bluuebunny/crossref_metadata_2025_split huggingface dataset:
184. Seven vs. 14 Days Treatment Duration for Afebrile Men with Urinary Tract Infections; A Randomized Clinical Trial
Authors: Drekonja Dimitri , Johnson James R , Carla Amundson , Kuskowski Michael , Trautner Barbara 
Published: January 2021

Abstract

Background
Trials show that shorter-duration therapy is effective for many infectious diseases, but the optimal duration for UTI in men is unknown. Observational data suggests shorter-duration performs as well as longer-duration therapy, but trial data shows men with febrile UTI (a small but important subset of patients) do worse with 7 vs. 14 days of therapy. We performed a randomized controlled trial of afebrile men with UTI to determine whether 7 days of treatment was non-inferior to 14 days.

Methods
Men with symptomatic UTI at 2 VA hospitals were enrolled. Inclusion criteria included male gender, outpatient treatment, prescribed 7 to 14 days of ciprofloxacin or trimethoprim/sulfamethoxazole, and new onset of at least 1 of: dysuria, frequency, urgency, hematuria, costovertebral angle tenderness, and perineal, flank, or suprapubic pain. Exclusion criteria included UTI treatment in the past 14 days, symptoms due to a non-UTI diagnosis, and inadequate empiric treatment. Enrolled subjects took their clinically-prescribed medications days 1–7, then study medication days 8–14. Study medications were placebo or the originally prescribed antimicrobial, different in appearance from the original medication. The primary outcome was percentage of subjects with symptom resolution 14 days after completion of active therapy. Secondary outcomes included recurrence of UTI and adverse events. A pre-specified minimally clinically significant difference of 10% was selected, with a P value of 0.05 considered to be significant. Primary analysis was per-protocol; intention-to-treat performed as secondary analysis.

Results
Enrollment totaled 273, with 272 randomized to 7 (n = 136) vs. 14 (n = 136) days of antimicrobials. Mean age was 67.8 (SD 11.6), with a mean Charlson comorbidity index of 1.3 (SD 1.6). Overall, 254 subjects were in the per-protocol analysis. Symptom resolution occurred in 122 of 131 (93.1%) subjects receiving 7 days treatment, and 111 of 123 (90.2%) receiving 14 days (difference 2.9%, 95% CI -4.7 to 10.5% P = .50), confirming non-inferiority. Intention-to-treat analysis (n = 272) showed similar results.

Conclusion
Treatment with 7 days of antimicrobials was non-inferior to 14 days for symptom resolution. Afebrile men with UTI should not be treated beyond 7 days.

Disclosures
All Authors: No reported disclosures
185. Despite the Availability of Free Testing and Care Testing for Extragenital Sexually Transmitted Infections in a Cohort of Hiv-infected Department of Defense Beneficiaries Is Low and Similar to the Rates Observed Nationwide
Authors: Ganesan Anuradha , Wang Xun , Blaylock Jason M , Okulicz Jason , Maves Ryan C , Colombo Rhonda , Utz Gregory , Schofield Christina , Kronmann Karl , Lalani Tahaniyat , Garges Eric , Agan Brian 
Published: January 2021

Abstract

Background
Background- Current guidelines recommend annual extragenital [EG] testing for all sexually active men who have sex with men (MSM), and every 3−6 months for MSM at risk for sexually transmitted infections (STIs). Compliance with this guideline is low and testing rates among MSM with HIV have ranged between 30–46%. Financial disincentives (such as the lack of reimbursement for EG testing) may contribute to the lower EG testing rates. To examine if access to free testing improves EG testing rates, we used data from the US Military HIV Natural History Study (NHS), a cohort comprised of HIV-infected Department of Defense beneficiaries with access to care and free testing.

Methods
Methods- Among NHS participants with a follow-up visit between 1/1/2013 and 1/1/2018, genital (primarily urine samples) and EG testing rates (pharyngeal and rectal) were calculated and temporal trends examined. Multivariate logistic regression analysis was used to examine factors associated with EG testing. In a sub-set of participants who answered a risk behavior survey we examined risk-related information.

Results
Results- Of the 1971 male participants who had a NHS visit during the study period, 1962 (99.5%) had genital and 1419 (72%) had EG testing performed at least once. Annual genital and EG testing rates ranged between 96 - 98% and 33% - 46% respectively. No temporal trends were observed in EG testing rates. EG testing rates were higher in those with a history of gonorrhea, chlamydia or syphilis in the year prior, ranging between 50 and 67%. EG testing was more likely to occur in those who were younger and those with a prior history of STI (Table 1). In a subset of participants with risk behavior information, those who reported being MSM were more likely to be tested [Referent heterosexual; Odds Ratio 2.35 [95% CI 1.60–3.46].

Conclusion
Conclusion-Despite the availability of free EG testing, EG testing rates were low in the NHS and similar to those observed nationwide This contrasts with the genital testing rates which were well over 95%, suggesting provider/patient related barriers are likely driving the lower testing rates. To improve testing rates further study is required to fully characterize indications for EG testing and potential provider- and/or patient-related barriers to EG testing.

Disclosures
All Authors: No reported disclosures
192. The Use of Area Under the Curve to Determine Therapeutic Vancomycin Dosing in Skin and Soft Tissue Infections
Authors: Dea Lauren , Johns Scott T , Ma Ariel 
Published: January 2021

Abstract

Background
The vancomycin AUC/MIC target ratio of 400 to 600 mg*h/L that is recommended (level IA+) in the 2020 IDSA/ASHP vancomycin TDM guidelines is appropriate for patients with complicated MRSA infections; using lower targets for less complicated infections may reduce the risk for nephrotoxicity without compromising efficacy. The current methodology surrounding vancomycin AUC/MIC targets is unrefined, with no source specific targets identified, especially for relatively lower risk MRSA infections such as skin and soft tissue infections (SSTIs).

Methods
This was a retrospective observational study of hospitalized patients at the Veterans Affairs Health Care System in San Diego, CA with a SSTI and prescribed intravenous vancomycin between January 1, 2016 and December 31, 2019. Patients included were adults, 18 years of age and older, treated with IV vancomycin with ≥1 measured concentration for at least one of the ICD-10 CM codes for SSTI. Patients were excluded if they had any of the following SSTIs: (1) osteomyelitis; (2) infection related to chronic ulcers or wounds; (3) head SSTI; (4) peri-rectal SSTI; (5) human or animal bite SSTI; (6) SSTI related to retained foreign body; (7) necrotizing SSTI; (8) surgical site infection. Patients were also excluded if they were undergoing dialysis or had severe immunosuppression.

Results
A total of 722 patients on vancomycin for a SSTI were identified from the database query for screening, and 243 (34%) met inclusion criteria for the study. Classification and Regression Tree (CART) modeling identified a calculated AUC of &gt;253 as having the highest correlation with clinical success. Clinical cure was significantly different between the AUC ≤253 (6/9 [67%]) and AUC &gt;253 (214/234 [91%]) cohorts (p=0.043). There were no differences in hospital length of stay or duration of vancomycin therapy. Nephrotoxicity occurred in seven patients, all of who had AUC &gt;253.

Conclusion
Overall treatment success in patients with SSTIs was associated with a vancomycin AUC &gt;253, which is lower than the guideline recommended range of 400–600. Identification of vancomycin AUC targets for other low risk sources of infection, such as UTIs, is needed to prevent vancomycin overexposure.

Disclosures
All Authors: No reported disclosures
199. Short versus Extended Antibiotic Treatment with a Carbapenem for High-risk Febrile Neutropenia in Hematology Patients with Fever of Unknown Origin: A Randomized Multicenter Noninferiority Trial
Authors: de Jonge Nick A , Sikkens Jonne , Zweegman Sonja , Beeker Aart , Ypma Paula , Herbers Alexandra , Vasmel Wies , de Kreuk Arne , Coenen Juleon , Lissenberg-Witte Birgit , Budding Andries , Kramer Mark , Van Agtmael Michiel , Janssen Jeroen 
Published: January 2021

Abstract

Background
In hematology patients with high risk neutropenia due to intensive chemotherapy the optimal antibiotic treatment duration for fever of unknown origin (FUO) is unknown. Early antibiotic discontinuation has been advocated to reduce unnecessary exposure to broad-spectrum antibiotics, but there is limited evidence for the safety of this strategy. We aimed to assess if short treatment with carbapenems is non-inferior to extended treatment for neutropenic patients with FUO.

Methods
Multicenter, open-label, randomized clinical trial in 6 centers in the Netherlands. Hematology patients with FUO during high risk neutropenia (≥7 days) were eligible for participation. Eligible patients who gave informed consent were randomly assigned (1:1) to either the short treatment arm, where the carbapenem was discontinued after 72 hours, irrespective of presence of fever, or the extended treatment arm, where the carbapenem was continued for ≥ 9 days until afebrile for 5 days or end of neutropenia (EON), whichever came first. The primary endpoint was treatment failure defined as a composite of recurrent fever or a carbapenem-sensitive infection between day 4 and day 8 and septic shock or death from day 4 until EON. Secondary endpoints included all-cause and infection-related mortality until 30 days post-EON. We used 10% as noninferiority margin.
Trial Intervention Flowchart

Results
Between December 2014 and August 2019 292 patients were included. Risk of treatment failure in the modified intention-to-treat analysis (mITT) was 23.5% (32/136) in the short treatment versus 18.3% (24/131) in the extended treatment arm (adjusted risk difference (ARD) 3.7% (90% CI -2.6% to 9.9%)) and in the per-protocol analysis 27.9% (29/104) versus 18.2% (22/121) (ARD 8.9% (90% CI 0.6% to 17.2%). Short treatment was non-inferior to extended treatment in the mITT population, but not in the per protocol population.
All-cause mortality until 30 days post-EON was significantly higher in the short treatment group: 3.7% (5/136) versus 0.8% (1/131) (ARD 2.8%, 95% CI 1.3 to 4.4%), but infection-related mortality until 30 days post-EON was not statistically different between the treatment arms.
Primary and Secondary Endpoint Results

Subgroup Analyses Results

Bloodstream infections after day 3

Conclusion
Short treatment with a carbapenem in neutropenic patients with fever was noninferior to extended treatment with regard to treatment failure.
Conclusion Summary

Disclosures
All Authors: No reported disclosures
315. Alternating Magnetic Fields (AMF) and Antibiotics Eradicate Biofilm on Metal in a Synergistic Fashion
Authors: Wang Qi , Vachon Jonathan , Pybus Christine A , Shaikh Sumbul , Chopra Rajiv , Greenberg David E 
Published: January 2021

Abstract

Background
Hundreds of thousands of human implant procedures require surgical revision each year due to infection. Implant infections are difficult to treat with conventional antibiotics due to the formation of biofilm on the device surface. We have developed a non-invasive method to treat metal implant infections using alternating magnetic fields (AMF). The outer surface of a metal implant is heated when exposed to AMF, and we hypothesize that this heating can be used to eradicate biofilm or sensitize them to antibiotics (Fig 1). This study investigated the interaction of biofilm and antibiotics in vitro.
Fig 1. Scheme showing the principle of AMF treating metal implant infection (MII).

Methods
P. aeruginosa (PAO1) and Staphylococcus aureus (UAMS1) biofilms were cultured on stainless steel rings. The biofilms were then treated as in Fig 2, receiving a series of AMF exposures every 12 hours. Each dose of AMF was comprised of multiple 3s-AMF exposures every 5 min, with a peak ring temperature of 65 °C. Biofilms were incubated in the presence or absence 0.5 mg/mL ciprofloxacin or ceftriaxone. At the end of 12 and 24 hours, samples were harvested and colony forming units (CFU) were calculated.
Fig 2. AMF treatment design.

Results
AMF alone resulted in a transient decrease in CFU which recovered by the second dose. Antibiotics alone resulted in an ~2-log decrease in CFU at 24 hours. However, the combination of AMF plus cipro showed a synergistic response with a &gt;4-log decrease (Fig 3a). Confocal microscopy confirmed these findings. This effect was not limited to Pseudomonas aeruginosa as similar synergistic responses were seen with Staphylococcus aureus and ceftriaxone (Fig 3b).
Fig 3 The bacteria number (CFU) change during 24 hr AMF and antibiotics treatment session. a) P. aeruginosa (PAO1) treated with AMF and ciprofloxacin. b) Staphylococcus aureus (UAMS1) treated with AMF and ceftriaxone.

Conclusion
When combined with antibiotics, AMF displays a synergistic effect in eradicating biofilm. This effect was seen in different pathogens and in multiple antibiotics. Synergy was seen at different target temperatures as well. This interaction has important implications for deployment of this innovative non-invasive approach to treating biofilm-related infections on metal implants.

Disclosures
All Authors: No reported disclosures
316. Application of New Consensus Definition Identifies High Numbers of Fracture Related Infections with Negative Cultures
Authors: Weinert-Stein Kaitlyn E , Slater Julia C , Sagi Henry C , Powers-Fletcher Margaret , Palacio Federico 
Published: January 2021

Abstract

Background
Fracture related infection (FRI) is a severe complication in trauma surgery but defining the full impact of these infections has been challenging with the lack of clear diagnostic criteria. This is particularly problematic for culture-negative FRI (CNFRI), which lack pathogen identification to guide antimicrobial therapy. However, new consensus definition and criteria for the diagnosis of FRI (Table) may help reduce the risk of diagnostic error. The purpose of this study was to determine the proportion and clinical characteristics of CNFRI cases at a level I trauma hospital using the new diagnostic criteria.

Methods
Laboratory reports were used to identify all patients with at least one specimen submitted for microbiology culture by an orthopedic surgeon at our trauma I level hospital in Cincinnati, Ohio during a three-year study period. This cohort was refined by an electronic medical record (EMR) review to select patients that met the diagnostic criteria for suspected/confirmed FRI. The specimen details and results of the cultures were recorded for the first orthopedic surgeon collection for each suspected FRI case. Clinical data, including fracture characteristics, surgical treatment, antibiotic utilization, and patient outcomes were also extracted from the EMR for each case.

Results
A total of 246 patients were identified with at least one culture specimen; 35.8% (n = 88) of these were deemed suspected/confirmed FRI based on consensus guidelines. The cultures for the first orthopedic surgery collection on these FRI were negative for 35% (n = 31). The most common location for CNFRI were proximal lower extremity fractures (52%), a distribution different from that of culture positive (Figure). Culture positive FRI were predominated by Staphylococcus aureus (39%) followed by gram negative rods (23%).

Conclusion
This retrospective cohort study identified a sizable proportion of CNFRI at our trauma center using the recently published consensus definition. While further analysis is necessary to determine the exact impact of these new criteria, this suggests that clearer definitions may facilitate improved recognition of CNFRI. Because of the relatively high rates of CNFRI, efforts to standardize laboratory diagnostic processes and case management will be required.

Disclosures
Henry C. Sagi, MD, FACS, Conexxions (Board Member)GLW trauma (Consultant)GLW trauma (Shareholder)Stryker (Consultant)
320. Does Guideline-Based Management of Diabetic Foot Osteomyelitis Reduce Risk of Further Proximal Amputations?
Authors: Lee Eugene , Pupaibool Jakrapun , Certain Laura 
Published: January 2021

Abstract

Background
The antibiotic management of diabetic foot osteomyelitis involving surgical limb-sparing amputation is controversial. While there are several guidelines that provide recommendations regarding antibiotic therapy for diabetic foot osteomyelitis after amputation, we do not know of any studies that show that adherence to guidelines improves clinical outcomes. We assessed whether adherence to antibiotic choice and duration in accordance with our institution’s guidelines, which are based on IDSA guidelines, reduced risk of future amputations.

Methods
We conducted a retrospective cohort study of 110 patients with diabetic foot osteomyelitis treated with limb-sparing amputations at a VA hospital. We collected relevant clinical data such as patient comorbidities, antibiotic allergies, labs, imaging, culture data, histopathologic reports, pre-op and post-op antibiotics. We used our institutional guidelines, which are based on the 2012 IDSA Guidelines for the Diagnosis and Treatment of Diabetic Foot Infections, to assess antibiotic choice and duration for diabetic foot osteomyelitis therapy after amputation. We stratified cases as either adherent or non-adherent based on whether antibiotic choice and duration were both in accordance with our institutional guideline. For each case, we recorded the primary outcome of further proximal amputation occurring within six months or death from all causes within three months.

Results
We found a significant difference in primary outcomes between the groups that were treated with antibiotics adherent with guidelines and antibiotics non-adherent with guidelines. For patients who were treated with antibiotics that were non-adherent to guidelines, 15 of 36 (42%) patients needed further amputation or died. Of the patients treated according to guidelines, 12 of 74 (16%) patients needed further amputation or died. There was a statistically significant difference between these two groups (p=0.004).

Conclusion
Our study showed that guideline-based antibiotic therapy for diabetic foot osteomyelitis treated with amputation significantly lowered rates of further amputation compared to antibiotic therapies that were not adherent to guidelines.

Disclosures
All Authors: No reported disclosures
323. First case of Prosthetic joint infection due to Nocardia veterana-elegans
Authors: Fazili Tasaduq , Bansal Ekta , Garner Dorothy C , Bajwa Vijendra 
Published: January 2021

Abstract

Background
Nocardia are Gram-positive filamentous bacteria that cause Nocardiosis, a rare opportunistic infection. The most common site of infection is the lungs, with metastatic spread usually to the central nervous system. Prosthetic joint infection due to Nocardia is very rare.

Methods
We report the first case of prosthetic joint infection due to Nocardia veteran-elegans, and review the literature regarding Nocardia septic arthritis, with particular attention to prosthetic joint infection.

Results
The patient was a 35 year old male with history of Hodgkin’s Lymphoma for which he received chemotherapy previously, poorly controlled diabetes, motor vehicle accident in 2003 with right open tibial plateau fracture requiring hardware placement, who was admitted with a two week history of right knee pain and swelling. Knee aspiration revealed purulent fluid and synovial culture grew Nocardia species. He underwent right knee arthrotomy and debridement with removal of hardware. The Nocardia species was speciated as N. veterana-elegans, sensitive to trimethoprim/sulfamethoxazole, linezolid, clarithromycin, imipenem and amikacin. He was placed on oral linezolid for four weeks, which was then switched to oral trimethoprim/sulfamethoxazole, with a plan for a six month course of therapy. He has completed two months of therapy thus far and is doing well clinically.
Nocardia is an uncommon cause of septic arthritis. We found only 37 cases reported in the English literature thus far. Amongst these, only six involved prosthetic joints, including our case, which is the first one to be caused by N. veterana-elegans.Three cases were caused by N. nova and one each by N. farcinica and asteroides. Septic arthritis due to Nocardia has a favorable outcome with a combination of surgical debridement and prolonged antimicrobial therapy of three to six months. For prosthetic joint infections, removal of hardware seems to carry a better prognosis. Trimethoprim/sulfamethoxazole is the preferred antimicrobial, including for bone and joint infection, although susceptibilities can vary amongst the different species.

Conclusion
Nocardia is an uncommon cause of septic arthritis. Prosthetic joint infection is very rare. Prognosis is fair with a combination of hardware removal and prolonged antibiotic therapy.

Disclosures
All Authors: No reported disclosures
326. More Specialties, Less Problems: Creating collaborative competency between Infectious Disease, Podiatry, and Pathology co-managing diabetic foot infections
Authors: Jhaveri Vimal V , Sullivan Chrsitopher , Ward Ashley , Giurini John , Karchmer Adolf W , Stillman Isaac , Davis Roger , Freed Jason , LaSalvia Mary , Stead Wendy 
Published: January 2021

Abstract

Background
According to the 2016 and 2017 National Health Interview Survey, 9.7% of the US population is estimated to have diabetes mellitus (either type 1 or type 2). 1 Among patients with diabetes, there is a 15% lifetime risk of developing a foot ulcer, making it an extremely common medical problem seen in both outpatient and inpatient settings.2 In fact, Medicare spends $9–13 billion/year on diabetic foot osteomyelitis (DFO).3 Despite this high prevalence and cost, experts have not agreed on a set of diagnostic criteria for diagnosing DFO, 4 nor the optimal antibiotic management.5 For example, while traditionally diabetic foot osteomyelitis has been treated with 4–6 weeks of IV antibiotics in the United States, oral antibiotics have been shown to be effective with similar cure rates in multiple studies 6–8, non-inferior in a Cochrane review,5 and are recommended in the most recent (2012) Infectious Disease Society of America (IDSA) DFO clinical practice guidelines.9

Methods
Representatives from ID, Podiatry, and Pathology collaborated to develop consensus on aspects of management of DFO. We created an educational session, inviting providers from all three departments to develop consensus on some of the controversial aspects of DFO. We assessed for knowledge gain by having these providers complete a pre-test survey as well as a post-test survey 2 weeks after the intervention.

Results
27 providers completed both a pre and post-tests after attending the educational session. Significant improvements were observed in learners understanding of duration of antibiotic treatment and the role of oral antibiotics in certain cases of diabetic foot osteomyelitis to obviate the need for an unnecessary intravenous antibiotics and Peripherally Inserted Central Catheter (PICC) lines. Additionally, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality and efficiency of care provided to these patients.
Figure 1: Results of the Pre- and Post- Assessment

Conclusion
This multidisciplinary, educational session regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments. Further study is being completed assessing patient outcomes before and after this intervention and will be available by IDWeek.

Disclosures
All Authors: No reported disclosures