bluuebunny/crossref_metadata_2025_split huggingface dataset:
1415. Use of Adjunctive Steroids in Adults with Encephalitis
Authors: Allana Ambreen , Samannodi Mohammed , Hansen Michael , Hasbun Rodrigo 
Published: October 2019

Abstract

Background
To describe the use and the impact on clinical outcomes of adjunctive steroids in adults with encephalitis.

Methods
We conducted a retrospective observational study of 230 adults (age >17 years) who met the international consortium definition for encephalitis. An adverse clinical outcome was defined as a Glasgow outcome score of 1–4. The study took place at three tertiary care hospitals in Houston TX, between August 2008 and September 2017.

Results
A total of 230 adults with encephalitis were enrolled, out of which 121 (52.6%) received steroids. Adjunctive steroids were given more frequently to those with focal neurological deficits (P = 0.013), had a positive cerebrospinal fluid (CSF) HSV PCR (P = 0.013), required mechanical ventilation (MV) (P = 0.011), required intensive care unit (ICU) admission (P < 0.001), had white matter abnormalities (P = 0.014) or had cerebral edema on the brain magnetic resonance imaging (MRI) (P = 0.003). An adverse outcome was seen in 139 (60.7%) of patients. Predictors for adverse outcomes included a Glasgow coma score (GCS) < 8, fever, seizures, ICU admission, and presence of edema on brain MRI. The use of adjunctive steroids did not impact clinical outcomes (P = 0.521). Independent prognostic factors on logistic regression analysis were edema on brain MRI (7.780 [1.717–35.263] P = 0.008), GCS < 8 (6.339 [1.992–20.168] P = 0.002), and fever (2.601 [1.342–5.038] P = 0.005).

Conclusion
Adults with encephalitis continues to be associated with significant adverse clinical outcomes in the majority of patients. Adjunctive steroids are used in the sicker patients and it is not associated with improved clinical outcomes.

Disclosures
All authors: No reported disclosures.
1420. Successful Treatment of Acute Osteomyelitis with Once-Weekly Oritavancin
Authors: Van Hise Nicholas W , Chundi Vishnu , Didwania Vishal , Anderson Michael , Van Hise Allyssa , Petrak Russell M 
Published: October 2019

Abstract

Background
Osteomyelitis is a complex infection with high morbidity and without standard treatment guidelines. Intravenous therapy is the standard of care, often requiring multiple daily antibiotic doses in an infusion center or home setting. Many of these infections are gram-positive and therefore are commonly treated with vancomycin or daptomycin. Oritavancin, a lipoglycopeptide antibiotic was FDA-approved in 2014 as a single dose regimen for treatment of ABSSSI and may be useful for the treatment of osteomyelitis where once-weekly therapy presents logistical advantages over vancomycin.

Methods
This was a retrospective case series of patients treated with four to six weekly doses of oritavancin at 20 infusion centers in 6 states under the care of 37 infectious diseases physicians. Patients were administered oritavancin between January 1, 2016 and December 31, 2018. Post therapy evaluation was completed by an ID PharmD utilizing a standardized set of questions. This study has been approved by an IRB.

Results
One-hundred 34 patients received oritavancin during the study period, all for acute osteomyelitis. All patients received baseline diagnostic imaging with MRI, along with clinical evaluation from a Metro Infectious Disease Consultants physician throughout their care. Cultures showing staph aureus, either MSSA or MRSA, were present in 120/134 (89.5%) of patients with MRSA encompassing the majority of patients 96/120 (80%). Patients were dosed with 1200 mg initially, and 800 mg weekly thereafter. At the end of therapy, clinical cure or improvement was achieved in one-hundred eighteen patients (88%). Follow-up was obtained through phone calls with all patients at 3 months and 6 months post-therapy in one-hundred thirty patients. Persistent or relapsing infection was diagnosed in patients 13/120 patients (10.8%). Nine patients were readmitted, but none for osteomyelitis or adverse drug reactions. Adverse reactions were reported in 5 patients (3.7%) including hypoglycemia (3) and tachycardia (2) in which 2 went to the emergency room, but were not admitted.

Conclusion
The use of oritavancin for gram-positive infections resulted in clinical cure or improvement in the majority of patients treated, offering a convenient and effective therapeutic option for the treatment of osteomyelitis.

Disclosures
All authors: No reported disclosures.
1423. Antibiotic Utilization and Outcomes in Patients with Sacral Osteomyelitis and Decubitus Ulcers
Authors: Carpenter Byrge Kelly , Bailey Amanda , Harris Bryan , Talbot Thomas , Wright Patty , Bloch Karen 
Published: October 2019

Abstract

Background
Osteomyelitis is a common complication of advanced stage pressure ulcers and known to be associated with increased mortality, length of stay (LOS), and treatment costs. However, limited data and lack of guidelines regarding appropriate diagnosis and treatment result in variability in management. We sought to investigate whether microbiology data are associated with reduced antibiotic utilization in patients with osteomyelitis secondary to decubitus ulcers.

Methods
This retrospective cohort study included hospitalized patients from 2007 to 2015 with an advanced stage (IV or unstageable) sacral decubitus ulcer and clinical concern for osteomyelitis. The exposure group was those who underwent tissue culture (superficial swab, deep bedside or surgical tissue, or bone biopsy). The primary outcome was antibiotic days of therapy (DOT). Additional secondary outcomes including clinical characteristics at presentation, LOS, readmission rates, and antibiotic-related complications were evaluated using Fisher’s exact or Wilcoxon-Mann–Whitney test for continuous variables.

Results
A total of 220 cases of advanced-stage decubitus ulcer with clinical concern for osteomyelitis were identified. Data abstracted from 40 cases show that tissue cultures were obtained in 22 (55%). Bacterial growth was identified from 100% of samples sent for culture. Antibiotic use prior to admission was the most significant predictor of failure to obtain tissue cultures (P = 0.0002). MRI was performed in 15% of abstracted cases, with radiographic evidence of osteomyelitis noted in 100%. Bone biopsy was performed in 4 cases; bone pathology was not sent in any of these instances. Median antibiotic DOT was 84 days in both groups.

Conclusion
In cases of sacral osteomyelitis secondary to decubitus ulcers, antibiotic use prior to admission was inversely related to the likelihood of obtaining a tissue culture. When tissue cultures were obtained, they were uniformly positive; however, in our preliminary analysis of 40 cases, this did not appear to influence antibiotic utilization as determined by DOT. Bone biopsy was rarely performed, and when done, was not sent for pathology despite this being recognized as the gold standard in the diagnosis of osteomyelitis.

Disclosures
All authors: No reported disclosures.
1435. Urinary Tract Infections Due to Extended-Spectrum Β-Lactamase-Producing Bacteria in Hospitalized Children: Demographics, Risk Factors, Clinical Characteristics, Imaging and Treatment
Authors: Bukhari Areej , Villacis Nunez Diana S , Etinger Veronica , Clemente Melissa , Gruber Joshua , Lozano Michell M , Iskowitz Seth , Marin Ruiz Beatriz F , Sedor Alanna , Houssay Magdalena , Rockwell Mikaela , Calderon Rebeca , Laufer Marcelo 
Published: October 2019

Abstract

Background
Urinary tract infections (UTIs) are a common cause for hospitalization in children. Inadequate treatment can lead to long-term renal damage. AAP guidelines recommend third-generation cephalosporins as empiric therapy. However, the incidence of community-acquired multiresistant, extended-spectrum β-lactamase (ESBL)-producing pathogens is rising. More research is needed to evaluate risk factors and management of ESBL UTI in children.

Methods
A case–control retrospective study was conducted at a tertiary care children’s hospital from July 2014 to December 2017. Hospitalized, non-ICU patients aged 0–18 years with UTI and urine culture positive for potentially ESBL-producing organisms were retrieved. Of the 1301 cultures reviewed, 106 cases (UTI+ESBL) were identified and 208 controls (UTI+non-ESBL) were randomly selected. We compared demographics, risk factors, clinical characteristics and treatment between both groups.

Results
Both groups had similar demographics, except for a higher median age for ESBL patients (3 vs. 0 years). ESBL patients were significantly more likely (P < 0.001) to have recent antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities. Both groups had similar clinical presentations and laboratory results. ESBL patients had more VCUGs performed (59.4% vs. 38%), but the prevalence of high-grade VUR was similar in both groups. ESBL patients had longer course of IV antibiotics and length of stay (mean 6 vs. 3 days). Although 59.4% of ESBL patients received inappropriate initial antibiotics based on culture susceptibilities, 77.4% of these patients clinically improved with initial therapy.

Conclusion
Our results support previous studies demonstrating that prior antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities are risk factors for ESBL UTI. When these are encountered, the suspicion for ESBL should be higher and may guide antibiotic therapy pending culture results. Given the similar prevalence of high-grade VUR in both groups, the presence of ESBL UTI alone should not be an indication to obtain a VCUG. Finally, a subgroup of patients with ESBL UTI might be clinically responsive to third-generation cephalosporins, despite in vitro resistance.

Disclosures
All authors: No reported disclosures.
1440. Prevalence and Regional Variation of in ESBLs and CRE Enterobacteriaceae (ENT) among Adult, Hospitalized Patients with ENT on a Urine Culture: A Multicenter Evaluation
Authors: Lodise Thomas , Gupta Vikas , Yu Kalvin , Gupta Kalpana , Early Maureen , Ye Gang , Schranz Jennifer , Gelone Steven P 
Published: October 2019

Abstract

Background
Despite increased public health awareness of ESBLs and CRE, limited data exist regarding the true frequency of these resistant bacteria in urine cultures collected from adult patients in US hospitals. This study sought to quantify the prevalence and rates of ESBLs and CRE from urine cultures in adult hospitalized patients with ENT.

Methods
All hospitalized adults with a urine culture (first urine isolate of a species per 30-day period) from 377 hospitals in 2018 were evaluated (BD Insights Research Database, Becton, Dickinson & Company). ESBL was defined as an ENT that was ESBL-positive per commercial panels or intermediate or resistant (non-susceptible, [NS]) to a third-generation cephalosporin; CRE was defined as an ENT that was NS to imipenem, meropenem, doripenem or ertapenem. Urine isolates were classified as community-onset (CO: < 3 days of an inpatient admission and no previous admission within 14 days) or hospital-onset (HO: ≥ 3 days post-admission or within 14 days of discharge) period. Prevalence and rates per 100 admissions were calculated overall, by onset location (CO vs. HO), and by US Department of Health and Human Services (HHS) geographic region.

Results
In 2018, there were 193,476 non-duplicate ENT urine isolates across 4,623,333 admissions; 63.6% were E. coli (EC), 19.5% were K. pneumoniae/oxytoca (KPO), and 8.7% were P. mirabilis (PM). Overall, 12.6% were ESBL and 0.9% were CRE. Rate per 100 admissions was 0.484 and 0.037 for ESBL and CRE, respectively. Among CO, 11.8% were ESBLs and ESBL rates per 100 admissions were 0.358; 0.7% were CRE and CRE rates per 100 admissions was 0.024. Among HO, 15.7% were ESBLs and ESBL rates per 100 admissions was 0.126; 1.5% were CRE and CRE rates per 100 admissions was 0.013. Regional differences in both ESBL and CRE ENT were noted (table).

Conclusion
The prevalence of ESBLs/CRE among adult hospitalized patients with ENT in a urine culture was 13% and 1%, respectively. The % ESBL/CRE was higher among patients HO urine isolates whereas ESBL/CRE rates per 100 admissions were higher among patients with CO urine isolates. Considerable geographic variations were observed. Region and site of onset differences in ESBL/CRE epidemiology should be considered when making empiric antibiotic treatment decisions.

Disclosures
All authors: No reported disclosures.
1450. Risk Factors for Antibiotic Resistance of Escherichia coli Urinary Isolates in Outpatients
Authors: Frisbie Lauren , Weissman Scott , Kapoor Hema , A. D’Angeli Marisa , Salm Ann , Rabinowitz Peter 
Published: October 2019

Abstract

Background
Antibiotic-resistant E. coli infections represent a major cause of morbidity and mortality, and pose a challenge to antibiotic stewardship. Patient age has been suggested as a key determinant of resistance patterns in studies based in the United States and Europe, although local antibiotic use patterns may affect this relationship. We analyzed results from clinical antibiotic susceptibility tests performed at a large reference laboratory to further examine the association of age with E. coli urinary tract resistance patterns in WA State.

Methods
We analyzed 5 years of E. coli antibiotic susceptibility data for outpatient urinary tract infections in WA State from a national clinical reference laboratory. We included only the first isolate recorded for each patient and calculated crude rates of resistance to antibiotics for the age groups of 50 years. In a multivariate logistic model, we tested the effect of patient age, year of antimicrobial susceptibility test submission, and sex on antibiotic resistance.

Results
Univariate analyses indicated that resistance rates differed significantly across patient age groups for ciprofloxacin and nitrofurantoin. Among females, resistance rates also differed significantly across patients age groups for amoxicillin-clavulanate and gentamicin. Logistic regression using data from male patients found the odds of resistance to be significantly greater in older individuals for ciprofloxacin (OR 2.59) and lower in older individuals for amoxicillin-clavulanate (OR 0.56). For females, logistic regression found the odds of resistance to be significantly greater for older individuals for amoxicillin-clavulanate (OR 1.43), ciprofloxacin (OR 3.04), ceftriaxone (OR 2.58), nitrofurantoin (OR 2.20), and gentamicin (OR 1.62).

Conclusion
In WA State, the distribution of antibiotic resistance in E. coli urinary isolates varies with age, sex and the antibiotic of interest. Greater and more timely use of databases of susceptibility testing of clinical isolates from outpatient settings can allow for the creation of age-specific antibiograms to guide and improve stewardship.

Disclosures
All authors: No reported disclosures.
1452. Is Carbapenem-Sparing Therapy as Effective as Carbapenems Against Extended-Spectrum β-Lactamase Producing Enterobacteriaceae in UTI?
Authors: Hyun Jonghoon , Lee Yongseop , Seong Hye , Ho Kim Jung , su Ku Nam , yong Choi Jun , Yeom Joon-Sup , Jin Jeong Su 
Published: October 2019

Abstract

Background
With the emergence of carbapenem-resistant strains of Enterobacteriaceae, non-carbapenem antibiotics are suggested as the alternative treatment of extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae infection. In this study, efficacy of non-carbapenem antibiotics on acute pyelonephritis (APN) with ESBL-producing Enterobacteriaceae was compared with that of carbapenems.

Methods
The medical records of patients who had diagnosed to have acute pyelonephritis with ESBL-producing Enterobacteriaceae on their urine culture, from January 2011 to December 2018, were reviewed retrospectively. Patients were classified as carbapenem and non-carbapenem group according to the definitive antibiotics they had treated with.

Results
Total number of patients was 141, including 112 (79.4%) who had received carbapenem, and 29 (20.6%) received non-carbapenem as definitive therapy against to APN with ESBL-producing Enterobacteriaceae. The duration of hospitalization was shorter for non-carbapenem group (median 9.93 days) than for carbapenem group (median 14.39 days) (P < 0.001). The duration of negative conversion of culture was shorter for carbapenem group (median 40.73 hours) than for non-carbapenem group (median 56.79 hours). There was no significant difference in time to febrile period and duration of definitive therapy between two groups.

Conclusion
Non-carbapenem therapy against APN with ESBL-producing Enterobacteriaceae has no significant difference in clinical outcome compared with carbapenem therapy.

Disclosures
All authors: No reported disclosures.
1454. Cephalosporins and Quinolones Account for 95 Percent of Oral Antibiotic Treatment for Uncomplicated Cystitis in Japan
Authors: Kusama Yoshiki , Ishikane Masahiro , Kihara Tomomi , Ohmagari Norio 
Published: October 2019

Abstract

Background
Uncomplicated cystitis (UC) imposes a large burden on antimicrobial use due to its high morbidity. IDSA/ESCMID guidelines recommend nitrofurantoin, sulfamethoxazole/trimethoprim (SMX/TMP), fosfomycin trometamol, and pivmecillinam for treating UC, but only SMX/TMP and fosfomycin calcium (FOM-C) are available in Japan. Therefore, we examined the antibiotics use to treat UC in Japan.

Methods
We obtained data from the JMDC Inc. claims database, which includes data of corporate employees and their family members. We extracted all records of oral antibiotic prescriptions for the treatment of acute cystitis (ICD-10 code: N300) between 2013 and 2016, and excluded prescriptions for male individuals and inpatients because they were considered to have complicated cystitis. Prescriptions for durations >7 days were also excluded because they were potentially prophylactic. Furthermore, we defined treatment failure as cases that required re-prescription within 13 days after the first prescription and estimated the treatment failure rate (TFR) of each antibiotic.

Results
Cephalosporins and quinolones accounted for 41.5% and 53.2% of the total number of antibiotic prescriptions (48,678). SMX/TMP and FOM-C only accounted for 0.7% and 0.8%. Third-generation cephalosporins accounted for 93.8% of total cephalosporins. TFR was less than 10% across almost all antibiotic categories, with the only exception being FOM-C.

Conclusion
Cephalosporins and quinolones accounted for 94.7% of oral antibiotic treatment for UC in Japan between 2013 and 2016. To avoid spreading antimicrobial resistance, approval of new antibiotics with good efficacy or an official recommendation for the use of narrower-spectrum antibiotics for treating UC may be required.

Disclosures
All authors: No reported disclosures.
1455. Epidemiology, Empiric Treatment, and Outcomes Among Hospitalized Patients With Complicated Urinary Tract Infections in the United States, 2013–2018
Authors: Zilberberg Marya , Nathanson Brian , Sulham Kate , Shorr Andrew F 
Published: October 2019

Abstract

Background
Complicated urinary tract infection (cUTI) is common among hospitalized patients. Though carbapenems are an effective treatment in the face of rising resistance, overuse drives carbapenem resistance (CR). We hypothesized that resistance to routinely used antimicrobials is common, and, despite the frequent use of carbapenems, associated with an increased risk of inappropriate empiric treatment (IET), which in turn worsens clinical outcomes.

Methods
We performed a multicenter retrospective cohort study in ~180 hospitals in the Premier database, 2013–2018. Using an ICD-9/10-based algorithm we identified all adult patients hospitalized with cUTI and a positive blood or urine culture (CR excluded). We examined with the impact of triple resistance (TR; resistance to >3 of the following drugs/classes: third-generation cephalosporin [C3R], fluoroquinolones, trimethoprim-sulfamethoxazole, fosfomycin, and nitrofurantoin), on the risk of receiving IET. We derived multivariate models to compute the impact of IET on hospital outcomes.

Results
Among 23,331 patients with cUTI (96.2% community-onset), 3,040 (13.0%) had a TR pathogen. Compared with those with non-TR, patients with TR were more likely male (57.6% vs. 47.7%), black (17.9% vs. 13.6%), and in the South (46.3% vs. 41.5%), P < 0.001 each; had a higher median Charlson score (3 vs. 2), and were more likely to need early ICU (22.3% vs. 18.6%) and mechanical ventilation (7.0% vs. 5.0%), P < 0.001 each. Patients with TR were hospitalized at centers with higher median prevalence of both C3R (16.3% vs. 14.4%) and TR (15.1% vs. 12.2%), P < 0.001 each. IET was more frequent in TR than non-TR group (19.6% vs. 5.4%) despite greater empiric carbapenem use in TP (43.3% vs. 16.2%), P < 0.001 each. Though IET did not have an impact on adjusted hospital mortality or 30-day readmission rate, it was associated with excess adjusted resource utilization ($1,364 in costs and 0.66 day in length of stay).

Conclusion
Among hospitalized patients with cUTI, TR is common, and is associated with a nearly 4-fold increase in exposure to IET, which in turn contributes to excess resource utilization. Given the high prevalence of TR, clinicians should consider a lower threshold for broader empiric treatment in appropriate patients.

Disclosures
All authors: No reported disclosures.
1461. Antimicrobial Susceptibility Patterns of Common Complicated Urinary Tract Infection Pathogens in US Hospitals, 2013–2018
Authors: Zilberberg Marya , Nathanson Brian , Sulham Kate , Shorr Andrew F 
Published: October 2019

Abstract

Background
In response to increasing rates of antimicrobial resistance, carbapenems have become first-line treatments for many infections. This, in turn, fosters the potential for resistance (CR). Efforts to mitigate the emergence of CR through carbapenem-sparing strategies must rest on a fundamental understanding of antibiotic resistance patterns among commonly encountered pathogens. Therefore, we examined the microbiology of complicated urinary tract infections (cUTI) in hospitalized patients in the United States.

Methods
We performed a multicenter retrospective cohort study in the Premier database of approximately 180 hospitals, 2013–2018. Using an ICD-9/10-based algorithm we identified all adult patients hospitalized with cUTI and included those with a positive blood or urine culture. Patients with carbapenem-resistant organisms were excluded. We examined the microbiology and susceptibilities to common cUTI antimicrobials (third-generation cephalosporin [C3], fluoroquinolones [FQ], trimethoprim-sulfamethoxazole [TMP/SMZ], fosfomycin [FFM], nitrofurantoin [NFT], and triple-resistant [TR]) over time.

Results
Among 28,057 organisms from 23,331 patients, the 3 most common pathogens were E. coli (EC, 41.0%), K. pneumoniae (KP, 12.1%), and P. aeruginosa (PA, 11.0%). Among these organisms, resistance to C3 was 10.4% among PA, 12.6% KP and 48.9% EC. EC was most likely to exhibit resistance to all agents of interest, and demonstrated the highest resistance rate to TMP/SMZ (61.5%), and lowest to NFT (10.4%). In contrast, KP had the highest rate of resistance to NFT (27.9%) and lowest to FQ (4.9%). The lowest rate of resistance among PA was to TMP/SMZ (1.9%), and highest to C3 (10.4%). The prevalence of TR in 2013–2014 and 2017–2018, respectively, was 34.2% and 37.4% for EC, 11.8% and 14.2% for KP, and 7.0% and 4.6% for PA.

Conclusion
Among the most common pathogens isolated in hospitalized patients with cUTI, and particularly in EC, high and increasing single resistance and TR rates to common antimicrobials were evident, Current empiric treatment strategies may be insufficient against the growing threat of TR.

Disclosures
All authors: No reported disclosures.