bluuebunny/crossref_metadata_2025_split huggingface dataset:
1424. Association Between Erythrocyte Sedimentation Rate (ESR) Change and Treatment Failure in Patients with Osteomyelitis
Authors: Pearson Christopher D , Holzum Dorothy , Moenster Ryan P , Linneman Travis W 
Published: October 2019

Abstract

Background
Erythrocyte sedimentation rate (ESR) is monitored during therapy for osteomyelitis (OM) but the degree of reduction associated with treatment success remains unclear.

Methods
This retrospective cohort study evaluated patients treated for at least 2 weeks with intravenous (IV) antibiotics for OM through the VA St. Louis HCS from 1 January 2010 to 1 January 2018 with at least 2 ESR values during their therapy. Patients were excluded if they had comorbidities that could cause elevations in ESR. The primary outcome was the rate of treatment failure in patients achieving ≥50% decrease in ESR from baseline compared with those without a 50% decrease. Treatment failure was defined as a need for unplanned surgical intervention or re-initiation of antibiotic therapy for OM of the same anatomical site within 6-months after initial therapy was discontinued. The presence of diabetes, peripheral vascular disease (PVD), age >70, baseline creatinine clearance (CrCl) < 50 mL/minute, surgical intervention as part of initial therapy, and ESR reduction ≥50% from baseline were included in a univariate analysis with variables with a P < 0.2 included in a multivariate logistic regression model.

Results
A total of 143 patients were included; 74 patients with a ≥50% decrease in ESR and 69 patients with a decrease <50%. Mean initial ESRs were not different between groups (79.5±31 vs. 79.9 ± 32 mm/hour, P = 0.95), but end-of-treatment values were significantly higher in the <50% reduction group vs. ≥50% (20.6 ± 14 vs. 72.4 ± 42 mm/hour, P < 0.05, respectively). There were no baseline differences between groups in regards to age, rates of diabetes, PVD, CrCl < 50 mL/minute, initial surgical therapy management, or definitive vs. empiric therapy. Thirty percent (22/74) of patients with a ≥50% reduction in ESR failed treatment vs. 55% (38/69) in patients with a <50% reduction (P < 0.01). Only ESR reduction of ≥50% met criteria for inclusion in the multivariate regression model and was associated with a 65.5% relative risk reduction in treatment failure (OR 0.345; 95% CI 0.173–0.687; P = 0.002).

Conclusion
Achieving an ESR reduction of ≥50% from baseline during treatment for OM was independently associated with a significant reduction in risk of treatment failure.

Disclosures
All authors: No reported disclosures.
1432. Estimating the Incubation Period of Salmonella Urinary Tract Infection (UTI) Using Foodborne Outbreak Data
Authors: Jacobs Slifka Kara M , Blackstock Anna , Nguyen Von , Schwensohn Colin , Gieraltowski Laura , Mahon Barbara 
Published: October 2019

Abstract

Background
Urinary tract infections (UTI) are common bacterial infections that may occur as a part of foodborne outbreaks. Salmonella, a less common cause of UTI, has been identified during foodborne outbreaks, but the epidemiology and pathogenesis are poorly understood.

Methods
PulseNet, the United States national molecular subtyping network for foodborne disease surveillance, was used to identify Salmonella isolates associated with outbreaks from 2004 to 2013 containing at least one urine and one stool isolate in which the duration was ≤1 year and a food vehicle was suspected or confirmed. We standardized isolation dates across outbreaks by calculating the mean date for stool isolation within an outbreak and subtracting this from the date of each stool/urine isolate in that outbreak. A linear-mixed model with random effect for stool/urine was used to estimate the difference in incubation periods between stool/urine isolates. We also surveyed patients from a 2012 Salmonella Cubana outbreak with many urinary isolates and associated with sprouts, to ask about diarrhea, UTI symptoms, diagnosis, and treatment. Descriptive statistics were calculated.

Results
Urine isolates had later isolation dates than stool isolates for 102 of the 110 outbreaks identified. The average difference between stool and urine isolates was 10.6 days (95% CI: 6.0, 15.2). Seven women from the Salmonella Cubana outbreak were reached. All women were diagnosed with either a UTI (6/7 = 86%) and/or kidney infection (2/7 = 29%) and were treated with antibiotics (7/7 = 100%). All six women completing the survey reported multiple signs and/or symptoms including frequency, urgency, dysuria, and hematuria with only two women reporting diarrhea prior to UTI.

Conclusion
Salmonella UTI seen during foodborne outbreaks are symptomatic foodborne infections not associated with diarrhea and appear to have a longer incubation period than Salmonella gastrointestinal (GI) illness. A 13- to 16-day incubation period for Salmonella UTI may be more appropriate, calculated by adding a 3- to 4-day GI illness incubation period plus delay in obtaining a stool isolate. Foodborne UTI investigation may need to change as the current method of obtaining a food history for the 6–72 hours prior to illness does not accurately reflect the incubation period for Salmonella UTI.

Disclosures
All authors: No reported disclosures.
1433. Predictive Models for Antibiotic Coverage of Gram-Negative Urinary Tract Infections
Authors: Hebert Courtney , Gao Yuan , Rahman Protiva , Dewart Courtney M , Shah Nirav , Lustberg Mark , Stevenson Kurt , Pancholi Preeti , Hade Erinn 
Published: October 2019

Abstract

Background
Providers use institutional recommendations, national guidelines, and antibiograms to decide on empiric antibiotics. As local antibiograms are most effective after organisms are known, we sought to use local microbiology and clinical data to develop predictive models for antibiotic coverage prior to identifying the organism. We focused on Gram-negative organisms as they are common urinary pathogens and are often the cause of sepsis originating in the urinary tract. As such, they are important to cover in hospitalized patients with urinary tract infections (UTI).

Methods
Hospitalized patients, with a diagnosis of UTI and a positive urine culture in the first 48 hours were included. Gram-positive organisms, yeast, and cultures without susceptibilities were excluded. Unknown susceptibilities were filled in using expert-derived rules. Clinical information from electronic health record (EHR) data were extracted on each patient. Penalized logistic regression with 10-fold cross validation was used to develop final models for coverage for five antibiotics (cefazolin, ceftriaxone, ciprofloxacin, cefepime, piperacillin–tazobactam). Final models were chosen based on their discrimination, calibration, and number of predictors, and then tested on a held-out validation dataset.

Results
Included were 5,096 patients (80% training; 20% validation). Coverage ranged from 65% for cefazolin to 90% for cefepime. Positive blood cultures were present in 544 (11%) with 388 (71%), including a urinary pathogen. In the first 24 hours, 2329 (46%) were hypotensive, 2179 (43%) had a respiratory rate > 22, 2049 (40%) had a WBC > 12, 1079 (21%) were febrile, and 584 (11%) required ICU care. Final model covariates included demographics, antibiotic exposure, prior resistant pathogens, and antibiotic allergies. The five predictive models had a point-estimate for the area under the ROC on the validation set that ranged from 0.70 for ciprofloxacin to 0.73 for ceftriaxone.

Conclusion
In this cohort of moderate to high acuity hospitalized patients with Gram-negative urinary pathogens, we used EHR data to develop 5 models that predict antibiotic coverage which could be used to support empiric prescribing. These models performed well in a held-out validation set.

Disclosures
All authors: No reported disclosures.
1438. Escherichia coli (EC) ST131-H30 Clonal Group is Associated with Antimicrobial Resistance, Illness Severity, Host Compromise, and Non-Cure among Patients with Bacteriuria
Authors: Mahoney Melanie T , Brigman Hunter V , Johnston Brian , Raux Brian R , Johnson James R , Hirsch Elizabeth B , Hirsch Elizabeth B 
Published: October 2019

Abstract

Background
EC sequence type ST131 is the leading cause of extraintestinal EC infections, and accounts for most fluoroquinolone (FQ)-resistant and extended-spectrum β-lactamase (ESBL)-producing EC clinical isolates. The ST131-H30 subclone (H30) is responsible for most antimicrobial resistance within ST131; however, H30’s impact on clinical outcomes is poorly defined. We compared empiric treatment patterns and clinical outcomes of patients with bacteriuria caused by ST131 vs. non-ST131 EC, and by H30 vs. non-H30 EC strains.

Methods
Phylogroups, ST131, H30, and CTX-M-type β-lactamase genes were detected by PCR for 142 non-duplicate EC isolates collected prospectively from hospitalized or emergency-department-attending adults with monomicrobial bacteriuria at a Boston academic medical center (August 2013–January 2014). Clinical and microbiologic data were collected retrospectively from electronic health records. Baseline characteristics, empiric treatment, and clinical cure rates were compared between ST131 vs. non-ST131, and H30 vs. non-H30, patient cohorts.

Results
Of 142 patients with EC bacteriuria, most (76%) were female and elderly (mean age 65.2 ± 21.2 years). Overall, 35% of isolates were ST131, of which 80% (39/49) were H30. Compared with other isolates, H30 isolates demonstrated a higher frequency of ESBL production (33% vs. 8%; P < 0.001) and FQ resistance (90% vs. 8%; P > 0.001). Patients with H30 isolates (vs. non-H30 isolates) were older (mean 73.4 ± 13.6 vs. 62.1 ± 22.7 years; P < 0.01), had higher median (interquartile range [IQR]) APACHE II scores (10 [4] vs. 8 [9.5]; P = 0.01), more commonly had underlying complicating conditions (100% vs. 83%; P = 0.03) and received in vitro-inactive empirical treatment (26% vs. 3%; P < 0.01), and had a numerically lower clinical cure rate (84% vs. 96%; P = 0.08). In contrast, patients with ST131 vs. non-ST131 isolates had similar median [IQR] APACHE II scores (9 [5] vs. 8 [9]), frequencies of symptomatic UTI (61% vs. 70%) and underlying complicating conditions (24% vs. 19%), and clinical cure rates (87% vs. 95%).

Conclusion
Among patients with EC bacteriuria, the ST131-H30 subclone was associated significantly with ESBL production, FQ resistance, illness severity, host compromise, and numerically lower clinical cure rates in symptomatic UTI.

Disclosures
Elizabeth B. Hirsch, PharmD, Merck: Grant/Research Support, Research Grant; Nabriva Therapeutics: Advisory Board; Paratek Pharmaceuticals: Advisory Board.
1449. Antibiotic Choice, Duration, and Outcome in Community-Acquired Urinary Tract Infections (UTI) in Male Patients
Authors: Chen Joshua C , Pham Jonathan , Yazdi Mona T 
Published: October 2019

Abstract

Background
It is common medical practice for all urinary tract infections (UTIs) in males to be diagnosed as “complicated” UTIs. Current guidelines recommend 7 to 14 days of antibiotics for complicated UTIs. Longer duration of antibiotics potentially exposes a patient to harm without sufficient evidence for benefit. This research will attempt to determine the optimal antibiotic and duration of treatment for males diagnosed with a UTI.

Methods
This study is a retrospective cohort study that utilized the electronic health record for Kaiser Permanente Southern California to search for male patients with a diagnosis of cystitis or UTI in the outpatient setting from 2011 to 2016. Only patients with confirmed bacteriuria >100,000 CFU/mL of a gram-negative organism were included. Exclusion criteria included Foley catheterization, intermittent self-catheterization, prostatitis and Pseudomonas infection. There were 10,662 patients in our database who fit these criteria, but only 134 patients were reviewed for preliminary analysis for this abstract. Outcomes included recurrence of UTI within 30 days of finishing treatment

Results
A total of 134 patients were included. Most patients were prescribed Ciprofloxacin (69%) or Cephalexin (19%). The prescription duration was >8 days for 52%, 7–8 days for 34% and <7 days for 14% of all the patients. There was a statistically significant difference in recurrence by antibiotic duration (Figure 1). The odds of recurrence were 3.9 times higher for people with <7 days prescription compared with those with > 8 days (95% CI, 1.28–11.89, P = .017) (Table 1). The odds of recurrence were 1.5 times higher for those with a prescription of 7–8 days compared with those with a prescription of > 8 days, but the difference was not statistically significant (95% CI: 0.59, 3.7, P = .38).

Conclusion
Male patients diagnosed with a UTI who were treated with a course of antibiotics for > 7 days were less likely to have a UTI recurrence than patients who were treated for < 7 days. However, there was no statistically significant difference between 7 to 8 days vs. >8 days of antibiotics in terms of recurrence. This study will be continued to increase study power. Determining the best treatment course will reduce healthcare cost and patient morbidity from UTI recurrences.

Disclosures
All authors: No reported disclosures.
1457. Antimicrobial Resistance of Urinary Tract Infection Pathogens in South Korea: A Surveillance Report of the One-Year Assessment in 2017
Authors: Liu Changseung , Yoon Eun-Jeong , Kim Dokyun , Hee Shin Jong , Hwan Shin Jeong , Seob Shin Kyeong , Ah Kim Young , Uh Young , Soo Kim Hyun , Ree Kim Young , Jeong Seok Hoon 
Published: October 2019

Abstract

Background
Korean Antimicrobial Surveillance System (Kor-GLASS) was established in 2016, which is compatible with the Global Antimicrobial Resistance Surveillance System launched by WHO. Here, we report a one-year assessment of Kor-GLASS in 2017, focusing on the antimicrobial resistance of urine isolates.

Methods
Non-duplicated clinical isolates of E. coli and K. pneumoniae recovered from urine cultures were collected from 8 sentinel hospitals. Demographic information, infection origin (hospital origin or community origin), and admission type were investigated. Bacterial species were confirmed using a matrix-assisted laser desorption/ionization time-of-flight mass spectrometer. Antimicrobial susceptibility was tested by disk diffusion and broth microdilution methods.

Results
During the one-year period of surveillance from January 2017 to December 2017, a total of 9,130 (11.9%) isolates of target pathogens were recovered from urine specimens of 76,625 patients with suspected urinary tract infection (UTI). The rate of culture-positive was the highest in the < 1 age group (AG) (22.5%), stiffly decreased in the 5–<15 AG to 3.4%, and gradually increased with age up to 19.6% in the ≥ 85 AG. The mean occurrence of UTI per 10,000 patient-days for inpatients was 19.3 (range, 3.4–46.1) for E. coli and 4.0 (range, 1.5–7.3) for K. pneumoniae. Resistance rate for cefotaxime was higher than those for ceftazidime both in E. coli (31.3% vs. 10.3%) and K. pneumoniae isolates (39.0% vs. 29.8%). Resistance rate for ciprofloxacin in E. coli isolates was 40.9%, and that in K. pneumoniae isolates was 31.9%. Only 4.9% and 10.9% of E. coli and K. pneumoniae isolates exhibited resistance phenotype to cefoxitin, respectively. Ertapenem-resistance was more frequently identified in K. pneumoniae isolates (1.6%) than in E. coli isolates (0.1%). Multidrug-resistance (MDR) phenotype was identified in 61.4% of the E. coli and 44.8% of K. pneumoniae urine isolates.

Conclusion
Kor-GLASS generated well-curated surveillance data devoid of collection bias or isolate duplication. Cefoxitin was an alternative treatment to ciprofloxacin for urinary tract infections caused by Enterobacteriaceae. About one-half of urine isolates belonged to either MDR or XDR.

Disclosures
All authors: No reported disclosures.
1460. The Effectiveness of Short vs. Long Antibiotic Therapy in Hospitalized Adult Patients with Urinary Tract Infections: A Systematic Review and Meta-Analysis
Authors: Ballouz Tala , Rizk Nesrine 
Published: October 2019

Abstract

Background
Urinary tract infections (UTIs) are a frequent cause of morbidity and mortality in hospitalized patients, if not adequately and promptly treated. The optimal treatment duration is controversial and most recommendations are based on clinical experience. Current guidelines recommend 5–14 days of treatment depending on the type and severity of infection and the antibiotic used. With the emergence of multi-drug resistance, shorter durations are increasingly favored. This systematic review of randomized controlled trials (RCTs) aims at providing updated evidence on the effectiveness of short (≤7 days) vs. long (>7 days) antibiotic regimens in hospitalized adult patients.

Methods
MEDLINE, EMBASE, and CENTRAL were searched to identify relevant RCTs. Trial quality was evaluated using Cochrane’s Risk of Bias Tool. The primary outcome was clinical success. Secondary outcomes included microbiological success, withdrawal due to adverse events (AE), relapse, and reinfection rates. A random-effect meta-analysis was performed using R.

Results
8 RCTs conducted between 1995 and 2018 were identified. Trial quality was considered poor in 5, fair in 1 and good in 2 RCTs. Clinical and microbiological success was reported in all studies. Withdrawal due to AE was reported in 5, relapse and reinfection in 3 studies. Overall, there was no difference in clinical success between short and long courses (OR = 0.92, 95% CI 0.66–1.29; 2111 patients) (figure). Similarly, microbiological success was comparable in the two arms (OR = 1.0, 95% CI 0.70–1.43; 2111 patients). There was a higher, but nonsignificant, number of withdrawals due to AE in the long duration arm (OR = 0.78, 95% CI 0.29–2.11; 1890 patients). Patients receiving short courses had a nonsignificant higher rate of relapse (OR = 2.65, 95% CI 0.31–22.39, 175 patients). However, there was no difference in reinfection rates (OR = 1.12, 95% CI 0.26–4.90; 175 patients). A subgroup analysis limited to complicated UTIs showed similar results.

Conclusion
Based on the limited available evidence, short antibiotic courses appear to be equally effective as longer courses in the management of inpatient UTIs. Further research is needed to determine appropriate antibiotic treatment durations and assess treatment-related development of drug resistance.

Disclosures
All authors: No reported disclosures.
1462. Derivation of a Prediction Model for Risk of Drug-Resistant Urinary Tract Infection
Authors: Ali Sabeen , Claeys Kimberly C 
Published: October 2019

Abstract

Background
Urinary tract infections (UTIs) are among the most common indications for antibiotic therapy. As antibiotic resistance continues to grow, it is critical to identify those at higher risk for drug-resistant (DR) UTIs to guide empiric therapy, improve clinical outcomes, and limit costs of care. The aim of this study was to identify risk factors for DR UTI and develop a risk scoring tool which could aid in empiric antibiotic prescribing.

Methods
Single-center retrospective pilot study of adult patients treated for UTI from August 1, 2015 to August 31, 2016. Patients who had asymptomatic bacteriuria, were pregnant within 4 months of admission, or had improperly collected urine cultures were excluded. DR was defined as phenotypic resistance to at least 1 agent in 3 or more antibiotic classes commonly used to treat UTIs. Risk factors for DR UTI were derived from previously published literature and multivariable logistic regression of individual patient data (IPD). Adjusted odds ratios (aORs) were developed by combining ORs from previous literature and IPD. A scoring tool was derived from weight-proportional integer-adjusted coefficients of the predictive model aORs.

Results
Risk factors were derived from 9 previously published studies and adapted using IPD (N = 77) and included: long-term care (aOR = 4.31), prior hospitalization (aOR = 1.8), previous antibiotics (aOR = 4.33), advanced age (aOR = 1.12), urinary catheterization (aOR = 2.2), immune suppression (aOR = 1.6), and male sex (aOR = 2.56). Previous DR UTI was forced into the model (OR = 1.1). Baseline incidence of DR UTI was 28.7%. A risk score from 1 to 20 was developed and applied to IPD and demonstrated an area under the receiver operator curve (AUROC) of 0.625 (95% CI 0.484–0.767). Removing sex from the score produced an AUROC of 0.64 (95% CI 0.497–783). A sensitivity analysis applying the score to only urinary isolates that exhibited resistance to third-generation cephalosporins (13.8%) produced similar results.

Conclusion
Residence in long-term care and previous antibiotics were among the risk factors most closely associated with DR UTI. Considering cumulative risk scores may be useful in predicting DR UTI however the current study was hindered by a large degree of heterogeneity in previous literature.

Disclosures
All authors: No reported disclosures.
1463. The Rates of UTI Outpatient and Inpatient Visits from 2001 to 2015 Among an Insured Population
Authors: Foster Kendra , Simmering Jacob E , Polgreen Philip M , Polgreen Linnea A 
Published: October 2019

Abstract

Background
Hospitalizations attributable to urinary tract infections (UTI) have increased in recent years. One possible reason for the increase in admissions is a lack of effective oral agents, due to increasing rates of antimicrobial resistance, necessitating treatment with IV antibiotics. Our objective was to compare the rates of inpatient vs. outpatient treatment for UTIs.

Methods
We used the MarketScan database to identify UTI inpatient and outpatient visits from January 2001 through September 2015. Incidence rates for inpatient and outpatient visits were determined as a function of people at risk for UTIs. A difference-in-difference model with a change point in 2007 was used.

Results
During our study period, we identified 32,521,146 outpatient visits for UTI and 297,470 inpatient UTI visits. Rates for inpatient and outpatient visits were rising at similar rates before 2007. After 2007, the slopes differed, and the incidence of outpatient visits increased statistically (P = 0.023) when compared with inpatient visits.

Conclusion
Incidence of UTI hospitalizations is increasing but not as quickly as UTI outpatient visits. Since 2007, patients are more likely to be treated in the outpatient setting rather than in the inpatient setting.

Disclosures
All authors: No reported disclosures.