bluuebunny/crossref_metadata_2025_split huggingface dataset:
334. Treatment Duration of Antibiotics for Sacral Osteomyelitis After Skin Flap Procedure
Authors: Frye Emily , Linneman Travis W , Moenster Ryan P 
Published: January 2021

Abstract

Background
Patients with spinal cord injuries frequently develop sacral osteomyelitis. Optimal treatment often involves intravenous antibiotics and skin flap closure of the ulcer; however, best practices for the duration of antibiotic therapy pre- and post-procedure are unknown.

Methods
This was a retrospective, cohort study of spinal cord injury patients at the VA St. Louis undergoing a skin flap procedure from 1 October 2014 to 31 March 2019. Patients aged 18 to 89 years with a documented spinal cord injury and receiving treatment for sacral osteomyelitis with antibiotics and skin flap placement were considered for inclusion. The primary outcome was to determine if there was a difference in antibiotic treatment duration, both pre-procedure and post-procedure, between those that failed combination therapy and those patients for which the treatment was successful. Treatment failure was defined as documentation of no resolution of sacral osteomyelitis after treatment, re-initiation of antibiotics for sacral osteomyelitis of the same area, documented flap break-down, or an unplanned flap-related procedure within 1 year of completion of antibiotic therapy.

Results
Twelve patients were identified for inclusion. Baseline characteristics were similar between groups; 5/8 patients successfully treated received vancomycin, compared to 4/4 patients that failed therapy. Overall, 75% (8/12) had a successful treatment outcome at 12 months. In qualifying patients, average days of pre-procedure and post-procedure antibiotics were similar between patients who achieved success and those who failed (45.5 vs. 44.3 days pre-procedure, respectively (p &gt;0.05) and 39 vs. 43 days post-procedure (p &gt;0.05), respectively). When evaluated by weeks of therapy, no statistically significant differences were noted in treatment success rates between those treated for less than 6 weeks versus those treated for longer (66.6% [2/3] vs. 63.6% [6/9], p &gt;0.05).

Conclusion
No difference in pre- or post-flap procedure antibiotic duration was observed in patients who failed therapy compared to those who were successfully treated.

Disclosures
All Authors: No reported disclosures
335. Using high temperatures to eradicate prosthetic joint associated biofilms on metal implants using alternating magnetic field: Efficacy and safety implications
Authors: Shaikh Sumbul , Prasad Bibin , Sturge Carolyn , Pybus Christine A , Pifer Reed , Wang Qi , Chatzinoff Yonathan , Bing Chenchen , Chopra Rajiv , Greenberg David E 
Published: January 2021

Abstract

Background
Prosthetic joint infection (PJI) is a significant complication of modern arthroplasty. Revision surgery is frequently required due to the formation pf biofilm. The presence of biofilm makes non surgical treatment difficult in part because traditional antibiotics are unable to penetrate this structure.
We have developed a noninvasive way to eradicate biofilm off the outer surface of metal implant utilizing alternating magnetic fields (AMF). AMF creates focused surface heating on metal lic implants and can be delivered in a fashion spares significant heating of surrounding tissue. The study was to determine efficacy and safety of AMF when combined with traditional antibiotics in animal models of implant infection.

Methods
Pseudomonas aeruginosa (PA) and staphylococcus aureus (SA) were grown individually on stainless steel ball that were implanted into the thigh muscle of the mice. Mice placed in a custom built solenoid coil for AMF treatments. AMD exposures generating peak temperature of 80 or 65 C on the implant were delivered once a day. Treatment groups included AMF alone, antibiotic alone, and combination therapy. Antibiotics tested included ciprofloxacin, ceftraixone and rifampin. Residual biofilm was measured by CFU counts. Histopathology was analyzed to determine area of damage in response to AMF treatment.

Results
Combination of a single AMF pulse with antibiotics lead to a greater biofilm reduction than either treatment alone. PA with AMD (80 C peak) and ciprofloxacin resulted in &gt;2 log reduction of biofilm (p&lt; 0.0001) compared to minimal reduction (AMF or ciprofloxacin alone) at Day 4. Similar treatment outcome was seen with SA and ceftraixone with combination treatment resulting on multi log reduction. Combined treatment effects were seen at lower temperatures (65 C). Histopathologic analysis demonstrates a small area of tissue damage at the end of treatment (Day 4). In mice that were survived fro additional 28-days after the final treatment, the tissue showed no signs of damage.

Conclusion
AMF combined with antibiotics leads to enhanced reduction of biofilm on metallic implants in vivo. This non invasive approach to eradicating biofilm could serve as a new paradigm in treating these challenging infections.

Disclosures
All Authors: No reported disclosures
338. Analysis of Etiologies of Aseptic Meningitis within a Nation-Wide Hospital Network
Authors: Aravagiri Arunmozhi S , Kubomoto Scott , Napatkamon Ayutyanont , Wilson Sarah , Mallela Sudhakar 
Published: January 2021

Abstract

Background
Aseptic meningitis can be caused by an array of microorganisms, both bacterial and non-bacterial, as well as non-infectious conditions. Some etiologies of aseptic meningitis require treatment with antibiotics, antiviral, antifungals, anti-parasitic agents, immunosuppressants, and or chemotherapy. There are limited diagnostic tools for diagnosing certain types of aseptic meningitis, therefore knowing the differential causes of aseptic meningitis, and their relative percentages may assist in diagnosis. Review of the literature reveals that there are no recent studies of etiologies of aseptic meningitis in the United States (US). This is an epidemiologic study to delineate etiologies of aseptic meningitis in a large database of 185 HCA hospitals across the US.

Methods
Data was collected from January 2016 to December 2019 on all patients diagnosed with meningitis. CSF PCR studies, and CSF antibody tests were then selected for inclusion.

Results
Total number of encounters were 3,149 hospitalizations. Total number of individual labs analyzed was 10,613, and of these 262 etiologies were identified. 23.6% (62) of cases were due to enterovirus, 18.7% (49) due to HSV-2, 14.5% (38) due to West Nile virus, 13.7% (36) due to Varicella zoster (VZV), 10.5% (27) due to Cryptococcus. Additionally, we analyzed the rate of positive test results by region. Nationally, 9.7% of tests ordered for enterovirus were positive. In contrast, 0.5% of tests ordered for HSV 1 were positive. The southeastern United States had the highest rate of positive tests for HSV 2 (7% of tests ordered for HSV 2 were positive). The central United States had the highest rate of positive test for West Nile virus (11% of tests ordered for West Nile were positive). The northeastern region and the highest rate of positive tests for varicella zoster (18%).
Table 1: Percentage of positive CSF tests (positive tests/tests ordered)

Table 2: Lists the number of HIV patients and transplant patients that had positive CSF PCR/serologies

Figure 1: Percentage of positive CSF tests in each region

Conclusion
Approximately 40% of aseptic meningitis population had treatable etiologies. A third of the Cryptococcus meningitis population had HIV. Furthermore, enteroviruses had the majority of cases within the US, which are similar to studies done in other parts of the world.

Disclosures
All Authors: No reported disclosures
339. Assessing Utilization of the Venereal Disease Research Laboratory Test in Cerebrospinal Fluid for the Diagnosis of Neurosyphilis: A Cohort Study
Authors: Sytsma Terin , Theel Elitza , Temesgan Zelalem , Toledano Michel 
Published: January 2021

Abstract

Background
The Venereal Disease Research Laboratory (VDRL) test performed in cerebrospinal fluid (CSF) is considered highly specific for the diagnosis of neurosyphilis, but algorithms to diagnose neurosyphilis require positive syphilis serologic testing prior to obtaining CSF-VDRL. Inappropriate use of diagnostic tests depletes healthcare resources, and contributes to rising healthcare expenditures. CSF-VDRL has historically been improperly utilized; however there is no recent evaluation of its use in clinical practice. We aimed to quantify rates of appropriate CSF-VDRL testing, determine the CSF-VDRL false-positivity rate and describe causes of false-positive CSF-VDRL reactivity.

Methods
In this retrospective cohort study of three Mayo Clinic sites (Rochester, MN, Jacksonville, FL, and Scottsdale, AZ), we measured the rate of appropriate CSF-VDRL test utilization in patients with negative testing from January 1, 2011 to December 31, 2017. We then identified all patients with positive CSF-VDRL testing from January 1, 1994 to February 28, 2018, characterized true- and false-positive rates and described causes of CSF-VDRL false-positivity.

Results
Among 8,553 persons with negative CSF-VDRL results, testing was unnecessarily ordered in 8,399 (98.2%). The word “syphilis” or “neurosyphilis” appeared in the notes of only 1,184 (13.8%) individuals with a negative CSF-VDRL result. From January 1994 through February 2018, 33,933 CSF-VDRL tests were performed on 32,626 individual patients. Among 60 positive CSF-VDRL results, 41 (68.3%) were true-positives, 2 (3.3%) were indeterminate, and 17 (28.3%) were false-positives. Every patient with true-positive CSF-VDRL had positive serologic syphilis testing prior to CSF testing. All patients with false-positive CSF-VDRL results were inappropriately tested. Neoplastic meningitis was a common cause of false-positive CSF-VDRL results.

Conclusion
This is the first study in decades to review CSF-VDRL utilization for the diagnosis of neurosyphilis. Inappropriate use of CSF-VDRL testing for diagnosis of neurosyphilis remains problematic in clinical practice. Following recommended testing algorithms would prevent unnecessary testing, preserve resources, and minimize false-positive results.

Disclosures
All Authors: No reported disclosures
340. Association between Meningococcal Meningitis and Santa Ana Winds in Mexican Children and Adolescents from Tijuana, Baja-California, Mexico
Authors: Chacon-Cruz Enrique , Lopatynsky-Reyes Erika Z , Montano-Duron Jesus G 
Published: January 2021

Abstract

Background
The Tijuana, Baja-California, and San Diego, California, USA -border, is considered to be the most transited in the world. Based on our active surveillance studies, Tijuana has the highest incidence of meningococcal meningitis (MeM) in Mexico (Chacon-Cruz E. et al.: Ther. Adv. Vaccines 2016; 4: 15–9. J. Infect. Dis. Treat. 2017; 3: 1–4. Emerg. Infect. Dis. 2011; 17: 543–6. And Ther. Adv. Vaccines 2019; 6: 1–7), and an outbreak of MeM in 2013 (Chacon-Cruz et al. Ther. Adv. Vaccines 2014; 2: 71–6). The Santa Ana Winds (SAWs) are episodic pulses of easterly, downslope, offshore flows over the coastal topography of the California Border Region: Southern California and Northern Baja-California (Mexico), occurring mostly from October to April, and are associated with very dry air, often with anomalous warming at low elevations, similar to the Harmattan winds associated with MeM outbreaks in Africa. We hypothesized that the high incidence of MeM in Tijuana is, in part, associated with SAWs. This association has never yet been described.

Methods
Based on 13 years of active/prospective surveillance (2005–2018) in children &gt; 7 days and &lt; 16 years of age at the General Hospital of Tijuana, we identified 51 cases of MeM (25% lethality), and 30 non-meningococcal meningitis (NMeM). Association between cases per month of MeM and NMeM, with SAWs seasons (from a 65 years review: Guzman-Morales J, et al. Geophys. Res. Lett. 2016; 43: 2827–34), was calculated by Risk Ratio (RR). A z test was also used to compare proportions of MeM during SAWs seasons vs. non-SAWs seasons.

Results
From 51 MeM, 44 (86.27%) occurred during SAWs seasons (z test = 7.32, p&lt; 0.0002). Cases per month during 13 years (91 months for SAWs seasons and 60 months for non-SAWs seasons) were as follow (See Figure-1):
SAWs seasons: non-SAWs seasons:
MeM 0.483 cases/month 0.107 cases/month
NMeM 0.186 cases/month 0.216 cases/month
RR =1.76, p=0.0002 (95% CI 1.23 to 2.49)

Conclusion
1. In Tijuana, Baja-California, Mexico, there is a strong association of Meningococcal Meningitis with seasons when Santa Ana Winds occur.
2. Routine immunization against vs. Neisseria meningitidis should be seriously considered in the region.

Disclosures
All Authors: No reported disclosures
341. Clinical and Laboratory Data in Patients with Viral and Bacterial Meningitis in Conjunction with FilmArray Meningitis/Encephalitis Panel Use: A Multi-Site Retrospective Cohort Study
Authors: Goodrich Nathaniel , Nabower Aleisha M , Rajbhandari Prabi , Martin Kimberly C , Ekambaram Maheswari , Eisenberg Jaclyn , McCulloh Russell , Cipriano Frank , Stone Bryan , Lyden Elizabeth , Snowden Jessica 
Published: January 2021

Abstract

Background
The ability to quickly recognize and diagnose meningitis is a critical component in its management. The use of the FilmArray Meningitis/Encephalitis (ME) panel has made pathogen identification easier and faster. Although literature exists regarding clinical and laboratory data in patients with bacterial meningitis, less is known about the characteristics of viral meningitis caused by viruses detected by the ME panel This study aims to compare differences in clinical and laboratory characteristics between viral and bacterial meningitis identified by the ME panel.

Methods
We conducted a multisite retrospective review of pediatric patients with cerebral spinal fluid (CSF) positive for viral or bacterial organisms from January 2015 - February 2019. Demographic, clinical, and lab characteristics were extracted from medical records. Frequencies and percentages are used to explain descriptive data. Fisher’s exact test was used for categorical data. The Mann-Whitney test was used for continuous data.

Results
Four hundred thirty-eight patients were included in the analysis with baseline characteristics found in Table 1. Among these, 345 and 93 patients tested positive for viral and bacterial organisms respectively. Viral organisms identified are presented in Figure 1. Patients with bacterial organisms were more likely to have a history of prematurity, a prior neurosurgical procedure, neurological symptoms at presentation, neurological complications, and death within 30 days of admission. The median serum white blood cell (WBC) count, C-reactive protein (CRP), procalcitonin, CSF WBC count, CSF neutrophil percentage, and CSF protein were significantly higher in patients with bacterial organisms compared to viral organisms (Table 2).
Table 1: Baseline Characteristics of the Study Population

Figure 1: Viral organisms identified.

Table 2: Comparison of Laboratory Data by CSF Pathogen Group

Conclusion
Patients positive for bacterial meningitis were more likely to have higher markers of infection compared to patients with viral organisms. Patients with bacterial organisms were also more likely to have death within 30 days of admission and neurological symptoms and subsequent complications, although the small number of patients limits these conclusions. These findings may help clinicians utilize clinical and laboratory data in conjunction with a ME panel result.

Disclosures
All Authors: No reported disclosures
342. Clinical Utility of a Next Generation Sequencing Test for Pathogen Detection in Pediatric Central Nervous System Infections
Authors: Ramchandar Nanda , Foley Jennifer , Enriquez Claudia , Osborne Stephanie , Arrieta Antonio , Sendi Prithvi , Totapally Balagangadhar , Dimmock David , Farnaes Lauge , Salyakina Daria , Janvier Michelin J 
Published: January 2021

Abstract

Background
Pediatric central nervous system (CNS) infections are potentially life-threatening and may incur significant morbidity. Identifying a pathogen is important, both in terms of guiding therapeutic management, but also in characterizing prognosis. However, standard care testing by culture, serology, and PCR is often unable to identify a pathogen. We examined use of next generation sequencing (NGS) of cerebrospinal fluid (CSF) in detecting an organism in children with CNS infections.

Methods
We prospectively enrolled children with CSF pleocytosis and suspected CNS infection admitted to 3 tertiary pediatric hospitals. After standard care testing had been performed, the remaining CSF was submitted for analysis by NGS.

Results
We enrolled 70 subjects over a 12-month recruitment period. A putative organism was isolated from CSF in 24 (34.3%) subjects by any diagnostic modality. NGS of the CSF samples identified a pathogen in 20 (28.6%) subjects. False positive results by NGS were identified in 2 patients. There were no cases in which NGS alone identified a pathogen. In 4 cases, a putative organism was recovered by standard care testing of the CSF, but not by CSF NGS. CSF culture recovered a putative organism in 12 cases (12.1%). A CSF PCR multiplex panel was utilized for 51 subjects. An organism was detected in 15 of these (29.4%). Using a reference composite of standard care testing, we determined the sensitivity and specificity of CSF NGS to be 83.3% (95% CI, 62.6–95.3%) and 91.3% (95% CI, 79.2–97.6%) respectively.

Conclusion
Sequencing of CSF has the potential to rapidly and comprehensively identify infection with a single test. Further studies are needed to determine the optimal use of NGS for diagnosis of CNS infections.

Disclosures
All Authors: No reported disclosures
344. Demographics of Patients with Brain Abscesses: A 10-year Mayo Clinic-Multicenter-Based Population Descriptive Study
Authors: Campioli Cristina G Corsini , Go John Raymond U , Sohail M Rizwan , O’Horo John C , O’Horo John C 
Published: January 2021

Abstract

Background
Brain abscess and cerebritis are diseases associated with high-risk morbidity and mortality despite the advancement of imaging technologies and antimicrobial therapy for the past 30 years. We aimed to describe the demographics of patients with brain abscess and cerebritis at Mayo Clinic.

Methods
We retrospectively reviewed the demographics of all adult patients with the diagnosis of intracranial brain abscess, cerebritis, or both at our institution from January 1, 2009, through December 31, 2019. All analyses were performed using JMP software (Cary, NC).

Results
A total of 666 patients with brain abscess and cerebritis were identified during the study period. The median patient age was 59.7 years, and the majority were males (64.8%; P=0.0001). A total of 587 (88.1%) patients self-identified as Whites (P=&lt; 0.0001) and 608 (91.2%) as Non-Hispanic or Latino (P=&lt; 0.0001). A total of 453 (68.01%) patients were from the Midwest, with Minnesota and Wisconsin being the two most common States with 243 (36.4%; P=&lt; 0.0001) and 101 (15.1%; P=0.01) patients respectively. The majority of patients (69.2%) had coronary artery disease and peripheral vascular disease with a median Charlson comorbidity index of 7 (P= &lt; 0.0001) and an estimated 10-year survival of 0%.

Conclusion
Male, White Non-Hispanics, and elderly patients seem to be the most prevalent patient population at risk for brain abscess or cerebritis. This investigation provides clinicians the demographic data needed to identify potentially complex patients with brain abscesses.

Disclosures
M. Rizwan Sohail, MD, Aziyo Biologics (Consultant)Medtronic Inc (Consultant, Research Grant or Support)
345. Early Oral Therapy for Streptococcus anginosus Purulent Brain Infections: A Single Center Experience
Authors: Dodson Daniel S , Heizer Heather R , Gaensbauer James 
Published: January 2021

Abstract

Background
Pediatric Streptococcus anginosus intracranial pyogenic are commonly treated with prolonged intravenous (IV) antibiotics, exposing patients to risks of a long-term central catheter. Antibiotics with high oral bioavailability, such as levofloxacin, may allow early oral transition.

Methods
To characterize patients with S. anginosus intracranial infections transitioned to oral therapy, we performed a retrospective review at Children’s Hospital Colorado from 1/2004 to 2/2019. Inclusion criteria were radiologic evidence of an infected parenchymal, subdural, or epidural fluid collection AND a positive culture for S. anginosus from an intracranial source, specific extracranial sources (sinus, scalp, orbit), or blood. The primary endpoint was oral antibiotic failure defined as worsening infection on oral therapy. Comparisons were done using Fisher’s exact test.

Results
94 patients met inclusion criteria, 57 of whom were transitioned to oral therapy during treatment. Oral levofloxacin was used in 54 of the 57. 12% of oral transitions occurred in the first 14 days of therapy (range 3–8 days), and 35% in the first 28 days. Patients transitioned in the first 28 days were more likely to have an epidural collection (p:&lt; 0.01), and less likely to have a subdural collection (p: 0.03) or brain abscess (p:&lt; 0.01). Of the 57, none had oral antibiotic failure. Contributing reasons for oral transition included central line complications (18%), IV medication reaction (18%), hematologic abnormality presumed secondary to IV antibiotics (33%), and provider judgement (56%). Two patients required re-introduction of IV therapy for reasons other than clinical failure (one for medication non-adherence and one for adverse reaction to levofloxacin).

Conclusion
We observed success and tolerance of levofloxacin-based oral therapy for pediatric pyogenic intracranial S. anginosus brain infections and confirmed the frequent occurrence of adverse events associated with IV treatment. Transition to oral therapy should be considered, particularly if complications of IV therapy arise in treatment of an epidural infection. A subset of patients in our study transitioned within the first 14 days of therapy; prospective studies are needed to characterize the safety of such very early transition.

Disclosures
All Authors: No reported disclosures