bluuebunny/crossref_metadata_2025_split huggingface dataset:
279. Dalbavancin for Bloodstream Infections and Endocarditis: Real-World Outcomes From the DRIVE Registry
Authors: Gonzalez Pedro , Rappo Urania , McGregor Jennifer , DiPompo-Day Lisa , McCarthy Matthew W 
Published: January 2021

Abstract

Background
Dalbavancin, a long-acting lipoglycopeptide approved by the US FDA and EMA for acute bacterial skin and skin structure infections (ABSSSI) has potent activity against Gram-positive pathogens including MRSA. A total of 39 of 39 patients with baseline S aureus bacteremia from previous studies who received dalbavancin (1500 mg or 1000 mg followed by 500 mg 1 week later) had clearance of bacteremia (100%). We describe the clinical features and efficacy of dalbavancin in patients with bacteremia or endocarditis from a retrospective registry study of dalbavancin.

Methods
Dalvance Utilization Registry Investigating Value and Efficacy (DRIVE) was a phase 4 observational, multicenter, retrospective cohort study of the real-world use of dalbavancin in adults across the US. Data collected between 03/25/2017 and 11/27/2018 included patient, disease, and pathogen characteristics, antibiotic use, clinical outcome, and safety. Clinical outcome was assessed by chart review from last dalbavancin dose through 60 days. Success was defined as presumed or documented clinical or microbiological cure with no need for rescue IV antibiotic therapy. Failure was defined as presumed or documented clinical or microbiologic failure, or the need for rescue IV antibiotic therapy, or death. Outcome was indeterminate if there were insufficient data to determine status at 60 days.

Results
Of 1092 evaluable patients treated with dalbavancin for any indication, 32 had baseline bloodstream pathogen data and Gram-positive bacteremia (Figure). 29 of 32 patients were previously treated with antibiotics (91%) with a median duration of 8.5 days. The 3 patients with endocarditis were among those most heavily pretreated (9, 4, and 4 prior IV antibiotics each). Clinical success was achieved in 30/32 (94%); outcome was indeterminate in 2/32 (6%). Most common dalbavancin regimens were 1500 mg x 1 (50%) or 1500 mg weekly x 2 (13%). Negative blood cultures for baseline pathogen prior to dalbavancin were documented in 53% of patients. There were no adverse events assessed as related to dalbavancin.

Conclusion
Dalbavancin use in Gram-positive bacteremia appears well tolerated and effective in the real-world setting.

Disclosures
Pedro Gonzalez, MD, MT, AbbVie (Employee) Urania Rappo, MD, MS, PharmD, Allergan (before its acquisition by AbbVie) (Employee) Jennifer McGregor, RPh, AbbVie (Employee) Lisa DiPompo-Day, n/a, AbbVie (Employee) Matthew W. McCarthy, MD, Allergan (prior to its acquisition by AbbVie) (Consultant, Grant/Research Support)
281. Detecting bacterial sepsis among allogeneic HCT recipients with population-specific bedside tools
Authors: Lind Margaret , Pergam Steven A , Liu Catherine , Phipps Amanda , Mooney Stephen , Althouse Benjamin , Carone Marco 
Published: January 2021

Abstract

Background
Diagnosing sepsis among allogeneic hematopoietic cell transplant (aHCT) recipients remains challenging. Existing criteria, for use in hospitalized patients, have limited predictive accuracy among aHCT recipients and their use may lead to missed events or antibiotic overuse. We developed bedside bacterial sepsis prediction tools (criteria and decision tree [DT]) for aHCT recipients and compared them against Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score (NEWS) criteria.

Methods
Adult aHCT recipients transplanted between September 2010–2019 with ≥ 1 potential infection (PI) within 100 days post-transplantation were randomly assigned to model/validation (7/3) cohorts. Tools included demographic and clinical factors and were built against a bacterial sepsis endpoint (gram-negative, Staphylococcus aureus, or Streptococcus species bacteremia). The tools were developed using best subset selection with rare event logistic regression (criteria) and classification tree (DT) algorithms. Criteria scores were estimated using a beta/10 integer weighting approach and tool predictive performances were compared against existing criteria.

Results
Between September 2010–2019, 1571 recipients with ≥ 1 PI contributed 7755 PIs and 238 sepsis events. The DT model included 7 terminal nodes based on 3 predictors: temperature, respiratory rate (RR), and sex. The criteria model contained 10 categories with 4 predictors: RR, temperature, pulse, and diastolic blood pressure (Figure 1). Our criteria and DT had AUCs of 71.1% (95% Confidence Interval (CI): 64.3, 77.9%) and 70.0% (CI: 63.7, 76.2%). SIRS had the highest AUC of existing criteria – 64.7% (CI: 57.1, 71.9%). Our criteria had the highest net benefit (for probabilities &lt; 10%) and, at a 7+ cut-point, had a sensitivity of 73.8% (CI: 61.5–84.0%) and specificity of 55.0% (CI: 52.9, 57.1%) (Figure 2).

Conclusion
We developed aHCT recipient-specific bedside bacterial sepsis prediction tools with higher AUCs than existing criteria. Tools targeted to high-risk populations may lead to fewer missed sepsis events and, in turn, reduce sepsis related mortality among this high-risk population.

Disclosures
Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)
288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes
Authors: Elamin Azza , Khan Faisal , Abunayla Ali , Jagarlamudi Rajasekhar , Dash aditee 
Published: January 2021

Abstract

Background
As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood.
Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes.

Methods
We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment.
Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant.

Results
482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001)
Microbiology of index blood culture in those with and without FUBCs

Outcomes in those with and without FUBCs

FUBCs characteristics

Conclusion
Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB.

Disclosures
All Authors: No reported disclosures
289. Impact of Clinician Specialty on the Use of Oral Antibiotic Therapy for Definitive Treatment of Uncomplicated Bloodstream Infections
Authors: Marcelin Jasmine R , Keintz Mackenzie R , Ma Jihyun , Stohs Erica J , Alexander Bryan , Bergman Scott , Van Schooneveld Trevor C 
Published: January 2021

Abstract

Background
No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat uncomplicated bloodstream infections (uBSIs) and practices may vary depending on clinician specialty and experience.

Methods
An IRB-exempt web-based survey was emailed to Nebraska Medicine clinicians caring for hospitalized patients, and widely disseminated using social media. The survey was open access and once disseminated on social media, it was impossible to ascertain the total number of individuals who received the survey. Chi-squared analysis for categorical data was conducted to evaluate the association between responses and demographic groups.

Results
Of 275 survey responses, 51% were via social media, and 94% originated in the United States. Two-thirds of respondents were physicians, 16% pharmacists, and infectious diseases clinicians (IDC) represented 71% of respondents. The syndromes where most were comfortable using OAT routinely for uBSI were urinary tract infection (92%), pneumonia (82%), pyelonephritis (82%), and skin/soft tissue infections (69%). IDC were more comfortable routinely using OAT to treat uBSIs associated with vertebral osteomyelitis and prosthetic joint infections than non-infectious diseases clinicians (NIDC), but NIDC were more likely to report comfort with routine use of OAT to treat uBSIs associated with meningitis and skin/soft tissue infections. IDC were more likely to report comfort with routine use of OAT for uBSIs due to Enterobacteriaceae and gram-positive anaerobes, while NIDC were more likely to be comfortable with routinely using OAT to treat uBSIs associated with S. aureus, coagulase-negative staphylococci and gram-positive bacilli. In one clinical vignette of S. aureus uBSI due to debrided abscess, 11% of IDC would be comfortable using OAT vs 28% of NIDC; IDC were more likely to report routinely repeating blood cultures (99% vs 83%, p&lt; 0.05).
Figure 1: Clinician comfort using oral antibiotic therapy to treat uncomplicated bacteremia due to specific syndromes

Figure 2: Clinician comfort using oral antibiotic therapy to treat uncomplicated bacteremia due to specific organisms

Conclusion
Considerable variation in comfort using OAT for uBSIs among IDC vs NIDC exists, highlighting opportunities for IDC to continue to demonstrate their value in clinical practice. Understanding the reasons for variability may be helpful in creating best practice guidelines to standardize decision making.

Disclosures
All Authors: No reported disclosures
291. Impact of Surveillance and Offered Infectious Diseases Consults for Staphylococcus aureus Bacteremia on Quality of Care Indicators
Authors: Jhaveri Khushali , Ramdeen Sheena 
Published: January 2021

Abstract

Background
Staphylococcus aureus bacteremia (SAB) remains the leading cause of bloodstream infections and is associated with 20–40% mortality. Past studies demonstrated that Infectious Diseases (ID) consultation is associated with better adherence to quality of care indicators (QCIs), including follow-up blood cultures, echocardiography, early source control, and appropriate choice and duration of antibiotics. A 2014 quality improvement project at Medstar Washington Hospital Center (MWHC) by Narsana et al. showed significantly better adherence to SAB QCIs among patients with ID consults and a non-significant trend towards lower mortality. In 2015, MWHC instituted a policy advocating ID consultation for all SAB patients, and active surveillance was performed by the ID Section to offer prompt consults prospectively. Our study aimed to assess the impact of this policy and the proactively offered ID consults on adherence to SAB QCIs and mortality rates amongst patients with SAB with and without ID consults.

Methods
We retrospectively reviewed 557 patients diagnosed with SAB between July 1st, 2015 - June 30th, 2018. Data included follow-up blood cultures, echocardiography, presence of a focal source of infection, use of appropriate antibiotics, measurement of vancomycin levels, duration of therapy, death during hospitalization, and presence of an ID consultation. Chi-Square and Fisher exact tests, and t-test and Wilcoxon rank sum test were used to analyze categorical and continuous variables, respectively.

Results
A total of 513 patients were included in the analysis, 88% (n=453) of whom had ID consultations. Patients with ID consultations were more likely to have a focal source of infection (84% vs. 50%, p &lt; 0.0001), echocardiography (97% vs. 56%, p &lt; 0.0001), use of a beta-lactam antibiotic for methicillin-susceptible S. aureus (90% vs 65%, p &lt; 0.0001), and a longer duration of therapy (33 vs 9 days, p&lt; 0.0001). Mortality was lower among patients with ID consults (16% vs. 23%, p=0.1495), but the difference was not statistically significant.
Table 1

Conclusion
Our study demonstrates that ID consultation is associated with better adherence to SAB QCIs, with a trend towards lower mortality. Hospital systems should support mandatory ID consultation for patients with Staphylococcus aureus bacteremia.

Disclosures
All Authors: No reported disclosures
293. Influence of a Pharmacist Led Treatment Algorithm for the Management of Staphylococcus Bacteremia
Authors: Lomanno Jessica , Elarabi Salwa , Fleisher Jorge 
Published: January 2021

Abstract

Background
Staphylococcus bacteremia is a major healthcare burden and currently there is no widely recommended treatment algorithm. Our institution adopts all elements of antimicrobial stewardship including rapid diagnostic testing. Despite these efforts, management of staphylococcus bacteremia continues to be problematic. The objective of this project is to evaluate implementation of a pharmacist-driven algorithm to guide treatment selection for staphylococcus bacteremia.

Methods
This is a single center, IRB-approved cohort study with a retrospective and prospective phase. The algorithm was designed in collaboration with the infectious disease (ID) service. Retrospective data was collected from June 2019 through September 2019. The algorithm was implemented on October 1, 2019 and prospective data was collected through January 2020. Prospectively a pharmacy resident identified positive blood cultures and recommended treatment based on the algorithm. Patients 18 years of age or older with a positive blood culture for staphylococcus were included. Patients were excluded if treatment was initiated at an outside hospital. The primary outcome is algorithm adherence. Secondary outcomes include days to negative blood culture, days to de-escalation, length of hospital stay and whether ID was consulted.
Treatment Algorithm

Results
A total of 64 patients were identified in the retrospective cohort and 46 in the intervention group. There were no significant differences in baseline characteristics. Algorithm adherence increased from 45% to 72% upon implementation (p=0.006). The algorithm resulted in a shorter time to de-escalation from 2.1 to 1.3 days (p=0.04). There were no statistically significant differences in days to negative blood culture, 2.3 vs. 2.2 days, or in average length of stay, 12.1 vs. 10.6 days in the retrospective and intervention groups, respectively. ID was consulted on 50% of patients in the retrospective cohort and 48% in the intervention group.

Conclusion
Implementation of a staphylococcus bacteremia treatment algorithm optimizes management. Additional layers of pharmacy involvement also result in a shorter time to de-escalation. These results highlight the importance of continuity of antimicrobial stewardship efforts.

Disclosures
All Authors: No reported disclosures
295. Is Herd Immunity from Pneumococcal Conjugate Vaccines Changing the Clinical Features of Invasive Pneumococcal Disease in Adults?
Authors: McGeer Allison , Plevneshi Agron , Hassan Kazi 
Published: January 2021

Abstract

Background
Numerous factors that affect the presentation and severity of pneumococcal disease. Several studies in the pre-PCV era demonstrated that organism characteristics, including serotype, are associated with variability in disease presentation and severity. We undertook an analysis of population based surveillance for invasive pneumococcal disease (IPD) to assess whether herd immunity from PCVs will change the presentation and severity of IPD in adults

Methods
TIBDN has performed population-based surveillance for IPD in Toronto and Peel region (pop’n 4.5M) since 1995. All sterile site isolates of S. pneumoniae are reported to a central study laboratory, isolates are serotyped, and clinical and vaccination data are collected via patient and physician interview and chart review. Population data are obtained from Statistics Canada. Backwards stepwise logistic regression assessed patient characteristics, illness features, and isolate factors associated with clinical presentation and case fatality.

Results
Between 1995 and 2018, 8815 episodes of IPD were identified in adults. Patients infected with PCV10not7 serotypes were younger, more likely male and without underlying illness. Patients with infections due to non-vaccine types were more likely to be immunocompromised. Case fatality in IPD declined from 177/754 in 1995/6 to 113/554 in 2017/8; OR 0.67, 95%CI0.51-0.86, P&lt; .0001) and in all serotype groups (Figure). In multivariable models adjusted for host factors, relative to infections caused PCV7 serotypes, those caused by PCV10not7 were less likely to be fatal (OR 0.65, 95%CI 0.46–0.91); those caused by PCV13not10 were more likely to be fatal (OR 1.6, 95%CI 1.3–1.9). Bacteremic pneumonia as a proportion of presentations is highest in IPD due to PCV10not7 and PCV13not10 serotypes (85% and 83%, respectively), and lowest in IPD due to non-vaccine serotypes and PCV20not15 (59% and 68%, P&lt; .0001). Meningitis is least common in IPD due to PCV10not7 serotypes (2.6%), and highest in cases due to non-vaccine types and PCV20not15 (9.0% and 8.0%, respectively, P&lt; .0001).
FIgure

Conclusion
In our population, herd immunity from PCVs will result in a higher proportion of adult IPD occurring in immunocompromised cases, and a shift from bacteremic pneumonia to bacteremia without focus and meningitis.

Disclosures
Allison McGeer, MD, FRCPC, GlaxoSmithKline (Advisor or Review Panel member, Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Research Grant or Support)
296. IV-to-PO Antibiotic Step-down Therapy for Treatment of Uncomplicated Streptococcal Bloodstream Infections
Authors: Ramos-Otero Gerardo P , Brett Meghan , Ryan Keenan L , Sarangarm Preeyaporn , Walraven Carla 
Published: January 2021

Abstract

Background
Beta-lactams are the drug of choice for uncomplicated Streptococcal bloodstream infections (BSIs). However, due to the low bioavailability of oral beta-lactams, it’s unclear whether de-escalation from IV to PO therapy is safe and effective. Our objective was to compare the efficacy and safety of step-down IV-to-PO antibiotic therapy to IV-only treatment of uncomplicated Streptococcal BSIs.

Methods
This was a retrospective study at a level-1, academic medical center in New Mexico of patients ≥ 18 years of age treated for uncomplicated Streptococcal BSI between January 2017 and December 2019. The primary outcome was clinical failure in patients receiving IV-only therapy compared to IV-to-PO step-down therapy. Clinical failure was defined as having at least one of the following: persistent bacteremia, 30-day reinfection at any site or new-onset sepsis, 30-day BSI recurrence, or 30-day all-cause mortality. Secondary outcomes include 30-day all-cause readmission, 30-day antibiotic-related side effects, 30-day C. difficile-associated diarrhea and hospital length of stay (HLOS).

Results
A total of 98 patients were included: 51 in the IV-to-PO group and 47 in the IV-only therapy group. The median age for both groups was 61 years; 65% patients were male, and 72% were Caucasian. BSIs were predominantly associated with respiratory infections (24.5%). Streptococcus pneumoniae (29.6%) was the most common pathogen. Nine patients (19.1%) in the IV-only group and none in the IV-to PO group experienced a clinical failure. 30-day reinfection at any site or new-onset sepsis (88.9%) was the primary cause of clinical failures. Fourteen patients (14.3%) were readmitted due to any cause within 30 days, 6 patients (11.8%) from the IV-to-PO and 8 (17%) from the IV-only group. Patients in the IV-to-PO group had a shorter duration of therapy than patients in the IV-only group (13 vs. 15 days, p=0.001), and decreased HLOS (5 vs. 12 days, p&lt; 0.001). Clinical failure was not statistically different when assessed for co-morbidities, source of infection, Pitt bacteremia score, documented BSI clearance, ICU admission or pathogen.

Conclusion
IV-to-PO step-down therapy appears to be a safe and effective alternative for treating uncomplicated Streptococcal BSIs in patients who are otherwise clinical stable.

Disclosures
Keenan L. Ryan, PharmD, PhC, Theravance (Advisor or Review Panel member)
298. Multicenter retrospective cohort study of the clinical significance of Staphylococcus lugdunensis isolated from a single blood culture set
Authors: Hauser Naomi , Kim Justin , Luethy Paul , Schmalzle Sarah , Bork Jacqueline 
Published: January 2021

Abstract

Background
Staphylococcus lugdunensis is a coagulase negative Staphylococcus (CoNS) species with the potential to cause aggressive infection. Guidance surrounding S. lugdunensis bacteremia (SLB) is lacking, especially in the case of a single positive set of blood cultures.

Methods
We performed a multicenter, retrospective observational cohort review of adult patients with SLB from at least one blood culture set within the University of Maryland Medical System from November 2015-November 2019. Objectives were to (1) describe baseline characteristics, (2) compare available criteria for evaluating clinical significance, and (3) evaluate the clinical outcomes among patients with SLB in 1 vs ≥2 positive blood culture sets. Descriptive statistics with Chi-squared and Mann-Whitney U tests were carried out.

Results
There were 5,548 CoNS-positive blood culture sets, 49 (0.88%) with S. lugdunensis comprising 36 adult patients (24 with 1 positive set and 12 with ≥2 positive sets). Patients with ≥2 positive sets were more likely to be on hemodialysis (HD) (p=0.029) and to have an HD catheter present (p=0.10) (Table 1). Thirty-five of the 36 patients fulfilled at least one of the following: systemic inflammatory response syndrome (SIRS), Souvenir criteria, or clinical criteria (infectious focus on imaging and/or second positive culture site) (Table 2). Twenty-eight (78%) patients were treated with antimicrobial therapy and/or central line removal. SIRS criteria were met more often among patients with 1 positive set (p=0.05). Patients with ≥2 positive sets were more often treated with antibiotics for longer than 2 weeks (p=0.02). The mean time of positive cultures to discharge was 11 days and was longer for patients with only one set of positive blood cultures (13 vs. 6 days), although this difference was not statistically significant (p=0.29) (Table 3).

Conclusion
SLB was rare and occurred more frequently as a single set of positive blood cultures. Though limited by sample size, this study found similar patient characteristics, clinical significance and outcomes between patients with one set and those with ≥2 sets of blood cultures positive for S. lugdunensis. Given the potential severity of SLB, it seems prudent to treat S. lugdunensis in a single blood culture, but larger studies are needed.

Disclosures
All Authors: No reported disclosures