bluuebunny/crossref_metadata_2025_split huggingface dataset:
1667. Change in characteristics of community-onset ciprofloxacin-resistant E. coli isolates causing community-acquired acute pyelonephritis in South Korea
Authors: Kim Bongyoung , Kwon Ki Tae , Ryu Seong-yeol , Wie Seong-Heon , Jo Hyun-uk , Kim Jieun , Park Se Yoon , Hong Kyung-Wook , Kim Hye In , Kim Hyun ah , Kim Mi-Hee , Bae Mi-Hyun , Sohn Yong-Hak , Kim Jieun , Lee Yangsoon , Pai Hyunjoo 
Published: January 2021

Abstract

Background
The aim of this study was to examine the change in characteristics of community-onset ciprofloxacin-resistant (CIP-R) E. coli isolates causing community-acquired acute pyelonephritis (CA-APN) in South Korea between 2010-2011 and 2017-2018.

Methods
E. coli samples isolated from the blood or urine were collected from patients with CA-APN aged 19 years and more who were admitted to 8 Korean hospitals from September 2017 to August 2018, prospectively. One isolate was collected from each patient. Phylogenetic typing, multilocus sequence typing (MLST), and molecular characterization of β-lactamase resistance and plasmid-mediated quinolone resistance (PMQR) determinants were performed. The data were compared with those from the previous study with same design in 2010-2011.

Results
A total of 346 and 300 isolates were collected during 2017-2018 and 2010-2011, respectively. Among them, 76 (22.0%) and 77 (25.7%) were CIP-R isolates. Significantly higher antimicrobial resistance against ampicillin (75.7% vs. 100%, P &lt; 0.001) and cefotaxime (23.9% vs. 77.9%, P &lt; 0.001) were observed for isolates in 2017-2018 compared to those in 2010-2011. The proportion of phylogenic group B2 had increased significantly (44.7% vs. 79.2%, P &lt; 0.001). As for MLST, the proportion of ST131 (27.6% vs. 66.2%, P &lt; 0.001) had increased while that of ST393 (18.4% vs. 3.9%, P =0.004) had decreased significantly. Higher proportion of CIP-R E. coli isolates in 2017-2018 had extended-spectrum β-lactamase (ESBL)/plasmid-mediated AmpC β-lactamase (PABL) (23.7% vs. 79.2%, P &lt; 0.001) and PMQR determinant (11.8% vs. 40.8%, P &lt; 0.001) compared to those in 2010-2011.
Phlogenetic tree

Analyzed by SplitsTree

Conclusion
Among uropathogenic CIP-R E. coli isolates in South Korea, ST131 predominance had become more prominent and the proportion of containing ESBL/PABL and/or PMQR determinants had increased.

Disclosures
All Authors: No reported disclosures
1668. Clinical Risk Score Model for Predicting Extended Spectrum Beta Lactamase (ESBL)-Positive Urinary Tract Infection among Hospitalized Filipino Patients: a Retrospective Single-Center Study
Authors: Edding Sherida , Cadeliña Jekrylei , Leaño Danice Romagne , Panaligan Mario , Hufano Ma Charmian 
Published: January 2021

Abstract

Background
Infections caused by Extended-Spectrum B-lactamases (ESBL) organisms are an emerging health concern worldwide. In the background of progressive rise of antibiotic resistant organisms, efforts should be started to minimize antibiotic resistance. The development of clinical risk score models to predict the possibility of infection with these drug resistant organisms will bridge the gap between treating too late and treating too early and too much.

Methods
This is a single-center cross-sectional study of ESBL positive urinary tract infection (UTI) among patients admitted at St Luke’s Medical Center - Global City from January 2018 to December 2018. A total of 93 patients positive for ESBL-positive UTI and 186 patients with ESBL-negative UTI were included in the study. Clinical characteristics, medical and medication histories were obtained from the computerized medical database. To develop the risk score, clinical risk indicators measured at the time of recruitment were built by logistic regression. Regression coefficients were transformed into item scores and added up to a total score. A risk-scoring scheme was developed from clinical predictors.

Results
The following factors were observed to be predictive of ESBL UTI: hospital-acquired or healthcare-associated infection, prior ESBL infection, cardiac comorbidity and history of carbapenem intake. Scoring for the predictive model is as follows: having age at least 50 years old=1.5, hospital-acquired or healthcare-associated infection=1, having prior ESBL infection=2, having cardiac comorbidity (NYHA I-II)=1, having cardiac comorbidity (NYHA III-IV)=2.5, and history of carbapenem intake=3. ROC analysis showed that the optimum cut point in the model predictive of ESBL is 3.5/10. The risk prediction model for ESBL had high sensitivity of 87%, medium specificity of 68%, and good predictive accuracy of 0.78.

Conclusion
A simple and non-invasive scoring scheme of three predictors provides good prediction indices for presence of ESBL organisms in patients diagnosed with UTI. However, a large sample study is needed to improve the power of the study. Validation studies are also needed.

Disclosures
All Authors: No reported disclosures
1678. Evaluation of Sodium-Glucose Co-Transporter 2 Inhibitor Therapy and Other Potential Risk Factors for the Development of Bacteremia in Patients with Urosepsis
Authors: Slaten Kelly , Harnden Adam , Britton Johnathyn , Covington Elizabeth W , Johnson William 
Published: January 2021

Abstract

Background
Though sodium-glucose co-transporter 2 (SGLT2) inhibitors have been associated with an increased risk of urinary tract infection, it is unknown whether SGLT2 inhibitors increase the risk of urinary-source bacteremia. Early recognition of bacteremia risk factors in patients with urosepsis could allow rapid management to improve patient outcomes. The purpose of this study is to assess patients presenting with urosepsis and a positive urine culture to evaluate the impact of sodium-glucose co-transporter 2 (SGLT2) inhibitor receipt and other potential risk factors for developing bacteremia.

Methods
This was a single-center, retrospective, case-control study performed at a community hospital. Patients were included if they presented with a positive urine culture and met pre-specified criteria for urosepsis. Patients were categorized in one of two groups: bacteremia and non-bacteremia. The following patients were excluded: confirmed pregnancy, age less than 18 years, and/or a proven source of bacteremia outside the urogenital tract. The primary endpoint assessed the percentage of patients taking a SGLT2 inhibitor in the bacteremia versus non-bacteremia groups. Independent risk factors for bacteremia were assessed via binary logistic regression. Additional statistical analysis included chi-square for categorical data and Student’s t-test for continuous data.

Results
A total of 162 patients were analyzed in the study (n=81 in bacteremia and non-bacteremia groups). There was no difference in percentage of patients with or without bacteremia who received SGLT2 inhibitor therapy (p = 0.499). The following were identified as independent risk factors for bacteremia in the binary logistic regression analysis: temperature ≥ 100.4 degrees Fahrenheit (OR 4.1; 95% CI 1.5 – 11.4), bicarbonate level &lt; 20 mmol/L (OR 11.4; 95% CI 3.1 – 41.5), and blood glucose level &gt; 180 mg/dL (OR 3.9; 95% CI 1.3 – 11.6).

Conclusion
In this study of patients in a community hospital, SGLT2 inhibitors in the setting of patients with urosepsis and positive urine cultures did not increase the risk for bacteremia. Independent risk factors associated with an increased risk of bacteremia included temperature ≥ 100.4 degrees Fahrenheit, bicarbonate level &lt; 20 mmol/L, and blood glucose level &gt; 180 mg/dL.

Disclosures
All Authors: No reported disclosures
1680. Evaluation of the Urinalysis Reflex to Culture Sensitivity and Impact on Antibiotic Utilization
Authors: Wellen Jacob , Harrington Nicole , Leri Jessica 
Published: January 2021

Abstract

Background
In June of 2016 at ChristianaCare a urinalysis with reflex to culture (UARC) order set was made available, which allows for urine cultures to be performed automatically if pre-defined criteria for a positive urinalysis are met. The objective of this study was to evaluate the utility of the UARC as it relates to identifying a symptomatic urinary tract infection (UTI), as well as to describe the impact of UARC on antibiotic utilization.

Methods
A retrospective cohort study was performed including patients aged 18 to 89 ordered a UARC. Patients were excluded if they were currently pregnant, had an absolute neutrophil count of &lt; 100 cells/mm3, were undergoing a urological procedure, or receiving antibiotics for another indication. The primary outcome of this study was to determine the utility of the UARC in identifying a symptomatic UTI, as determined by the Youden index. Secondary outcomes evaluated included mean days antibiotics and length of stay, adherence to duration of treatment guidelines, 30 day post discharge readmissions, 30 day post discharge mortality, and new Clostridioides difficile infection within 30 days.

Results
A total of 123 patients were included in this study. A Youden index of 7.2% was calculated for the primary outcome. Patients with a positive UARC and UTI symptoms received an average of 7.54 days of antibiotics. Asymptomatic patients with a positive UARC received significantly more antibiotics than those with a negative UARC (3.05 vs 0 days, respectively,p=0.02). Adherence to duration of treatment guidelines was found to be 77.8%, 66.7%, and 50% for uncomplicated cystitis, complicated cystitis and pyelonephritis respectively. No difference was observed between groups for length of stay, 30 day post discharge readmissions, and 30 day post discharge mortality. No cases of new C. difficile infection were identified.

Conclusion
This study demonstrates that the UARC does not have utility as a diagnostic test for predicting a symptomatic UTI. The presence of a positive UARC in the absence of symptoms attributable to a UTI resulted in inappropriate prescribing of antibiotics. Further evaluation of how a UARC is ordered, perhaps requiring prescribers to document urinary symptoms, in addition to caregiver education is warranted

Disclosures
All Authors: No reported disclosures
1682. Health Resource Utilization in Patients with Complicated Urinary Tract Infections (cUTI) and Antibiotic Resistance or Treatment Failure: A Retrospective Database Analysis
Authors: Sulham Katherine , Reese Jennifer 
Published: January 2021

Abstract

Background
In the United States, urinary tract infections (UTIs) are predominately treated in the outpatient setting. Resistance to gram-negative bacteria has substantially increased in recent years, however, and many common oral treatment options continue to lose efficacy. As a result, patients may receive multiple courses of antibiotics at various outpatient settings and may ultimately require hospitalization. Here, we quantify health resource utilization and rate of hospitalization in patients with complicated UTI (cUTI).

Methods
A retrospective study was performed in partnership with Komodo Health, Inc., using aggregate data from the Komodo Healthcare Map™ for cUTI-related events. Inclusion criteria: (1) 2+ UTI-related encounters within 35 days, beginning in 2017-2018, (2) clinical/coding features indicative of treatment failure or antibiotic resistance, or treatment with carbapenem or piperacillin/tazobactam.. Location of service, number of cUTI-related healthcare encounters, and rate of hospitalization following service location were quantified.

Results
1,889,216 cUTI patients with antibiotic resistance or treatment failure were identified; 1,545,559 were included in the site of care analysis. These patients incurred 8,694,236 cUTI-related healthcare encounters in 2017-2018. In 2017, among 1,105,459 patients, there were 385,981 cUTI-related inpatient hospitalizations, 798,574 emergency department (ED) visits, 285,985 long-term care (LTC) stays, 147,291 home health (HH) visits, and 2,534,083 other outpatient (OP) encounters. For patients with an ED visit, the mean number of visits was 1.67/patient; mean number of LTC, HH, and OP visits were 1.67, 3.07, and 2.97/patient, respectively. Of those who were hospitalized, 38% of patients were hospitalized following an ED encounter; hospitalization rates following LTC, HH, and OP visits were 30%, 43%, and 24%, respectively. The 30-day cUTI-related rehospitalization rate for inpatients was 12%. 2018 data was similar.

Conclusion
cUTI is associated with substantial health resource utilization, the majority of which occurs in the outpatient setting.

Disclosures
Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor) Jennifer Reese, PharmD, Spero Therapeutics (Employee)
1710. Comparison of herpes simplex prevalence in serum and semen-cervical sample of infertility patients: A systematic review and meta-analysis
Authors: Chiu Chia-Yu , Sarwal Amara , Yangga Peter , Feinstein Addi , Hennessey Karen 
Published: January 2021

Abstract

Background
Herpes simplex virus (HSV) is a common pathogen of sexually transmitted infections, however the role it plays in the development of infertility is unknown. In animal studies, inoculating murine rete testis with HSV-1 revealed irreversible atrophy of the germinal epithelium. Another study found that human herpesvirus 1 thymidine kinase (HHV-1 TK) protein disrupts spermatogenesis by creating immature sperm and accelerating apoptotic cell death in rodent. Although it is well established that herpes virus affects fertility in male animal models, the question remains as to the effect of HSV in human infertility.
Routine testing of serum HSV IgG/IgM/DNA or HSV PCR in semen-cervical sample is not commonly done in clinical practice, and there are no set guidelines as when to screen. We aim to review the available literature and compare the prevalence of HSV in serum versus semen-cervical samples, focusing on the infertile patient population.

Methods
We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov from inception to December 2019. Our search terminology included: “Herpes, Human herpesvirus, infertility.” Inclusion criteria required testing to be done on either serum, sperm, menstrual fluid, or endocervical sample in infertile patients.
PRISMA Flow Diagram for study selection.

Results
17 retrospective studies were included in this review. In the male-infertility cohort, a total of 11 studies were compared. The random-effects pooled prevalence was 12.7% in semen sample, and 16.8% in serum sample. In the female-infertility cohort, a total of 6 studies were compared. The random-effects pooled prevalence was 12.1% in menstrual fluid /endocervical sample, and 17.8% in serum sample.
Figure 1. Studies enroll in this meta-analysis, Male

Figure 2. Studies enroll in this meta-analysis, Female

Conclusion
The prevalence of HSV in semen-cervical sample was about 12%, compared to HSV in serum sample is about 17%. Therefore, HSV contribution to infertility will be overestimated when we use serum sample for diagnosis. It is noteworthy to mention that the seroprevalence of HSV IgG is much higher in general population, previously reported at 35% to 50%. In addition, given that current antiviral treatment for HSV has side effects that could cause infertility on its own, as seen in animal studies. More studies are needed to evaluate the role HSV plays in causation of infertility.

Disclosures
All Authors: No reported disclosures
1711. Comparison of the clinical course and prognosis of dengue cases with and without Diabetes Mellitus
Authors: Rivera-Ortiz Lorreine , Torres-Borrero Natasha , Rodriguez-Gonzalez Robert , Alvarado-Domenech Luisa I , Rivera-Amill Vanessa 
Published: January 2021

Abstract

Background
Dengue, the most prevalent arboviral infection disease worldwide affects more than 2.5 billion people. Puerto Rico has endemic transmission of dengue virus (DENV). Chronic diseases like diabetes mellitus (DM) tend to increase susceptibility to infectious diseases. Diabetes mellitus (DM) is also one of the chronic diseases with higher prevalence in the United States (9.1%) and Puerto Rico (12.8%), and its effect on arboviral infections is understudied.

Methods
A Sentinel Enhanced Dengue Surveillance System was established in a tertiary hospital in the southern region of Puerto Rico. Study aims are to describe and compare the clinical course and prognosis of dengue in patients with and without the DM co-morbidity. A retrospective case-control study (2012-2015) was performed, where 1,005 participants with confirmed dengue were identified.

Results
In those with dengue, we examined 57 cases with DM and 171 controls without DM on presentation. Mean age of participants was 40 years old, 31 (54.4%) were males. Relevant clinical features of cases were high blood pressure (HBP) in 51%, muscle pain (70.2%) and joint pain (63.2%). Laboratory results were thrombocytopenia (40%), high creatinine &gt;1.2mg/dl (18.5%), high BUN &gt;20mg/dl (16.6%) and low albumin &lt; 3.4 g/dl (28.7%). For controls, clinical and laboratory results were HBP in 26.9%, muscle pain (64.3%) and joint pain (56.7%); thrombocytopenia (38.6%), high creatinine (4.7%), high BUN (1.8%) and low albumin (21.6%). ANOVA test compared the means of clinical features and laboratory parameters between the case and control groups. The results indicate that high blood pressure, high creatinine and high BUN were significantly more common in cases than in controls (P &lt; 0.01). Cases that had high creatinine (OR = 2.03 [CI: 0.01 – 6.08]), high BUN (OR = 1.30 [CI: 0.93 – 1.81]) and high blood pressure (OR = 1.02 [CI: 0.93 – 1.11]) were more likely to present bleeding, a warning sign for severe dengue. Also, diabetic cases that presented thrombocytopenia were more likely to be admitted to the hospital (OR = 2.64 [CI: 0.36 – 19.37]).

Conclusion
Understanding the clinical manifestation of dengue in patients with DM can increase clinician awareness of the importance of this co-morbidity in order to implement preventive measures and improve clinical outcomes.

Disclosures
All Authors: No reported disclosures
1712. Epidemiology, Clinical Characteristics, and Outcomes of Influenza-Associated Hospitalizations in Children in the post-2009 Pandemic Era
Authors: Kamidani Satoshi , Garg Shikha , Campbell Angela P , Cummings Charisse N , Openo Kyle P , McMullen Chelsea L , Chai Shua , Herlihy Rachel , Yousey-Hindes Kim , Monroe Maya , Kim Sue , Lynfield Ruth , Dufort Elizabeth , Billing Laurie M , Sutton Melissa , Talbot Helen , McCaffrey Keegan , Anderson Evan J 
Published: January 2021

Abstract

Background
Significant changes in influenza vaccination coverage and antiviral treatment guidance occurred following the 2009 influenza pandemic in children. However, data are limited describing recent epidemiology, clinical characteristics, antiviral use, vaccine coverage, and outcomes of influenza-related hospitalizations in children.

Methods
Children &lt; 18 years hospitalized with influenza during seasons 2010–2011 through 2018–2019 were included through the US Influenza Hospitalization Surveillance Network (FluSurv-NET). Age-stratified hospitalization rates were calculated using the number of catchment-area residents with laboratory-confirmed influenza within 14 days prior to or ≤3 days after hospital admission during October 1-April 30 of each influenza season. Data on underlying medical history, influenza vaccination, antiviral use, and outcomes were abstracted from medical records using standard case report forms by trained surveillance officers.

Results
Over 9 seasons, 13,235 children were identified. Stepwise decreases in unadjusted hospitalization rates with age occurred, with the highest rates in infants &lt; 6 months (ranging 56–184 per 100,000 persons) (Fig.1). Among these children, 56% were male, 34% were non-Hispanic White, 55% had a preexisting medical condition, and 8% were immunocompromised (Table 1). Use of antiviral treatment substantially increased from 56% to 85%, and influenza vaccination rates among hospitalized children increased from 34% to 43% over time. Regarding severe outcomes, 2,676 (20%) were admitted to ICU, 2,262 (17%) had pneumonia, 690 (5%) required mechanical ventilation, and 72 (0.5%) died. In univariable analysis, compared to hospitalized infants &lt; 6 months, children &gt;13 years had higher odds of ICU admission (odds ratio (OR), 2.0; 95% CI, 1.7–2.4), mechanical ventilation (OR, 1.7; 95% CI, 1.2–2.3), and pneumonia (OR, 2.6; 95% CI, 2.1–3.3) (Table 2).
Figure 1

Table 1

Table 2

Conclusion
Although influenza-related hospitalization rates decreased with increasing age, severe outcomes were more common among hospitalized older children. Room for improvement exists in influenza vaccination coverage and antiviral use. While 20% of children were admitted to ICU, death was uncommon.

Disclosures
Sue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support) Melissa Sutton, MD, MPH, CDC funding (Emerging Infections Program) (Grant/Research Support) Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator)
146. Outpatient Antibiotic Stewardship in the COVID Era: Trends in antibiotic prescription in a statewide Veteran’s Affairs health care system
Authors: Werzen Alissa , Dave Rohini , Talwani Rohit , Bork Jacqueline 
Published: January 2021

Abstract

Background
Outpatient antibiotic stewardship is an emerging area of interest. The COVID-19 pandemic has led to unique restrictions such as social distancing and an increase in telemedicine visits. The effects on outpatient antimicrobial prescription needs further exploration.

Methods
We investigated the outpatient antimicrobial prescription trend pre (January 5 to March 14 2020) and post (March 15 to May 31 2020) COVID-19 restrictions at the Veteran’s Affairs Maryland Health Care System. We compared prescribing characteristics pre and post restrictions using Chi-squared and Mann Whitney U tests. Segmented regression analysis was used to compare antimicrobial prescriptions per 1000 encounters, with a control group from the same weeks in 2019.

Results
There were 3,881 total antibiotics prescribed for 382501 encounters during the 16 weeks in 2020. Post-restrictions, there was a significant decrease in encounters and antibiotics per week with mean difference of -15241 and -147, for encounters and antibiotics, respectively. The mean antibiotics per 1000 encounters was slightly higher in the post-restriction group, but without statistical significance by this analysis (10.1 vs 10.4, p-value 0.48). Other notable changes post-prescription described in the Table was a decrease in macrolide and an increase in trimethoprim-sulfamethoxazole; urgent care prescriptions decreased, while primary care prescription increased; and refill prescriptions were less common, while mail prescriptions were more common. On regression analysis, we found a significant level change of +2.7 antibiotics per 1000 encounters (p=0.02) immediately after restrictions were placed, without any significant change in trend (Figure). This translates to an additional 243 antibiotics prescribed during the post-restriction weeks. This was in comparison to data from 2019 which had no significant level or trend change during the same weeks.
Table 1. Characteristics of antibiotics prescribed and comparison between pre and post COVID-19 restrictions in 2020, with 2019 control.

Figure 1. Segmented Regression of antibiotic prescription per 1000 encounters pre and post COVID-19 restrictions with 2019 as control group.

Conclusion
We found an immediate increase in antibiotics relative to encounters post COVID-19 restrictions though antibiotics and encounters were all generally decreased with azithromycin showing the most appreciable decrease. Further investigation is needed to understand these findings and the implications on the population.

Disclosures
All Authors: No reported disclosures