bluuebunny/crossref_metadata_2025_split huggingface dataset:
1456. Increase in Resistance to Antibiotics in Enterobacteriaceae from Ambulatory Urinary Samples in Buenos Aires City
Authors: Bissio Emiliano , Luis Montes José , Mariela Merkt , Riselli Virginia , Sucari Adriana , Pennini Magdalena 
Published: October 2019

Abstract

Background
During the last years, an increase in the rates of resistance among causal agents of urinary tract infection (UTI) has been reported, even in community-acquired infections. This increase in resistance is problematic since it affects most therapeutic agents used in the ambulatory setting and often implies the lack of oral options for treatment. The aim of this study was to determine whether there were changes in the prevalence of resistance among samples from patients with UTI in the ambulatory setting caused by the most common Enterobacteriaceae.

Methods
We analyzed the resistance profiles of the three most common Enterobacteriaceae recovered in cultures from urinary samples of ambulatory adult patients, processed in a reference Laboratory in Buenos Aires City; according to calendar year, from January 1, 2010 till December 31, 2017. Sensitivity to antibiotics was determined using disk-diffusion methods and interpreted according to CLSI guidelines.

Results
A total of 26774 urinary samples were processed in the mentioned period and were analyzed for this study. Of these, 84% were from women, mean (SD) age was 59.7(20.4) years. Distribution according to bacterial genus and species was: E. coli: 84.6%; Klebsiella pneumoniae: 9.9%; Proteus sp.: 5.5% There were no significant differences in gender, mean age or bacterial genus/species distribution according to calendar year. When comparing 2010 to 2017 we found significant differences in the prevalence of resistance to fluoroquinolones: 26.6% vs. 33.6% respectively, P < 0.01; third G cephalosporins: 5.2% vs. 10.0%, P < 0.01; carbapenems: 0.2% vs. 0.4%, P < 0.01. Prevalence of resistance to TMS (39.0% vs. 40.2%) and nitrofurans (11.9% vs. 10.3%) remained stable. Results of analysis of resistance according to bacterial genus/species comparing results from 2010 to results from 2017 are shown on the table.

Conclusion
Resistance to antibiotics in Enterobacteriaceae recovered from urinary samples has increased significantly in the last years, especially for quinolones, third G cephalosporins (100% increase) and carbapenems (100% increase). Resistance to TMS was high but remained stable. E coli shows very good sensitivity to nitrofurantoin. It is key to improve and amplify the measures to prevent emergence of resistance and aim to revert this increasing trend in urinary tract infections from the community.

Disclosures
All authors: No reported disclosures.
1459. Oral Cephalosporins vs. Fluoroquinolones for the Empiric Treatment of Acute Uncomplicated Pyelonephritis
Authors: Lin Kevin , Ortwine Jessica , Mang Norman , Wei Wenjing , Prokesch Bonnie C 
Published: October 2019

Abstract

Background
The Infectious Diseases Society of America guidelines for the treatment of acute uncomplicated pyelonephritis (AUP) recommend oral fluoroquinolones (FQs) as a first-line agent in patients not requiring hospitalization. However, with increasing rates of FQ and trimethoprim/sulfamethoxazole resistance, oral β-lactams are attractive agents due to improved empiric susceptibility patterns at our institution. The current guideline advises caution when using oral β-lactams due to concern for inferior efficacy, but studies specifically evaluating the efficacy of oral cephalosporins (CPHs) in AUP are limited. The purpose of this study was to provide additional evidence for the safe and effective use of oral CPHs for empiric treatment of AUP.

Methods
Retrospective chart review was performed on all patients prescribed oral CPHs or FQs for AUP from the Emergency Department (ED) at Parkland Memorial Hospital between September 2017 and July 2018. The primary endpoint was treatment failure within 30 days, defined as ED return due to any cause or modification to an alternative antibiotic. Secondary endpoints included ED return within 30 days due to continued symptoms of AUP, documented adverse drug reactions (ADRs), and C. difficile infection (CDI) within 30 days.

Results
Of the 333 patients included in the study, treatment failure occurred in 72 (21.6%) patients and was similar between oral FQs and CPHs (21.4% vs. 21.7%). A higher rate of treatment failure was observed for first-generation (1GC) CPHs compared with second-generation (2GC) or third-generation (3GC) CPHs (19/51 [43.1%] vs. 18/107 [16.8%] vs. 9/68 [13.2%]). The primary reason for treatment failure was modification to an alternative antibiotic, and was highest for oral 1GC, followed by FQs, then 2GC and 3GC (19/51 [37.3%] vs. 14/107 [13.1%] vs. 11/107 [10.3%] vs. 4/68 [5.9%]). Rates of return to the ED for continued symptoms of AUP were found to be lower for oral CPHs (8/226 [3.5%]) vs. FQs (9/107 [8.4%]). Documented ADRs were low (5/333 [1.5%]) and none developed CDI.

Conclusion
Oral CPHs appear to be as safe and effective as FQs for the empiric treatment of AUP. In concordance with the susceptibility data of our institutional antibiogram, 2GC and 3GC were observed to have a lower rate of treatment failure compared with 1GC and FQs.

Disclosures
All authors: No reported disclosures.
1464. The Utility of Double Balloon Urinary Catheter in Reducing Rates of Catheter-Associated Urinary Tract Infections in a Tertiary Care Teaching Hospital
Authors: Katzman Ju Hee , Garcia Cristina Vanessa , Lakshmi Seetha , Thompson Peggy , Archibald Lennox 
Published: October 2019

Abstract

Background
Catheter-associated urinary tract infections (CAUTI) have been shown to increase hospital length of stay, healthcare costs, morbidity, and mortality. Studies that evaluate the role of urinary catheter design in preventing CAUTI are lacking. One such design is the double-balloon (DB) urinary catheter that has a second distal balloon; this design is aimed at reducing mucosal injury and inhibiting coiling of the in situ catheter. We carried out a comparative study to (a) determine whether CAUTI rates differ for different types of urinary catheters, and (b) identify risk factors associated with the acquisition of CAUTI in patients with DB vs. non-double-balloon (NDB) urinary catheters.

Methods
We conducted a retrospective cohort study of all patients who acquired CAUTI from January 2017 through December 2018. We collected age, sex, body mass index, medical history including benign prostatic hypertrophy, urinary tract infection (UTI), prostate cancer, stroke, surgery within the last 30 days including the type of surgery, indication for indwelling urinary catheter, location of catheter insertion, duration of catheterization, presence of pyuria, and type of catheter used. Statistical analyses were carried out using IBM SPSS software. Test statistics included independent sample t-test. CAUTI rates were expressed per 1000 catheter-days.

Results
Sixty-seven patients acquired CAUTI during the study period. NDB catheters included the following types: Foley, temperature sensing catheters, and coude catheters. Patients with DB and NDB catheters were similar in age, gender, diabetes, history of stroke, history of recent surgery, or history of UTI. CAUTI rates among patients with the DB catheters was 28 events per 29,018 catheter-days vs. 39 events per 33,579 catheter days for NDB type (P = NS). On stratification, CAUTI rates for foley, temperature sensing catheters, and coude catheters were 1.12, 1.27 and 2.70, respectively (P = NS).

Conclusion
There were no statistically significant differences in CAUTI rates at our facility among patients with DB vs. NDB urinary catheters. The decision on the choice of the catheter for use in our facility will likely depend on the comparative costs of the respective catheters.

Disclosures
All authors: No reported disclosures.
1466. Alkaline Urine: A Cause for Urinary Tract Infection Recurrence
Authors: Wattengel Bethany A , Schroeck Jennifer , DiTursi Sara , Sellick John A , Mergenhagen Kari A 
Published: October 2019

Abstract

Background
Urinary tract infections (UTIs) are one of the most common indications for antibiotics in both the inpatient and outpatient setting. The purpose of this study was to examine the impact of urinary pH on recurrence of UTIs. A recent review article stated imaging should be considered for patients with a urinary pH of 7 or higher. This study examines the impact of pH on outcomes of patients with UTI to determine whether pH plays a role in recurrent infection and representations to the healthcare facility.

Methods
This was a retrospective chart review via the computerized patient record system. Patients over the age of 18 years who presented to the healthcare facility between January 1, 2005 to January 1, 2019 for treatment of UTIs were included in this study. Alkaline urine was defined as a urinary pH greater than or equal to 7, while acidic urine was defined as a urinary pH less than 7. Urease splitting organisms included Proteus spp., Providencia spp., and Morganella spp. Outcomes included recurrence and re-presentation to the healthcare facility within 30 days.

Results
A total of 793 patients were included in this study, of which 21.3% had alkaline urine. Patients with alkaline urine were more likely to have recurrence of UTI (8.3% vs. 4.3%). Patients with a catheter were more likely to have alkaline urine (30% vs 18%; P = 0.0005). As expected, alkaline urine was associated with a higher frequency of urease splitting organisms (19% in alkaline urine vs. 3% in acidic urine). Renal calculi were found in 3.6% of patients with alkaline urine; however, only 34.3% of patients with alkaline urine had imaging completed. The use of drugs which can alkalinize the urine did not differ significantly between groups.

Conclusion
Patients with an alkaline urinary pH were more likely to experience recurrence and readmission within 30 days. Imaging was performed in a minority of patients which may represent a potential target for stewardship programs. Alkaline urine may be a marker for urease splitting organisms and calculi formation. More widespread imaging may be able to detect stones, allowing for potential urologic intervention, preventing subsequent antibiotic courses and repeated healthcare presentations.

Disclosures
All authors: No reported disclosures.
1471. Medical Claims Analysis as a Tool to Evaluate Empiric and Targeted Antibiotic Therapy in UTIs
Authors: Hui Wing , Antunes Nuno T , Veeramani Shriram , Holman David 
Published: October 2019

Abstract

Background
Empiric therapy is a mainstay of the inpatient management of urinary tract infections (UTIs), and the choice of empiric antibiotic is shaped by local epidemiology and patient risk factors and comorbidities. Pathogen identification (ID) and antibiotic susceptibility testing (AST) provide information that can guide adjustments in therapy, allowing de-escalation to more targeted, narrow-spectrum antibiotics.

Methods
Real-world data (hospital billing claims) from 2017 was used to extract relevant information from general hospitals on inpatients with bacterial UTIs including patient demographics and antibiotics line of therapy progression. Patients were projected to the USA national event totals and validated with other projection-related data sources (HCUP) and secondary market research. Data obtained in the claims analysis was validated by primary market research (PMR).

Results
Analysis of 33M claims identified 169K patients with a code for UTI; in at least one-third of patients, there were no codes associated with ID/AST assays. Among those with codes for ID/AST assays, the vast majority were performed in the first 3 days following hospital admission. Approximately two-thirds of patients with associated ID/AST codes were already receiving an antibiotic when the assays were performed, which was assumed to be the empiric treatment. Analysis of the line of antibiotic therapy progression in patients where ID/AST was performed identified subsequent changes in antibiotic prescribing in approximately one-third of patients within 3 days, compatible with changes due to delivery of conclusive results and were interpreted as a transition from empiric to targeted treatment.

Conclusion
To the best of our knowledge, this is the first attempt at understanding the impact of ID/AST assays on prescribing practices with basis on analysis of claims data. Our results align with PMR conducted by DRG internally, supporting the validity of this methodology. Although this claims analysis delivers reliable data when claims are associated with ID/AST assays, it is limited by incompletely filled claims, which may underestimate the use of these assays.

Disclosures
All authors: No reported disclosures.
1479. Clinical Efficacy and Safety Analysis Evaluating Oral Gepotidacin (GSK2140944) from a Phase IIa Study in the Treatment of Uncomplicated Urinary Tract Infections
Authors: Overcash J Scott , Dumont Etienne , Perry Caroline R , Tiffany Courtney , Scangarella-Oman Nicole , Raychaudhuri Aparna , Hossain Mohammad 
Published: October 2019

Abstract

Background
Urinary tract infections (UTIs) are very common, with approximately 11% of women >18 years of age experiencing at least 1 episode of acute cystitis per year. Multidrug resistance, typically associated with nosocomial infections, has now emerged at the community level making treatment options for UTIs more difficult. Gepotidacin (GEP), a first-in-class, novel triazaacenaphthylene antibacterial has demonstrated in vitro activity against uropathogens including E. coli and provides high and sustained urine concentrations. It selectively inhibits bacterial DNA replication through a unique mechanism not utilized by any currently approved antibacterial. GEP presents an opportunity to address an unmet medical need and warrants study as a potential new and effective oral treatment for acute cystitis.

Methods
This Phase IIa single-center study was designed primarily to evaluate plasma and urine pharmacokinetics (PK) of gepotidacin in female participants with acute cystitis. Safety data and clinical and microbiological efficacy of gepotidacin were also assessed as secondary and exploratory endpoints. All participants received oral gepotidacin 1,500 mg BID for 5 days (total of 10 doses) during clinic confinement. Pretreatment and posttreatment PK collections were performed together with safety, efficacy, microbiological, and exploratory assessments throughout the study.

Results
Summary of Exploratory Endpoints (ITT Population). Clinical Efficacy: All subjects had significant improvement of clinical symptoms (dysuria, frequency, urgency, lower abdominal pain) within 24 to 48 hours of treatment. Most subjects, (20/22; 90.9%) achieved symptom resolution at test of cure (ToC) and follow-up (F/U). Microbiological eradication was achieved independent of baseline CFU’s (see microbiology abstract). Safety Endpoint: Most common AEs involved the GI tract (diarrhea (18/22 [82%] and nausea 17/22 [77%]). Per investigator observation, tolerance to nausea was observed with repeat dosing. No withdrawal due to AE. There were no clinically relevant trends in safety laboratories, ECG, or vital signs.

Conclusion
This first report of efficacy and safety in the treatment of acute cystitis supports further study of the clinical use of GEP in this indication.

Disclosures
All authors: No reported disclosures.
1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India
Authors: Surapareddy Bhavana , Varma Muralidhar , V Shashidhar 
Published: October 2019

Abstract

Background
Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis

Methods
This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis.

Results
A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%)
Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75)

Conclusion
Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI

Disclosures
All authors: No reported disclosures.
1495. Fluoroquinolone as an Alternative Regimen for Klebsiella pneumoniae Liver Abscess
Authors: Chuang Chien , Chou Sheng-Hua , Lin Yi-Tsung 
Published: October 2019

Abstract

Background
Klebsiella pneumoniae liver abscess (KPLA) is an endemic disease in East Asia. KPLA is usually caused by hypervirulent strains that are susceptible to all kinds of antibiotics except ampicillin. Patients with KPLA are commonly treated with β-lactams and need prolonged duration of intravenous therapy. Fluoroquinolone has high oral bioavailability and has the potential to shorten the duration of intravenous therapy, but studies regarding fluoroquinolone use in KPLA are limited. We aimed to compare the outcomes of patients with KPLA treated with β-lactams and fluoroquinolone.

Methods
Consecutive patients with KPLA in a tertiary medical center of Taiwan between 2011 and 2018 were enrolled retrospectively. Clinical characteristics and treatment outcomes were compared between cases treated with β-lactams and fluoroquinolones. Logistic regression was performed to identify risk factors of prolonged hospitalization (defined as > 30 days). Capsular genotypes and presence of rmpA or rmpA2 genes were analyzed among K. pneumoniae strains collected after July 2012. Hypervirulent strains were defined as those had rmpA or rmpA2 genes.

Results
A total of 330 KPLA patients identified, and the in-hospital mortality was 0.9% (n = 3). Nearly all K. pneumoniae strains were hypervirulent strains (97.1%). Capsular type K1 (n = 176) and K2 (n = 63) were the most common capsular types. Most patients received β-lactams (n = 296, 89.7%), and only 34 (10.3%) patients received fluoroquinolones as the main antibiotics (levofloxacin = 17; moxifloxacin = 10; ciprofloxacin = 7). The duration of intravenous antibiotics use in fluoroquinolones group was shorter than β-lactams group (20.12 ± 9.21 vs. 26.81 ± 16.10, P = 0.001). Prolonged hospitalization was more common in β-lactams group than fluoroquinolones group (32.1% vs. 11.8%, P = 0.014). The in-hospital mortality, duration of antibiotic use, and recurrence rate were similar between the two groups. Fluoroquinolones was independent protective factor for prolonged hospitalization (hazard ratio, 0.28; P = 0.026).

Conclusion
Fluoroquinolone is able to shorten the duration of intravenous antibiotic use and beneficial in prolonged hospitalization in patients with KPLA.

Disclosures
All authors: No reported disclosures.
1500. Gastric Carcinoma Survival Related with Helicobacter pylori Infection in Cali, Colombia: A Hospital-Based Cancer Study
Authors: Rosso Fernando , Carlos Bravo Juan , Parra-Lara Luis Gabriel , Camilo Falla Juan , Eduardo Bravo Luis , Zambrano Angela 
Published: October 2019

Abstract

Background
Gastric carcinoma (GC) has been associated with the presence of Helicobacter pylori infection. The infection rates vary according to geographic region and the majority of infected persons remain asymptomatic. Recent studies have suggested a controversial role of H. pylori infection in GC prognosis. The GC incidence rate in Colombia is among the highest of all Latin-American countries at 18.5 per 100,000 people. Furthermore, GC is responsible for the highest mortality rate among all malignancies in the country. This study aimed to describe GC survival in patients with H. pylori infection.

Methods
Hospital registries for all patients diagnosed with GC between 2000 and 2015 were consulted for clinical data. The hospital-based cancer registry was cross-linked with a population-based cancer registry to obtain IARC/WHO ICD-O-3 classification and follow-up information on all patients. Survival analysis was estimated using the Kaplan–Meier method. Differences between H. pylori cases and non-H. pylori cases were assessed through Pearson chi-2, Fisher exact test, log-rank test, and Cox regression.

Results
A total of 500 GC cases were included and 8.6% had H. pylori infection. In the H. pylori cases, the median age was 62 years (IQR = 52–71), 56% were men. All cases had a tumor size >5 mm, Lauren classification was 60% intestinal type and 40% diffuse type. Regarding clinical stage, 33% of the patients were classified as localized (TNM AJCC 7th edition: IA, IB, IIA), 35% as regional (IIB, IIIA, IIIB, IIIC) and 12% were distant (IV). There was a statistically significant difference between H. pylori cases and non-H. pylori cases survival (P = 0.0151). In univariate analysis, H. pylori infection was associated with better cancer-specific survival [HR = 0.5398; 95% CI: 0.3255–0.8950; P = 0.017]. In multivariate analysis, H. pylori infection [HR = 0.5934; 95% CI: 0.3577–0.9843; P = 0.043] and clinical stage [HR = 1.5327; 95% CI: 1.3672–1.7182; P < 0.001] were independent prognostic factors for cancer-specific.

Conclusion
This study showed that H. pylori infection is a beneficial prognostic indicator in patients with GC Cases, and GC survival in cases with H. pylori infection was better compared with non-H. pylori cases.

Disclosures
All authors: No reported disclosures.