bluuebunny/crossref_metadata_2025_split huggingface dataset:
814. Successful Treatment of Cutibacterium acnes (CA) Prosthetic Device Infection (PDI) with Oral Linezolid and Rifampin (LR)
Authors: Nahass Ronald G , Esquivel Maalikat , Smith Krystle , Heinemann Danielle , Seneca Kathleen H 
Published: December 2021

Abstract

Background
CA PDI is increasingly recognized. CA is felt to create a slime layer that makes infection more likely and treatment more difficult in this setting. Traditional management has included prosthetic device explantation (PDE), prolonged antibiotic treatment, and delayed reimplantation. Recent interest in the use of oral treatment regimens and single stage procedures with long duration antibiotic therapy led us to treat a series of patients with oral treatment and retained prosthesis after debridement. We report those results.

Methods
Sequential patients with CA PDI treated with oral therapy were identified. All patients underwent debridement of the tissue, exchange of components and/or reimplantation of the prosthetic device. Only patients with exchanges were included. PDE was excluded. MIC testing for CA isolates was obtained when possible. Initial treatment was recorded at time of surgery. LR was the treatment of choice unless toxicity developed. A minimum of a 3-month follow-up post treatment was required to be included. 6 and 12 month follow up were obtained for all patients but 1 at this time.

Results
10 patients were treated (Table 1). Shoulder joint infections were most common. All patients were treated with LR. All completed a minimum of 42 days of treatment (Table 2). The medication was well tolerated. The most common adverse events were nausea. 9/10 patients with 12 month follow up had no evidence of relapse. 1/10 had no relapse at 3 months. Typical for CA infection laboratory markers for infection were not markedly elevated. Notably thrombocytopenia did not occur (Table 3).
Table 1. Distribution of Prosthetic Device Infections

Table 2. Duration of Treatment

Table 3. Selected Laboratory Results

Conclusion
We demonstrated the ability to successfully treat 10/10 patients with CA PDI without explantation using prolonged oral treatment with LR after debridement. This combination should be considered a treatment option and explored further as a low cost, well tolerated, high value treatment approach to this difficult infection.

Disclosures
Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker’s Bureau)Merck (Grant/Research Support, Speaker’s Bureau) Kathleen H. Seneca, MSN, Abbvie (Research Grant or Support)Alkermes (Research Grant or Support)Gilead (Speaker’s Bureau)
815. Short-Course vs. Extended-Course Perioperative Antibiotic Prophylaxis in Patients Receiving Unilateral Primary Total Knee Arthroplasty
Authors: Lim Jia Le , Yii Daphne Yah Chieh , Hung Kai Chee , Lee Winnie , Kwa Lay Hoon Andrea , Yeo Nicholas Eng Meng , Tan Andrew Hwee Chye , Chung Shimin Jasmine 
Published: December 2021

Abstract

Background
International guidelines recommend up to 24 hours of perioperative antibiotic prophylaxis (AP) in joint replacement procedures. However, some observational studies support AP beyond 24 hours for the prevention of surgical site infections (SSI) and prosthetic joint infections (PJI), and this practice is also observed in our institution. This study aims to evaluate the incidence of SSI and PJI in patients receiving short- vs extended-course AP after unilateral primary total knee arthroplasty (TKA) at our center.

Methods
This was a retrospective cohort study of patients who underwent elective unilateral primary TKA from October to December 2019 at Singapore General Hospital. Patients were excluded if they received antibiotics for reasons other than post-operative AP or underwent other procedures in addition to unilateral primary TKA. Data was collected from electronic medical records and patients who received a short-course of AP (≤24 hours) were compared with patients who received an extended-course of AP. Primary outcomes were 30-day SSI and 30-day PJI rates. Secondary outcome was the impact of duration of AP on length of stay. Statistical analysis was performed using SPSS software version 20.

Results
There were 394 patients included in the study. 247 received short-course and 147 received extended-course AP. There were no differences in demographics (Table 1). Amongst those who received extended-course AP, median duration was 7 (IQR 4, 8) days, during which 119 (81.0%) patients switched from intravenous to oral route of antibiotics. Between the short- and extended-course arms, there were no differences observed in 30-day SSI (6.9% vs 6.1%, p=0.769) or PJI rates (0.4% vs 0.7%, p=0.999). However, extended-course AP was associated with a longer median length of stay (4 [IQR 3, 6] vs 5 [IQR 4, 7] days, p=0.001). In a subgroup analysis of 106 diabetic patients, there were no differences in 30-day SSI rates (12.3% vs 9.8%, p=0.763) and 30-day PJI rates (0% vs 2.4%, p=0.387) between both groups.

Conclusion
In this single center study, short-course AP in elective TKA was safe and effective. Extending AP did not reduce SSI or PJI rates, even in diabetic patients. In addition, extending AP was associated with increased length of stay, which translates to higher healthcare costs.

Disclosures
All Authors: No reported disclosures
816. Early Surgical Site Infections in High Risk Orthopedic Surgery Patients Following Change in Perioperative Antibiotic Selection
Authors: Lee Benjamin , Pasikhova Yanina , Morrison Austin R , Baluch Aliyah , Binitie Odion 
Published: December 2021

Abstract

Background
Endoprosthestic or allograft reconstruction has become common following resection of malignant musculoskeletal tumors. Reported SSI rates after resection and reconstruction have been reported as high as 10 – 39% due to concurrent radiation and/or chemotherapy, compared to 0.6% - 2.0% in other orthopedic procedures. Though the optimal duration and perioperative antibiotic prophylaxis is well defined in other orthopedic procedures, there is little evidence to guide management in patients undergoing reconstruction with large endoprosthesis. At Moffitt Cancer Center (MCC), cefepime and vancomycin (FEP/VAN) were historically used for perioperative antibiotic prophylaxis; however, due to national logistical issues, these antibiotics were modified on June 6th, 2015 to cefazolin and vancomycin (CFZ/VAN).

Methods
We report a pre-post quasi-experimental interrupted time-series non-inferiority study conducted at MCC with 150 high-risk orthopedic surgery patients with a primary objective of demonstrating non-inferiority of CFZ/VAN to FEP/VAN with reducing early SSI rates for patients after tumor resection followed by reconstruction. Statistical analysis was performed utilizing a multivariate logistic regression analysis of the interventions and primary outcome. Data were processed and analyzed within the R version 4.0.2 software.

Results
Both groups included 75 patients with most common indications for surgery being sarcoma of any type (53%) and metastatic bone disease (27%), with the most common location of reconstruction at the distal femur (25%) and acetabulum (24%). Rates of early SSIs were low and numerically similar with 3 (4%) in the FEP/VAN group and 4 (5.4%) in the CFZ/VAN group. There was one instance of hardware removal due to infection within the FEP/VAN group.
Baseline Characteristics

Baseline characteristics for total study population, FEP/VAN, and CFZ/VAN
Results including SSI rate, pathogens, infection

Surgical site infection rates, culture site, group and interventions

Conclusion
Overall, the rates of early SSI rates at MCC between both groups are numerically lower compared to previous studies. Between groups, the rates are similar and supports the use of CFZ/VAN in this patient population. The low rate of early SSIs in this study may be attributed to several factors such as extended oral antibiotic prophylaxis at discharge. Further analysis is ongoing to determine the statistical significance of any differences between confounding variables.

Disclosures
All Authors: No reported disclosures
818. Understanding Current Practices of an Electronic Antimicrobial Resistant Organism (ARO) Screening Tool Used in Healthcare Facilities in Alberta, Canada
Authors: Leal Jenine , Versluys Kristen , Pfister Ted , Ellison Jennifer , Bush Kathryn , Pitchko Janice , Woolsey Samantha , Vayalumkal Joseph V , Lee Bonita , Smith Stephanie , Kim Joseph , May Elissa Rennert 
Published: December 2021

Abstract

Background
Increasing antibiotic resistance is a global problem. By detecting individuals colonized with antimicrobial resistant organisms (AROs) through hospital admission screening, enhanced precautions can be implemented to interrupt transmission during their hospitalization. The objective is to understand current practices of ARO screening in Alberta hospitals by evaluating completeness of an electronic ARO screening tool.

Methods
A retrospective cohort study using electronic medical record (EMR) data from Connect Care (Epic Systems Corp.) at one adult and one pediatric tertiary hospital in Edmonton, Alberta between January 1, and December 31, 2020 was conducted. All hospital admissions were included. Outcomes included proportion of admissions with a completed ARO tool and a comparison of the best practice actions triggered (e.g. ARO screening swab and/or isolate) between those with and without a completed ARO tool. Test of proportions was used, with a two-sided α of 0.05 and was conducted using STATA/SE 16.1.

Results
During the study period, there were 32,600 total admissions, of which 16,342 (50.1%) had the ARO tool completed. The overall compliance was greater in the adult hospital (53.9%) compared to the pediatric hospital (36.3%) (&lt; 0.001). For both hospitals, the compliance rate in December 2020 was 30.0% lower than in January 2020, with a continuous decline during the 12 months. An isolation order or screening swab was ordered in 40.6% of admissions without an ARO tool completed compared to 56.5% of admissions with the ARO tool completed. Based on responses in the completed ARO tool, 81.2% of patient admissions had a microbiologic swab ordered when indicated, of which only 4.7% were positive. However, only 35.9% of patient admissions had additional precautions ordered when indicated.

Conclusion
ARO screening is a required organizational practice and although standardized across all Alberta hospitals and embedded within an EMR, compliance was poor. Further work is needed to understand point-of-care risk assessment processes to inform future interventions aimed at early identification and decreased transmission of ARO in hospitals.

Disclosures
All Authors: No reported disclosures
819. Antibiotic Resistance in Pathogens Causing Hospital Acquired Infections in Brazil: A Multicenter Study
Authors: Starling Carlos , Couto Bráulio R G M , Silva Estevão Urbano , Andrade Virginia , Leite Edna M M , Gonçalves Simony , Melo Mariana , Bandeira Raquel , Carvalho Priscila , Pereira Hoberdan , Fernandes Rafael , Mata Camila , Vasconcelos Débora , Vieira Laura , Silva Magda , Aguiar Lilian , Gomes Luciene , Rocha Maria Izabella , Silva Raphael , Filho Graccho Cesarino , Pessoa Jussara , Alvim André Luiz , Maia Amanda , Matoso Roberta , Mara Thalita 
Published: December 2021

Abstract

Background
In the present study we determined the prevalence of antibiotic resistance in the most common organisms causing healthcare-associated infections in tertiary-care hospitals in Belo Horizonte, a 3,000,000 inhabitants city from Brazil.

Methods
Microbiology data of hospital acquired infections (HAI) defined by the National Healthcare Safety Network (NHSN)/CDC protocols of seven general hospitals were analyzed: three public institutions, two philanthropic, and two private hospitals.
Samples from different topographies were plate in an ideal culture medium and after growth, the microorganisms were identified by standard biochemical and microbiological methods, using the VITEK 2 compact system (Biomerieux), which allows the simultaneous identification of Gram-positive and Gram bacteria -negative and combine the identification and TSA results in a single report. Six hospitals used automated methods and one institution used manual method for antimicrobial susceptibility testing.

Results
Samples of seven Gram-negative and two Gram-positive bacteria collected between Dec/2019-Nov/2020 from HAI isolates were analyzed: 565 Klebsiella, 293 Escherichia coli, 153 Proteus, 403 Pseudomonas, 275 Acinetobacter, 174 Serratia, 153, 361 Staphylococcus aureus, and 176 Enterococcus. Antibiotic resistance profile of each strain is summarized in Figures 1, 2, and 3.
Resistance profile: Klebsiella, E. coli, Proteus.

ATB profile: Pseudomonas, Acinetobacter, Serratia.

ATB profile: Enterobacter, S. aureus, Enterococcus .

Conclusion
Benchmarks for antibiotic resistance in the most common organisms causing healthcare-associated infections were defined, and can be used as indicators for healthcare assessment, specially in developing countries institutions.

Disclosures
All Authors: No reported disclosures
820. Optimal Specimen Source(s) for Carbapenemase-Producing Acinetobacter Colonization Screening
Authors: Dale Jennifer , Anacker Melissa , Craft Bradley , Gross Annastasia , Fischer Jill , Blanding Justin , Lindemann Stephanie , Tang Angela , Brister Sarah , Dowdell Ashlie , Stein Emma , O’Malley Sean , Pattee Brittany , Vagnone Paula Snippes 
Published: December 2021

Abstract

Background
Infection prevention (IP) strategies are implemented to limit the transmission of healthcare-associated infections (HAIs), which are estimated to occur in 1 out of 31 hospitalized patients per day in the United States. Carbapenem-resistant Acinetobacter (CRA) cause HAIs classified as an urgent threat by CDC. When carbapenemase-producing CRA (CP-CRA) are identified, containment strategies are implemented, including screening patients at high risk for colonization with CP-CRA. Point prevalence surveys (PPS) are conducted to assist with HAI outbreak investigations and identify colonized patients.

Methods
Herein, we describe results from culture-based CP-CRA colonization testing of multiple specimen sources (rectal, skin [axilla/groin or groin], respiratory, and/or wound). A total of 744 PPS specimens from 356 patients, across six states, were obtained from February 2019 to May 2021 for CP-CRA colonization screening including 30% (224/744) rectal, 52% (390/744) skin, 10% (73/744) respiratory, and 8% (57/744) wound sources. The specimens were plated onto both non-selective (blood agar) and selective media (MacConkey, ESBL CHROMagar, Acinetobacter CHROMagar), and RT-PCR was performed for detection of the Acinetobacter-specific carbapenemase genes blaOXA-23, blaOXA-24, and blaOXA-58.

Results
Twelve percent (90/744) of specimens, representing 17% (62/356) of patients, were positive for detection of blaOXA-23 and/or blaOXA-24 CP-CRA. The majority (96%) of CP-CRA harbored blaOXA-24. Of the 62 colonized patients, 52% (32/62) had more than one collection source and 47% (15/32) of those had more than one source positive for CP-CRA. There was no consensus regarding a single source type across positive specimens. However, rectal or skin swab collection alone would potentially miss 2% (4/163) or 8% (14/186) of positive specimens, respectively.

Conclusion
These data suggest that rectal or skin source collection alone could be sufficient for detection of CP-CRA. Overall, multiple factors should be considered to guide the source(s) for CP-CRA specimen collection, such as infection type, regional prevalence, patient factors, and/or IP gap(s) within a facility.

Disclosures
All Authors: No reported disclosures
822. Tenofovir Alafenamide (TAF) is an Independent Risk Factor for Hyperlipidemia in Persons with Human Immunodeficiency Virus (HIV) on Antiretroviral Therapy (ART)
Authors: Patel Yesha , Doshi Anjali , Levesque Anna , Lindor Shelsie , Moranville Robert , Okere Sheila , Robinson Danielle , Taylor Lauren , Lustberg Mark , Malvestutto Carlos 
Published: December 2021

Abstract

Background
ART-associated weight gain, metabolic disorders, and co-morbidities such as cardiovascular disease are challenges in long-term human immunodeficiency virus (HIV) care. We explore the effects of different ART classes on lipids at The Ohio State University Medical Center Infectious Diseases Clinic.

Methods
This was a retrospective, cohort study of adult PWH on ART for ≥ 3 months seen at our clinic from 1/1/2015 to 1/1/2017. Patients with CD4+ count &lt; 200 cells/mm3 and viral load &gt;200 copies/mL, history of malignancy, or pregnancy were excluded. Lipid values were collected over the study period. The primary outcome was change in total cholesterol (TC), high density lipoprotein (HDL) cholesterol, and non-HDL cholesterol over the study period. Multivariable regression was used to model these outcomes.

Results
Among 411 PWH who met criteria, 87.4% were male, and 43.3% had a baseline diagnosis of hyperlipidemia. 21.1% were on a protease inhibitor (PI), 45% were on a non-nucleoside reverse transcriptase inhibitor (NNRTI), and 37% were on an integrase strand transfer inhibitor (INSTI). 70.1% were on tenofovir disoproxil fumarate (TDF)/ emtricitabine (FTC), 20.7% were on abacavir (ABC)/ lamivudine (3TC), and 4.4% were on TAF/FTC. The mean population (MP) difference in TC was -1.54 ± 1.34 mg/dL (p=0.25), the MP difference in non-HDL cholesterol was -1.78 ± 1.26 mg/dL (p=0.16), and the MP difference in HDL cholesterol was 0.24 ± 0.43 mg/dL (p=0.6). In multivariable linear regression models (Table 1), TAF/FTC was associated with a change of TC of 18.2 ± 6.4 mg/dL (P= 0.005), a change of non-HDL cholesterol of 12.0 ± 6.0 mg/dL (p=0.046), and a change of HDL cholesterol of 6.2 ± 2.1 mg/dL (p=0.003). These models included terms for months of follow up, male gender and baseline hyperlipidemia. Though race, diabetes mellitus, and ethnicity were not significant in the model, after adjustments for them, PWH on TAF/FTC showed a change of TC of 18.0 ± 6.4 mg/dL (p=0.005), a change of non-HDL cholesterol of 11.8 ± 6.0 mg/dL (P=0.051), and a change of HDL of 6.2 ± 2.1 (p=0.03).
Multivariable Linear Regression Models for Change in Total Cholesterol and Non-HDL Cholesterol

Conclusion
Prior studies have shown an increase in lipid levels associated with TAF compared to TDF. This study shows that TAF is an independent risk factor for increased TC, non-HDL cholesterol, and HDL cholesterol in the PWH population as a whole.

Disclosures
Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member)
102. A Retrospective Case Series of West Nile Neuroinvasive Disease in Two Tertiary Health Centers in Miami
Authors: Cordova Leopoldo , Rehman Aliya F , Balan Shuba , Ayoade Folusakin , Paniagua Lizy , Bini Julia , Rivera Cynthia 
Published: December 2021

Abstract

Background
According to the Centers for Disease Control and Prevention, Florida was the third leading state in reported West Nile Neuroinvasive Disease (WNND) infections in 2020. WNND accounts for less than 1% of all West Nile virus (WNV) infections but carries a 10% mortality rate. The clinical characteristics of WNND have not been well described in Florida, an area with high mosquito activity. We hereby describe the clinical characteristics of WNND at two large hospitals in Miami.

Methods
A 10-year retrospective study was performed at the University of Miami Hospital and Mount Sinai Medical Center to identify adult patients with confirmed WNV infection and neuroinvasion. Patient demographics, symptoms, neurological exam findings, laboratory diagnostics, intensive care unit (ICU), and hospital length of stay (LOS), and outcomes were described.

Results
Eleven patients (73% male, mean age 64.4 ± 16.3 years) were identified between January 2010 to December 2020. The most prevalent comorbidities were HTN (64%) and DM (27%). The most common positive findings on the review of symptoms were fever (100%), confusion (81.8%), and headache (63.6%). The mean hospital LOS was 15.5 ±11.3 days, while the mean ICU LOS was 7.2 ± 11.9 days. The majority of patients (75%) spent more than 2 weeks in the ICU. Subject age was correlated with hospital LOS with a Pearson correlation of 0.624 (p=0.04). The survival rate was 91%. At the time of discharge, 80% of patients continued to have neurological symptoms.

Figure 1: The percentage of subjects with different types of WNND. The section titled others, includes atypical presentations such as amnesia, focal neurological deficits (ataxia, hemiparesis), and myelopathy.

Figure 2: Month and year of presentation at the time of hospital admission.

Figure 3: Clinical presentation (%).

Conclusion
This is the largest case series of WNND in Florida. Most cases occurred during summer 2020, which corresponds to the peak of the COVID-19 pandemic. Despite pandemic restrictions, we may have seen an increase in WNV cases due to higher-than-normal temperatures promoting mosquito abundance, increased outdoor activities due to the COVID-19 pandemic, and/or the redistribution of public health resources towards the pandemic rather than mosquito control. Residual neurological symptoms and impaired functional outcomes are common. Within the limitation of our small sample size, subject age appeared to correlate with hospital LOS. This correlation should be further explored in a larger case series. A high index of suspicion for WNND is suggested for patients presenting with fever and neurologic symptoms in Florida.

Disclosures
Cynthia Rivera, MD, Gilead Sciences (Advisor or Review Panel member)Viiv Healthcare (Advisor or Review Panel member)