bluuebunny/crossref_metadata_2025_split huggingface dataset:
2279. Study of Prescribing patterns and Effectiveness of Ceftolozane–tazobactam (C/T): Real-world Analysis (SPECTRA): a multi-national, multicenter observational study
Authors: Soriano Alex , Puzniak Laura , Paterson David , Thalhalmmer Florian , Kluge Stefan , Viale Pierluigi , Kaul Sundeep 
Published: October 2019

Abstract

Background
C/T has demonstrated efficacy in randomized clinical trials to treat cIAI and cUTI and recently completed a study in ventilator-associated bacterial and ventilated hospital-acquired bacterial pneumonia. The purpose of this study was to evaluate the real-world clinical use and outcomes of C/T in a multi-national study.

Methods
SPECTRA is a multi-national, multicenter, retrospective, inpatient, observational study of patients treated with C/T in Australia, Austria, Germany, Italy, Spain and United Kingdom. Patients admitted with greater than 48 hours of C/T treatment were included. Demographics, clinical characteristics, treatment management patterns, microbiological findings and outcomes were analyzed.

Results
There were 155 patients from 20 participating hospitals in 6 countries. The average age was 58.0 years (±17.8) and most were male 114 (74%). The majority 130 (84%) had at least one comorbidity, with the most common being renal impairment 87 (56%), immunocompromised 62 (40%), and diabetes 52 (34%). The majority, 94 (61%), had previous hospitalizations ≥ 6 months prior to receiving C/T, of which 29 (31%) had an ICU stay and surgeries 64 (42%). Most patients 126 (82%) received antibacterials within 30 days of receiving C/T, 61 (40%) received carbapenems and 47 (31%) received aminoglycoside. The average duration of C/T was 15 (SD12) days. The source of infection was cUTI for 31 (20%), cIAI for 19 (12%) and respiratory for 43 (28%) of C/T treated patients. Most 107 (70%) had an ID consult with an average of 7 (SD 11.3) consults. The top pathogen was Pseudomonas 124 (81%) followed by E. coli 22 (14%), with 56 (37%) having a polymicrobial infection. Over half of the patients were in the ICU 84 (55%), 58 (38%) underwent at least 1 surgery, with 65 (48%) being related to the infection, 60 (39%) had sepsis and 21 (14%) had septic shock. All-cause in hospital mortality was 16%. 30-day all-cause readmission was 12% and 6% were infection related.

Conclusion
Despite the complexity of the patients in this real-world analysis, most C/T patients had beneficial outcomes that are similar to results of controlled clinical trials.

Disclosures
All authors: No reported disclosures.
2285. Emergence of perioperative antibiotic non-susceptible pathogens causing prosthetic joint infections in monomicrobial Gram-negative and polymicrobial infections.
Authors: Coyle Meredith M , Riederer Kathleen M , Hooshmand Babak , Youssef Dima , Bhargava Ashish 
Published: October 2019

Abstract

Background
Current recommendations by Infectious diseases society of America (IDSA) endorse cefazolin for perioperative use. What is less known currently is the emergence of resistance in Gram-positive (GP) and Gram-negative (GN) prosthetic joint infections (PJIs) in the setting of perioperative use of antibiotics.

Methods
A retrospective multi-centric cohort was studied at three hospitals from January 2012 to December 2018. Patients with PJIs were identified using ICD codes. We reviewed electronic medical records and identified PJIs which followed primary arthroplasties. We included cases where perioperative antibiotics records were available.

Results
66 infected PJIs with available preoperative records were included. 40 (61%) patients were females, and 42 (64%) were caucasians. Indications for undergoing arthroplasty were degenerative joint disease (DJD) in 52 (78%), trauma in 13 (20%) and avascular necrosis in 1 (1.5%). Sites for arthroplasty were knee in 33 (50%), hip 28 (42.5%), shoulder 4 (6%), and ankle in 1(1.5%). 43 (65%) had GP monomicrobial, 6 (9%) had GN monomicrobial and 17 (26%) had polymicrobial infections. 40 (60.5%) patients received cefazolin, 25 (38%) received vancomycin and 1 (1.5%) received ceftriaxone as perioperative prophylaxis. 7 (11%) PJIs among monomicrobial infections and 6 (35%) among polymicrobial infections had non-susceptible (NS) organisms (Figure 1 and 2). 8 (47%) polymicrobial PJIs had a mixed susceptibility profile with drug susceptible and resistant organisms.

Conclusion
In general, when monomicrobial GP pathogens are causative for PJI, current use of cefazolin as perioperative drug of choice is sound and we agree with the current perioperative recommendations. It should be recognized that in situations where the PJI is due to GN or is polymicrobial, resistance to perioperative antibiotics may be present at a greater rate. From this study we conclude that in cases where the pathogen is known to be GN or polymicrobial from a diagnostic aspiration, then a broader antibiotic selection may be of benefit perioperatively.

Disclosures
All authors: No reported disclosures.
2288. Role of Β Lactam-Β Lactamase Inhibitors in Indian Tertiary Care Hospitals: Results from a Nationwide Survey
Authors: Kamat Shweta , Gupta Pankaj , Mane Akshata 
Published: October 2019

Abstract

Background
Broad-spectrum antibiotics, particularly third-generation cephalosporins, are routinely used in the treatment of nosocomial infections. The emergence of Extended Spectrum Β-Lactamase (ESBL)-producing pathogens in Indian tertiary care hospitals warrants the need to reassess β-lactam–β-lactamase inhibitors (BL-BLIs) as better alternative treatments.

Methods
An online survey was conducted by Pfizer India to understand the usage of BL-BLIs across Indian hospitals. The survey was administered to 334 clinicians across multiple specialties out of which 195 were from tertiary care hospitals. Results were analyzed using MS-Excel statistical tools.

Results
One-hundred ninety-five (195) clinicians from tertiary care hospitals completed the survey. About 78% of HCPs revealed the resistance to third-generation cephalosporins (e.g., ceftriaxone, ceftazidime) to be between 10–60% in their clinical settings. BL-BLIs were mostly preferred for treatment based on hospital antibiograms (64%) and used as first-line options for hospitalized adults with mild-moderate severe infections caused by ESBL-producing organisms (71%) and in mild-moderate infections caused by susceptible Gram-negative bacteria such as Enterobacteriaceae (54%). The average duration of IV BL-BLI treatment was 5–7 days (66%). The HCPs considerations while choosing BL-BLIs were mainly based on anti-microbial spectrum (81%), and rationality of BL/BLI combination (63%) and clinical experience with the BL-BLI molecule (63%). Cefoperazone-Sulbactam (CS) and Piperacillin–tazobactam (PT) were most commonly prescribed BL-BLIs and HCPs preferred the latter for pneumonia (67%), skin and soft-tissue infections (57%), bloodstream infections (67%) and cancer-associated febrile neutropenia (64%); while they preferred former for urinary tract infections (64%). CS and PT were preferred for intra-abdominal infections (57% and 64% respectively) and post-surgical infections (56% and 53% respectively).

Conclusion
CS and PT were the most commonly prescribed BL-BLIs probably due to their wide antimicrobial spectrum, rationality of the BL/BLI combination and the clinical experience with the molecules. BL-BLIs are still a mainstay of treatment for infections due to ESBL producing organisms.

Disclosures
All authors: No reported disclosures.
2292. Incidence of Acute Kidney Injury Associated with Duration of Vancomycin and Piperacillin/tazobactam Combination Therapy
Authors: McMullen Lisanne , Craft Rachael , Tenkku Mackenzie 
Published: October 2019

Abstract

Background
Empiric antibiotic therapy for serious and healthcare-acquired infections often requires coverage for resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. These regimens commonly consist of vancomycin plus an antipseudomonal β-lactam. Recent studies have reported increased acute kidney injury (AKI) risk associated with concomitant vancomycin and piperacillin/tazobactam therapy compared with each agent alone. The objective of this study was to determine whether vancomycin with piperacillin/tazobactam had an increased AKI incidence compared with vancomycin plus cefepime or meropenem. Furthermore, data were analyzed to determine whether a specific duration was associated with an increased AKI incidence.

Methods
A retrospective cohort study was conducted analyzing patients who received vancomycin in combination with piperacillin/tazobactam (V+PT), cefepime (V+C), or meropenem (V+M) between January 1, 2018 through June 30, 2018. Adult patients with normal baseline renal function and receipt of at least 48 hours of combination therapy, with the two antibiotics initiated within 24 hours of one another, were included. AKI events, evaluated using the Acute Kidney Injury Network (AKIN) criteria, during antibiotic therapy and up to 72 hours after antibiotic discontinuation were recorded. This data were used to calculate the AKI incidence with each regimen and AKI incidence associated with each day of therapy.

Results
A total of 181 patients were included in the study. The incidence of AKI in the V+PT group was 22.8% vs. 5.6% and 16.7% in the V+C and V+M groups, respectively (P = 0.237). Median duration of therapy when AKI occurred was 3 days for V+PT, 4 days for V+C, and 2 days for V+M (P = 0.015). Patients in the V+M group received more nephrotoxic agents compared with V+PT and V+C (P = 0.004). Statistical analysis did not find a specific day of V+PT therapy predictive of AKI. However, a time to event analysis demonstrated a steady increase in AKI risk with V+PT from day 2 through 6.

Conclusion
Although not statistically significant, V+PT therapy was associated with a higher incidence of AKI compared with V+C or V+M. Future studies are needed to further assess the impact of duration of therapy on AKI incidence.

Disclosures
All authors: No reported disclosures.
2297. Epidemiology of Antibiotic-resistant Pathogens and Empiric Treatment Patterns in Community-Onset Sepsis
Authors: Rhee Chanu , Kadri Sameer S , Dekker John P , Danner Robert L , Chen Huai-Chun , Fram David , Klompas Michael 
Published: October 2019

Abstract

Background
Guidelines recommend immediate empiric broad-spectrum antibiotics for all patients with suspected sepsis. Understanding the epidemiology of antibiotic-resistant pathogens and empiric treatment patterns in sepsis could inform improvements in antibiotic utilization and outcomes.

Methods
We identified adults admitted during 2009–2015 to 104 US hospitals in the Cerner HealthFacts dataset who met CDC Adult Sepsis Event criteria and had positive clinical cultures within 2 days of admission. We characterized prevalence and empiric treatment rates for methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococcus (VRE), ceftriaxone-resistant Gram-negative organisms (CRO) (including P. aeruginosa), and extended-spectrum β-lactamase Gram-negative organisms (ESBL). We evaluated associations between in-hospital mortality and either inappropriate empiric therapy (antibiotics inactive against any isolated pathogen) or excessively broad therapy (empiric MRSA or VRE coverage, extended spectrum β-lactam, or carbapenem therapy when targeted organisms were absent), adjusting for baseline characteristics and severity-of-illness.

Results
The cohort included 17,962 patients with culture-positive sepsis; 2,965 (16.5%) died in-hospital. The most common culture-positive sites were urine (51.2%), blood (41.8%), and respiratory (16.5%). The most common pathogens were E. coli (33.0%), S. aureus (20.9%), and Streptococcus (13.2%) (Figure 1). Most (81.6%) patients received empiric antibiotics active against all isolated pathogens. Empiric therapy was directed at resistant organisms in 67.5% of cases (primarily vancomycin and extended spectrum β-lactams, Figure 2), but resistant organisms were isolated in only 25.2% (MRSA 11.5%, CRO 12.9%, VRE 2.0%, ESBL 0.8%). Both inappropriate empiric therapy and excessively broad empiric therapy were associated with higher mortality on multivariate analysis (OR 1.30, 95% CI 1.14–1.48 and OR 1.20, 95% CI 1.05–1.38, respectively).

Conclusion
Most patients with community-onset sepsis do not have resistant pathogens, yet empiric broad-spectrum antibiotics are frequently prescribed. Both inappropriate empiric therapy and excessively broad therapy are associated with worse outcomes.

Disclosures
All authors: No reported disclosures.
2300. Incidence, Complications, and Recurrence of Herpes Zoster in Unvaccinated Adults ≥50 Years of Age
Authors: Ackerson Bradley , Bruxvoort Katia , Sy Lina S , Luo Yi , Tanenbaum Hilary , Tian Yun , Zheng Chengyi , Cheung Bianca P , Patterson Brandon J , Van Oorschot Desiree , Fu Tseng Hung 
Published: October 2019

Abstract

Background
More recent baseline epidemiological data for Herpes Zoster (HZ) in adults ≥ 50 years of age, obtained before the introduction of the adjuvanted Recombinant Zoster Vaccine (RZV), are needed for future evaluations of the impact of RZV on HZ epidemiology.

Methods
The study comprised five elements: (1) The incidence of HZ was estimated from immunocompetent adults ≥ 50 years of age not vaccinated with Zoster Vaccine Live who had incident HZ between 2011–2015. HZ was identified by International Classification of Diseases (ICD) codes from electronic health records (EHR) of 4.6 million Kaiser Permanente Southern California members; (2) Postherpetic neuralgia (PHN) was identified by validated survey and medical record review of laboratory-confirmed incident HZ cases recruited during 2012–2015 for HZ-related pain ≥ 90 days after initial HZ diagnosis; (3) HZ Ophthalmicus (HZO) with ocular complications was identified by ICD codes and keyword search in EHR among patients identified with HZO using a validated natural language processing algorithm; (4) The proportion of HZ-related non-PHN and non-HZO cutaneous, neurological or other complications was assessed by double abstraction of EHRs from a sample of 600 incident HZ cases; (5) Recurrent HZ was identified by having an HZ diagnosis with HZ antiviral medication ≥ 6 months after the most recent HZ diagnosis with HZ antiviral medication in a cohort initially diagnosed with HZ between 2007 and 2008 and followed through 2016.

Results
We identified 40,893 incident HZ cases with an overall incidence of 9.92 (95% confidence interval [CI]: 9.82–10.01) per 1000 person-years. The proportion of incident HZ cases with PHN and HZO with ocular involvement was 18.37% (95% CI: 14.90–21.84%) and 8.06% (95% CI: 7.80–8.32%), respectively. The proportion of cutaneous, neurological, and other complications was 7.20% (95% CI: 5.44–8.96%), 0.87% (95% CI: 0.79–0.95%), and 1.24% (95% CI: 1.15–1.33%), respectively. The incidence of recurrent HZ was 10.96/1000 person-years (95% CI: 10.18–11.79).

Conclusion
HZ is common among unvaccinated US adults ≥ 50 years of age, with PHN and HZO occurring most frequently among incident HZ cases.

Funding
GlaxoSmithKline Biologicals SA, GSK study identifier: HO-17-18378.

Disclosures
All authors: No reported disclosures.
2301. Increased Risk of Varicella-Associated Hospitalizations Among Adult Immigrants From Temperate and Tropical Countries After the Introduction of a Childhood Varicella Vaccination Program in Quebec, Canada
Authors: Mah Jordan , Lieu Anthony , Greenwald Zoë R , Akaberi Arash , Song Sunny , Azoulay Laurent , Brisson Marc , Quach Caroline , Greenaway Christina 
Published: October 2019

Abstract

Background
Varicella zoster virus (VZV) hospitalizations are an uncommon, severe and costly consequence of VZV. Childhood VZV vaccination leads to decreased VZV rates across all age groups through herd immunity but increases the age of VZV acquisition and the potential risk of severe VZV in non-immune adults. A large proportion (~15%) of young adult immigrants from tropical regions are susceptible to VZV due to different transmission dynamics in their countries of origin and lack of vaccination. We aimed to describe the impact of the childhood VZV program introduced in 2006 in Quebec on VZV hospitalizations in immigrants and nonimmigrants.

Methods
A population-based cohort of all medically-attended VZV cases in Quebec, Canada (1996–2014) were identified in administrative health databases and linked to immigration data. VZV-attributable hospitalizations included those with primary or secondary ICD-9 or ICD-10 codes for VZV. Overall age-standardized and age-specific rates of hospitalizations were calculated during pre- (1996–98), private (1999–2005) and public vaccination (2006–14) periods and by immigrant status and pregnancy. Relative risk (RRI-NI) and 95% CI for immigrants vs. nonimmigrants were estimated.

Results
5873 hospitalizations occurred among 230,052 VZV cases. Hospitalization rates decreased dramatically in the pre to public vaccination period (6.6 to 1.3/100,000 population); however, the proportion of hospitalized varicella cases increased from 1.7% to 3.9% (P < 0.01). Immigrants only accounted for 3.6% of hospitalizations (N = 213) however, the proportion of all hospitalizations among immigrants increased in the pre- vs. public-vaccination periods in those aged 10–19 years (2.9% to 13.7%) and 20–39 years (8.8% to 22.7%). The RR was higher in these age groups in the public vaccination period [RRI-NI 1.96 and RRI-NI 1.67] (Table 1). Adults (>20 years) accounted for 52% (CI: 45–59%) and pregnant women 18% (13–25%) of all hospitalizations among immigrants compared with only 14% (13–15%) and 1.6% (1.3–2.0%) in nonimmigrants, respectively.

Conclusion
Young adult and pregnant immigrants bore a disproportionate burden of VZV hospitalizations after the introduction of childhood VZV vaccination. Susceptible immigrant adults would benefit from targeted VZV vaccination.

Disclosures
All authors: No reported disclosures.
2304. Incidence and Risk Factors for Herpes Zoster among Diabetes Patients at Siriraj Hospital; Results from a 10-year Cohort
Authors: Chuanchaiyakul Nalinee , Thongtang Nuntakorn , Rattanaumpawan Pinyo 
Published: October 2019

Abstract

Background
Herpes Zoster (HZ) is the reactivation of latent varicella-zoster virus. Diabetes Mellitus (DM) is one of well-known risk factors for HZ. Nowsday, the knowledge on the incidence of and risk factors for HZ among Thai DM patients is limited.

Methods
We conducted a nested case–control study of DM patients who attended the Siriraj DM clinic for ≥6 consecutive months during 2005–2014. Eligible subjects were identified through the DM clinic registry database (n = 1,427). Cases were those who had ≥1 episode of HZ while controls were those without evidence of HZ during the study period. We captured 40 cases and randomly sampled 175 controls (1 case: 4 controls). All data were obtained via chart-review, the ICD-10, pharmacy and laboratory databases

Results
During the 10-year study period, the cumulative incidence and the incidence rate of HZ were 0.28% [95% CI: 0.20–0.38%] and 3.96 [95% CI: 2.90–5.28] per 1,000 person-years. The most common sites were trunk (27.5%), followed by herpes opthalmicus (22.5%). Thirty-five percent had post-herpetic neuralgia and only 1 case required hospitalization. Independent risk factors for HZ [adjusted odd ratio; 95% CI; P-value] identified from multivariate analysis included underlying hypertension [3.48; 1.28–9.43; P = 0.01], number of hypoglycemic drug used [1.46; 1.03–2.08; P = 0.04] and previous use of herbal remedies [3.83; 1.06–13.84; P = 0.04]. Furthermore, higher body mass index was an independent protective factor [0.89;0.81–0.98; P = 0.02].

Conclusion
The incidence rate of HZ among DM patients at our institute was comparable to other Asian countries. Risk factors for HZ can be used to identify patients who would benefit the most from preventive interventions.

Disclosures
All authors: No reported disclosures.
2313. Influenza and Respiratory Syncytial Virus (RSV) Surveillance in the US Department of Veterans Affairs (VA): 2018–2019 Season
Authors: Lucero-Obusan Cynthia , Schirmer Patricia , Oda Gina , Holodniy Mark 
Published: October 2019

Abstract

Background
VA conducts ongoing surveillance for viral respiratory infections, notably influenza and more recently RSV. VA’s large elderly population is at higher risk for influenza and RSV complications, including hospitalization and death. Herein we summarize VA’s 2018–19 national surveillance data.

Methods
Influenza telephone triage, influenza-like-illness (ILI) encounters and antiviral prescriptions plus outpatient visits, laboratory testing (antibody tests excluded), hospitalizations and deaths for both influenza and RSV were obtained from VA data sources (9/30/18–3/31/19) and compared with prior seasons. Influenza vaccinations were captured starting 8/1/2018. Vaccination rates were calculated based on VA users during the fiscal year.

Results
Surveillance metrics are presented (Table, Figure). ILI visits ranged from 0.9%-3.3% during the season. RSV peaked earlier than influenza (Week 1 vs. Week 11). Testing revealed 1,674 RSV positives out of 31,404 tests performed (5.3%) and 15,052 influenza positives out of 105,760 tests performed (14.2%). We identified 22 cases of RSV and influenza co-infection (positive test results on the same date or within 3 days). 22% of laboratory-confirmed influenza cases were hospitalized (same proportion as the prior season) while 35% of RSV cases were hospitalized. Median length of stay was longer for RSV hospitalizations (4 days vs. 3 days for influenza).

Conclusion
The 2018–2019 influenza season was less severe than the 2017–2018 season, and most like the 2016–2017 season. 2018–2019 saw relatively little Influenza B in VA patients, despite elevated activity into the spring. High-dose/adjuvanted vaccine administration increased over the seasons evaluated. RSV surveillance for 2018–2019 demonstrated an earlier peak in activity and the percentage of patients with laboratory-confirmed RSV who were hospitalized and died during their hospitalization was higher compared with influenza. Although fewer RSV tests were performed and testing practices were variable across VA facilities, the weekly trend aligned closely with influenza. Surveillance for both viruses is important in VA given their associated morbidity and mortality.

Disclosures
All authors: No reported disclosures.