiosis.

Methods

We present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB).

Results

A 60-year-old Caucasian lady from Florida with type 2 diabetes mellitus, hypertension, hyperlipidemia, presented to the emergency room with complaints of altered mentation. Per husband, she was having episodes of emesis and diarrhea 3 days prior to admission that resolved however, her mentation significantly deteriorated to where she was unable to perform simple chores around the house. Pertinently she had resection of lung mass 2 months prior to admission which found to be benign. Vital sign at admission was stable and on examination, the patient was alert and oriented, however, lethargic appearing. Neurological examination was pertinent for expressive aphasia; however, cranial nerves II-XII were grossly intact. The patient was also found to have a 3 cm by 4 cm, tender, cystic lesion on the left-sided occipital scalp. The remainder of the physical examination was unremarkable. Admission laboratories were remarkable for leukocytosis and hyperglycemia. MRI of the brain was completed that showed multiple areas of vasogenic edema and multiple nodules with the largest being 1.8 cm suggestive of abscesses. She was started empirically on vancomycin, ceftriaxone, metronidazole, and ampicillin. Cerebral spinal fluid showed neutrophilic pleocytosis, low glucose, and high protein. Initial cultures including CSF were negative. Left-sided occipital scalp lesion was excised and sent for pathology and culture. Initial cultures showed gram-positive bacilli, so antibiotics were de-escalated to sulfamethoxazole/trimethoprim and ceftriaxone. Repeat imaging showed improving abscess, and final cultures resulted in NB.

Conclusion

NB is believed to have originated in Southeast Asia. NB has been associated mainly with infections in immunocompromised. In the United States, the two only other cases of NB described in immunocompetent hosts were interestingly from Florida as well.

Disclosures

All authors: No reported disclosures.
1417. Detection of Human Herpesviruses DNA in Cerebrospinal Fluids of Patients Suspected with Central Nervous System Infection
Authors: Higashimoto Yuki , Ishimaru Soichiro , Miura Hiroki , Kozawa Kei , Ihira Masaru , Kawamura Yoshiki , Yoshikawa Tetushi
Published: October 2019

Background

Of the nine human herpesviruses (HHVs), most viruses have neurovirulence. Clinical manifestations of central nervous system (CNS) complications caused by some of the HHVs are well examined in children and immunocompromised adults; however, information of EBV and β-herpesviruses in an immunocompetent adult is limited.

Methods

Between April 2013 and March 2018, 322 patients (median age; 51.6 years old, male/female; 196/126) suspected to CNS infection were enrolled in this study. Patients with unconsciousness or characteristic change lasting more than 24 hours and abnormal brain MRI or EEG were defined as encephalitis. Real-time PCRs for detection of the 7 HHVs DNA including HSV-1, HSV-2, VZV, CMV, EBV, HHV-6, and HHV-7 were carried out in DNA extracted from 200 μL CSF. HHV-6 was discriminated between HHV-6A and HHV-6B using RFLP analysis.

Results

Herpesviruses DNA was detected in 33 (10.2%) of the 322 patients. The most frequently detected HHVs was VZV (19 cases) and followed by HHV-6B (4 cases), HSV-1 (3 cases), HSV-2 (3 cases), and EBV (2 cases). Multiple HHVs DNAs were detected from the 2 patients (case A; HSV-2, HHV-6, and EBV, case B; EBV and HHV-6B). No CMV and HHV-7 DNAs were detected in any of the samples. Eleven cases were assigned as encephalitis, and other 22 cases were non-encephalitis. Although all 3 patients with positive HSV-1 DNA were encephalitis, all 3 patients with positive HSV-2 DNA were meningitis. Fourteen (13 patients had zoster) of the 19 patients with positive VZV DNA were meningitis, and the remaining 5 patients (4 patients had zoster) were encephalitis. Two of the 4 HHV-6B-positive patients were non-encephalitis, one patient was diagnosed Orbital apex syndrome and another patient was myelitis. One of the 2 encephalitis patient was chromosomally integrated (ci) HHV-6. Additionally, case B was also ciHHV-6.

Conclusion

Approximately 10% of the samples were positive of HHVs DNA. VZV was the most frequently detected viral DNA in this cohort. Thirty-three percent of the patients were encephalitis, remaining patients were non-encephalitis such as meningitis and myelitis. As suggested, ciHHV-6 can cause miss-diagnosis of patients suspected with CNS infection.

Disclosures

All authors: No reported disclosures.
1428. Comparing Outcomes of Diabetic Foot Infections Requiring Amputation, Negative vs. Positive Margins
Authors: Dixon Michael K , Cadena Jose , Walter Elizabeth
Published: October 2019

Background

This was a retrospective, observational cohort study of patients with diabetes and lower extremity osteomyelitis requiring amputation. Patients were categorized as having negative margins (without residual osteomyelitis or with joint disarticulation), or positive margins (with residual osteomyelitis). Health outcomes were compared between groups. The primary outcomes were relapse of infection at one year and reintervention at one year. Secondary outcomes include mortality at 30 days, 90 days, and 1 year; treatment failure at one year; and a composite of relapse of infection at one year, reintervention at 1 year, and death at 1 year.

Methods

CPRS ICD-10 codes were reviewed from patients at Audie L. Murphy VA with amputation for osteomyelitis between July 2, 2015 and July 13, 2017. Pathology reports were reviewed for the presence or absence of residual osteomyelitis, and outcomes were determined by chart review. Patient characteristics were recorded, such as age, serum albumin, presence of diabetes, hemoglobin A1c, organism on culture, peripheral vascular disease, and occurrence of a peripheral vascular intervention.

Results

The ALMVA is a 500-bed medical center with an active BMT program. Clinical data from 146 patients were obtained and analyzed. There were no significant differences in primary or secondary outcomes relative to patients with positive margins or negative margins. A lack of consistency in margin reporting by Pathology was seen. Albumin level and number of patients with residual osteomyelitis were significantly different between the two groups (table).

Conclusion

There were no significant differences in outcomes between amputations with positive margins and those with negative margins. Based on current IDSA guidelines, treatment varies significantly for patients with positive or negative margins, with the former requiring 6 weeks of parenteral antibiotic therapy. Extended courses of parenteral antibiotics increase risk for treatment-associated morbidity, and more evidence is needed to support these recommended durations. A quality improvement project is underway with the ID, Podiatry and Pathology departments to resolve issues related to obtaining and processing surgical samples, as well as interpreting and reporting margin results.

Disclosures

All authors: No reported disclosures.
1434. Risk Factors for Community-Acquired Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase (ESBL) Producing Escherichia coli in Children: A Case–Control Study
Authors: Zhu Frank , Maria Rodado , Asmar Basim , Salimnia Hossein , Thomas Ronald , Abdel-Haq Nahed M
Published: October 2019

Background

In recent years, there has been an increasing incidence of community-acquired urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli. However, the risk factors of ESBL-producing bacteria in community-acquired (CA)-UTI in children in the USA remain unclear.

Methods

A retrospective case–control study of UTI due to CA-ESBL-producing E. coli during a 5-year period (2011–2016) was performed. Control cases of non-ESBL-producing E. coli UTI were matched by age, gender, and year of infection. Medical records were manually reviewed to collect data for potential risk factors for ESBL-positive infection.

Results

A total of 111 patients with ESBL-producing E coli UTI and 103 control patients were included. The proportion of ESBL-producing E coli UTI ranged from 7% to 15% per year. The median age was 4 years with female predominance (84%). The ESBL group was predominantly African American (32%) followed by patients of Middle Eastern (ME) ethnic background (31%). Risk factors by univariate analysis were vesicoureteral reflux (VUR): (20.9 ESBL group vs. 6% controls; P = 0.002), prior antibiotic usage in the previous 3 months (including β-lactams), prior UTI (last 3 months), recent hospitalization (last 3 months) and ME ethnic background. However, multivariate analysis showed that only prior antibiotic usage (P = 0.001) and ME ethnic background (P < 0.001) remained statistically significant. 18% (11/60) of patients exposed to prior antibiotic use in the ESBL group were on long-term antibiotic prophylaxis for VUR.

Conclusion

Risk factors for CA-ESBL-producing E coli UTI in children were: (1) antibiotic usage within the previous 3 months and (2) ME background. Prior antibiotic usage as a risk factor reinforces the need for judicious use of antibiotics. The high percentage of patients in this group (18%) receiving long-term antibiotic prophylaxis for VUR warrants further study as this practice may increase the prevalence of ESBL-producing infections in a population at high risk for UTI. The increased risk among children of ME ethnic background warrants further study to evaluate possible additional associated risk factors such as recent international travel or contact with international travelers.

Disclosures

All authors: No reported disclosures.
1448. Prostate Abscess: Clinical Features, Management, and Outcomes of a “Stealth” Infection: A Case Series
Authors: Wooster Margaux E , Huang Glen , Sanders John W , Peacock James E
Published: October 2019

Background

Prostate abscess (PA) is uncommon and the diagnosis is often delayed or missed. Traditionally, PA has resulted from acute prostatitis or ascending genitourinary (GU) infection due to gram-negative bacilli but S. aureus is an emerging cause.

Methods

A retrospective review of all adult patients admitted with an ICD-9 or -10 diagnosis of PA between January 2013 and July 2018 was conducted. Inclusion criteria included age ≥18 years, a compatible GU infection syndrome, and imaging consistent with PA.

Results

Twenty-two patients with PA were identified. The median age was 57 years. Five patients (22.7%) were immunosuppressed and 11 (50%) had diabetes. The median Charlson Comorbidity Index was 2. No patient had a prior history of PA but 3 patients had a past diagnosis of prostatitis. Only 1 patient had GU instrumentation in the preceding 6 weeks and no patient had an indwelling urethral catheter. Fever (59%), dysuria (49%), and urinary retention (32%) were the most common presenting symptoms. Only 7/18 (39%) patients had a tender prostate on examination; fluctuance was not described. Pelvic CT revealed PAs in all patients; 14 (64%) were solitary and 16 (73%) were >2 cm in greatest diameter. The median abscess size was 3.2 cm. Urine cultures were positive in 11/18 (61%) patients with 6/11 (55%) growing S. aureus (MRSA 3); 9/16 (56%) patients had positive blood cultures (S. aureus 7 with MRSA 3) and 5/5 had positive PA cultures (S. aureus 1). Nine patients (41%) were managed with antibiotics alone whereas 13 (59%) underwent abscess drainage. The median duration of antibiotic therapy was 34.5 days. All-cause mortality at 4 weeks was 9.1%. No relapses were documented at 6 months. When comparing patients with S. aureus PA to those with other causes, S. aureus patients more often had diabetes (86% vs. 33%, P = 0.06) and a longer median duration of antibiotic therapy (35 days vs. 31 days, P = 0.04) but age, abscess size, and mortality did not differ between groups.

Conclusion

PA is relatively uncommon and may be difficult to distinguish clinically from acute prostatitis. CT is critical to an accurate diagnosis. Optimal management usually requires both antibiotics and drainage. Given the frequent occurrence of S. aureus as a cause, coverage for MRSA should be a component of empiric treatment for PA.

Disclosures

All authors: No reported disclosures.
1456. Increase in Resistance to Antibiotics in Enterobacteriaceae from Ambulatory Urinary Samples in Buenos Aires City
Authors: Bissio Emiliano , Luis Montes José , Mariela Merkt , Riselli Virginia , Sucari Adriana , Pennini Magdalena
Published: October 2019

Background

During the last years, an increase in the rates of resistance among causal agents of urinary tract infection (UTI) has been reported, even in community-acquired infections. This increase in resistance is problematic since it affects most therapeutic agents used in the ambulatory setting and often implies the lack of oral options for treatment. The aim of this study was to determine whether there were changes in the prevalence of resistance among samples from patients with UTI in the ambulatory setting caused by the most common Enterobacteriaceae.

Methods

We analyzed the resistance profiles of the three most common Enterobacteriaceae recovered in cultures from urinary samples of ambulatory adult patients, processed in a reference Laboratory in Buenos Aires City; according to calendar year, from January 1, 2010 till December 31, 2017. Sensitivity to antibiotics was determined using disk-diffusion methods and interpreted according to CLSI guidelines.

Results

A total of 26774 urinary samples were processed in the mentioned period and were analyzed for this study. Of these, 84% were from women, mean (SD) age was 59.7(20.4) years. Distribution according to bacterial genus and species was: E. coli: 84.6%; Klebsiella pneumoniae: 9.9%; Proteus sp.: 5.5% There were no significant differences in gender, mean age or bacterial genus/species distribution according to calendar year. When comparing 2010 to 2017 we found significant differences in the prevalence of resistance to fluoroquinolones: 26.6% vs. 33.6% respectively, P < 0.01; third G cephalosporins: 5.2% vs. 10.0%, P < 0.01; carbapenems: 0.2% vs. 0.4%, P < 0.01. Prevalence of resistance to TMS (39.0% vs. 40.2%) and nitrofurans (11.9% vs. 10.3%) remained stable. Results of analysis of resistance according to bacterial genus/species comparing results from 2010 to results from 2017 are shown on the table.

Conclusion

Resistance to antibiotics in Enterobacteriaceae recovered from urinary samples has increased significantly in the last years, especially for quinolones, third G cephalosporins (100% increase) and carbapenems (100% increase). Resistance to TMS was high but remained stable. E coli shows very good sensitivity to nitrofurantoin. It is key to improve and amplify the measures to prevent emergence of resistance and aim to revert this increasing trend in urinary tract infections from the community.

Disclosures

All authors: No reported disclosures.
1459. Oral Cephalosporins vs. Fluoroquinolones for the Empiric Treatment of Acute Uncomplicated Pyelonephritis
Authors: Lin Kevin , Ortwine Jessica , Mang Norman , Wei Wenjing , Prokesch Bonnie C
Published: October 2019

Background

The Infectious Diseases Society of America guidelines for the treatment of acute uncomplicated pyelonephritis (AUP) recommend oral fluoroquinolones (FQs) as a first-line agent in patients not requiring hospitalization. However, with increasing rates of FQ and trimethoprim/sulfamethoxazole resistance, oral β-lactams are attractive agents due to improved empiric susceptibility patterns at our institution. The current guideline advises caution when using oral β-lactams due to concern for inferior efficacy, but studies specifically evaluating the efficacy of oral cephalosporins (CPHs) in AUP are limited. The purpose of this study was to provide additional evidence for the safe and effective use of oral CPHs for empiric treatment of AUP.

Methods

Retrospective chart review was performed on all patients prescribed oral CPHs or FQs for AUP from the Emergency Department (ED) at Parkland Memorial Hospital between September 2017 and July 2018. The primary endpoint was treatment failure within 30 days, defined as ED return due to any cause or modification to an alternative antibiotic. Secondary endpoints included ED return within 30 days due to continued symptoms of AUP, documented adverse drug reactions (ADRs), and C. difficile infection (CDI) within 30 days.

Results

Of the 333 patients included in the study, treatment failure occurred in 72 (21.6%) patients and was similar between oral FQs and CPHs (21.4% vs. 21.7%). A higher rate of treatment failure was observed for first-generation (1GC) CPHs compared with second-generation (2GC) or third-generation (3GC) CPHs (19/51 [43.1%] vs. 18/107 [16.8%] vs. 9/68 [13.2%]). The primary reason for treatment failure was modification to an alternative antibiotic, and was highest for oral 1GC, followed by FQs, then 2GC and 3GC (19/51 [37.3%] vs. 14/107 [13.1%] vs. 11/107 [10.3%] vs. 4/68 [5.9%]). Rates of return to the ED for continued symptoms of AUP were found to be lower for oral CPHs (8/226 [3.5%]) vs. FQs (9/107 [8.4%]). Documented ADRs were low (5/333 [1.5%]) and none developed CDI.

Conclusion

Oral CPHs appear to be as safe and effective as FQs for the empiric treatment of AUP. In concordance with the susceptibility data of our institutional antibiogram, 2GC and 3GC were observed to have a lower rate of treatment failure compared with 1GC and FQs.

Disclosures

All authors: No reported disclosures.
1464. The Utility of Double Balloon Urinary Catheter in Reducing Rates of Catheter-Associated Urinary Tract Infections in a Tertiary Care Teaching Hospital
Authors: Katzman Ju Hee , Garcia Cristina Vanessa , Lakshmi Seetha , Thompson Peggy , Archibald Lennox
Published: October 2019

Background

Catheter-associated urinary tract infections (CAUTI) have been shown to increase hospital length of stay, healthcare costs, morbidity, and mortality. Studies that evaluate the role of urinary catheter design in preventing CAUTI are lacking. One such design is the double-balloon (DB) urinary catheter that has a second distal balloon; this design is aimed at reducing mucosal injury and inhibiting coiling of the in situ catheter. We carried out a comparative study to (a) determine whether CAUTI rates differ for different types of urinary catheters, and (b) identify risk factors associated with the acquisition of CAUTI in patients with DB vs. non-double-balloon (NDB) urinary catheters.

Methods

We conducted a retrospective cohort study of all patients who acquired CAUTI from January 2017 through December 2018. We collected age, sex, body mass index, medical history including benign prostatic hypertrophy, urinary tract infection (UTI), prostate cancer, stroke, surgery within the last 30 days including the type of surgery, indication for indwelling urinary catheter, location of catheter insertion, duration of catheterization, presence of pyuria, and type of catheter used. Statistical analyses were carried out using IBM SPSS software. Test statistics included independent sample t-test. CAUTI rates were expressed per 1000 catheter-days.

Results

Sixty-seven patients acquired CAUTI during the study period. NDB catheters included the following types: Foley, temperature sensing catheters, and coude catheters. Patients with DB and NDB catheters were similar in age, gender, diabetes, history of stroke, history of recent surgery, or history of UTI. CAUTI rates among patients with the DB catheters was 28 events per 29,018 catheter-days vs. 39 events per 33,579 catheter days for NDB type (P = NS). On stratification, CAUTI rates for foley, temperature sensing catheters, and coude catheters were 1.12, 1.27 and 2.70, respectively (P = NS).

Conclusion

There were no statistically significant differences in CAUTI rates at our facility among patients with DB vs. NDB urinary catheters. The decision on the choice of the catheter for use in our facility will likely depend on the comparative costs of the respective catheters.

Disclosures

All authors: No reported disclosures.
1466. Alkaline Urine: A Cause for Urinary Tract Infection Recurrence
Authors: Wattengel Bethany A , Schroeck Jennifer , DiTursi Sara , Sellick John A , Mergenhagen Kari A
Published: October 2019

Background

Urinary tract infections (UTIs) are one of the most common indications for antibiotics in both the inpatient and outpatient setting. The purpose of this study was to examine the impact of urinary pH on recurrence of UTIs. A recent review article stated imaging should be considered for patients with a urinary pH of 7 or higher. This study examines the impact of pH on outcomes of patients with UTI to determine whether pH plays a role in recurrent infection and representations to the healthcare facility.

Methods

This was a retrospective chart review via the computerized patient record system. Patients over the age of 18 years who presented to the healthcare facility between January 1, 2005 to January 1, 2019 for treatment of UTIs were included in this study. Alkaline urine was defined as a urinary pH greater than or equal to 7, while acidic urine was defined as a urinary pH less than 7. Urease splitting organisms included Proteus spp., Providencia spp., and Morganella spp. Outcomes included recurrence and re-presentation to the healthcare facility within 30 days.

Results

A total of 793 patients were included in this study, of which 21.3% had alkaline urine. Patients with alkaline urine were more likely to have recurrence of UTI (8.3% vs. 4.3%). Patients with a catheter were more likely to have alkaline urine (30% vs 18%; P = 0.0005). As expected, alkaline urine was associated with a higher frequency of urease splitting organisms (19% in alkaline urine vs. 3% in acidic urine). Renal calculi were found in 3.6% of patients with alkaline urine; however, only 34.3% of patients with alkaline urine had imaging completed. The use of drugs which can alkalinize the urine did not differ significantly between groups.

Conclusion

Patients with an alkaline urinary pH were more likely to experience recurrence and readmission within 30 days. Imaging was performed in a minority of patients which may represent a potential target for stewardship programs. Alkaline urine may be a marker for urease splitting organisms and calculi formation. More widespread imaging may be able to detect stones, allowing for potential urologic intervention, preventing subsequent antibiotic courses and repeated healthcare presentations.

Disclosures

All authors: No reported disclosures.
1471. Medical Claims Analysis as a Tool to Evaluate Empiric and Targeted Antibiotic Therapy in UTIs
Authors: Hui Wing , Antunes Nuno T , Veeramani Shriram , Holman David
Published: October 2019

Background

Empiric therapy is a mainstay of the inpatient management of urinary tract infections (UTIs), and the choice of empiric antibiotic is shaped by local epidemiology and patient risk factors and comorbidities. Pathogen identification (ID) and antibiotic susceptibility testing (AST) provide information that can guide adjustments in therapy, allowing de-escalation to more targeted, narrow-spectrum antibiotics.

Methods

Real-world data (hospital billing claims) from 2017 was used to extract relevant information from general hospitals on inpatients with bacterial UTIs including patient demographics and antibiotics line of therapy progression. Patients were projected to the USA national event totals and validated with other projection-related data sources (HCUP) and secondary market research. Data obtained in the claims analysis was validated by primary market research (PMR).

Results

Analysis of 33M claims identified 169K patients with a code for UTI; in at least one-third of patients, there were no codes associated with ID/AST assays. Among those with codes for ID/AST assays, the vast majority were performed in the first 3 days following hospital admission. Approximately two-thirds of patients with associated ID/AST codes were already receiving an antibiotic when the assays were performed, which was assumed to be the empiric treatment. Analysis of the line of antibiotic therapy progression in patients where ID/AST was performed identified subsequent changes in antibiotic prescribing in approximately one-third of patients within 3 days, compatible with changes due to delivery of conclusive results and were interpreted as a transition from empiric to targeted treatment.

Conclusion

To the best of our knowledge, this is the first attempt at understanding the impact of ID/AST assays on prescribing practices with basis on analysis of claims data. Our results align with PMR conducted by DRG internally, supporting the validity of this methodology. Although this claims analysis delivers reliable data when claims are associated with ID/AST assays, it is limited by incompletely filled claims, which may underestimate the use of these assays.

Disclosures

All authors: No reported disclosures.
1479. Clinical Efficacy and Safety Analysis Evaluating Oral Gepotidacin (GSK2140944) from a Phase IIa Study in the Treatment of Uncomplicated Urinary Tract Infections
Authors: Overcash J Scott , Dumont Etienne , Perry Caroline R , Tiffany Courtney , Scangarella-Oman Nicole , Raychaudhuri Aparna , Hossain Mohammad
Published: October 2019

Background

Urinary tract infections (UTIs) are very common, with approximately 11% of women >18 years of age experiencing at least 1 episode of acute cystitis per year. Multidrug resistance, typically associated with nosocomial infections, has now emerged at the community level making treatment options for UTIs more difficult. Gepotidacin (GEP), a first-in-class, novel triazaacenaphthylene antibacterial has demonstrated in vitro activity against uropathogens including E. coli and provides high and sustained urine concentrations. It selectively inhibits bacterial DNA replication through a unique mechanism not utilized by any currently approved antibacterial. GEP presents an opportunity to address an unmet medical need and warrants study as a potential new and effective oral treatment for acute cystitis.

Methods

This Phase IIa single-center study was designed primarily to evaluate plasma and urine pharmacokinetics (PK) of gepotidacin in female participants with acute cystitis. Safety data and clinical and microbiological efficacy of gepotidacin were also assessed as secondary and exploratory endpoints. All participants received oral gepotidacin 1,500 mg BID for 5 days (total of 10 doses) during clinic confinement. Pretreatment and posttreatment PK collections were performed together with safety, efficacy, microbiological, and exploratory assessments throughout the study.

Results

Summary of Exploratory Endpoints (ITT Population). Clinical Efficacy: All subjects had significant improvement of clinical symptoms (dysuria, frequency, urgency, lower abdominal pain) within 24 to 48 hours of treatment. Most subjects, (20/22; 90.9%) achieved symptom resolution at test of cure (ToC) and follow-up (F/U). Microbiological eradication was achieved independent of baseline CFU’s (see microbiology abstract). Safety Endpoint: Most common AEs involved the GI tract (diarrhea (18/22 [82%] and nausea 17/22 [77%]). Per investigator observation, tolerance to nausea was observed with repeat dosing. No withdrawal due to AE. There were no clinically relevant trends in safety laboratories, ECG, or vital signs.

Conclusion

This first report of efficacy and safety in the treatment of acute cystitis supports further study of the clinical use of GEP in this indication.

Disclosures

All authors: No reported disclosures.
1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India
Authors: Surapareddy Bhavana , Varma Muralidhar , V Shashidhar
Published: October 2019

Background

Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis

Methods

This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis.

Results

A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%)

Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75)

Conclusion

Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI

Disclosures

All authors: No reported disclosures.
1495. Fluoroquinolone as an Alternative Regimen for Klebsiella pneumoniae Liver Abscess
Authors: Chuang Chien , Chou Sheng-Hua , Lin Yi-Tsung
Published: October 2019

Background

Klebsiella pneumoniae liver abscess (KPLA) is an endemic disease in East Asia. KPLA is usually caused by hypervirulent strains that are susceptible to all kinds of antibiotics except ampicillin. Patients with KPLA are commonly treated with β-lactams and need prolonged duration of intravenous therapy. Fluoroquinolone has high oral bioavailability and has the potential to shorten the duration of intravenous therapy, but studies regarding fluoroquinolone use in KPLA are limited. We aimed to compare the outcomes of patients with KPLA treated with β-lactams and fluoroquinolone.

Methods

Consecutive patients with KPLA in a tertiary medical center of Taiwan between 2011 and 2018 were enrolled retrospectively. Clinical characteristics and treatment outcomes were compared between cases treated with β-lactams and fluoroquinolones. Logistic regression was performed to identify risk factors of prolonged hospitalization (defined as > 30 days). Capsular genotypes and presence of rmpA or rmpA2 genes were analyzed among K. pneumoniae strains collected after July 2012. Hypervirulent strains were defined as those had rmpA or rmpA2 genes.

Results

A total of 330 KPLA patients identified, and the in-hospital mortality was 0.9% (n = 3). Nearly all K. pneumoniae strains were hypervirulent strains (97.1%). Capsular type K1 (n = 176) and K2 (n = 63) were the most common capsular types. Most patients received β-lactams (n = 296, 89.7%), and only 34 (10.3%) patients received fluoroquinolones as the main antibiotics (levofloxacin = 17; moxifloxacin = 10; ciprofloxacin = 7). The duration of intravenous antibiotics use in fluoroquinolones group was shorter than β-lactams group (20.12 ± 9.21 vs. 26.81 ± 16.10, P = 0.001). Prolonged hospitalization was more common in β-lactams group than fluoroquinolones group (32.1% vs. 11.8%, P = 0.014). The in-hospital mortality, duration of antibiotic use, and recurrence rate were similar between the two groups. Fluoroquinolones was independent protective factor for prolonged hospitalization (hazard ratio, 0.28; P = 0.026).

Conclusion

Fluoroquinolone is able to shorten the duration of intravenous antibiotic use and beneficial in prolonged hospitalization in patients with KPLA.

Disclosures

All authors: No reported disclosures.
1500. Gastric Carcinoma Survival Related with Helicobacter pylori Infection in Cali, Colombia: A Hospital-Based Cancer Study
Authors: Rosso Fernando , Carlos Bravo Juan , Parra-Lara Luis Gabriel , Camilo Falla Juan , Eduardo Bravo Luis , Zambrano Angela
Published: October 2019

Background

Gastric carcinoma (GC) has been associated with the presence of Helicobacter pylori infection. The infection rates vary according to geographic region and the majority of infected persons remain asymptomatic. Recent studies have suggested a controversial role of H. pylori infection in GC prognosis. The GC incidence rate in Colombia is among the highest of all Latin-American countries at 18.5 per 100,000 people. Furthermore, GC is responsible for the highest mortality rate among all malignancies in the country. This study aimed to describe GC survival in patients with H. pylori infection.

Methods

Hospital registries for all patients diagnosed with GC between 2000 and 2015 were consulted for clinical data. The hospital-based cancer registry was cross-linked with a population-based cancer registry to obtain IARC/WHO ICD-O-3 classification and follow-up information on all patients. Survival analysis was estimated using the Kaplan–Meier method. Differences between H. pylori cases and non-H. pylori cases were assessed through Pearson chi-2, Fisher exact test, log-rank test, and Cox regression.

Results

A total of 500 GC cases were included and 8.6% had H. pylori infection. In the H. pylori cases, the median age was 62 years (IQR = 52–71), 56% were men. All cases had a tumor size >5 mm, Lauren classification was 60% intestinal type and 40% diffuse type. Regarding clinical stage, 33% of the patients were classified as localized (TNM AJCC 7th edition: IA, IB, IIA), 35% as regional (IIB, IIIA, IIIB, IIIC) and 12% were distant (IV). There was a statistically significant difference between H. pylori cases and non-H. pylori cases survival (P = 0.0151). In univariate analysis, H. pylori infection was associated with better cancer-specific survival [HR = 0.5398; 95% CI: 0.3255–0.8950; P = 0.017]. In multivariate analysis, H. pylori infection [HR = 0.5934; 95% CI: 0.3577–0.9843; P = 0.043] and clinical stage [HR = 1.5327; 95% CI: 1.3672–1.7182; P < 0.001] were independent prognostic factors for cancer-specific.

Conclusion

This study showed that H. pylori infection is a beneficial prognostic indicator in patients with GC Cases, and GC survival in cases with H. pylori infection was better compared with non-H. pylori cases.

Disclosures

All authors: No reported disclosures.
1504. Epidemiology and Etiology of Pyogenic Liver Abscess in the Calgary Health Zone: A Population-Based Study
Authors: Losie Jennifer A , Lam John , Gregson Dan , Parkins Michael
Published: October 2019

Background

Pyogenic liver abscess (PLA) is a significant cause of morbidity and mortality. Epidemiological data regarding risk factors and outcome determinants are often ascertained from referral population bases. We utilized a population-based study design to better understand PLA.

Methods

Calgary Health Zone (CHZ) residents ≥18 years of age (population ~1.3 million) who were hospitalized with PLA in 2017 were included. Charts were manually reviewed to determine demographics and clinical outcomes. Univariate and multivariate logistic regression were used to assess for factors associated with 30-day mortality using STATA 15.1 (College Stn., TX).

Results

Forty-four patients with PLA were identified (39% female, median age 61 [IQR 56–68] years) corresponding to an incidence rate of 3.7 cases per 100,000 population. Prevalent co-morbidities with PLA included; hemodialysis dependence (4.5%), cancer (25%), diabetes (23%), and cirrhosis (6.8%), each of which was significantly more common (P < 0.05) than in the general population; 85.3X, 11.2X, 3.6X, 29.9X, respectively. Rates of other comorbidities including ischemic heart disease, COPD, and rheumatoid arthritis did not differ from general populations (P > 0.05). The etiology of PLA was established in 72% of cases, of which biliary was most common (48%). Most (91%) cases had at least one organism identified via blood or liver aspirate culture. The most common organisms were Streptococcus anginosus group (12), Klebsiella pneumoniae (11), Klebsiella oxytoca (6), Escherichia coli (4), and obligate anaerobes (3). Blood cultures were positive in 25/44 (56%) cases. Thirty-day mortality from admission was 11% and had multiple risk factors (Table-1).

Conclusion

PLA in the CHZ is common and associated with high mortality. Understanding factors influencing PLA occurrence and outcome can assist in correctly identifying and optimally treating patients.

Disclosures

All authors: No reported disclosures.