bluuebunny/crossref_metadata_2025_split huggingface dataset:
1553. Efficacy and Safety of Dalbavancin and Oritavancin in the Treatment of Gram-Positive Infections
Authors: Brown Vanessa , Linneman Travis W , Moenster Ryan P 
Published: January 2021

Abstract

Background
Lipoglycopeptides are approved for acute bacterial skin and skin structure infections (ABSSSI), but are often used in other infections, including osteomyelitis (OM) and bloodstream infections (BSI).

Methods
This retrospective cohort study included VA St. Louis Health Care System patients aged ≥18 through ≤89 years treated for ABSSSI, BSI, or OM with lipoglycopeptides. Patients were excluded if they received ≥72 hours (ABSSSI, BSI) or ≥7 days (OM) of antibiotics prior to lipoglycopeptide administration or other intravenous antibiotics were administered for ≥48 hours after lipoglycopeptide. The primary efficacy outcome was clinical success in the lipoglycopeptide cohort, defined per infection. Secondary outcomes were a comparison of clinical success in the lipoglycopeptide cohort to historical controls of patients treated at the VA St. Louis for ABSSSI, BSI, or OM. A multivariate regression was also conducted to find factors in the lipoglycopeptide group independently associated with clinical success. Safety outcomes compared adverse drug reactions between single- and 2-dose regimens of lipoglycopeptides.

Results
A total of 36 patients were included in the analysis; no patients met inclusion for bloodstream infection. Twenty-nine patients were treated for ABSSSI and 7 patients met inclusion for OM treatment. Dalbavancin was the agent used most often for both OM (4/7) and ABSSSI (22/29). The primary outcome of clinical success occurred in 77.7% (28/36) of the lipoglycopeptide cohort. There was no difference in clinical success between the lipoglycopeptide cohort and historical controls for ABSSSI (86% [5/29] vs 84% [159/189], p &gt;0.05) or OM (43% [3/7] vs 58% [83/143], p &gt;0.05). No difference in adverse outcomes between single- and 2-dose regimens of lipoglycopeptide were observed.

Conclusion
Clinical success for patients treated with lipoglycopeptides for ABSSSI and OM in this small cohort were comparable to historical controls. No difference was identified in the safety between single- and 2-dose regimens of lipoglycopeptides.

Disclosures
All Authors: No reported disclosures
1554. Epidemiology of Adult Bacterial Hand Infections at Two Urban Hospitals
Authors: Yassin Arsheena , Stavropoulos Christine , Woods Krystina L , Xu Jiashan , Carale Justin , Khachaturyan Elena , Taduran Chris , Sy Hendrik , Farkas Andras 
Published: January 2021

Abstract

Background
Hand infections represent a major source of morbidity, which can result in hand stiffness and amputation. Early appropriate empiric antibiotic regimen may reduce the associated morbidity, hence the importance to examine local epidemiology. The aim of this study was to define the current epidemiology of adult hand infections at two urban hospitals in New York City.

Methods
We performed a double center, retrospective study of adult patients hospitalized from March 2018 to May 2020. Patients with positive cultures associated with the hand infections were included. Retrospectively, 100 patients were reviewed. Data on baseline demographic, clinical, surgical, microbiology, and treatment parameters were collected.

Results
Of the 100 patients, 76% were male, with median age of 47.5 years (35, 58.25) and average C-reactive protein (CRP) of 50.66 mg/L (± 64.64) on admission (see Table 1). Previous hospitalization within 1 year (38%), previous surgical procedures (39%) and recent IV medication use (26%) were common. 130 bacterial isolates were identified (see Table 2). The most frequent organisms were Gram-positive, with Methicillin susceptible Staphylococcus aureus (MSSA, 25.38%), Streptococcus species (20.08%), and Methicillin resistant Staphylococcus aureus (MRSA, 15.38%) being the most common. Gram-negative organisms were infrequent, with Haemophilus parainfluenzae (3.85%), Enterobacter cloacae (3.85) and Pseudomonas aeruginosa (3.08%) being the most prevalent. Of the 100 patients, 27% had polymicrobial infections, associated with trauma (6%), illicit IV use (6%) and unknown (7%) etiologies.
Table 1: Baseline demographics and co-morbid conditions

Table 2: Types and numbers of organisms in relation to etiologies

Conclusion
Within our population, the most common organisms associated with hand infections were Gram-positive, with Staphylococcus aureus and Streptococcus species being the most prevalent. Gram-negative pathogens were infrequently isolated. The results within this study can provide guidance to clinicians on assessing the appropriate empiric antibiotic regimen in patients with hand infections, and can serve as a basis for further studies identifying risk factors associated with isolation of organisms associated with hand infections.

Disclosures
All Authors: No reported disclosures
1555. Evaluation of Local Pathogens and Management of Diabetic Foot Infections
Authors: Seadler Jessica L , Tucker Natalie , Cady Beth , Mullangi Praveen 
Published: January 2021

Abstract

Background
Diabetic foot infections (DFI) are a potentially devastating complication for patients with diabetes. When treating these patients, there is a need for selection of highly effective antibiotics coupled with a need to avoid excessive use of broad-spectrum antimicrobial agents that could lead to adverse patient outcomes. At this institution, it has been observed that there is a lack of compliance with consensus guideline recommendations for the choice of empiric antibiotic therapy for DFI, leading to overuse of broad-spectrum antibiotics.

Methods
A retrospective chart review was performed for hospitalized patients over 18 years of age that received antibiotics for DFI during the period of August 1, 2018 to July 31, 2019. Patients were excluded if they were continuing outpatient antibiotics for an existing DFI, were being treated with antibiotics for a concurrent infection, or were pregnant. The primary objective was the rate of guideline-compliant empiric antibiotic regimens as broken down by infection severity. Secondary objectives included the duration of antibiotic therapy per patient, and rates of empiric methicillin-resistant Staphylococcus aureus (MRSA) and P. aeruginosa coverage.

Results
A total of 114 patients were included in the analysis. A majority of patients had an infection of moderate severity (65.8%), followed by 19.3% with severe infections, and 14.9% with mild infections. In the total population, only 26.3% of patients received empiric antibiotic regimens that were guideline-compliant. A large percentage of patients received empiric anti-MRSA antibiotics (95.6%) and empiric anti-pseudomonal agents (89.5%). Use of these broad-spectrum agents did not differ by infection severity. Ninety-nine (86.8%) patients had a site culture collected. S. aureus was the most commonly isolated organism and there was a low rate of P. aeruginosa (10.1%).

Conclusion
There is room for improvement in the management of DFI at this institution. A specific area that has been identified is the overuse of empiric anti-pseudomonal agents in patients without risk factors for P. aeruginosa. The results of this study will be evaluated alongside consensus guidelines and used to create institution-specific treatment guidance that providers can employ to optimize the management of DFI.

Disclosures
All Authors: No reported disclosures
1556. Financial Analysis of Dalbavancin for Acute Bacterial Skin and Skin Structure Infections in a self-pay population
Authors: Murray E Yancey , Pizzuti Adam G , Bland Christopher M , Wagner Jamie L , Gaul Derek , Jones Bruce M 
Published: January 2021

Abstract

Background
Acute bacterial skin and skin structure infections (ABSSSI) are an increasing cause of admission in the self-pay population and can be difficult to treat due to socioeconomic status. We have previously described ABSSSI patients discharged to receive dalbavancin, a novel lipoglycopeptide, and shown a decreased length of stay (LOS) and total direct costs without increasing 30-day readmission rate. For patients who are financially eligible, a dalbavancin vial replacement program can offset costs in this population. The objective of this study was to determine cost differences in treating ABSSSI in self-pay inpatients discharged to receive dalbavancin compared to standard of care (SOC).

Methods
This retrospective cohort within a community health system compared self-pay adult inpatients with ABSSSI from 2/3/16 - 8/5/19 discharged to receive dalbavancin at an outpatient infusion center with SOC intravenous antibiotics. Patients were included with a diagnosis of cellulitis, abscess, or postoperative wound infections based on International Classification of Disease 10 (ICD-10) codes. Excluded populations were those without dalbavancin vial replacement performed, pregnant patients, infections caused exclusively by gram-negative bacteria or fungi, or ICD-10 codes not consistent with ABSSSI. The primary outcome was direct cost of hospital stay. Secondary outcomes included LOS, 30-day readmission rates, adverse events (AE), and indirect hospital costs. Based on previous studies, a one-sided Student’s t-test with an alpha of 0.025 deeming statistical significance was performed on the financial data.

Results
Twelve dalbavancin and 263 SOC patients met criteria for study entry. Direct cost ($2,758 vs $4,010, p=0.105) and indirect hospital cost ($2,913 vs $3,645, p=0.162) per patient was less in the dalbavancin group. There was no significant difference between median LOS (4 vs 4, p=0.888), AE (0% vs 14.8%), and 30-day readmission rates for dalbavancin vs SOC group (8.3% vs 7.2%, p=0.604).

Conclusion
Self-pay ABSSSI patients discharged to receive dalbavancin with vial replacement resulted in decreased direct and indirect cost per patient with similar 30-day readmission rates, AE, and LOS. More studies targeted toward this population are warranted to determine ultimate benefit.

Disclosures
Christopher M. Bland, PharMD, FCCP, FIDSA, BCPS, ALK Abello, Inc. (Grant/Research Support)Biomerieux (Consultant)Merck (Consultant, Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)Tetraphase (Speaker’s Bureau) Bruce M. Jones, PharmD, BCPS, ALK-Abello (Research Grant or Support)Allergan/Abbvie (Speaker’s Bureau)
1557. First Report of Nocardia veterana Soft Tissue Abscess
Authors: Radcliffe Christopher , Grant Matthew 
Published: January 2021

Abstract

Background
Members of the genus Nocardia are filamentous, gram-positive, aerobic bacteria and exist ubiquitously in most environments. In 2001, the species Nocardia veterana was first isolated, and it predominantly causes pulmonary infections in immunocompromised hosts.

Methods
We present the first report of a soft tissue abscess caused by N. veterana in a 59-year-old woman being treated for chronic cutaneous graft-versus-host disease.

Results
After failing to improve with empiric treatment, two incision and drainage procedures were required. She subsequently completed a one-year course of oral antibiotic therapy consisting of trimethoprim-sulfamethoxazole then azithromycin. No relapse occurred. To better characterize N. veterana infections, we performed a systematic literature review and summarized all previously reported cases.
Nocardia veterana abscess

Conclusion
The rising prevalence of immunocompromising conditions warrants increased vigilance for N. veterana infections and other atypical or opportunistic pathogens.

Disclosures
All Authors: No reported disclosures
1558. Injection Drug Use-Related Skin and Soft Tissue Infections Serve as Sentinel Events for Healthcare Utilization in a Vulnerable Population
Authors: Knodle Ryan D , Bielick Catherine , Burrowes Shana , Barlam Tamar F 
Published: January 2021

Abstract

Background
Persons with injection drug use (IDU) can have frequent skin and soft tissue infections (SSTIs) and high healthcare utilization. We sought to examine whether IDU-related SSTIs are associated with an acceleration in disease course and increased healthcare utilization (a ‘sentinel event’) and may present an important opportunity for intervention.

Methods
We performed a retrospective chart review of patients with an emergency department (ED) visit or hospital admission due to an IDU-related SSTI between 10/1/2015 and 6/1/2019 to obtain information on demographics, microbiologic data, addiction service consultation, and treatment with medications for opioid use disorder (MOUD). We compared the number of healthcare encounters in the 12 months before and after the SSTI using the Wilcoxon signed rank test for data with non-normal distribution. We examined differences in the distribution of variables between patients who were admitted and those discharged from the ED using Chi Square and Fisher exact tests for categorical variables and t-tests and Wilcoxon tests for continuous variables.

Results
In all, 305 patients met inclusion criteria for an IDU-related SSTI. The patients were 66.5% male, had a median age of 41 years (range 23-70), 84% were experiencing homelessness and 87% had Medicaid. Most patients (55.7%) were admitted to the hospital and the remainder were discharged from the ED. There was a statistically significant change in healthcare utilization in the year prior to the SSTI compared to the year after (median change +16.7%, p &lt; 0.0001). Compared to those who were admitted, it was rare for patients discharged from the ED to have microbiologic data sent (13% vs 87%, p &lt; 0.0001), an addiction consult completed (4% vs 96%, p &lt; 0.0001), or to be discharged on MOUD (8.0% vs 92%, p &lt; 0.0001). Despite these differences, there were no significant predictors of high vs low utilization among all-comers based on demographic and clinical data.

Conclusion
IDU-related SSTIs serve as sentinel events with increased healthcare utilization after the episode. Addiction consultation and initiation of MOUD had no impact on the trajectory of healthcare utilization. Further work must be done to identify how best to improve outcomes for this vulnerable population.

Disclosures
All Authors: No reported disclosures
1559. Methicillin Susceptible Staphylococcus aureus Is The Predominant Organism In Septic Bursitis With The Majority Involving The Olecranon Bursa: A Study Of 61 Cases
Authors: Kannangara Don , Pandya Dhyanesh 
Published: January 2021

Abstract

Background
Bursae are fluid filled structures between mobile parts of the musculoskeletal system to reduce friction between surfaces by lubrication. The most frequently infected are the olecranon and prepatellar bursae. In reported studies there is male preponderance, a relationship to occupational or recreational activities, a mean age of about 50 years and the most frequent organism being Staphylococcus aureus. The frequency of methicillin resistance is not well documented.

Methods
We analyzed approximately 7000 Staphylococcus aureus isolates reported by the laboratory over a 3-year period in 10 of our network hospitals, 9 in Eastern Pennsylvania and one in adjacent Warren County, New Jersey and found 61 cases of S. aureus septic bursitis.

Results
Only 13/61 (21.3%) were caused by methicillin resistant S. aureus (MRSA), 8 olecranon (61.5%), 4 prepatellar (30.8%) and one subacromial (7.7%). Only one in MRSA group (olecranon bursitis) was female. The mean age of MRSA cases was 58.5. Methicillin susceptible S. aureus (MSSA) predominated with 34/48 (70.8%) olecranon bursitis (28M/6F), 11/48 (22.9%) prepatellar bursitis (10M/1F) and 3/48 (6.3%) sub acromial bursitis (1M/2F) with a mean age of 61.9. Overall (MRSA +MSSA), 51/61 (83.6%) were male and 10/61 (16.4%) were female. The olecranon bursa was involved in 42/61 (68.9%), prepatellar bursa 15/54 (24.6%) and subacromial bursa 4/54 (6.6%). The mean age for the entire group was 61.2 with the youngest 23 and the oldest 93. The occupational history was recorded only in a few patients e.g. roofer, floor worker, construction worker. Three in the MSSA group had bacteremia (2 subacromial bursitis and 1 olecranon bursitis). There was 1 death from gram negative sepsis which was unrelated. The majority were successfully treated with a combination of drainage and antibiotics.

Conclusion
In summary, our study shows a predominance of olecranon bursitis, with a higher incidence in males and majority caused by MSSA. The mean age around 61 was higher than the mean age in prior reports around 50 years. Elbows and knees accounted for 57/61 (93%) cases of septic bursitis. Avoidance of activities involving friction or repeated trauma to elbows and knees should help prevention of septic bursitis. As far as we are aware, this is the largest series of septic bursitis reported.

Disclosures
All Authors: No reported disclosures
129. Antimicrobial Stewardship Intervention Bundle Decreases Fluoroquinolone Prescribing for Urinary Tract Infection in Urgent Care and Primary Care Clinics
Authors: Cubillos Ashley L , Caulder Elisabeth , Patch Megan , Saunders Mary B , Lynch Leah W , Gieselman Morris R , Calkins Karen 
Published: January 2021

Abstract

Background
Fluoroquinolone antibiotics are associated with a number of serious adverse effects, and are not recommended for use in uncomplicated infections, including urinary tract infections (UTIs), where other reasonable antibiotic alternatives exist. This analysis describes the impact of a multi-interventional antimicrobial stewardship initiative on outpatient fluoroquinolone prescribing rates for UTI within a large community health system across a variety of practice settings.

Methods
Interventions included prescriber education, standardized order sets, and monthly feedback on fluoroquinolone prescribing rates in UTI at the prescriber level (for urgent care clinics) or clinic level (for primary care/internal medicine/employee health clinics). To assess the impact of these interventions, total fluoroquinolone prescribing rate in UTI patients was compared for defined 6-month time periods pre- and post-intervention implementation.

Results
Fluoroquinolone prescriptions from urgent care clinics within our health system (N=4) for patients with a primary diagnosis of UTI decreased significantly, from 660/3081 (17.6%) in the pre-intervention period to 111/3641 (3%) in the post intervention period (P&lt; 0.0001). Prescribing in primary care, internal medicine, and employee health clinics (N=19) decreased from 492/2071 (23.8%) to 156/2287 (6.8%) (P&lt; 0.0001).

Conclusion
A multi-interventional initiative to reduce the utilization of fluoroquinolone antibiotics resulted in decreased prescribing rates of these agents for UTI across a variety of outpatient practice settings.

Disclosures
All Authors: No reported disclosures
1562. Reduction in Healthcare Utilization and Overdose after Skin and Soft Tissue Infections for Injection Drug Users through Addiction Medicine Consultation
Authors: Bielick Catherine G , Knodle Ryan D , Burrowes Shana , Barlam Tamar F 
Published: January 2021

Abstract

Background
Healthcare encounters for skin and soft tissue infections (SSTIs) due to injection drug use (IDU) may provide opportunities for interventions to improve outcomes. We explored factors that may impact reduction of healthcare utilization and modify other complications of substance use disorder after an IDU-related SSTI.

Methods
We conducted a retrospective cohort chart review for 305 patients with IDU-related SSTIs between 10/1/2015 and 6/1/2019 to examine demographic, clinical and healthcare utilization data one year before and after the SSTI encounter. Patients were categorized as a low utilizer if they had &lt; 3 emergency department encounters and as a high utilizer if they had ≥3 encounters in the one-year period before or after the SSTI. For patients that changed utilization categories from the pre- to post-SSTI period, we analyzed demographic and clinical differences using Chi Square tests. We performed a secondary analysis using a Wilcoxon test to examine the relationship between receipt of an addiction consult and change in number of overdoses after SSTI.

Results
131 patients were low utilizers at baseline and 174 were high utilizers. Patients who transitioned from low to high utilization (64 patients) were significantly less likely to have received an addiction consult, 16 (25%), than patients who transitioned from high to low utilization, 15 (48%), p=0.03. However, high utilizers were significantly more likely to remain a high utilizer (p&lt; 0.0001) with no variable predictive of transition to low utilization including addiction consultation, homelessness, insurance type, or treatment with medications for opioid use disorder. Patients who were low utilizers at baseline were more likely to remain low utilizers if they were not homeless, p=0.01. Of the entire sample, 96.2% (p&lt; 0.0001) of those admitted obtained an addiction consult, which significantly reduced rates of overdose in the following year (p=0.0014) for 223 patients for which we had overdose data.

Conclusion
Patients with IDU-related SSTIs who do not receive an addiction consult are more likely to cross from low to high utilization after the event. Preferentially targeting this population for addiction consultation can significantly improve outcomes.

Disclosures
All Authors: No reported disclosures
1569. In Vitro Activity of Ceftazidime-avibactam and Comparator Agents against Enterobacterales and Pseudomonas aeruginosa Collected from Patients with Bloodstream Infections as Part of the ATLAS Global Surveillance Program, 2015-2018
Authors: Kazmierczak Krystyna , Lob Sibylle , Stone Greg , Sahm Daniel F 
Published: January 2021

Abstract

Background
Avibactam (AVI) is a β-lactamase inhibitor with potent inhibitory activity against Class A, Class C, and some Class D serine β-lactamases. The combination of ceftazidime (CAZ) with AVI has been approved in Europe and in the United States for several indications. This study evaluated the in vitro activity of CAZ-AVI and comparators against Enterobacterales (Eba) and Pseudomonas aeruginosa (Pae) isolates collected from patients with bloodstream infections as part of the ATLAS surveillance program in 2015-2018.

Methods
A total of 57048 Eba and 15813 Pae non-duplicate clinically significant isolates, including 7720 Eba and 1286 Pae isolated from bloodstream infections, were collected in 52 countries in Europe, Latin America, Asia/Pacific (excluding mainland China), and the Middle East/Africa region. Susceptibility testing was performed by CLSI broth microdilution. CAZ-AVI was tested at a fixed concentration of 4 µg/ml AVI. Meropenem-nonsusceptible (MEM-NS) Eba and Pae isolates were screened for the presence of β-lactamase genes.

Results
Susceptibility data are shown in the Table. Percentages of susceptibility (% S) to the tested agents were 0.3-2.9% lower among Eba and Pae from bloodstream infections compared to isolates from combined sources in most cases. CAZ-AVI showed potent in vitro activity against all Eba bloodstream isolates and the CAZ-NS subset (MIC90, 0.5-2 µg/ml, 93.4-98.1% S). Reduced activity against MEM-NS Eba was attributable to carriage of class B metallo-β-lactamases (MBLs) because 99% of MEM-NS MBL-negative isolates were susceptible to CAZ-AVI. None of the tested comparators exceeded the activity of CAZ-AVI. CAZ-AVI also showed good in vitro activity against the majority of Pae bloodstream isolates (MIC90, 16 µg/ml, 89.4% S). Activity was reduced against CAZ-NS and MEM-NS subsets (54.2-63.8% S), which included isolates carrying MBLs, but exceeded the activity of CAZ and MEM against these subsets by 26-31 percentage points. Amikacin was the only tested comparator that demonstrated comparable activity against Pae bloodstream isolates.
Table

Conclusion
CAZ-AVI provides a valuable therapeutic option for treating bloodstream infections caused by MBL-negative Eba and Pae isolates.

Disclosures
Krystyna Kazmierczak, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Sibylle Lob, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Greg Stone, PhD, AztraZeneca (Shareholder, Former Employee)Pfizer, Inc. (Employee) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)