bluuebunny/crossref_metadata_2025_split huggingface dataset:
883. Evaluation of Post-operative Antibiotic Prophylaxis in Patients Undergoing Urologic Procedures
Authors: Elmarakbi Mohamed , Care Julianne , Laude Jillian , D Pharm 
Published: January 2021

Abstract

Background
Many national guidelines do not recommend post-operative antibiotic prophylaxis due to lack of literature supporting its use; however, they are frequently prescribed at ChristianaCare for urologic procedures. Use of post-operative antibiotics has not correlated with reduction in post-operative infections, and has been show to increase risk for resistant infections, Clostridiodes difficile (C. difficile) and acute kidney injury (AKI).

Methods
A single center retrospective chart review was conducted to evaluate endpoints of patients who underwent a urologic procedure and received post-operative antibiotics (intervention group) compared to those who did not (control group) from June 1st 2018 to September 1st 2019. The primary endpoint was to compare the incidence of post-operative infections, including surgical site infections (SSIs), bacteremia, and urinary tract infections (UTIs) between the intervention and control groups. The secondary endpoints included comparing the incidence of prespecified adverse outcomes, between the two groups.

Results
A total of 250 patients were included in this study. Baseline demographics were similar across a number of characteristics in both groups. There was no difference between the intervention and control groups in the incidence of post-operative bacteremia (p = 0.608), SSIs (p = 0.491) and 30 day UTIs (p = 0.307). The rate of AKI between both groups were similar. There was a higher percentage of resistant organisms seen in the intervention group compared to the control group (21.4 % vs. 16.7%). The intervention group experienced an increase in post-operative antibiotic related adverse effects. Although a small number of patients were tested for C. difficile, there was one positive C. difficile PCR in the intervention group compared to zero in the control group.

Conclusion
The results of this study support withholding post-operative antibiotics in urologic procedures given no benefit in reducing post-operative infections and potential to increase adverse effects and development of resistant organisms. Efforts to change this current practice at our institution will be implemented via collaboration with the urology section and review of current order sets.

Disclosures
Jillian Laude, Pharm D, BCPS, Shionogi Inc (Other Financial or Material Support, Received one-time speaker fee for a round table discussion. The financial relationship does not relate to this research project.)
884. Evaluation of Surgical Site Infections in Solid Organ Transplant Recipients with Beta-Lactam Allergies
Authors: Mowrer Clayton , Van Schooneveld Trevor C , Matthews Stephen , Stohs Erica J 
Published: January 2021

Abstract

Background
Beta-lactam allergies (BLA) are common, but the prevalence and impact on solid organ transplant (SOT) recipients is largely unknown. We assessed the prevalence of BLA labels in SOT recipients at the time of transplant and evaluated their influence on surgical site infection (SSI) prophylaxis and SSI incidence.

Methods
All patients undergoing first heart, kidney, liver SOT at our institution were retrospectively reviewed (1/1/2015-12/31/2019). Antibiotic allergies, surgical antibiotic prophylaxis, and SSIs were abstracted from the electronic medical record. Reported BLA reactions were classified as potentially IgE-mediated, delayed, or non-allergic based on documentation. SSIs were reported according to NHSN definitions, and the incidence of SSI was compared between patients with and without reported BLA. SSI prophylaxis regimens were compared to institutional guidelines. Basic descriptive statistics were performed.

Results
Out of a total cohort of 751 patients (122 heart, 435 kidney, 209 liver, 4 multi-organ), 129 (17%) reported at least one BLA, with 104 (15%) with reactions to penicillins, 26 (3%) to cephalosporins, and 1 (0.1%) to carbapenems. Commonly reported reactions were rash (38%), hives (25%), and “other” (21%); 28% of documented reactions were not documented or classified as non-allergic. SSI developed in 7 (6.1%) of heart, 10 (2.5%) of kidney, and 16 (9.4%) of liver transplant recipients. Excluding 44 patients already on antibiotics for treatment of systemic infection, guideline concordant beta-lactam antibiotic surgical prophylaxis was administered to 6 (5.2%) of BLA group vs 490 (85.8%) in the non-BLA group (p&lt; 0.01); among the BLA group who did not receive a beta-lactam, 96 (83%) received a regimen concordant with institutional guidelines for penicillin allergy and 14 (12%) received guideline non-adherent regimens. Patients reporting BLA did not have a higher incidence of SSIs compared to those without BLA: 6 (4.8%) vs 27 (4.5%) respectively, p=0.86.

Conclusion
BLA prevalence in our SOT population was similar to previously reported rates, but many reported reactions were not allergic in nature. Pre-transplant allergy evaluation for patients with reported BLA may improve SSI antibiotic prophylaxis compliance.

Disclosures
All Authors: No reported disclosures
889. Improving patient compliance with preoperative universal decolonization to reduce surgical infection rate and costs
Authors: Candray Kimberly 
Published: January 2021

Abstract

Background
In order to address spine patient non-compliance with preoperative nasal decolonization, a trial was undertaken to replace nasal povidone iodine (PVI) with alcohol based nasal antiseptic paired with chlorhexidine (CHG) bathing for all spine fusion and laminectomy patients for a period of three months.

Methods
In addition to preoperative CHG bathing already in place, an alcohol based nasal antiseptic was applied to the nose of all spine surgery fusion and laminectomy patients within one hour of surgery instead of the PVI nasal antiseptic that had been in use previously.

Results
After switching the alcohol based nasal antiseptic, there was a reduction in surgical site infections (SSI) of 64% from 0.58 to 0.21/100 spine fusion procedures and a reduction in SSI of 100% from 0.46 to 0.00/100 laminectomy procedures. This represents an estimated cost avoidance of $127K associated with infections prevented. There was also a $37K cost savings resulting from switching from nasal PVI to alcohol based nasal antiseptic, with patients reporting greater satisfaction.

Conclusion
Universal preoperative decolonization for spine fusion and laminectomy patients using an alcohol based nasal antiseptic and CHG bathing resulted in reduced infection rates and associated costs, reduced nasal antiseptic cost and improved patient satisfaction.

Disclosures
All Authors: No reported disclosures
894. Patient and Surgery Characteristics on Wound Complication and Surgical Site Infection in Sarcoma Patients undergoing Hemipelvectomy
Authors: Katzman Ju Hee , Sun Steven , Joyce David , Greene John 
Published: January 2021

Abstract

Background
Hemipelvectomy is associated with a significant risk of wound complications, including infections, bleeding and injuries to nearby neurovascular structures as well as the gastrointestinal and genitourinary tract. This study aimed to determine the patient characteristics and approach to treatment that could affect the occurrence of surgical site infection or wound complications in sarcoma patients undergone hemipelvectomy.

Methods
We conducted a retrospective analysis of 33 adult patients who underwent hemipelvectomy at Moffitt Cancer Center, Tampa, FL, from 2008 to 2016. We used Chi-square (Exact Fisher) test to investigate the association between wound complication and categorical variables. We used a T-test to evaluate the difference in numerical variables for outcomes.

Results
Out of 33 patients, 12 (36.4%) patients experienced wound complications after hemipelvectomy (Table 1). The average age of patients with wound complications was 63.3 3 (57.1±15.4) years old, significantly higher than that of patients without wound complications (p=0.004). Without adjustment, the use of computer navigation had a lower wound complication rate (p=0.027). Patients with wound complications had longer hospital length of stay (14.8 vs. 7.0 days, p=0.016). Among patients with surgical site infection (Table 2), there were no patients’ characteristics or surgical characteristics associated with this outcome. Five (15%) patients developed surgical site infection and they had longer hospital stay (19.4 vs. 8.1 days, p=0.001). The organisms identified from wound cultures include methicillin-resistant Staphylococcus aureus, viridans Streptococcus, Peptostreptococcus asaccharolyticus, Enterobacter cloacae, Pseudomonas aeruginosa, Candida albicans. The organisms in late infections (more than 6 months since surgery), included above organisms plus Stenotrophomonas maltophilia and Achromobacter xylosidans.

Conclusion
Older patients undergoing hemipelvectomy are at an increased risk of developing wound complications with a prolonged hospital stay. Initial antimicrobial therapy for suspected surgical site infection should include a broad-spectrum coverage to include skin and gastrointestinal flora.

Disclosures
All Authors: No reported disclosures
898. Prevalence of Extended Spectrum Beta-Lactamase Producing Escherichia coli, Klebsiella Pneumoniae and Pseudomonas Aeruginosa from Hospital Acquired Surgical Site Infections in Ghana
Authors: Egyir Beverly , Nkrumah-Obeng Noah , Nyarko Edward , Fox Anne , Letizia Andrew , Sanders Terrel 
Published: January 2021

Abstract

Background
Globally, ESBL-producing bacteria pose a great challenge for treating hospital acquired SSI. Currently, the prevalence of ESBL pathogens in Ghana hospitals is poorly understood. Determining the frequency ESBLs are encountered will, in turn, provide insight for antibiogram development and shape antimicrobial stewardship policies in Ghana.

Methods
Using U.S. CDC criteria for SSI, wound swabs or aspirates were collected from 112 participants who met study inclusion criteria. Specimens were plated on MacConkey and blood agar; then colonies were isolated and identified using MALDI-TOF. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method and interpreted according to the 2018 Clinical and Laboratory Standards Institute (CLSI) guidelines. The combined disk method was used to screen for ESBLs among E.coli and K. pneumoniae isolates. Genes associated with ESBL production (SHV, TEM and CTX-M) were detected using PCR analysis.

Results
Thirty-eight percent of the bacterial isolates recovered were E. coli, K. pneumonia accounted for 32%, and P. aeruginosa accounted for 16% of the total isolates; remaining isolates were gram positive pathogens not discussed here. ESBL production was detected in 50% of E. coli isolates and 73% of K. pneumoniae isolates. ESBL-producing isolates were susceptible to meropenem but resistant to cefuroxime, cefotaxime, tetracycline, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin and chloramphenicol. P. aeruginosa isolates were only sensitive to meropenem, gentamicin, and ciprofloxacin. In our study, CTX-M was the most frequently detected gene producing the ESBL-phenotype: 33% of E. coli isolates and 73% of K. pneumoniae isolates possessed the CTX-M gene.

Conclusion
Approximately 70% of total bacterial isolates recovered from our SSI study were ESBL producers. The presence of these multi-drug resistant organisms raises clinical concerns due to the absence of routine antimicrobial resistance (AMR) testing and lack of suitable first-line antimicrobials for ESBL pathogens. Improved laboratory capacity to more readily detect MDROs is essential for effective clinical management of patients, antibiogram development and refining antimicrobial stewardship practices in Ghana hospitals.

Disclosures
All Authors: No reported disclosures
900. Retrospective Review of Microbiological profile in Post Surgical Spine Infections and Assess the Appropriateness of Current Pre-Op Antibiotic Prophylaxis Policy
Authors: Patel Kavya , Smulian Alan , Apewokin Senu , Grawe Erin , Vargas Edwin , Liao Siyun 
Published: January 2021

Abstract

Background
SSI is a devastating complication of spine surgery that results in significant morbidity as it requires prolonged antibiotic courses and multiple surgical debridements. It also increases the economic burden on the health care system. So, it becomes important to learn the microbiological profile and assess the current pro-op antibiotic prophylaxis policy.

Methods
All cases reported by the hospital infection control surveillance program based on CDC/NHSN Surveillance definitions between January 2017 and July 2019 were retrospectively reviewed for microbiological data and surgical characteristics using electronic medical record, and non-parametric test was used to assess the difference in proportional distribution of gram-negative organisms between upper and lower spine groups.

Results
Between January 2017 and July 2019, 3561 spine surgeries were performed, 51 cases of SSI were reported, and 50 patients have microbiological data available. The most commonly isolated organism was Staphylococcus aureus (38%), followed by Escherichia coli (12%). There was no statistical difference for the distribution of gram-negative organisms in upper spine (17) and lower spine (33) surgeries (29.4% vs 48.4%, P Value = 0.24). However total gram-negative organisms accounted for 42% cases and lower spine surgical procedures were more likely to be associated with mixed infections including both gram negative and gram-positive organisms (15.1% vs 0%). Cefazolin resistant gram-negative organisms accounted for 22% of all gram-negative infections. Our current pre-op antibiotic policy recommends cefazolin plus or minus vancomycin (If MRSA screen positive) and clindamycin plus vancomycin in patients with severe penicillin allergy.
Table 1: Characteristics of the cultures

Table: 2 Microorganisms isolated from 50 patients with post-surgical spine infections

Figure 1: Proportional distribution of Micro-organisms between lower and upper spine (Percentage on left side and No. of positive cultures on right side)

Conclusion
Although gram-positive organism predominated, there was a substantial portion of gram-negative organisms in post-surgical spine infections. Cefazolin would cover at least half of the gram-negative organisms identified based on our antibiogram susceptibility pattern. However, in patients with penicillin allergy, our current recommended pre-operative antibiotic prophylaxis does not provide gram-negative coverage. We will therefore explore the value of adding an agent with gram negative coverage based on our institutional antibiogram.

Disclosures
All Authors: No reported disclosures
908. Evaluation of Blood Culture Submission Rates in Japan
Authors: Tajima Taichi , Tsuzuki Shinya , Asai Yusuke , Endo Mio , Matsunaga Nobuaki , Hayakawa Kayoko , Ohmagari Norio 
Published: January 2021

Abstract

Background
Blood culture tests are useful for accurate diagnosis of bacteremia and selection of antimicrobial treatment, and they are essential for instituting antimicrobial resistance (AMR) countermeasures. This study investigated blood culture submission rates in Japan and their association with the incidence of bloodstream infections.

Methods
Blood culture data recorded in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) database from January to December 2019 and data submitted for consecutive 12 months from acute care hospitals (hospitals with a mean length of patient stay of ≤19 days) were included for analysis. Samples comprised 1 set of blood culture samples (aerobic and anaerobic bottles) defined as one submission. The annual blood culture submission rate was calculated as the total number of submitted blood cultures per 1000 patients/day. The incidence of bloodstream infections was calculated as the number of positive blood cultures excluding contaminated specimens per 1000 patients/day. The blood culture submission rate was then divided into four categories, respectively: category 1: 0–15; category 2: 15–30; category 3: 30–45; and category 4: 45–80.
The Kruskal-Wallis test was performed to determine overall difference among 4 submission rate categories and the Dunn test with Bonferroni correction was used to compare pairs of submission rate categories.
Filtering of facilities for data analysis

Results
A total of 117 hospitals were included in the analysis. The median number of beds was 415.0 (interquartile ratio [IQR]: 274.5–549.5). The median incidence of bloodstream infection was 2.78 (2.17–3.87). The median blood culture submission rate was 26.18 (17.20–35.76). The median incidence of bloodstream infection by category of blood culture submission rate was 1.39, 2.53, 3.61, and 4.48, respectively; with a significant difference observed among the four categories overall (p&lt; 0.01). Significant differences were observed between categories 1 and 2 and between categories 2 and 3 (both p&lt; 0.01) but not between categories 3 and 4 (p=0.758).
Characteristics of the acute hospitals by category of blood culture submission rate

Incidence of bloodstream infections by category of blood culture submission rate

Conclusion
The blood culture submission rate is considered to be around 45 in the acute hospital setting in Japan. The incidence of bloodstream infections is greatly affected by submission rates.

Disclosures
All Authors: No reported disclosures
909. Reassessing Pathogens Eligible for the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) “Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection” Criteria
Authors: Chea Nora , Magill Shelley , Benin Andrea L , Allen-Bridson Katherine , Dudeck Margaret , Patel Prachi , Thomson Nicola D 
Published: January 2021

Abstract

Background
NHSN Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection (MBI-LCBI) includes pathogens likely to cause bloodstream infections (BSI) in some oncology patients. MBI-LCBIs are excluded from central line-associated BSI (CLABSI) reporting to the Centers for Medicare & Medicaid Services. NHSN users have requested other pathogens be added to MBI-LCBI. To make decision, we compared CLABSI pathogen distributions in three NHSN patient location groups.

Methods
We analyzed CLABSI data from hospitals conducting surveillance for ≥ 1 month from January 2014–December 2018 in ≥ 1 MBI high-risk location (leukemia, lymphoma, and adult and pediatric hematopoietic stem cell transplant wards). We compared CLABSI pathogen distributions and rates in MBI high-risk locations to medium-risk (solid tumor, adult and pediatric general hematology-oncology wards) and low-risk locations (adult and pediatric medical, surgical, and medical-surgical wards), and used χ2 tests to compare percentages with statistical significance at P ≤ 0.05.

Results
Overall, 122 hospitals reported 23,578 CLABSIs and 12,961,921 central line (CL)-days (1.81 CLABSIs per 1,000 CL-days) (Table). Percentages of CLABSIs due to three MBI-LCBI pathogens (E. coli, E. faecium, Viridans streptococci) were significantly higher in high- versus low-risk locations, while for other MBI-LCBI pathogens (K. pneumoniae/oxytoca, E. faecalis, Candida spp., Enterobacter spp.) percentages were significantly lower in high-risk locations (Figure). For pathogens not currently in MBI-LCBI, coagulase-negative staphylococci caused similar percentages of CLABSIs across locations, S. aureus caused a significantly higher percentage of CLABSIs in low-risk locations, while PA caused a significantly higher percentage of CLABSIs in high-risk locations.
Table CLABSIs attributed to MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018

Figure Percentages of top 10 pathogen-specific CLABSIs in MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018

Conclusion
Differences in percentages of CLABSIs due to selected pathogens between MBI high-risk and low-risk locations are evident in NHSN data. Lower percentages of Klebsiella and Candida spp. in high-risk locations might be partially due to antimicrobial prophylaxis in oncology patients. Although PA caused a significantly higher percentage of CLABSIs in high-risk locations, the absolute difference was modest. Additional analyses are needed.

Disclosures
All Authors: No reported disclosures
915. Global 2018 Surveillance of Eravacycline Against Gram-positive Pathogens, Including Resistant Isolates
Authors: Morgan Steven , Hwang Sara , Efimova Ekaterina , Hawser Stephen , Morrissey Ian , Lijfrock Virgil 
Published: January 2021

Abstract

Background
Eravacycline (ERV) is a fully-synthetic, fluorocycline antibacterial approved by the FDA and EMA for the treatment of complicated intra-abdominal infections (cIAI) in patients ≥18 years of age. The purpose of this study was to further monitor the in vitro activity of ERV against Gram-positive pathogens, such as Staphylococcus aureus (including methicillin-resistant S. aureus, MRSA), Enterococcus spp. (including vancomycin-resistant Enterococcus, VRE) and Streptococcus spp.

Methods
Isolates were collected globally during 2018 from various body sites. Minimum inhibitory concentrations (MICs) were determined by CLSI broth microdilution. Antibiotic susceptibility was determined using the most recent CLSI breakpoints (30th ed CLSI M100 document), except for ERV and tigecycline (TGC) where FDA breakpoints from 2018 and 2005, respectively, were applied.

Results
Summary MIC data for ERV and select comparators are shown in the Table. ERV MIC50/90 for Enterococcus spp were 0.06/0.12 μg/mL and were not affected by the presence of vancomycin resistant mechanisms. The MIC90 of ERV against VRE was 2-fold lower than TGC, at a value of 0.12 μg/mL. ERV MIC90 values for methicillin-susceptible S. aureus (MSSA) was 0.12 μg/mL and for MRSA was 0.25 μg/mL. Generally, for all pathogens, ERV MIC90 values were 2- to 4-fold lower than TGC.
Table

Conclusion
ERV in vitro activity was demonstrated for clinically important Gram-positive pathogens, including resistant isolates. Overall, ERV demonstrated lower MIC90 values than comparators for all organisms. This 2018 global surveillance highlights ERV’s utility against Gram-positive organisms and further underscores its role in cIAI, where these pathogens play a causative role.

Disclosures
Steven Morgan, PharMD, Tetraphase Pharmaceuticals (Employee) Sara Hwang, PharMD, Tetraphase Pharmaceuticals (Employee) Ekaterina Efimova, PharMD, Tetraphase Pharmaceuticals (Employee) Stephen Hawser, PhD, Tetraphase Pharmaceuticals (Scientific Research Study Investigator) Virgil Lijfrock, PharMD, Tetraphase (Employee)