bluuebunny/crossref_metadata_2025_split huggingface dataset:
270. Clinical Outcomes of Ceftriaxone versus Penicillin G for Complicated Viridans Group Streptococci Bacteremia
Authors: Wo Stephanie , Dubrovskaya Yanina , Siegfried Justin , Papadopoulos John , Jen Shin-Pung 
Published: January 2021

Abstract

Background
Viridans group streptococci (VGS) is an infrequent yet significant cause of bloodstream infections, and complicated cases may require prolonged antibiotic therapy. Ceftriaxone (CTX) and penicillin G (PCN G) are both considered first line options for VGS infections, but comparisons between these agents are limited. We evaluated the clinical outcomes amongst patients treated with CTX and PCN G for complicated VGS bacteremia.

Methods
This was a single-center, retrospective study of adult patients with ≥1 positive VGS blood culture who were treated with either CTX or PCN G/ampicillin (both included in PCN G arm) between January 2013 and June 2019. The primary outcome was a composite of safety endpoints, including hospital readmission due to VGS or an adverse event (AE) from therapy, Clostridioides difficile infections, treatment modification or discontinuation due to an antibiotic-related AE, and development of extended-spectrum beta lactamase resistance. Secondary outcomes included the individual safety endpoints, VGS bacteremia recurrence, hospital readmission, and all-cause mortality.

Results
Of 328 patients screened for inclusion, 94 patients met eligibility criteria (CTX n= 64, PCN G n=34). Median age was 68 years (IQR 56–81) and 68% were male. Study patients did not present with critical illness, as reflected by a median Pitt bacteremia score of 0 in the CTX and 1 in the PCN G arms, P=0.764. Streptococcus mitis was the most common VGS isolate and infective endocarditis (IE) was the predominant source of infection. CTX was not significantly associated with increased risk of the primary outcome (14% vs. 27%; P= 0.139). The driver of the composite outcome was hospital readmission due to VGS bacteremia or therapy complications. Results were similar in the subgroup of patients with IE (12.5% vs. 23.5%). No secondary endpoints differed significantly between groups. On multivariate analysis, source removal was a protective factor of the primary outcome (OR 0.1; 95% CI 0.020–0.6771; P= 0.017).

Conclusion
Despite potential safety concerns with the prolonged use of CTX in complicated VGS bacteremia, this study did not demonstrate a higher rate of treatment failure, adverse events, or resistance. These findings warrant further exploration.

Disclosures
All Authors: No reported disclosures
273. Comparative Effectiveness of Ampicillin in the Treatment of Enterococcus faecalis Bloodstream Infections in Patients With Cancer
Authors: Sanchez J P , Contreras German , Tran Truc T , Simar Shelby , Hanson Blake , Marx Kayleigh , Zervos Marcus , Reyes Katherine , Munita Jose M , Shelburne Samuel A , Arias Cesar A , Aitken Samuel L , Aitken Samuel L 
Published: January 2021

Abstract

Background
E. faecalis (Efc) isolates are usually susceptible to ampicillin (AMP). AMP-based regimens are the standard of care for enterococcal infections, although other antibiotics are often used as definitive treatment. We thus compared outcomes of patients with cancer and Efc bacteremia treated with AMP-containing (ACR) and non-AMP-containing antibiotic regimens (NACR).

Methods
A multicenter, prospective, observational cohort study conducted at MD Anderson Cancer Center, Henry Ford Hospital, and Memorial Hermann Health System. Eligible patients were ≥ 18 years old, diagnosed with cancer, and had at least one Efc bloodstream isolate collected from 12/2015 to 12/2018. Patients with polymicrobial infections were excluded. Patients were divided into two groups: i) ACR and ii) NACR. ACR included patients who received AMP at any time during treatment; other antimicrobials were permitted. NACR patients did not receive AMP at any time. The primary outcome compared desirability of outcome ranking (DOOR) between ACR and NACR at day 14. The DOOR consisted of six hierarchical levels: 1 - death; 2 - inpatient without microbiological cure (MC) and with acute kidney injury (AKI); 3 - inpatient without MC and without AKI; 4 - inpatient admitted with MC and with AKI; 5 - inpatient with MC and without AKI; 6 - alive and discharged. Comparison of DOORs between ACR and NACR was performed using inverse probability of treatment weighted (IPTW) ordered logistic regression.

Results
Seventy-one patients were included (ACR, n = 35; NACR, n = 36). No difference was seen in DOORs at day 14 between ACR and NACR (odds ratio [OR] 1.14, 95% Confidence Interval [CI] 0.45 – 2.92, p=0.78). No difference was observed for all-cause mortality at day 14 (OR 0.6, 95% CI 0.09 – 3.77, p=0.58) or day 30 (OR 0.42, 95% CI 0.09 – 1.94, p=0.27). Patients treated with ACR received a lower median duration of other antibiotics at any point during treatment compared to NACR: daptomycin (2 v 4 days) vancomycin (2 v 4 days), and linezolid (1 v 2 days).

Conclusion
Patients with cancer and Efc bloodstream infections had similar outcomes when treated with ACR and NACR. ACR were associated with less use of broad-spectrum antimicrobials. Future research should focus on the ecologic impact of use of NACR.

Disclosures
Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support) Cesar A. Arias, MD, MSc, PhD, FIDSA, Entasis Therapeutics (Scientific Research Study Investigator)MeMed (Scientific Research Study Investigator)Merck (Grant/Research Support)
275. Comparison of Cefazolin versus Nafcillin for Methicillin-Susceptible Staphylococcus aureus Bacteremia with a Deep-Seated Source
Authors: Mersinger Katherine E , Athans Vasilios , Binkley Amanda , Binkley Shawn , Hamilton Keith W , Redline Gretchen , Saw Stephen , Dutcher Lauren 
Published: January 2021

Abstract

Background
Historically, anti-staphylococcal penicillins have been the treatment of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, cefazolin may have advantages over these agents including convenience and tolerability. Despite several studies finding similar rates of clinical efﬁcacy using cefazolin with fewer adverse drug events, some prescribers remain hesitant to use this agent due to concern for an inoculum effect in deep-seated infections. The purpose of this study was to compare cefazolin and nafcillin for the treatment of MSSA bacteremia with exclusively deep-seated sources.

Methods
Adult patients who were admitted with MSSA bloodstream infections (BSI) treated with cefazolin or nafcillin between March 2017 and October 2019 were identified. Patients were included if their BSI had a deep-seated source, defined as endocarditis, osteomyelitis, septic arthritis, pneumonia, prosthetic material, mediastinitis, or abscess. Patients were excluded if they had polymicrobial BSI, central nervous system infection, or received less than 7 days of therapy. The primary efﬁcacy outcome (PEO) was a composite of treatment failure, 60-day mortality, and 60-day infection relapse, and was assessed using multivariate logistic regression. The primary safety outcome (PSO) was discontinuation of therapy due to adverse drug events, which was assessed with a chi-square test.

Results
A total of 164 patients were included in this analysis (141 treated with cefazolin and 23 with nafcillin). There were no significant differences in the baseline characteristics collected (Table 1), and the most common deep-seated sources were prosthetic material and endocarditis. Treatment with nafcillin was not found to be protective against the PEO in multivariate analysis (aOR, 1.19; 95% CI, 0.42 to 3.39; P = 0.75), and the PSO was reached significantly more often among nafcillin recipients compared to those treated with cefazolin (7/23 [30.4%] versus 8/141 [5.7%], P &lt; 0.0001).

Conclusion
Though the sample size was smaller than desired, cefazolin and nafcillin appeared to have similar efficacy for the treatment of MSSA BSIs with deep-seated sources. Nafcillin was associated with significantly more adverse drug events leading to discontinuation of therapy.

Disclosures
All Authors: No reported disclosures
278. Comparison of Oral Cephalexin Versus Oral Levofloxacin for Treatment of Uncomplicated Enterobacterales Bacteremia
Authors: Leung Thomas H , Tang Carolyn G , Ereshefsky Benjamin 
Published: January 2021

Abstract

Background
Aerobic gram-negative rods (GNR) are a common cause of bloodstream infections. While the use of oral antibiotics as step-down therapy for GNR bacteremia is generally accepted, there is debate as to which agents are best. Fluoroquinolones have high oral bioavailability but also have concerns for toxicity, while oral beta-lactams have lower achievable blood concentrations and require more frequent dosing. At Kaweah Delta Medical Center, patients are transitioned from IV antibiotics to oral levofloxacin or cephalexin. The purpose of this study is to determine if these two oral agents are comparable when used as step-down therapy for uncomplicated GNR bacteremia.

Methods
This was a single-center, retrospective study of adult patients who were admitted from May 2018 - May 2019 with a positive GNR blood culture. The primary objective was to assess treatment failure defined as a composite outcome of readmission due to recurrent bacteremia or mortality within 60-days. Secondary outcomes included subsequent Clostridioides difficile infection, emergence of resistant GNR bacteria, and hospital length of stay.

Results
A total of 82 patients met inclusion criteria. The combined median age of both treatment groups was 58.2 years (interquartile range [IQR], 46.7–73.5) and greater than 60% of patients were female. Most patients were Hispanic (45.1%) or non-Hispanic white (43.9%). The most common documented source of GNR bacteremia was the urinary tract (74.4%), and the most frequently recovered organism was Escherichia coli (78.0%). Patients were treated with IV antibiotics for a median treatment duration of 4 days (IQR, 4–5) and oral antibiotics for a median treatment duration of 10 days (IQR, 7.3–11) and 9 days (IQR, 7–11) for cephalexin and levofloxacin, respectively. The composite outcome occurred in 2 patients (4.3%) from the cephalexin group and 0 patients from the levofloxacin group (p=0.50). Positive cultures for resistant GNR were found for 3 patients in the cephalexin group. No patients developed subsequent C. difficile infections.

Conclusion
Patients who received cephalexin or levofloxacin did not have a significant difference in the composite primary outcome. These findings suggest that oral cephalexin is an effective step-down option to treat uncomplicated GNR bacteremia.

Disclosures
All Authors: No reported disclosures
280. Description of Transesophageal Echocardiography Prescribing Practices in non-Staphylococcus aureus Bacteremia with Application of Scoring Systems
Authors: Luttmann Kelly F , Headington Tre J , Hochanadel Alicia M , Deering Caytlin A , Harpenau Tara L 
Published: January 2021

Abstract

Background
In non-S. aureus gram-positive bacteremia (non-SAB), practices of obtaining transesophageal echocardiography (TEE) are mixed despite the availability of scoring systems in certain organisms (DENOVA for E. faecalis, HANDOC for non-beta hemolytic streptococci) that provide recommendations for TEE with scores 3 or higher. This study aimed to analyze the application of DENOVA and HANDOC scoring systems to coagulase-negative Staphylococci (CoNS), Enterococcus spp. and Streptococcus spp. in relation to TEE prescribing practices.

Methods
A retrospective, observational study was conducted at two tertiary care hospitals including patients with ≥1 positive blood culture for Enterococcus spp. or Streptococcus spp., or ≥2 positive blood cultures for CoNS with matching susceptibilities between November 2017 and November 2019. The primary outcome compared DENOVA and HANDOC scores in patients who received TEE vs. those who did not. Secondary outcomes included DENOVA and HANDOC scores in subgroup populations, adherence to DENOVA/HANDOC scoring systems, treatment characteristics, and patient outcomes.

Results
Of the 310 patients included, 96 (31%) underwent TEE and 214 (69%) did not. Fewer patients in the TEE group underwent transthoracic echocardiography: 29.2% vs. 69.9%, p&lt; 0.01. Infectious Diseases providers were involved in all patients that underwent TEE. Median scores were significantly higher in all patients who underwent TEE; DENOVA: 2 (1–3) vs. 1 (1–2), p&lt; 0.01; HANDOC: 3 (3–4) vs. 3 (2–3), p&lt; 0.01. DENOVA and HANDOC scores were significantly higher in the TEE group in Enterococcus spp. and Streptococcus spp., respectively; overall adherence to scoring system recommendations in these groups was less than 60%. HANDOC score was higher in the TEE group for patients with CoNS and 87.5% of these patients with score ≥3 had endocarditis (versus 50% with DENOVA score). More patients in the TEE group had endocarditis 46.9% vs. 6.5%, p&lt; 0.01.

Conclusion
DENOVA and HANDOC scores were significantly higher among TEE patients, but areas of improvement exist in relation to overutilization of TEE and development of scoring system for CoNS. Efforts to improve TEE utilization should be coordinated with Infectious Disease providers.

Disclosures
All Authors: No reported disclosures
282. Epidemiological Evaluation of Methicillin-Resistant Staphylococcus aureus (MRSA) and Methicillin-Susceptible Staphylococcus aureus (MSSA) Bacteremia: A Comprehensive Cancer Center’s 10-Year Experience
Authors: Ford Charles R , Katzman Ju Hee , Greene John 
Published: January 2021

Abstract

Background
Coagulase-positive Staphylococcus aureus bacteremia among cancer patients carries significant morbidity and mortality. This study aims to compare the risk factors and clinical outcomes among cancer patients diagnosed with bloodstream infection (BSI) with methicillin-sensitive S. aureus (MSSA) or methicillin-resistant S. aureus (MRSA).

Methods
We performed a retrospective cohort study on all patients diagnosed with an active solid tumor or hematologic cancer with positive blood culture for S. aureus from January 2009 to May 2019. We collected data on demographics, comorbidities, malignancy type, venous access, neutropenia status, echocardiogram results, treatment (tx) duration, antibiotics usage pre/post culture, hospital LOS, infection severity, and 7-day and 30-day mortality. We used the Chi-square test to analyze categorical variables, t-test to analyze continuous variables, and the Kaplan-Meier survival curve and multivariate regression to analyze mortality.

Results
Two hundred eighty-three cases with malignancies and S. aureus BSIs were reviewed, and 168 were identified with BSIs for MRSA or MSSA during the ten years. The mean age for MRSA cases was 73.1 (±13.7) and 70.1 (± 14.6) for MSSA; male patients were most of the sex (P &lt; 0.01). MRSA and MSSA bacteremia presented equally in hematologic malignancies, while MSSA was observed more in skin cancer than MRSA. Cancers that obstruct GU tracts may be associated with MRSA and MSSA from urine source as both were overrepresented in patients with bladder and rectal cancer. In most patients, the CVC was promptly removed and appropriate antibiotics were given promptly within 1 hour of the positive blood culture. For patients who underwent echocardiogram, most had a negative result in both groups. There was no significant difference for seven and 30-day mortality between the two groups. The mean hospital LOS was longer for MRSA cases (10.5 ± 13.5) versus MSSA cases (4.88 ± 9.1), (P &lt; 0.01).

Figures 1 & 2. Kaplan-Meier Survival Curve Comparing 7 and 30-day Mortality of Cancer Patients with MRSA vs MSSA BSI

Figure 3 & 4. Distribution of Cancer Types for MRSA (n=84) and MSSA (n=84) BSI

Conclusion
Endocarditis with either MRSA or MSSA BSI is not a prominent finding among cancer patients at our institution. Given the extensive usage of CVCs and devices in patients with malignancies, prompt removal and antibiotic administration are essential to reduce morbidity; even then, the LOS for MRSA BSI remains longer than MSSA BSI.

Disclosures
All Authors: No reported disclosures
283. Epidemiology and Clinical Significance of Persistent Bacteremia in Severely Burned Patients
Authors: Townsend Lisa , Rizzo Julie , Markelz Ana E , Blyth Dana M 
Published: January 2021

Abstract

Background
Recent literature questions the utility of follow-up blood cultures (FUBC), especially for gram-negative bloodstream infections (BSIs). This has yet to be evaluated in the burn intensive care unit (BICU), where many BSIs are gram-negative. We evaluated the FUBC frequency, positivity rate, and clinical significance of persistent BSI (p-BSI) in BICU patients.

Methods
Patients ≥ 18 years old admitted to the US Army Institute of Surgical Research for combat-related thermal burns from 1/2003–6/2014 were included. P-BSI was defined as the same organism isolated from initial and FUBC (within 1–5 days). Non-p-BSI (np-BSI) included patients without subsequent isolation of the same organism between 1–5 days post-positive blood culture. Exclusion criteria were initial blood culture with usual skin flora, polymicrobial BSI, fungemia, and death within 24 hours of notification of initial positive blood culture. Those factors significantly associated with mortality on univariate analysis were evaluated with binomial logistic regression (BLR).

Results
Of 126 patients meeting inclusion criteria with BSI, 53 (42.1%) had p-BSI and 73 (57.9%) had np-BSI (table 1). 50 (67.6%) np-BSI patients had FUBC. P-BSI and np-BSI patients did not differ in age, gender, or race, but p-BSI and np-BSI patients had median total body surface area (TBSA) burns of 47 (IQR 34–63) and 35.3 (IQR 23.3–56.6), respectively (p=0.021). P-BSI patients had longer hospitalizations, ICU stays, and intubations (p&lt; 0.01; table 1). Microbiology did not differ between p-BSI and np-BSI (p=0.517). Notably, 20 (37.7%) p-BSI patients died compared to 8 (10.8%) np-BSI patients (p&lt; 0.001; table 2). BLR revealed that p-BSI (p=0.031), TBSA (p&lt; 0.001), ISS (p=0.008), and length of ICU stay (p=0.002) and intubation (p&lt; 0.001) were independently significantly associated with mortality.
Table 1: Clinical characteristics of burn patients with and without persistent bacteremia

Table 2: Univariate analysis evaluating associations with mortality in burn patients with bacteremia

Conclusion
P-BSI was common in this burn population. Severe burns and longer duration of hospitalization, ICU stays, and intubation, but not microbiology were associated with p-BSI. However, p-BSI (in addition to more traditionally identified risk factors like TBSA and duration of hospitalization, ICU, and ventilator days), was independently associated with increased mortality. FUBC may serve as an additional prognostic factor in burn patients with BSI.

Disclosures
All Authors: No reported disclosures
284. Evaluation of Oral Step-Down Therapy for Enterobacteriaceae Bloodstream Infection
Authors: Utley Sara , Bouknight Dawn , Patel Radha , Stock Kent 
Published: January 2021

Abstract

Background
Oral antibiotic stepdown therapy for Gram-negative (GN) bloodstream infection (BSI) appears to be a safe option, though high bioavailability drugs like fluoroquinolones (FQ) and trimethoprim-sulfamethoxazole are often recommended without clear evidence demonstrating superiority. Due to increasing concerns of FQ resistance and collateral damage with an increasing community C. difficile rate, our organization sought to reduce overall FQ use and a shift toward oral beta-lactams (BL) was observed. A review was conducted to assess the outcomes of this shift.

Methods
This retrospective cohort included all patients within our 3-hospital system who had a positive GN blood culture and were transitioned to oral therapy to complete treatment outpatient for bacteremia between Jan 2017-Sept 2019. The primary outcome was recurrent BSI within 30 days of completing initial treatment. Secondary outcomes included 30-day mortality, 30-day recurrence of organism at an alternate source, 30-day readmission, and 90-day BSI relapse.

Results
Of 191 GN BSIs, 77 patients were transitioned to oral therapy. The mean age was 68 years, 60% were female. The most common source of infection was described as urine (39/77), intra-abdominal (16/77), unknown (13/77). Mean total antibiotic duration (IV plus PO) was 14 days (range 7–33). Patients received an average of 5 days IV prior to transitioning to PO therapy. The most common PO class was a 1st gen cephalosporin (29/77), followed by BL/BL inhibitor (16/77), and a FQ (13/77). There were no 30-day relapse BSIs observed in this cohort. There was 1 patient discharged to inpatient hospice, and no other 30-day mortality observed. There were 4 recurrent UTIs observed within 30 days, none of which required readmission. Of the twelve 30-day readmissions, 1 was considered by the investigators to be related to the initial infection.

Conclusion
An opportunity for education regarding duration of therapy was identified. Oral beta lactam use in our limited population appears to be a reasonable option to facilitate discharge. Results should be confirmed in additional, larger studies.

Disclosures
All Authors: No reported disclosures
292. Impact of the BACT/ALERT VIRTUO blood culture system in the management of Staphylococcus aureus bacteremia
Authors: Chavez Miguel A , Munigala Satish , Burnham Carey-Ann , Warren David K 
Published: January 2021

Abstract

Background
Staphylococcus aureus bacteremia (SAB) is a major cause of mortality. Recovery of SA may be enhanced with new blood culture systems resulting in a longer observed duration of bacteremia.

Methods
We performed a 24-month retrospective study of adults hospitalized with SAB at a 1250-bed academic hospital. Between 1/2018-12/2018 the VersaTREK system was used and 1/2019-12/2019 the BACT/ALERT VIRTUO (VIRTUO) system was used. We excluded patients without an Infectious Diseases (ID) consult. We defined SAB duration as short (1–2 days), intermediate (3–6 days), or prolonged (&gt;7 days). We compared SAB detection and management pre- and post-implementation of VIRTUO.

Results
456 patients had SAB during study period; 420 (92%) had ID consultation: 178 (42%) pre- and 242 (58%) post-implementation. Similar proportion of methicillin-resistant SAB was seen (44.9% pre- vs. 36.8% post-implementation, p=0.09). Post-implementation, patients were more likely to have intermediate (22.4% pre- vs. 40.1% post-implementation; p&lt; 0.001) and prolonged SAB duration (3.9% pre- vs. 13.6% post-implementation; p&lt; 0.001). Median time to positivity for the index blood culture was shorter (19.9 pre- vs. 15.0 hours post-implementation, p&lt; 0.001). Dual anti-staphylococcal therapy was used more frequently in the post-implementation period (6.2% pre- vs. 15.7% post-implementation, p=0.003). No difference was noted in frequency of diagnostic studies (transesophageal echocardiography, magnetic resonance imaging, and computed tomography). Source control was similar (46.1% pre- vs. 45.0% post-implementation; p=0.84) but the median time to source-control was shorter post-implementation (4 pre- vs. 2 days post-implementation; p=0.02). Median planned duration of intravenous antibiotics did not vary between pre- and post-implementation periods (6 vs. 6 weeks, p=0.31). There was no difference in 90-day readmissions (38.2% pre- vs. 34.3% post-implementation; p=0.41).

Conclusion
VIRTUO blood culture system decreased time to positivity and increased frequency of prolonged SAB compared to the VersaTREK system. This resulted in increased use of dual anti-staphylococcal therapy and shorter time to source-control, but no difference in interventions, planned duration of antibiotics, or readmissions.

Disclosures
All Authors: No reported disclosures