bluuebunny/crossref_metadata_2025_split huggingface dataset:
6. Staphylococcus aureus in a Single Blood Culture Bottle: Should We be Concerned?
Authors: Go John Raymond U , Challener Douglas , Corsini Campioli Cristina G , Sohail Muhammad R , Palraj Raj , Baddour Larry M , Saleh Omar Abu 
Published: December 2021

Abstract

Background
Staphylococcus aureus bacteremia (SAB) is common and is characterized by high rates of morbidity and mortality. The clinical importance of a single positive blood culture bottle (SPBCB), however, is poorly defined despite it being a frequent laboratory finding. We therefore examined patients with SPBCB to determine its clinical significance and to understand the rationale of current practice.

Methods
We performed a retrospective, multicenter study of patients with a SPBCB for S. aureus in initial cultures from January 2019 to December 2019 using data collected from both electronic health records and the clinical microbiology laboratory.

Results
Overall, 534 patients with SAB were identified, and 118 (22.1%) had a SPBCB. Among SPBCB cases, 106 (89.3%) were classified as clinically significant while 12 were considered contaminated or of unclear clinical significance. Baseline characteristics were similar between the groups (Table 1). A majority (92.4%) received antibiotic therapy, but patients with clinically significant bacteremia were treated with a longer antibiotic course (25.9 vs 5.7 days, p&lt; 0.001). Outcomes between those with SPBCB (contaminant vs clinically significant) were similar (Table 2). Of note, while there was no difference in use of echocardiography based on PREDICT criteria between the clinically significant SPBCB vs. the multiple positive blood culture bottles (MPBC) cohorts (Table 3), significant differences were seen in both frequency of echocardiography (65.1% vs. 84.6%, P&lt; 0.001) and IE diagnosis (3.8% vs. 14.2%, P=0.002) for patients in the SPBCB vs. MPBC groups, respectively. In addition, those with MPBC had higher 90-day, 6-month and 1-year mortality rates.

Conclusion
SPBCB was documented in almost one-quarter of SAB cases and should trigger a thorough investigation as its associated mortality was high and complications, including IE, occurred. Although some SPBCB cases may represent contamination, antibiotic treatment of SPBCB was commonplace. Patients with clinically significant SPBCB were less likely to undergo echocardiography and had a reduced prevalence of an IE diagnosis as compared to those with MPBC. Patients with SPBCB may have a more favorable long-term prognosis as compared to that in patients with MPBC.

Disclosures
Muhammad R. Sohail, MD, Medtronic (Consultant)Philips (Consultant) Larry M. Baddour, MD, Boston Scientific (Individual(s) Involved: Self): Consultant; Botanix Pharmaceuticals (Individual(s) Involved: Self): Consultant; Roivant Sciences (Individual(s) Involved: Self): Consultant
7. Clinical outcomes and epidemiological characteristics of bacteremia in the older population of Japan
Authors: Nakamura Keiji , Hayakawa Kayoko , Tsuzuki Shinya , Ide Satoshi , Nomoto Hidetoshi , Nakamoto Takato , Yamada Gen , Yamamoto Kei , Ohmagari Norio 
Published: December 2021

Abstract

Background
Japan is one of the most aging societies worldwide. Because older people are highly susceptible to infectious diseases, the characteristics and clinical consequences of bacteremia in this population need clarification.

Methods
Patients aged ≥ 65 years with positive blood cultures were included in this study conducted between April 1, 2015 and March 31, 2018, and divided into three groups: pre-old (65–74 years), old (75–89 years), and super-old (≥90 years) according to the criteria of the Japanese Society of Geriatrics. They were also classified based on medical exposure: community-acquired (CA), healthcare-associated (HCA), and hospital-onset (HO). Parameters retrieved from medical records were used to compare each group using the chi-square test or Fisher’s exact test; factors related to mortality were identified using multivariate logistic regression analysis after controlling for the confounding effect of baseline characteristics and underlying diseases. The Bonferroni corrected P &lt; 0.05 was deemed to be statistically significant.

Results
Overall, 1716 cases of bacteremia were identified in 1415 patients. Of these, 505 cases (29.4%) were found to be due to contamination. Of the 1211 cases without contamination, 397 (32.8%) included pre-old, 658 (54.3%) included old, and 156 (12.9%) included super-old patients. HCA bacteremia increased with age, while HO bacteremia was most common in pre-old patients. Escherichia coli bacteremia was most common in super-old patients. While a central line-associated bloodstream infection was more common in pre-old patients, a urinary tract infection was more common in old and super-old patients. The 7-day mortality was 7.4%, 5.8%, and 14.2% in the pre-old, old, and super-old groups, respectively (P = 0.002). The 7-day mortality for CA, HCA, and HO bacteremia was 5.4%, 6.6%, and 9.5%, respectively (P &gt; 0.05). Multivariate logistic regression showed that HO bacteremia (aOR: 1.76 [1.05–2.94], P = 0.028) and increasing age (aOR: 1.03 [1–1.06], P=0.038) are independent risk factors for 7-day mortality.
Table Comparison of characteristics of bacteremia among the pre-old, old, super-old groups, n (%)

Conclusion
The epidemiology of bacteremia differs among different older age groups; thus, these populations should not be treated as a single entity. A careful approach is needed for the optimal management of bacteremia in them.

Disclosures
All Authors: No reported disclosures
8. Sepsis-Associated Acute Kidney Injury and Acute Kidney Disease: A 15-Year Cohort Study of 4,226 Adult Sepsis Inpatient Survivors at a Tertiary Medical Center in Taiwan
Authors: Liang Chih-Chia , Yeh Hung-Chieh , Chen Pei-Shan , Kuo Chin-Chi , Chiang Hsiu-Yin 
Published: December 2021

Abstract

Background
Sepsis is the most common cause of acute kidney injury (AKI) and about one-third of patients with sepsis-associated AKI (SA-AKI) develop acute kidney diseases (SA-AKD) and may progress to unfavorable outcomes. We aimed to study the characteristics and outcomes associated with SA-AKI and SA-AKD.

Methods
This cohort study included adult inpatients with first-time sepsis who were admitted during 2003-2017, had qualifying serum creatinine (SCr) measurements at baseline (-365 to -3 days), -2 to +7 days, and +8 to +90 days of sepsis index day, and survived the first 90 days (Figure 1). Sepsis was identified using an electronic medical records-based Sepsis-3 criteria. We classified sepsis inpatients into SA-AKI(-), SA-AKD(-), SA-relapsed-AKD, and SA-nonrecovery-AKD (Figure 2). ESRD and mortality were ascertained by linking to the Catastrophic Illness records and to National Death Registry, respectively. Multivariable Cox proportional hazard model was used to evaluate the risk of mortality and end-stage renal disease (ESRD) associated with SA-AKI/AKD subtypes.
Figure 1. Flowchart of the selection process of adult sepsis survivors (N = 4226 patients).

Figure 2. Definitions of sepsis associated-acute kidney injury (SA-AKI) and sepsis associated-acute kidney disease (SA-AKD).

Results
Of 4,226 eligible sepsis inpatient survivors, 47.1% developed SA-AKI and 10.1% progressed to SA-AKD (5.4% relapsed and 4.7% nonrecovery). Patient with AKI and non-recovered AKD had the worst baseline renal function (SCr, 1.3 mg/dL) (Table 1). The multivariable analyses revealed that SA-relapsed AKD was significantly associated with increased risk of all-cause mortality for 1-year (aHR 1.67; 95% CI 1.25, 2.24), 3-year (aHR 1.38; 95% CI 1.11, 1.71), and overall (aHR 1.35; 95% CI 1.12, 1.61), compared with SA-AKI(-). SA-relapsed AKD and SA-nonrecovery AKD were both significantly associated with 1-year, 3-year, and overall ESRD, with the risk of about 4-fold or higher than SA-AKI(-) (Table 2).
Table 1. Baseline characteristics and outcomes among adult sepsis survivors, by different SA-AKI/AKD subtypes.

Table 2. Risk of all-cause mortality and end stage renal disease (ESRD) among adult sepsis survivors.

Conclusion
Sepsis survivors who initially had AKI and developed relapsed or nonrecovery AKD tended to have worse outcomes of all-cause and ESRD, compared with those without AKI. Unexpectedly, patients with non-recovered AKD did not have a higher mortality risk, possibly because we have selected those who survived the first 90 days of sepsis. We will develop two-stage prediction models to identify sepsis patients at risk of developing AKI and SA-AKI patients at risk of developing different types of AKD.

Disclosures
All Authors: No reported disclosures
9. The Skip Phenomenon in Staphylococcus aureus Bacteremia: Clinical Associations
Authors: Go John Raymond U , Baddour Larry M , Lahr Brian , Sohail Muhammad R , Palraj Raj 
Published: December 2021

Abstract

Background
Serial blood cultures are integral in managing Staphylococcus aureus bacteremia (SAB) as clinicians rely on the results to determine infectious complication risks and antibiotic duration. Current IDSA guidelines suggest a single set of negative blood cultures is adequate evidence of SAB clearance. Several studies, however, have identified the skip phenomenon (SP), which is the occurrence of intermittent negative blood cultures, and have recommended obtaining additional blood cultures to document bacterial clearance (Table 1). We therefore examined patients who manifested the SP to determine its clinical significance and to study this, associations were tested for SP in relation to various baseline factors as well as clinical outcomes.

Methods
We performed a retrospective, multicenter study of all patients with a positive blood culture for S. aureus from January 2019 to December 2019 using data collected from electronic health records and the clinical microbiology laboratory.

Results
A total of 602 patients with SAB were identified and 495 patients were included in the investigation (Figure 1). Overall, 25 (5.1%) patients had the SP. Significant differences between those who did and did not manifest the SP included higher rates of injection drug use, automatic implantable cardioverter defibrillator, and community onset of infection in the SP cohort (Table 2). Moreover, the median duration of SAB was longer (3.2 [2.3-5.4] vs 1.90 [1.2-2.9] days, p=0.002), and high-grade SAB, (88.0% vs 58.7%, p=0.004), complicated bacteremia (92.0% vs 67.9%, p=0.011) and IE diagnosis (28.0% vs 11.3%, p=0.013) were all more common in the SP group. In unadjusted outcome analyses, association of SP with hospital length of stay was not significant, although a higher risk of in-hospital mortality among SP patients approached statistical significance (p=0.055). Analysis of 435 hospital survivors revealed no significant differences in rates of 1-year mortality or 90-day relapse between the two groups (Table 3).

Conclusion
Findings of the current investigation demonstrates an increased risk of SAB complications in patients with the SP and support the notion that serial negative blood cultures are needed to document clearance of SAB.

Disclosures
Larry M. Baddour, MD, Boston Scientific (Individual(s) Involved: Self): Consultant; Botanix Pharmaceuticals (Individual(s) Involved: Self): Consultant; Roivant Sciences (Individual(s) Involved: Self): Consultant Muhammad R. Sohail, MD, Medtronic (Consultant)Philips (Consultant)
10. Impact of Infectious Disease Consultation and Theoretical Management Bundle in Patients with Candidemia
Authors: Adeghe ifueko J , Kabbani Dima , Dingle Tanis C , Chen Justin 
Published: December 2021

Abstract

Background
Candidemia is associated with significant morbidity and mortality. The impact of infectious diseases consultation (IDC) on clinical outcomes in patients with candidemia is not well established. We evaluated the impact of IDC and a management bundle on clinical outcomes in patients with candidemia.

Methods
A retrospective chart review of adult (age ≥ 18 years) patients with at least 1 blood culture growing Candida species identified at Alberta Precision Laboratories between December 1, 2019 to November 30, 2020 and hospitalized at the University of Alberta Hospital, Edmonton, Canada were included. Patients who died within 48 hours and those who left against medical advice within 24 hours of initial positive blood culture result were excluded. Demographics, management, and outcome data were collected. A complete management bundle was defined as having all the following elements performed: IDC, repeat blood cultures, empiric echinocandin therapy, ophthalmology consult, and echocardiogram.

Results
Thirty-one patients were included for study; mean age was 56 ± 17 years and 65% were male. 14 (45%) cases were admitted under critical care, 7 (23%) surgery, and 10 (32%) medicine. 3/17 (18%) required intensive care unit admission following candidemia diagnosis. Candida albicans was identified in more than half the cases. The primary source was intra-abdominal in 12 (39%), central-line associated in 8 (26%), and urinary in 6 (19%). IDC occurred in 27 cases (87%), echocardiogram in 22 (71%), ophthalmology consult in 10 (32%), and follow-up blood cultures in 30 (97%). 20 (65%) patients received empiric echinocandin. Of the remainder who received empiric fluconazole, 4 (36%) grew non albicans Candida species.
Higher in-hospital mortality was observed in cases without IDC than those with IDC (4/4, 100% vs 8/27, 29.6%, p=0.016) and in those that did not have a complete bundle (12/25, 48% vs 0/6, p=0.059). However, IDC was not associated with the receipt of individual bundle components nor the complete bundle (p=NS).

Conclusion
In patients with candidemia, lower in-hospital mortality was observed in patients who received IDC. Larger studies are required to confirm our findings and assess whether the implementation of a candidemia management bundle is beneficial.

Disclosures
Dima Kabbani, MD, AVIR Pharma (Grant/Research Support, Other Financial or Material Support, Speaker)Edesa Biotech (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator)
12. Development of Provider-Specific Antibiotic Prescribing Feedback for Inpatient Antibiotic Stewardship Programs in Veterans Affairs (VA) Facilities (ASP)
Authors: Goetz Matthew B , Goetz Matthew B , Fang Michelle , Calub Feliza , Belperio Pamela , Stevens Vanessa W , Hicks Lauri , Srinivasan Arjun , Srinivasan Arjun , Jones Barbara E , Neuhauser Melinda M , Jones Makoto M 
Published: December 2021

Abstract

Background
Provision of provider-specific outpatient antibiotic prescribing data has resulted in significant decreases in antibiotic use. We describe the development of reports of inpatient antibiotic prescribing by hospitalists attending on acute medical wards in VA medical facilities.

Methods
We created algorithms for determining the attending physician responsible for patient days present (DP), by considering changes of service (e.g., prior to admission from the emergency department) and transfers between services or physicians. Each antibiotic dose was assigned to a single attending, ward location, and service according to denominator assignment. Antibiotic use was grouped into Centers for Disease Control and Prevention drug categories and expressed as antibiotic days of therapy (DOT) per 1000 DP. Data were obtained from the VA Corporate Data Warehouse. Algorithms were iteratively refined based on reviews of medical records from three VA medical centers and applied to acute care patients at a single site for 2018-2020.

Results
In 2018-2020, 294 attendings oversaw acute inpatient care for &gt;= 14 DP. 129 attendings with &gt;= 300 DP oversaw 88.0% of all patient care and prescribed 87.6% of all antibiotics (480 DOT/1000 DP, IQR 375-559), 90.1% of broad-spectrum therapy for hospital-onset infections (55 DOT/1000 DP, IQR 31-72) and 88.3% of resistant Gram-positive therapy (70 DOT/1000 DP, IQR 39-89) in inpatient wards. The distribution of antibiotic use for acute care ward patients amongst these 129 staff is shown in the following figure.

Conclusion
We developed algorithms to attribute antibiotic therapy to inpatient attendings that can be broadly applied in facilities with electronic medical records. As with outpatient prescribing, we found large variation across inpatient attendings in overall antibiotic use and broad-spectrum antibiotic use. In future work, we will obtain provider feedback of report usability and interpretability and assess whether distribution of these reports allows antibiotic stewards to favorably influence provider prescribing practices.

Disclosures
Matthew B. Goetz, MD, Nothing to disclose Arjun Srinivasan, MD, Nothing to disclose
16. Attributable Mortality, Healthcare Costs and Out-of-Pocket Costs of Clostridioides difficile Infection in US Medicare Advantage Enrollees
Authors: Yu Holly , Nguyen Jennifer L , Alfred Tamuno , Zhou Jingying , Olsen Margaret A 
Published: December 2021

Abstract

Background
US attributable CDI mortality and cost data are primarily from Medicare fee-for-service populations. Little is known about Medicare Advantage Enrollees (MAEs), who comprise about 39% of the Medicare population.

Methods
Using 2017‒2019 Optum’s de-identified Clinformatics® Data Mart database, this retrospective cohort study identified first C difficile infection (CDI) episodes occurring in 2018 among eligible MAEs ≥66 y of age who were continuously enrolled for 12 mo before CDI diagnosis (baseline period). CDI was defined via ICD10 diagnosis codes or evidence of toxin testing with CDI antibiotic treatment. To assess all-cause mortality and CDI-associated healthcare and patient out-of-pocket (OOP) costs, CDI+ cases were matched 1:1 to CDI– controls using propensity scores (PS) and were followed through the earliest of death, disenrollment or end of the 12 mo followup. Additionally, outcome analyses were stratified by infection acquisition and hospitalization status.

Results
Among 3,450,354 eligible MAEs, 15,195 (0.4%) had a CDI episode in 2018. Using PS generated from &gt;60 variables collected in the baseline period, 14,928 CDI+ cases were matched to CDI– controls.
Over 12 mo of follow-up, the difference in 1-y attributable mortality was 7.9% in the CDI+ (26.3%) vs CDI– (18.4%) cohort (Figure 1). CDI-attributable mortality was higher among hospitalized CDI+ cases (18.4% for healthcare associated [HA]; 13.1% for community associated [CA]) vs nonhospitalized CDI+ cases (HA, 4.5%; CA, 1.0%).
Similarly, healthcare costs were higher for CDI+ vs CDI– patients, with excess mean total cost of &13,363 at the 2-mo follow-up (Figure 2). Total excess mean healthcare costs were greater among hospitalized CDI+ patients (HA, &28,139; CA, &28,136) than for nonhospitalized CDI+ patients (HA, &5741; CA, &2503). CDI-associated excess mean OOP cost was &409 for CDI+ cases at the 2 mo followup. Total excess mean OOP cost was highest in CA hospitalized CDI+ cases, followed by HA hospitalized CDI+ cases, HA nonhospitalized CDI+ cases and finally CA nonhospitalized CDI+ cases (&964, &574, &231 and &197, respectively).

Conclusion
CDI is associated with major mortality and total healthcare and OOP costs. Preventing CDI in the elderly may improve outcomes and reduce costs for healthcare systems and patients.

Disclosures
Holly Yu, MSPH, Pfizer Inc (Employee, Shareholder) Jennifer L Nguyen, ScD, MPH, Pfizer Inc. (Employee) Tamuno Alfred, PhD, Pfizer Inc. (Employee) Jingying Zhou, MA, MEd, Pfizer Inc (Employee, Shareholder) Margaret A. Olsen, PhD, MPH, Pfizer (Consultant, Research Grant or Support)
18. Global Surveillance of Clostridioides difficile Demonstrates High Prevalence in Non-Healthcare Settings
Authors: Jo Jinhee , Gonzales-Luna Anne J , Garey Kevin W 
Published: December 2021

Abstract

Background
Clostridioides difficile is a Gram-positive, spore-forming, toxin-producing organism that is the leading cause of healthcare-associated infections. However, past studies have isolated C. difficile spores from the community, suggesting an environmental reservoir that may play a role in transmission. This study aimed to examine the prevalence and strain types of C. difficile isolated from the United States (US) and internationally.

Methods
From 2014 to 2017, environmental swabs were collected from public areas, healthcare settings, and shoe soles. Samples were considered positive for C. difficile following growth on CCFA plates and confirmatory PCR testing for toxin genes and fluorescent PCR ribotyping (RT). The rate of C. difficile positivity and associated RT distribution were compared between settings, including shoe soles which were investigated for their potential role in environmental transmission.

Results
A total of 11,986 unique isolates were obtained primarily from the US (n=11,002; 92%) in addition to 11 other countries including Taiwan (n=200) and India (n=187). Samples were categorized as being from outdoor environments (n=2,992), private residences (n=2,772), shoe soles (n=1,420), public buildings (n=1,104) or acute care settings (n=3,698). Worldwide C. difficile sample positivity was 26% and was similar between US and non-US sampling sites. In the US, private residences (26.2%) and outdoor environments (24.1%) had the highest positivity rate compared to public buildings (17.2%). In a Texas sub-analysis (n=8,571), positivity rates were highest from outdoor samples (27%) and were similar between private residences (24%) and healthcare buildings (24%). The most prevalent RTs overall were F014-020 (16.4%), F106 (14.9%), and FP310 (11%). Shoe soles had the highest positivity rate (45%) with similar RT distribution between shoe soles and environmental samples.

Conclusion
Using a worldwide sample, 26% of environmental samples tested positive for toxigenic C. difficile strains from healthcare and non-healthcare sites. Community stewardship efforts will be needed to reduce the risk of CDI in vulnerable patients. Shoe sole sampling may be an ideal surveillance tool to test for emerging epidemic strains.

Disclosures
Kevin W. Garey, Pharm.D., M.S., FASHP, Summit Therapeutics (Research Grant or Support)