bluuebunny/crossref_metadata_2025_split huggingface dataset:
1357. Patterns of Extragenital Gonorrhea and Chlamydia Testing at a Community-Based Academic Emergency Department in Columbus, Ohio
Authors: Magaña Francisco M , Sobhanie Mohammad Mahdee , Malvestutto Carlos , Bazan Jose A , Lipps Ashley 
Published: December 2021

Abstract

Background
Sexually transmitted infections (STI), including gonorrhea (GC) and chlamydia (CT), are on the rise in the U.S. and emergency department (ED) visits for STI-related complaints are common. The ED plays a key role in testing for GC/CT. In addition to testing genital sites for GC/CT, the Centers for Disease Control and Prevention (CDC) recommends extragenital testing (oral/rectal) based on sexual history and exposure. In this study, we reviewed the proportion of extragenital GC/CT tests performed at a community-based academic ED in Columbus, Ohio.

Methods
This study was a retrospective chart review of all GC/CT tests performed at the Ohio State University Hospitals East ED from November 1, 2018 to November 1, 2020. Clinical and demographic information was collected for all patients who received extragenital GC/CT testing, including symptoms, test results, and documentation of sexual practices. A random convenience sample of 100 patients who only had genital GC/CT testing performed was also reviewed.

Results
Of the 5644 GC/CT tests performed during the study period, only 364 (6.4%) were from extragenital sites, which included 311 (5.5%) from oral and 53 (&lt; 1%) from rectal sites. Of the 100 patients reviewed who did not have extragenital GC/CT testing performed, only 5 (5%) had documentation of sexual practices, compared with 177/311 (56.9%) of those who had oral testing and 27/31 (50.94%) who had rectal testing performed. In the cohort of 100 patients who did not receive extra genital testing 28% were male and average age was 29. In the group who received extragenital testing 40% were male and average age was 30. The most common complaint across all groups was genital discharge

Conclusion
Despite the substantial number of CG/CT tests performed in the ED, only a very small proportion were from extragenital sites. Interventions are needed to identify and overcome barriers to extragenital GC/CT testing in the ED.

Disclosures
Mohammad Mahdee Sobhanie, M.D., Regeneron (Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator, Was a sub-investigator for Regeneron 2066 and 2069) Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member)
1359. Reported Neurologic, Ocular, and Otic Manifestations among Syphilis Cases — 16 States, 2019
Authors: Jackson David A , McDonald Robert , Weinstock Hillard , Torrone Elizabeth 
Published: December 2021

Abstract

Background
Syphilis can cause neurologic, ocular, or otic manifestations at any stage, possibly resulting in permanent disability or even death. In 2018, CDC began collecting clinical manifestation data for syphilis cases reported through the National Notifiable Diseases Surveillance System (NNDSS). We present the first estimates of the prevalence of neurologic, ocular, and otic manifestations among syphilis cases in the United States.

Methods
We reviewed NNDSS data to identify jurisdictions (states + DC) who reported ≥ 70% of their syphilis cases with clinical manifestation data (considered to have “complete reporting”) in 2019. Among these jurisdictions, we determined the prevalence of neurologic, ocular, and otic manifestations (combining verified, likely, and possible clinical manifestations together), stratified by HIV status and by syphilis stage (Unknown/late syphilis vs. Early syphilis [Primary, Secondary, and Early non primary non secondary syphilis]).

Results
In 2019, 16 states had complete reporting for neurologic, otic, and ocular manifestations. Of the 41,216 syphilis cases reported in these jurisdictions, clinical manifestations were infrequently reported: neurologic (n=445, 1.1%), ocular (n=461, 1.1%), and otic (n=166, 0.4%). Prevalence was higher among HIV-infected persons compared to HIV-negative persons for neurologic (1.4% vs. 0.9%) and ocular manifestations (1.3% vs 1.0%) but was similar for otic manifestations (0.4% vs 0.4%). Prevalence was higher among persons diagnosed with Unknown/late syphilis compared to Early syphilis for neurologic (1.6% vs 0.8%) and ocular manifestations (1.6% vs 0.9%) but similar for otic manifestations (0.5% vs 0.4%); however, 49.4% of cases reported with ≥ 1 of these clinical manifestations were diagnosed with Early syphilis.

Conclusion
The prevalence of neurologic, ocular, and otic manifestations was low among syphilis cases, but case data likely underestimate the true burden given potential underreporting. The frequency of clinical manifestations, including among HIV-negative persons and persons diagnosed with Early syphilis, emphasizes the importance of evaluating all syphilis cases for clinical signs or symptoms regardless of stage or HIV status.

Disclosures
All Authors: No reported disclosures
1360. Prevalence of Bacteremia in Hospitalized Patients with Skin and Soft Tissue Infections (SSTI)
Authors: Suarez Maria J , Lin Yu Shia 
Published: December 2021

Abstract

Background
Skin and soft tissue infections (SSTI) are common in outpatient and inpatient settings. The prevalence of positive blood cultures (BC) ranges from 2% to 52%. Because of the variations in published data, the exact prevalence of bacteremia in hospitalized patients with SSTI is unknown. Our objective is to determine the prevalence of bacteremia in hospitalized patients with SSTI.

Methods
Retrospective chart review from January 2017 to December 2018. Patients older than 18 years admitted with SSTI who required BC on admission were included. Patients who met the criteria for systemic inflammatory response syndrome (SIRS)/sepsis or severe SSTI, or had an underlying immunodeficiency underwent BC collection. Patients with diabetic foot ulcer, device related SSTI, necrotizing fasciitis, and osteomyelitis were excluded. Patients were divided into 3 groups: true positive (TP) defined as a true pathogen, false positive (FP) defined as a contaminant, and true negative (TN) defined as no growth in BC. Physician assessment, microorganisms isolated, number of positive bottles/culture sets, and timing of growth were reviewed. Patients’ comorbidities, presence of SIRS, laboratory data, duration of antibiotic use, and length of stay (LOS) were compared.

Results
We screened 583 patients and included 541 patients. The mean age was 62 ± 18.4 years, and 60% were male. 47/ 541 (8.6%) had skin abscesses. 57 patients (11%) had positive BC, of whom 32 were TP (6%), and 25 were FP (5%). 89% of patients (484) had TN BC. The organisms isolated are described in Figures 1 and 2. Patients in the FP and TN groups had prior antibiotic use, compared to TP (P&lt; 0.05). The FP group had a longer LOS and duration of antibiotic use compared to the TN group (p&lt; 0.05). 76% of FP had repeated BC. Beta-lactam antibiotics were mostly used, followed by anti-MRSA antibiotics (40%). We did not find risk factors to predict the likelihood of bacteremia. The outcome was not different among the 3 groups.
Figure 1. Microorganisms isolated from blood cultures of patients with SSTI – True pathogens

Figure 2. Microorganisms isolated from blood cultures of patients with SSTI – Isolated contaminants

Conclusion
There was a low incidence of true bacteremia (6%) in hospitalized patients with SSTI. More than 90% of TP were predictable causal microorganisms, which are covered by empiric antibiotics. BC may not affect the initial treatment of SSTI. FP BC were associated with an increased LOS, longer antibiotic use, and increased healthcare cost.

Disclosures
All Authors: No reported disclosures
1362. Adding Insult to Injury: Association of Stigmatizing Language and Suboptimal Outcomes in People Who Inject Drugs
Authors: Carpenter Joseph , Catalanotti Jillian S , Notis Melissa , Brokus Christopher J , Moran Timothy P , Kuo Irene , Akselrod Hana , McGonigle Keanan , Mai William , Eaton Ellen , Eaton Ellen , Burgan Kaylee W , Burkholder Greer A , Steck Alaina , Kattakuzhy Sarah , Rosenthal Elana S 
Published: December 2021

Abstract

Background
The National Academy of Medicine has identified stigma surrounding substance use disorders (SUDs) and infectious diseases (ID) as a key barrier to integration of opioid use disorder (OUD) and ID services. Prior literature on stigmatizing language in OUD clinical care focuses on surveys and theoretical scenarios rather than real-world data. As part of a larger study of patients admitted for infectious complications of injection drug use (CHOICE), we sought to determine how inpatient physicians describe persons with OUD, as well as associations of this language with outcomes along the OUD continuum of care.

Methods
CHOICE is a retrospective review of adults hospitalized with an infectious complication of OUD and IDU at four academic medical centers. Included patients were hospitalized between 1/1/2018-12/31/2018, had ICD9/10 diagnosis codes consistent with OUD and acute bacterial/fungal infection, and chart review verification of active infection associated with OUD. Data was abstracted regarding demographics, inpatient interventions, transitions of care, and outcomes 1 year after admission. Potentially stigmatizing language was identified based on the discharge summary. “Abuse” and “misuse” were considered potentially stigmatizing; “use disorder” was considered best practice. Associations of language and outcomes were analyzed via logistic generalized estimating equations.

Results
A total of 287 subjects met inclusion criteria; 119 (42%) were female and the median age was 40 years (IQR: 32 – 52). The most common terms used to describe OUD were “abuse” (190, 66%) and “IVDU” (119, 42%). “Use disorder” was noted in only 72 (25%) charts. In a regression analysis, any mention of “use disorder” was associated with not leaving against medical advice (OR 2.48, 95% CI 1.24 – 4.95), a plan for ongoing OUD treatment (OR 5.17, 95% CI 2.05-13.0), and addiction-specific follow up (OR 2.94, 95% CI 2.34-3.68).

Conclusion
In this multicenter retrospective study, inpatient physicians commonly referred to patients with OUD using stigmatizing language. When NIH-preferred language was used this was associated with improved outcomes along the OUD continuum of care, possibly reflecting increased awareness of best practices for treating patients with OUD.

Disclosures
Ellen Eaton, MD , Gilead (Grant/Research Support) Ellen Eaton, MD , Gilead (Individual(s) Involved: Self): Research Grant or Support Greer A. Burkholder, MD, MSPH, Eli Lilly (Grant/Research Support) Sarah Kattakuzhy, MD, Gilead Sciences (Scientific Research Study Investigator, Research Grant or Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support)
1363. Most Psoas Abscesses are Pyogenic; not Tuberculous: Experience from South India
Authors: Muhammed Niyas Vettakkara Kandy , Ananthanarayanan Rajalakshmi , Jomes Jeffery , Devi Arun Aravindakshan Sasikala , Sasidharan Aswathy 
Published: December 2021

Abstract

Background
It is a common belief that psoas abscess in patients from developing countries like India are mostly tubercular in origin. However, most of the diagnosis of a tubercular psoas abscess are based on radiological features and are not confirmed microbiologically. It is possible that many cases of pyogenic psoas abscesses are misdiagnosed as tubercular due to lack of good quality microbiology lab facilities in developing nations. We studied the microbiology of psoas abscess in patients admitted to KIMSHealth, a tertiary care hospital in Kerala, South India.

Methods
Clinical details of patients with a diagnosis of psoas abscess over a 6-year period (2015 – 2020) were retrieved from electronic medical records. Microbiological investigations done included bacterial culture of the pus, fungal culture, mycobacterial culture, cartridge based nucleic acid amplification test for Mycobacterium tuberculosis and blood cultures.

Results
21 patients who had complete clinical details were included. 15 of them were males and the median age was 58 years. Diabetes mellitus was the most common comorbidity (52%). Fever (61.9%) and back pain (52.4%) were the most common symptoms. The abscess was left sided in 11 patients, right sided in 7 and bilateral in 3. Vertebral involvement was present in 9 patients while hip joint was involved in 3 patients. A microbiological diagnosis was made in 14 patients (66%). Most commonly isolated organism was Staphylococcus aureus (8 patients,MSSA:6, MRSA:2) followed by E.coli (3)and Klebsiella pneumoniae (2). Blood cultures were positive in 5 patients. Anti-tuberculous therapy was started in only one patient, which was based on characteristic histopathology and negative bacterial cultures. Rest of the culture negative cases were also treated as pyogenic abscesses with antibiotics. Surgical drainage was done for 7 patients and pig tail drainage for 3 patients, while percutaneous aspiration was done for 9 patients. All 19 patients who followed up had clinical resolution, while two were lost to follow-up.

Conclusion
Contrary to what is believed, we observed that most psoas abscesses are pyogenic in origin. Our observations reiterates diligent microbiological investigations in all cases of psoas abscess to avoid empiric anti-tuberculous therapy.

Disclosures
All Authors: No reported disclosures
1366. Deep Neck Infections: Bacteriology and Antimicrobial Susceptibilities, Akron Children’s Experience
Authors: Upadhyayula Shankar , habeck Caleb 
Published: December 2021

Abstract

Background
Deep neck infections (DNI’s) are uncommon (~45,000 US cases annually) but, potentially serious. Published data regarding bacteriology and antibiotic usage for DNI’s in children is limited. In addition, geographic variation in the incidence of pathogens and their antimicrobial susceptibility limits generalization of treatment guidance. Reviewing our practice at Akron childrens we noted considerable variation in the choice of empiric antibiotics (ampicillin-sulbactam vs piperacillin-tazobactam vs Ceftriaxone and Clindamycin/vancomycin/linezolid). Admission unit (floors vs intensive care) and service (hospitalist vs infectious diseases) were some important determinants that influenced choice of empiric antibiotics. This retrospective study aimed to review local data and come up with standard guidance for empiric therapy.
Summary of the predominant bacterial isolates.

Methods
We reviewed records of 125 patients who underwent surgical drainage of DNI’s from 1/2015 – 12/2019. In addition to demographic data we gathered information on bacterial isolates and their susceptibilities. Chart review was performed for patients with staphylococcus aureus, to look for any unique presenting features.

Results
Up on reviewing the data- peritonsillar abscesses were common in older children (Median age 11 years). As expected, retropharyngeal and parapharyngeal infections were common in younger ones (&lt; 5 years). Group A streptococcus remained the most common aerobic isolate followed by Hemophilus influenzae/parainfluenzae. MRSA was detected in ~7 % of all cultures (see enclosed table). Notably, none of the MRSA isolates were clindamycin resistant. However, MSSA resistance to clindamycin was about 20%. No clinical characters predicted isolation of S. aureus. Anaerobic infections (polymicrobial) were overwhelmingly common across all abscess types.

Conclusion
Based on our review, Ampicillin-Sulbactam is a good empiric choice antibiotic for deep neck infections in our institution. Ceftriaxone with clindamycin is another option. Clindamycin monotherapy seems to be inadequate. Staph aureus and especially MRSA, were only isolated in a small percentage of cases. Unless a patient is ill appearing, vancomycin use seems unnecessary. Clinical presentation was not helpful to suspect infection with Staph aureus.

Disclosures
All Authors: No reported disclosures
156. Correlation Between WHO (World Health Organization) Case Definition of Severe Pneumonia and Lung POCUS (Point of Care Ultrasound) vs Chest X-ray (CXR) Findings to Diagnose Pediatric Community-Acquired Pneumonia (CAP) in Limited Resource Settings
Authors: Camelo Ingrid Y , Pieciak Rachel , castro-aragon Ilse , Setty Bindu , Etter Lauren , Gill Christopher 
Published: December 2021

Abstract

Background
Childhood pneumonia is one of the leading causes of death in low-income countries. The diagnosis of pediatric pneumonia is a critical epidemiological duty for treatment effectiveness and vaccine surveillance. Previous studies have demonstrated an important lack in correlation between CXR findings and the clinical WHO case definition of severe pneumonia. Lung Point of Care Ultrasound (POCUS) has demonstrated in multiple studies to be more sensitive and specific for diagnosing pneumonia in the pediatric population. With no exposure to radiation, extensive availability in limited-resource settings, and easy interpretation, this modality can be a breakpoint in making a more accurate correlation between pneumonia clinical findings and diagnostic imaging.

Methods
50 children from 1-59 months meeting the WHO case definition of severe pneumonia were enrolled at the Emergency Department at University Teaching Hospital (UTH) in Lusaka, Zambia. Children underwent lung POCUS and CXR. Correlation between symptoms and all abnormalities (consolidation, effusion, and interstitial patterns) seen in both imaging modalities were analyzed by calculating the proportion of children with abnormalities on CXR and ultrasound. Each participant was assigned a score based on findings. 0 = normal, 1 = consolidation only, 2 = Consolidation and non-consolidation (interstitial and/or effusion) and 3 = non-consolidation (interstitial and/or effusion) only.

Results
44 (90%) of children had abnormalities on CXR and 46 (94%) on POCUS. Five children (10%) had normal findings on CXR vs 3 (6%) on Lung POCUS. 4 (8%) had consolidation only on CXR vs 0 (0%) on POCUS. 19 (39%) had consolidation and non-consolidation (interstitial and/or effusion) on CXR vs. 20 (41%) on POCUS. 21 (43%) had non-consolidation (interstitial and/or effusion) only on CXR vs. 26 (53%) on POCUS.

Figure 1. Scores Asigned Based on Imaging Findings for CXR and Lung POCUS

Figure 2. Chest X Ray Anterior Posterior (AP) view showing Bilareral Interstitial Pattern

Figure 3. Lung POCUS (Point of Care Ultrasound) findings of bilateral Consolidation and non-consolidation pattern and bilateral interstitial pattern (only finding on CXR)

Conclusion
More children with clinical pneumonia had normal findings on CXR than on POCUS. POCUS was a better imaging technique to show consolidation and non-consolidation patterns than CXR. The higher proportion of children diagnosed with consolidation and non-consolidation patterns on POCUS suggest that CXR might not be the ideal gold standard to diagnose pneumonia in children.

Disclosures
All Authors: No reported disclosures
1368. Species Diversity and Co-Occurrence Patterning in Bone and Soft Tissue Infections
Authors: Mindru Cezarina , Rodriguez-Barradas Maria , Bidare Deeksha , Dudenhoeffer Jan-Hendrik , Crawford Kerri , Barshes Neal R 
Published: December 2021

Abstract

Background
Polymicrobial results from conventional cultures in bone and soft tissue infections have generally been reported as independent co-occurrences (i.e. assuming no relationship or interaction between species). The objective of this study was to identify non-random (dependent) co-occurrence in bone and soft tissue infections.

Methods
We used single center Theradoc (Premiere Inc., Charlotte, NC) data on microbiology specimens collected over a decade (4/2010 to 4/2020). We included only tissue, fluid and swab specimens identified as being obtained from bone, skin, soft tissue or a wound during a patient’s first episode of infection. Blood and liver biopsy specimens were excluded. Patterning involving &gt;2 organisms was examined with factor analysis. Analyses were done with R version 3.6.1. Threshold p-values were adjusted for multiple comparisons, often to p&lt; 0.001.

Results
Polymicrobial culture results were seen much more frequently in the foot (76%) and sacrum (78%) than specimens from other locations (43%). The highest Shannon diversity index was seen in sacral specimens, followed by foot and leg specimens. Pseudomonas aeruginosa and E. coli was found more frequently in sacral bone and soft tissue specimens, while S. aureus was found most often in the spine bone and foot bone and soft tissue. Corynebacterium was found more frequently in foot bone (23%) and foot soft tissue (18%) than in non-foot soft tissue specimens (11%). Analysis of pairwise species co-occurrences in foot specimens (n=765) demonstrated that S. aureus made significantly less frequent the presence of Bacteroides, Enterobacter, and other staphylococcal species (Table 1). Analysis of non-foot soft tissue specimens (n=2,647) confirmed this pairwise associations and suggested three patterns (Table 2): A, polymicrobial without S. aureus; B, Enterococcus + gram negatives; and C, streptococcal.
Table 1. Pairwise co-occurrences between species in bone and soft tissue specimens from foot infections (n=765).

Factor analysis results demonstrating species associated with three polymicrobial patterns in soft tissue infection specimens. Blue denotes positive association (more often occurring as part of the pattern), red or grey denotes negative associations (less often occurring as part of the pattern). Numbers denote factor weights, a measure of the strength of the association.

Conclusion
Species incidence and diversity vary by location and tissue type. The many non-random occurrences found suggest complex interrelationships between microbes in soft tissue and bone infections, including organisms often classified as non-pathogens. Further study may further characterize these relationships and aid in antibiotic selection.

Disclosures
All Authors: No reported disclosures