bluuebunny/crossref_metadata_2025_split huggingface dataset:
1657. Musculoskeletal Tuberculosis in a Large Healthcare System
Authors: Denmeade Travis , Smith William , Kooken Banks , Leonard Michael 
Published: January 2021

Abstract

Background
Musculoskeletal tuberculosis (TB) is an important and elusive manifestation of extrapulmonary TB. This purpose of this study was to examine incidence and associated co-morbidities of confirmed cases of musculoskeletal TB at Atrium Health, a large non-profit health system in the Southeastern United States.

Methods
Retrospective case series of 12 adult patients with confirmed musculoskeletal TB between 2008-2019. Individuals younger than 18 years were excluded. The primary objective was to compare local incidence of musculoskeletal TB with that reported in the literature. Secondary objectives included analysis of patient co-morbidities for their correlation with the development of musculoskeletal manifestations of TB and requirement of surgical correction for underlying deformities from TB infection.

Results
237 patients were identified with confirmed TB infection from 2008-2019 in a retrospective cohort within the Atrium Health System. Of 237 patients, 94 (40%) had extrapulmonary disease and 12 (5%) had musculoskeletal manifestations defined as involvement of bone, joint space, or muscle and were included in this analysis. Six (50%) of the 12 patients were foreign born individuals who immigrated to the US. Three (33%) had concomitant pulmonary disease. Vertebral involvement (8, 66%) was most common and 1 (8%) patient noted to have infected total knee arthroplasty. Other sites included wrist, sternum, ribs and pelvis. Co-morbidities evaluated included HIV status 0%, diabetes (2, 17%), immunosuppressive medications (1, 8%), ESRD 0%, and rheumatologic disease 0%. Surgical intervention was necessary in 4 (33%) patients for both diagnostic and therapeutic interventions.

Conclusion
Of those tested for HIV 100% were negative but only 50% were tested showing a need for improved HIV testing. Very few had other co-morbid conditions including diabetes, use of immunosuppressive medications, ESRD status, or rheumatologic disease. Surgical intervention was needed in 33% of patients with musculoskeletal TB including several with a preoperative suspected diagnosis of malignancy. In this retrospective case series, the incidence of musculoskeletal TB was 5% in comparison to the 2-3% reported consistently in the US.

Disclosures
All Authors: No reported disclosures
1658. Particularities Of Pulmonary Tuberculosis Among Children
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Rekik Khaoula , Smaoui Fatma , Elleuch Emna , Marrakchi Chakib , Jemaa Mounir Ben 
Published: January 2021

Abstract

Background
The diagnosis of pulmonary tuberculosis (PTB) among children remains challenging due to the non-specific clinical symptoms, laboratory features and the difficulty of sampling for microbiological investigations. We aimed to study clinical, therapeutic and evolutionary features of PTB among children.

Methods
We conducted a retrospective study including all children aged ≤ 18 years diagnosed with PTB between 1995 and 2016.

Results
We encountered 67 children with PTB, among whom 37 (55.2%) were female. The median age was 15 years [1-18years]. According to residency, 36 patients came from rural area (53.7%). We noted 7 cases (10.4%) of miliary tuberculosis (TB). Three cases of pleural TB (4.5%), one case of lymph node TB (1.5%) and one case of neuromeningeal TB were associated to PTB. Induced sputum or gastric aspirate were positive for Mycobacterium tuberculosis in 67.9% of the cases. Serologic tests for human immunodeficiency virus was positive in one case (1.5%). The mean duration of antitubercular therapy was 8 ±2 months. The treatment regimen was based on a quadritherapy for the first 2 months, followed by a bitherapy for the rest of the period. Fixed dose drug combinations were prescribed in 17 cases (25.3%). The disease evolution was favourable in 65 cases (97%). Two patients were dead (3%). There were no relapsing cases.

Conclusion
Prompt diagnosis and treatment of PTB among children improve the prognosis. Screening for PTB among children exposed to adult tuberculosis is crucial in order to prevent the disease.

Disclosures
All Authors: No reported disclosures
1659. Pharmacokinetics/pharmacodynamics of the Novel Gyrase Inhibitor SPR719/SPR720 and Clinical Dose Selection to Treat Pulmonary Mycobacterium avium-complex Disease
Authors: Deshpande Devyani , Kuret Daniel , Cirrincione Kayle , Cotroneo Nicole , Melnick David , Lister Troy , Stokes Suzanne , Gumbo Tawanda 
Published: January 2021

Abstract

Background
Current therapy for pulmonary Mycobacterium avium-complex [MAC] disease achieves poor sustained sputum conversion rates and is poorly tolerated. SPR719, the active metabolite of SPR720, a novel gyrase inhibitor, has demonstrated low MICs against MAC. SPR720 is being developed as an oral therapy for use in combination with other antibiotics for the treatment of patients with pulmonary disease due to infection with MAC. Our objective was identify SPR719 pharmacokinetic/pharmacodynamic [PK/PD] parameters and optimal SPR720 dose for treatment of pulmonary MAC.

Methods
SPR719 was administered once daily for 28 days using a simulated human half-life of 3.3 hours in the hollow fiber system model of pulmonary intracellular MAC [HFS-MAC]. Bacterial burden, including for SPR719-resistant subpopulations, and drug concentrations, were measured via repetitive sampling of HFS-MAC units. A separate dose fractionation study in the HFS-MAC was used to identify the PK/PD index linked to effect. MAC burden versus SPR719 exposure was modeled using the inhibitory sigmoid maximal effect [Emax] model and resistance using the “antibiotic resistance arrow of time” model. Finally, we performed Monte Carlo Experiments to identify the optimal clinical dose of SPR720 monotherapy.

Results
The median HFS-MAC intracellular-to-extracellular SPR719 AUC0-24 ratio was 2300:1. The PK/PD parameter best linked to microbial kill was determined to be AUC0-24/MIC. SPR719 Emax was -1.5 log10 cfu/mL compared to day 0; 1.0 log10 cfu/mL reduction and acquired-resistance suppression were achieved by an AUC0-24/MIC of 2.0 and 11, respectively. SPR720 1,000 mg/day was predicted to achieve 1.0 log10 cfu/mL kill in 95%, and resistance suppression in 43%, of 10,000 simulated subjects.

Conclusion
SPR720 monotherapy is predicted to achieve exposures associated with bactericidal effect against pulmonary MAC in 95% of patients at doses that have recently been established to be safe and well tolerated. These data support the continued development of SPR720 for the treatment of pulmonary MAC.

Disclosures
Nicole Cotroneo, Spero Therapeutics (Employee) David Melnick, MD, Spero Therapeutics (Employee)Spero Therapeutics (Employee) Troy Lister, PhD, Spero Therapeutics (Employee) Suzanne Stokes, PhD, Spero Therapeutics (Employee, Shareholder) Tawanda Gumbo, MD, Praedicare Inc (Employee, Shareholder)
1662. The Prevalence of M. tuberculosis among Acid Fast Cultures from Military Health System Beneficiaries from Hawaii and Pacific Islands from January 2002 to November 2019
Authors: Crecelius Elena M , Lustik Michael , Horseman Timothy , Jones Milissa 
Published: January 2021

Abstract

Background
Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), is the leading infectious cause of death worldwide and the state of Hawaii (HI) has the second highest case rate of TB in the United States. The prevalence of TB among military health system (MHS) beneficiaries (active duty service members, retirees, dependents, civilians and eligible Pacific Island civilians) in HI has not been previously reported. Our analysis evaluates the prevalence of MTB among acid fast cultures (AFCs) tested at Tripler Army Medical Center (TAMC) on Oahu, HI and describes demographic factors associated with positive samples.

Methods
We analyzed AFC results from TAMC clinical diagnostic microbiology laboratory from January 2002 to November 2019. Demographic data were recorded for each individual with an AFC sample during the study period. Prevalence was calculated based on the number of MTB-positive AFCs per all AFCs over the study period. Multivariable logistic regression was used to evaluate associations between demographic factors and MTB-positive AFC results.

Results
From January 2002 to November 2019 there were 4768 AFCs resulted at TAMC with 49 MTB-positive AFC, leading to a cumulative prevalence of 1.03 percent (Figure 1). After controlling for other factors, Asian-Pacific Islanders had nearly 15 times higher odds of having a positive AFC than whites (OR=14.96, 95% CI 5.03, 44.55, p=&lt; 0.001) and active duty personnel had 2.6 times the odds of having a positive AFC than dependents, civilians and retirees (OR=2.6, 95% CI 0.94, 7.22, p=0.067).
Figure 1. The Prevalence of M. tuberculosis (MTB) among Acid Fast Cultures (AFC) from Military Health System Beneficiaries from Hawaii and Pacific Islands from January 2002 to November 2019.

Conclusion
The low prevalence of MTB among AFCs performed at our institution over nearly 16 years suggests that living in the state of HI does not appear to confer high rates of TB to MHS beneficiaries. Persons with Asian-Pacific Islander ethnicity have higher odds of positive AFC which corroborates prior studies regarding risk factors for MTB. Further analysis is needed to further define risk factors associated with positive AFC among MHS beneficiaries in HI. Follow-up analysis is underway to describe the clinical course of the persons with MTB-positive AFC from this study.

Disclosures
All Authors: No reported disclosures
1663. The Significance of Acid Fast Cultures in Peritoneal Dialysis-associated Infections: A Non-tuberculous Mycobacteria Case Series
Authors: Lusby Heather , Cannella Anthony 
Published: January 2021

Abstract

Background
Non-tuberculosis mycobacteria (NTM) are a group of Mycobacterium that are defined as species other than Mycobacterium tuberculosis complex and Mycobacterium leprae. Rapid growing NTM’s grow on culture media as early as 5-7 days. NTM’s are considered a rare cause of peritoneal dialysis (PD) associated infections.

Methods
We highlight four cases of PD catheter associated infections due to rapid growing NTMs to covey the importance of these bacteria in the setting of PD associated infections.

Results
All of our cases all were on PD due to their end stage renal disease (ESRD). Case 1 is a 55-year-old man who was on PD due to IgA nephropathy. He had ulceration around catheter site and abdominal pain for 3 months prior to presentation. Catheter site and peritoneal fluid were both positive for Mycobacterium abscessus. Case 2 is a 59-year-old woman with who was on PD due to Alport syndrome. She presented with fever and pain around PD catheter site. Cultures were positive for Mycobacterium fortuitum. Case 3 is a 68-year-old woman who was on PD due to diabetic nephropathy. She presented after increased drainage around PD-catheter site after 2 months duration. Cultures from catheter site grew Mycobacterium porcinum. Case 4 is a 73-year-old male with who was on PD due to diabetic nephropathy. He presented due to erythema around his PD catheter site. Catheter site cultures were positive for M. abscessus. Each case was treated based upon culture data and for varied length of time, which can be further seen in Table 1.
Table 1

Conclusion
Typical organisms that cause peritonitis and PD exit site infections are from skin flora contamination. The International Society of Peritoneal Dialysis recommends anaerobic and aerobic cultures to be obtained in suspected peritonitis. Expected culture negative rate are typically about 10-20%. NTM’s can be often missed and diagnosed as a culture negative infection if routine acid-fast bacilli (AFB) cultures are not obtained. Also, NTMs are likely to be under represented since these are not considered reportable. A high index of suspicion would mandate culturing for NTMs as a potential cause of PD catheter associated infection. With having 4 cases all in Florida, we would like to stress the importance of ordering AFB cultures in PD catheter associated infections.

Disclosures
All Authors: No reported disclosures
1666. Yield of Tuberculosis Contact Tracing among Veterans after Outpatient Exposure
Authors: Yang Janet , Fritz Carman , Kundu-Raychaudhuri Smriti , Dailey Jeffrey , Bang Heejung , Nguyen Hien , Maniar Archana 
Published: January 2021

Abstract

Background
Tuberculosis contact tracing (TBCT) is essential to detecting transmission. High priority contacts for TBCT include children less than 5 and those with prolonged, close contact with a tuberculosis (TB) case. Other populations considered high priority include those with certain comorbidities. While data are limited, there is evidence for transmission in outpatient settings with short duration/casual contact. We describe the yield of TBCT among a high priority cohort after exposure in to active TB in VA clinics.

Methods
Between 2016-2019, VA Northern California performed 4 episodes of TBCT in the outpatient setting. In TBCT 1, the index case was an AFB smear positive healthcare worker (HCW) with 30-minute patient appointments. In TBCT 2-4, the index cases were patients, 2 of whom were AFB smear positive. TBCT included patients seen by the HCW (TBCT 1) and those with appointments one hour before or after the index patient in the same clinic (TBCT 2-4). Contacts were offered interferon-gamma release-assay (IGRA). Staff contacts were tested by purified protein derivative (PPD). Comorbidities, prevalent and new cases with positive TB testing were calculated and compared between different groups.

Results
Fifty-one percent of veteran contacts had comorbidities placing them in a high priority group for TBCT. Among the 593 patients who had an IGRA during TBCT, 40 (6.7%) tested positive. Twenty-six (4.4%) had no known history of prior positive TB test of whom 6 reported a previous TB exposure history. Veterans exposed to the HCW did not have a higher prevalence of IGRA positivity or a new positive IGRA compared to TBCT 2-4 (5.5% vs 8.0%, p-value 0.22 and 3.4% vs. 5.3%, p-value 0.26). Among the 130 staff tested in TBCT 1-4, one (0.7%) converted during TBCT 1.

Conclusion
After extensive TBCT, the prevalence of latent TB among short duration/casual contacts of TB was 6.7%, similar to the baseline prevalence of latent TB of 6% in California. In this high priority population for TBCT, no difference was seen when there was face-to-face contact versus a shared waiting room with the index case. Staff conversion rate was extremely low. While decisions to perform TBCT in outpatient settings need to be individualized, the yield of TBCT in this population of veterans was low.

Disclosures
All Authors: No reported disclosures
1671. Diagnosis and management of Escherichia coli bacteriuria at a Veterans Affairs hospital
Authors: Shah Niyati H , Decker Brooke K , Decker Brooke K , Sgro Gaetan , Boudreaux-Kelly Monique Y , Corredera Erica 
Published: January 2021

Abstract

Background
The IDSA recommends against screening for and treating ASB in all patients except for those pregnant or undergoing urologic procedures. Nevertheless, antibiotic treatment of ASB is widespread. We conducted a retrospective analysis of physician practices in diagnosis and management of Escherichia coli (E. coli) ASB in a male Veteran population, and compared outcomes in ASB patients treated or not treated with antibiotics.

Methods
Patients with an E. coli positive urine culture during an ED visit or inpatient admission from 01/2017 to 12/2017 were screened. Patients admitted to the intensive care unit or diagnosed with a sexually transmitted infection, pyelonephritis, prostatitis, or epididymitis/orchitis were excluded. A total of 163 patients were included. Demographics, clinical comorbidities and severity of illness, and outcomes were compared in ASB patients managed with or without antibiotics. ANOVA and Chi-square or Fisher’s exact tests were utilized for comparing measurements.

Results
ASB was present in 92/163 patients. The majority (74%) of these patients were given antibiotics. Regardless of qSOFA score or alternate infection, there were no significant differences in outcomes between ASB patients treated or not treated with antibiotics: 3-month mortality (15% vs 21%; p = 0.53), emergence of newly resistant bacterial pathogens (7% vs 13%; p = 0.43), recurrent urinary tract infections (61% vs 50%; p = 0.72), clearance of urinary pathogens (75% vs 58%; p = 0.45), length of hospital stay (7 vs 6 days, p = 0.67). Factors that were predictive of physician treatment of ASB included patient comorbid conditions such as benign prostatic hyperplasia, pyuria, and the absence of hematuria. The incidence of adverse events with antibiotic treatment of ASB was low.

Conclusion
The rate of antibiotic treatment of E. coli ASB in male veterans is high. Outcomes do not differ among ASB patients managed with or without antibiotics. Future studies examining outcomes in patients prescribed antibiotics for multiple episodes of ASB may yield differences, particularly in emergence of resistant pathogens. Focusing on patients with comorbid conditions who are not critically ill would be a high yield target for provider education to reduce ASB treatment.

Disclosures
All Authors: No reported disclosures
1674. Epidemiology of Urinary Tract Infections in the Renal Transplant Population in a Large Urban Midwestern Hospital: A Retrospective Cohort Study
Authors: Kumar Rebecca Nirmal , Zembower Teresa , Stosor Valentina 
Published: January 2021

Abstract

Background
Renal Transplant Recipients (RTR) are at high risk for Urinary Tract Infections (UTIs). However, the best empiric option for treatment is not well defined, because the prevalence of extended spectrum beta-lactamase (ESBL) Enterobacteriaceae and carbapenem resistant Enterobacteriaceae (CRE). The primary purpose of this study was to describe the prevalence of multidrug resistant UTIs in a contemporary cohort of RTR at a large Midwestern tertiary care hospital. Secondary outcomes evaluated frequency of key symptoms and physical exam findings, as well as characteristics of patients who developed multidrug resistant organisms, morbidity, and mortality.

Methods
This was a single-center retrospective cohort study. Patients were included if they were 18 years or older and underwent their transplant between July 11, 2019 and November 26, 2018. Statistical analysis was performed using Fischer’s Exact T-test for comparison of the patients with and without ESBL UTIs. Significance was defined by a p&lt; 0.05

Results
Two hundred fifty-two patients were evaluated (median age 54.4, 38.3% female gender), 36 patients developed UTIs, and no patients had CRE organisms. ESBL UTI prevalence was 7/252 (2.8%) among the total RTR population and 7/36 (19.4%) among the population of RTR who developed UTIs. Mortality rates did not differ significantly between patients with and without ESBL UTI (0% and 6.9%, respectively, p=.489) (Table 1). Additional clinical characteristics of the patients that developed ESBL UTIs were also obtained (Table 2).
Table 1: Comparison of non-ESBL UTI and ESBL UTI

Table 2: Characteristics of Patients with ESBL UTI

Conclusion
Prevalence of ESBL UTIs among RTR are low at a tertiary Midwestern hospital.

Disclosures
All Authors: No reported disclosures
1675. Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018
Authors: Foster Kendra , Polgreen Linnea A , Faine Brett , Polgreen Philip M 
Published: January 2021

Abstract

Background
Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting.

Methods
We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization.

Results
There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively.

Conclusion
E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common.

Disclosures
All Authors: No reported disclosures