bluuebunny/crossref_metadata_2025_split huggingface dataset:
76. Uncomplicated Urinary Tract Infections in the Multi-resistance Era: Is It Time of Microbiologic Diagnosis? An Observational Study in Buenos Aires City
Authors: Otreras Alvaro , Sabato Sofia , D′Alessandro Daniela , Errea Sylvia , Bottaro Edgardo , Ormazabal Cecilia , Alfonso Claudia , Scapellato Pablo 
Published: December 2021

Abstract

Background
Uncomplicated urinary tract infection (uUTI) is one of the main causes of antibiotics prescription in outpatient setting. Current recommendations, based on studies from pre-antimicrobial resistance era, suggest that diagnosis of uUTI can be made based on clinical symptoms and that urine analysis leads only to a minimal increase in diagnostic accuracy. We analyzed urine cultures (UC) from patients with clinical diagnosis.

Methods
Prospective and observational study carried out in an Emergency Department during August 2016 to August 2017. Women older than 15 years with 2 or more classic symptoms of uUTI and the absence of vaginal discharge and irritation were included. Those with complicated and recurrent urinary tract infection (UTI) were excluded. Urine cytology and UC were performed in all episodes. A bivariate and multivariate analysis was performed considering the probability of having a positive urine culture according to the different symptomatology variables.

Results
We enrolled 208 patients, with a median age of 25 (14-68 years). Previous UTI 6 (2.9%), previous antibiotic (last 3 months) 20 (9.6%). Inflammatory cytology 173 (83.2%), positive UC 109 (52.4%), cystitis 155 (74.5%). Symptoms: dysuria 154 (74%), frequency 111 (53.4%), tenesmus 97 (46.6%), fever 78 (37.5%), hematuria 43 (20, 7%), hypogastric pain 128 (61.5%), back pain 84 (40.4%). Combinations of 3 or more classic symptoms occurred in 52 (25%) episodes. The most frequent association was dysuria, frequency and tenesmus. No statistically significant association was found either in the bivariate or multivariate analysis in relation to presenting positive UC (Tables 1 and 2).

Conclusion
The results show that almost 50% of the patients with a clinical diagnosis of UTI had a negative urine culture. We consider it necessary to rethink the prescription of antibiotics without microbiological confirmation in the first episode of uUTI as a strategy to reduce inappropriate use of antibiotics.

Disclosures
All Authors: No reported disclosures
77. Opportunity for Improved Use of a Commercially Available Meningitis/Encephalitis Panel in Pediatric Patients
Authors: Valentine Marilyn E , Olson Jared , Thorell Emily A , Bonkowsky Anne , Lake Jason 
Published: December 2021

Abstract

Background
The BioFire® FilmArray Meningitis/Encephalitis (ME) panel delivers timely CSF analysis when meningitis or encephalitis is suspected and has the potential for earlier optimization of patient care. It is unclear if the M/E panel provides incremental benefit over standard microbiologic methods such as culture and cell counts, especially in the absence of significant pleocytosis. We evaluated the clinical utility of the ME panel with respect to CSF white blood cell count per high power field (WBC/hpf) and patient age.

Methods
We identified paired CSF ME panels and CSF cultures collected throughout a large healthcare system from 2016–May 2021 in children &lt; 18 years of age. CSF results from the same calendar day were included in the dataset. We reviewed standalone HSV and Enterovirus (EV) CSF studies to determine frequency of duplicative testing. Results were stratified by CSF WBC/hpf and patient age (&lt; 14 days, 14–60 days, &gt; 60 days and &lt; 5 years, and &gt; 5 years).

Results
1045 paired cultures and ME panels were identified. Of those, 921 (88%) ME panels were negative, but 5 of those cultures grew bacteria. Of 124 (12%) positive ME panel results, 66% were viral: 46 (37%) EV, 22 (18%) HHV-6 and 6 (5%) parechovirus. In 498 cases, ME panels were sent when CSF had &lt; 10 WBC/hpf, resulting in only 2 (0.4%) PCRs positive for bacteria, one which was gram stain positive and the other was considered a false positive (Table 1). In addition to a ME panel, standalone PCRs for enterovirus and HSV were sent in 134 (13%) and 213 (20%) of cases, respectively, with &lt; 2% discordance. Pathogen distribution by ME panel did not vary with age (Table 2).

Meningitis and encephalitis panel, standalone PCR and culture results overall and by age group.

Conclusion
In our cohort, the ME panels were overwhelmingly negative. Only 12% of ME panels were positive, mostly with self-limited viral pathogens (e.g., EV, parechovirus). Performance was worse when samples had &lt; 10 WBC/hpf. Duplicative testing was common and had no benefit. Performance was similar across age groups. More targeted use of the ME panel could improve the utility and efficacy of this test.

Disclosures
Anne Bonkowsky, MD/PhD, BioFire Diagnostics (Consultant, Grant/Research Support, Other Financial or Material Support, I have intellectual property through the University of Utah in BioFire Diagnostics and the FilmArray and receive royalties through the University of Utah.)Merck (Advisor or Review Panel member)
78. Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) Nares Screen on Vancomycin Utilization for Respiratory Tract Infections
Authors: Debnath Ashita , King Esther , Patel Dimple , Giordano Pamela 
Published: December 2021

Abstract

Background
S. aureus, including MRSA, is a common colonizer of the nares. Recent data have shown that a negative MRSA nares screen by PCR has a negative predictive value of 98%. This implies that the absence of colonization can significantly reduce empiric vancomycin utilization. This study aimed to determine the utilization of MRSA nares screening on patients receiving vancomycin for respiratory tract infections (RTI) following the addition of the screen to the institutional RTI management guidelines.

Methods
This was a retrospective chart review of adult inpatients presenting to two community-teaching hospitals who were prescribed vancomycin for the treatment of RTIs. Patients were divided into pre-guideline (Jan-Feb 2019), post-guideline 1 (Jan-Feb 2020), and post-guideline 2 (Jan-Feb 2021) groups. The primary endpoint was the difference in percent of vancomycin orders discontinued within 24 hours of a negative screen. Secondary endpoints included the percent of screens ordered, re-initiation of vancomycin within seven days for RTI, and total vancomycin days of therapy (DOT) per 1000 patient days (PD).

Results
Of 493 vancomycin orders screened, 100 orders in each arm were analyzed. There was an absolute increase of 20.6% in vancomycin orders discontinued within 24 hours of a negative screen between the pre-guideline and post-guideline 2 groups (59.1% vs. 79.7%, p = 0.0177). When compared to the pre-guideline group, utilization of the screen increased by 15% in the post-guideline 1 group (48% vs. 63%, p = 0.0328) and 26% in the post-guideline 2 group (48% vs. 74%, p = 0.000164). There was no difference in re-initiation of vancomycin. A statistically significant reduction in total vancomycin DOT/1000PD from the pre-guideline to the post-guideline 1 and 2 groups (66 to 63 to 60, respectively) was also observed.

Conclusion
The addition of the MRSA nares screen to the institutional RTI guidelines increased utilization of the test and demonstrated a reduction in vancomycin utilization. With an increase in education, prospective audit and feedback, and prescriber comfort with the use of the MRSA nares screen in the post-guideline 2 group, there was significant improvement in MRSA nares screen utilization, vancomycin discontinuation after a negative screen, and vancomycin utilization.

Disclosures
All Authors: No reported disclosures
79. Clinical Utility of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal PCR Assays Beyond Respiratory Infections
Authors: Noeldner Haley M , Bushman Amanda , Bliek Zach , Wilkinson Melissa S , Jones Nephi , Prusa Ryan , Rosa Rossana M 
Published: December 2021

Abstract

Background
Empiric use of vancomycin is common in clinical practice. Currently there is strong evidence to support the use of MRSA nasal screening to predict the absence of MRSA in respiratory infections; however, minimal data exists regarding its utility as a de-escalation tool beyond pulmonary indications. Furthermore, MRSA nasal PCR has been shown to be a more efficient way to detect the presence of MRSA colonization than traditional culture methods. The purpose of this study was to evaluate the correlation between results of MRSA nasal PCR assays and blood or bone/soft tissue cultures.

Methods
This was a retrospective study of patients who presented to any of three hospitals part of an integrated health system in Des Moines, Iowa, from March 1, 2019 to February 29, 2020. Included patients were those who underwent MRSA nasal PCR screening and had a clinical culture (blood, bone, tissue, deep podiatric wound, joint aspirate, or synovial fluid) obtained within 3 days of the MRSA nasal PCR. Data on age, sex, diabetes mellitus and dialysis were collected. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for all cultures, and blood and bone/soft tissue cultures separately were estimated.

Results
A total of 1989 patients were included in the study. Of these patients, 1953 patients had a blood culture obtained and 171 patients had a bone/soft tissue culture obtained. The median age was 66 years, and 1086 (54.6%) patients were male. At baseline, 33.1% and 3.8% of patients had diabetes or were on dialysis, respectively. The overall prevalence of MRSA colonization was 12.3%. The sensitivities of the MRSA nasal PCR screening were 67.5% for all clinical cultures, 81.8% for blood cultures, and 55% for bone/soft tissue cultures. Specificities were 88.8%, 88.5%, and 92.7% for all cultures, blood cultures, and bone/soft tissue cultures, respectively. The PPVs were 11%, 7.5%, and 50% for all cultures, blood cultures, and bone/soft tissue cultures, respectively, and the NPVs were 99.3%, 99.8%, and 92.7%, respectively.

Conclusion
MRSA nasal PCR screening showed high NPV across blood and bone/soft tissue cultures. These results indicate the clinical utility of MRSA nasal PCR assays beyond respiratory infections and can further support antimicrobial stewardship activities.

Disclosures
All Authors: No reported disclosures
81. Reducing Unnecessary Blood Cultures Through Diagnostic Stewardship
Authors: Govindan Sujeet , Strnad Luke 
Published: December 2021

Abstract

Background
At our institution, we learned the frequency of blood cultures was sometimes being changed from “Once” to “Daily” without a defined number of days. We hypothesized this led to unnecessary blood cultures being performed.

Methods
Over a 3 month period from 12/6/2019-3/6/2020, we retrospectively evaluated the charts of patients who had a blood culture frequency changed to “Daily”. We evaluated if there was an initial positive blood culture within 48 hours of the “Daily” order being placed and the number of positive, negative, or “contaminant” sets of cultures drawn with the order. Contaminant blood cultures were defined as a contaminant species, present only once in the repeat cultures, and not present in initial positive cultures.

Results
95 unique orders were placed with 406 sets of cultures drawn from 89 adults. ~20% of the time (17 orders) the order was placed without an initial positive blood culture. This led to 62 sets of cultures being drawn, only 1 of which came back positive. 78/95 orders had an initial positive blood culture. The most common initial organisms were Staphylococcus aureus (SA) (38), Candida sp (10), Enterobacterales sp (10), and coagulase negative staphylococci (7). 43/78 (55%) orders with an initial positive set had positive repeat cultures. SA (26) and Candida sp (8) were most common to have positive repeats. Central line associated bloodstream infections (CLABSI) were found in 5 of the orders and contaminant species were found in 4 of the orders. 54% of the patients who had a “Daily” order placed did not have positive repeat cultures. The majority of the cultures were drawn from Surgical (40 orders) and Medical (35 orders) services. Assuming that SA and Candida sp require 48 hours of negative blood cultures to document clearance and other species require 24 hours, it was estimated that 51% of the cultures drawn using the "Daily" frequency were unnecessary. Cost savings over a year of removing the "Daily" frequency would be ~&14,000.

Data from "Daily" blood culture orders drawn at Oregon Health & Science University from 12/6/2019-3/6/2020

Conclusion
Unnecessary blood cultures are drawn when the frequency of blood cultures is changed to "Daily". Repeat blood cultures had the greatest utility in bloodstream infections due to SA or Candida sp, and with CLABSI where the line is still in place. These results led to a stewardship intervention to change blood culture ordering at our institution.

Disclosures
All Authors: No reported disclosures
82. Assessment of Clinical Outcomes and Antibiotic Prescribing Patterns Following Implementation of the GenMark ePlex® Blood Culture Identification Panel for Gram-positive Bloodstream Infections
Authors: Wein Megan , Binkley Shawn , Athans Vasilios , Saw Stephen , Lee Tiffany , Patel Sonal , Hamilton Keith W , Binkley Amanda , Degnan Kathleen , Glaser Laurel , Dutcher Lauren , Talati Naasha J , Richard-Greenblatt Melissa 
Published: December 2021

Abstract

Background
Rapid diagnostic testing (RDT) of bloodstream pathogens provides key information sooner than conventional identification and susceptibility testing. The GenMark ePlex® blood culture identification gram-positive (BCID-GP) panel is a molecular-based multiplex platform, with 20 Gram-positive target pathogens and 4 bacterial resistance genes that can be detected within 1.5 hours of blood culture positivity. Published studies have evaluated the accuracy of the ePlex® BCID-GP panel compared to traditional identification methods; however, studies evaluating the impact of this panel on clinical outcomes and prescribing patterns are lacking.

Methods
This multi-center, quasi-experimental study evaluated clinical outcomes and prescribing patterns before (December 2018 – June 2019) and after (August 2019 – January 2020) implementation of the ePlex® BCID-GP panel in June 2019. Hospitalized, adult patients with growth of Enterococcus faecalis, Enterococcus faecium, or Staphylococcus aureus from blood cultures were included. The primary endpoint was time to targeted antibiotic therapy, defined as time from positive Gram-stain to antibiotic adjustment for the infecting pathogen.

Results
A total of 200 patients, 100 in each group, were included. Time to targeted therapy was 47.9 hours in the pre-group versus 24.8 hours in the post-group (p&lt; 0.0001). Time from Gram-stain to organism identification was 23.03 hours (pre) versus 2.56 hours (post), p&lt; 0.0001. There was no statistically significant difference in time from Gram-stain to susceptibility results, hospital length of stay (LOS), or all-cause 30-day mortality.

Conclusion
Implementation of the GenMark ePlex® BCID-GP panel reduced time to targeted antibiotic therapy by nearly 24 hours. Clinical outcomes including hospital LOS and all-cause 30-day mortality did not show a statistical difference, although analysis of a larger sample size is necessary to appropriately assess these outcomes. This study represents the effect of RDT implementation alone, in the absence of stewardship intervention, on antibiotic prescribing patterns. These findings will inform the design of a dedicated RDT antimicrobial stewardship intervention at our institution, while also being generalizable to other institutions with RDT capabilities.

Disclosures
All Authors: No reported disclosures
83. Impact of a Urine Culture Best Practice Advisory on Collection of Urine Cultures and Subsequent Antibiotic Therapy
Authors: White Logan , Dooley-Wood Andrea , Nguyen Hien , Bandali Aiman 
Published: December 2021

Abstract

Background
In the acute care setting, urinary tract infections (UTIs) may be over diagnosed in up to 40% of cases. In most scenarios, asymptomatic bacteriuria (ASB) is not an indication for antibiotic therapy; inappropriate therapy is associated with a higher incidence of antibiotic-resistant bacteria and adverse drug reactions. Limiting inappropriate collection of urine cultures may decrease unnecessary treatment of ASB. The objective of this study is to assess the impact of a urine culture best practice advisory (BPA) on collection of unnecessary urine cultures.

Methods
This retrospective, observational, single-center study included adult inpatients with an order for urinalysis/urine culture. Those who were pregnant, had a concomitant infection other than UTI and/or were taking antimicrobials for a non-UTI indication, and were undergoing urological procedures were excluded. Duplicate urine culture collections and/or admissions were excluded. Incorporation of a BPA into computerized provider order entry, allowing providers to assess need and document indication for urine culture collection, was implemented on July 2019. The following clinical outcomes were assessed: number of unnecessary urine cultures collected, number of antibiotic treatments, and antibiotic-associated adverse reactions.

Results
Two hundred met criteria for inclusion; 96 in the pre-BPA group (Aug – Oct 2018) and 104 in the post-BPA group (Aug – Oct 2019). Seventy-four (37%) were male and the mean age was 64 and 70 years (p=0.249), respectively. The Charlson Comorbidity Index (CCI) was similar between groups (4 vs. 5, p=0.162) and majority were admitted to a general medical ward (94.5%). Seventy patients (72.9%) in the pre-BPA group and 47 (51.6%) in the post-BPA group had inappropriately ordered urinalysis/urine cultures (OR 0.40; 95% CI 0.22-0.73; p=0.003). Of these patients, 15 (21.4%) and 9 (19.1%) from the pre- and post-BPA groups, respectively, were treated (p=0.077). Among those treated, only two adverse drug reactions were reported.

Conclusion
Implementation of a BPA significantly reduced the number of inappropriate urinalysis/urine culture orders. There was a trend towards decreased antibiotic use for ASB. Future studies are warranted to assess sustainability of these results.

Disclosures
All Authors: No reported disclosures
85. Evaluation of Urinalysis and Urine Culture Use at a Community Health-system
Authors: Brenneman Martin , Bohn Brian C , Moore Sarah E , Wilde Ashley , Wilde Ashley , Song Matthew 
Published: December 2021

Abstract

Background
The Infectious Diseases Society of America asymptomatic bacteriuria (ASB) guidelines recommend against screening for or treating ASB in most patients without symptoms of a urinary tract infection (UTI). The purpose of this study was to characterize current urine testing practices and their potential impact on identification and treatment of asymptomatic bacteriuria on hospitalized adults.

Methods
This retrospective, point prevalence study conducted at a 4 hospital community health-system that included all inpatients ≥ 18 years old present on November 13th, 2019. Patients were excluded if they were admitted or transferred to either a labor & delivery or mother-baby unit. A chart review was performed for a sub-group of patients with abnormal urine testing, with a target sample size of 200 (n=50 from each hospital). The primary outcome was the prevalence of patients with a urinalysis, urine culture, or both performed during their admission. Secondary outcomes included abnormal urine testing in the overall cohort and symptomatology and antibiotic use in the sub-group (Figure 1).

Results
947 patients met inclusion criteria. Of those patients, 516 (54%) had urine testing performed during their admission. 322 (34%) patients had abnormal urine testing results (Table 1). In the sub-group, 192 patients with abnormal urine tests were included. Antibiotics with a documented indication of UTI were administered to 66 (34%) patients. Of those given antibiotics with a UTI indication, 49/66 (74%) did not have documented signs or symptoms of a UTI (Figure 2).

Conclusion
Urine testing was performed on the majority of admitted adult patients. Unnecessary testing likely contributes to guideline discordant screening and treatment of ASB. Future studies are needed to identify effective diagnostic stewardship interventions to decrease screening and treatment of ASB.

Disclosures
Ashley Wilde, PharmD, BCPS-AQ ID, Nothing to disclose
88. Effect of an MDR Enterobacterales Screening Tool on Antibiotic Prescribing for Abdominal Infections Caused by Mixed Bacteria
Authors: Panichsillapakit Theppharit , Alby Kevin , Marx Ashley H , Mavrogiorgos Nikolaos 
Published: December 2021

Abstract

Background
Background: Choosing antibiotics for infections caused by mixed Enterobacterales is challenging. Our microbiology lab implemented a multi-drug resistance (MDR) screen for cultures with mixed gram-negative to direct clinicians to use 3rd generation cephalosporins for screen neg. pathogens, and to use broader beta-lactams for screen-pos. pathogens. Here we report the effect of MDR screen on final antibiotic choice.

Methods
Methods: We retrospectively reviewed cases with abdominal infections caused by mixed bacteria at UNC Medical Center between August and November 2020. Cultures with non-Enterobacteraeles gram negatives were excluded. MDR screen was done by plating mixed Enterobacterales on HardyCHROM™ ESBL agar. Screen-pos. cases were updated “MDR Enterobacterales present” and pathogens were identified with full susceptibilities. Screen-neg. cases were labeled “MDR Enterobacterales not present”. Definitely covering antibiotics were defined by the use of 3rd generation cephalosporins for screen neg. cases, or based on susceptibilities in case of screen pos. organisms or concomitant bacteremia. Possibly covering antibiotics included regimens whose susceptibility could not be predicted based on the screen (e.g., amox/clav or quinolone+metronidazole).

Results
Results: 51 cases were identified. Median age was 51 years (range 10 to 87). 54.9% were female and 45.1% male. Infections included intra-abdominal abscesses (n =35), perirectal or scrotal abscesses (10), abdominal wound infections (4), perineal necrotizing fasciitis (1), and cholecystitis (1). Sample types were abscess fluid (43), wound purulence (4) or tissue (3). MDR screen was pos. in 7.8%. Antibiotics were adjusted in 17.6% as a result of the screen report. 31.5% of final antibiotics definitely covered the isolated bacteria, 56.9% possibly covered, and 5.9% did not have an active antibiotic. Among screen pos. cases, final antibiotics definitely covered in 75% and possibly in 25%.

Conclusion
Conclusions: The MDR Enterobacterales screening tool for abdominal infections had limited impact on final antibiotic choice, but was useful when positive. Further directions include assessment of provider understanding of the MDR screen results and investigation of utility of screen in other infection types.

Disclosures
All Authors: No reported disclosures