bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Trends in the Distribution of Candida species Causing Candidemia at a Community Hospital in 2005 and 2014
Authors: Ishiekwene Celestine , Kasangana Maxine Seales , Ghitan Monica , Kuhn-Basti Margaret , Chapnick Edward , Lin Yu Shia 
Published: October 2017

Abstract

Background
Candida remains the most common cause of invasive fungal infections, with an attributable morality of 15–35%. Although five Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. glabrata, and C. krusei) account for 92% of cases of candidemia, Candida albicans remains the most common cause of candidemia. However, recent studies report that the frequency of non albicans species are increasing globally and the distribution of Candida spp. varies significantly among different geographic regions and hospitals units.

Objective
We determine the distribution of Candida species causing candidemia at an adult level 1 Trauma Center in Brooklyn, New York and compared the trends of Candida species between 2005 and 2014. The results were compared with trends of US data collected in 2004 and 2012. Knowledge of the frequency of causative species would facilitate appropriate selection of empiric antifungal therapy.

Methods
We performed a retrospective chart review of patients with candidemia who were admitted in 2005 and 2014. We determined the frequency of Candida species and compared 2005 data with those in 2014.

Results
In total, 226 and 109 patients with candidemia were admitted to our hospital in 2005 and 2014, respectively. Although, C. albicans was the most common species (43% of candidemia in 2005), its frequency decreased to 33% in 2014. The frequencies of C. glabrata and C. parapsilosis increased in 2014 compared with those in 2005 (24% vs. 16% and 33% vs. 26%, respectively). Figure 1 compared the proportion of Candida species in Maimonides Medical Center to National data.

Conclusion
Our finding of an increase in non-albicans spp. causing candidemia is consistent with published reports. We saw more cases of C. parapsilosis compared with published data. Our results may be used to inform empiric antifungal therapy.

Disclosures
All authors: No reported disclosures.
Candidemia with Ocular Manifestrations: A Review of 26 Cases in a University Hospital in Japan
Authors: Takata Tohru , Yoshimura Yoshinobu , Obata Yumiko , Togawa Atsushi , Takamatsu Yasushi 
Published: October 2017

Abstract

Background
Ocular candidiasis is a major complication of candidemia; however, many remains unknown for the incidence, risk factors, and outcome of eye involvement.

Methods
We retrospectively reviewed the medical records and obtained information related to fungal infection and its management, and visual outcome at Fukuoka University Hospital from 2000 to 2016.

Results
Of 143 patients with candidemia for whom an ophthalmology consult was requested, 26 had findings consistent with the diagnosis of ocular candidiasis. Patients with ocular candidiasis were mostly infected with Candida albicans (n = 20), followed by C. glabrata (n = 4), and C. tropicalis (n = 2). In contrast, only one patient infected with C. parapsilosis had ocular involvement although the number of the patients with C. parapsilosis candidemia was second the most among candidemia. No difference was seen for the β-d-glucan in patients with or without ocular candidiasis (128.6 vs. 106.1, P = 0.654). All of the isolates other than C. glabrata were susceptible to fluconazole. In all of 23 patients with existing central venous cathers, CVCs were removed after the diagnosis of candidemia. Four-week mortality rate in patients with ocular candidiasis was 16.7% (three of 18 patients) which was not significantly different from that in patients without ocular manifestations. All treated patients were confirmed for clearance of candidemia, received systemic antifungals, and improved for visual outcome or remained stable, and no patients complicated visual loss without surgical treatment. Therapy with micafungin or caspofungin followed by fluconazole (12 patients) was successful in all patients.

Conclusion
Ocular involvement occurred in 18% of patients with candidemia, and treatment with echinocandins followed by fluconazole was successful in most cases with follow-up.

Disclosures
T. Takata, Taisho Toyama Pharma: Speaker’s Bureau, Speaker honorarium
Epidemiology and Outcomes of Hospitalizations with Invasive Aspergillosis in the United States, 2010–2013
Authors: Zilberberg Marya D , Nathanson Brian , Harrington Rachel , Spalding James , Shorr Andrew F 
Published: October 2017

Abstract

Background
Invasive aspergillosis (IA) complicates the care of up to 13% of patients with varying forms of immune compromise. The accompanying morbidity and mortality associated with IA remains high. We sought to describe the epidemiology and outcomes for all hospitalizations associated with IA in the United States.

Methods
We analyzed the National Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality (AHRQ) for 2010–2013. We identified subjects with high-risk conditions for IA (stem cell or solid organ transplant, critical illness, major surgery, mild-to-moderate immune compromise, severe immune compromise, and other [human immunodeficiency virus, pneumonia, chronic obstructive pulmonary disease]). IA was identified via ICD-9-CM codes 117.3, 117.9, and 484.6. We compared characteristics and outcomes between those with (IA) and without IA (non-IA). We calculated the IA-associated excess mortality, length of stay (LOS) and costs using propensity-score (PS) matching.

Results
Of the 66,634,683 discharges who met the study inclusion criteria, 154,888 (0.2%) had a diagnosis of IA. Patients with IA were more likely to be male (50.9% IA vs. 46.7% non-IA, P &lt; 0.001), and African American (15.3% IA vs. 12.5% non-IA, P &lt; 0.001). The most common high-risk condition among those not classified as IA was major surgery (50.1%). In the IA group critical illness was noted most frequently (41.0%). The burden of both chronic (median [interquartile range, IQR] number of Elixhauser comorbidities 3 [1, 5] non-IA vs. 4 [3, 6] IA, P &lt; 0.001) and acute (median [IQR] number of procedures during the hospitalization 2 [1, 3] non-IA vs. 3 [1, 6] IA, P &lt; 0.001) illnesses was higher in the IA group than the non-IA. After PS-matching, mortality in IA (14.1%) was 37% higher than in non-IA (10.3%, P &lt; 0.001), translating to an odds ratio = 1.43; 95% CI (1.36, 1.51). IA was associated with 6.0 (95% CI 5.7, 6.4) excess days in the hospital and excess $15,542 (95% CI $13,869, $17,215) in costs/hospitalization.

Conclusion
Although rare even among high-risk groups, IA is associated with high hospital mortality, excess duration of hospitalization, and costs. Given nearly 40,000 annual IA admissions in the United States, we estimate that the aggregate IA-attributable excess costs may reach $600 million annually.

Disclosures
M. D. Zilberberg, Astellas: Grant Investigator, Research support. B. Nathanson, EviMed, LLC: Consultant, Consulting fee. R. Harrington, Astellas Pharma Global Development, Inc.: Employee, Salary. J. Spalding, Astellas Pharma Global Development, Inc.: Employee, Salary. A. F. Shorr, Astellas: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. Cidara: Consultant, Consulting fee. Merck: Consultant, Scientific Advisor and Speaker’s Bureau, Research support and Speaker honorarium
Validation of an Empiric Candidemia Treatment Algorithm
Authors: Stack Conor M , Olafsdottir Lovisa B , Mahoney Monica V , McCoy Christopher , Gold Howard S , Lasalvia Mary , Yassa David S , Wright Sharon B , Snyder Graham M 
Published: October 2017

Abstract

Background
Judicious use of echinocandins may limit the development of resistance in Candida species. Guidelines endorse the use of echinocandins as initial therapy in candidemia, with fluconazole as an alternate choice in select patients. We compared the ability of providers to predict the need for echinocandin therapy in Candida bloodstream infections to that of a proposed institutional treatment algorithm designed to optimize empiric antifungal use.

Methods
In this retrospective study (10/2015–10/2016), patients were included with Candida isolated in ≥1 blood culture, without candidemia in the prior 14 days. Empiric treatment (the first antifungal prescribed for ≥24 hours after index blood culture draw) was considered “overly broad” if an echinocandin was administered to a fluconazole-susceptible isolate and “inappropriate” if fluconazole was administered to a fluconazole-non-susceptible isolate. An institutional algorithm was created recommending empiric echinocandin use based on the presence of ≥1 risk factors (Table 1). Provider choice and the recommended agent according to the algorithm were compared with the final fluconazole susceptibility of the organism.

Results
Among 65 episodes of candidemia, the majority of isolates were C. glabrata (Figure 1). Ninety-one percent of patients received non-azole therapy, primarily micafungin. Fluconazole was recommended by the algorithm in 25% of cases but initially prescribed in only 9% (Figure 2). Providers prescribed both overly broad and inappropriate treatment at a higher rate than algorithm recommendations (Figure 3).

Conclusion
An algorithm using risk factors for fluconazole-non-susceptible Candida was able to predict appropriate empiric antifungal therapy better than provider decision making in cases of candidemia. Implementation of this algorithm into local treatment guidelines may improve empiric antifungal prescribing.

Disclosures
All authors: No reported disclosures.
Low Rate of Microbiologic Relapse in Two-Stage Exchange for Hip Prosthetic Joint Infections
Authors: Henry Michael , Russell Celeste , Nocon Allina , Westrich Geoffrey , Brause Barry , Miller Andy 
Published: October 2017

Abstract

Background
Prosthetic joint infection (PJI) is a grave complication of total hip arthroplasty (THA). Historically, two-stage arthroplasty exchange has been considered to be the definitive approach to eradicating infection and preserving joint function. However, patients are increasingly presenting with higher rates of comorbidities traditionally associated with poorer orthopedic surgical outcome, including advanced age, obesity and diabetes. We investigated whether two-stage exchange remains effective for THR PJI at an orthopedic specialty hospital, and what were the microbiologic etiologies in repeat infections.

Methods
A retrospective cohort of THA PJI treated with two-stage exchange was identified by query of hospital coding records from 2009 to 2014. The primary endpoint was defined as 2-year implant retention without further surgery. Failure was defined as a recurrence within in 2 years. Microbiologic failure was defined as a recurrence of the previously treated organism. Descriptive statistics were completed using the Fisher’s exact test for categorical variables and the Mann–Whitney U-test for continuous variables.

Results
One hundred and forty-four patients meeting Musculoskeletal Infection Society International Consensus criteria for THA PJI were identified. The average age was 65 years and 60% were female. One hundred and twenty-seven (88.2%) were cured at 2 years. Pathogens included Staphylococcus aureus (MSSA, 23%; MRSA, 13%), coagulase-negative staphylococci (17%), and streptococci (17%). In univariate analysis, no links were noted between primary outcome and patient age, comorbidities (including diabetes and tobacco), BMI, microbiology, or symptom duration. Of the 17 patients who did not meet criteria for success, 11 (65%) were diagnosed with new, microbiologically distinct infection. The remaining six met our criteria for microbiologic failure; four of the six patients had S. aureus infection (three MSSA).

Conclusion
We present 2-year outcomes on a large cohort of THA PJI treated with two-stage exchange arthroplasty. Nearly, two-thirds of the patients who failed were found to have a new infection at the time of relapse. Only 4% of the patients in our cohort failed to achieve cure of the primary infection. Two-stage exchange continues to be an effective approach to PJI treatment with a low rate of microbiologic failure.

Disclosures
All authors: No reported disclosures.
Clinical Characteristics and Outcomes of Healthcare-Associated Hematogenous Vertebral Osteomyelitis
Authors: Park Ki-Ho , Lee Yu-Mi , Moon Song Mi , Park Seong Yeon , Cho Oh-Hyun , Lee Mi Suk , Bae In-Gyu 
Published: October 2017

Abstract

Background
The incidence of hematogenous vertebral osteomyelitis (HVO) has increased over recent years, likely due to longer life expectancies, higher prevalence of chronic disease, and more effective diagnostic techniques. Recently, healthcare-associated infections, such as catheter-related and procedure-related bloodstream infections, also increase the risk of HVO. The aim of our study was to evaluate the clinical characteristics and outcomes of healthcare-associated HVO (HCA-HVO).

Methods
We conducted a retrospective chart review of adult patients with microbiologically diagnosed HVO from five tertiary-care hospitals over 8-year period. HCA-HVO was defined as onset of symptoms after 1 month of hospitalization or within 6 months after hospital discharge, or ambulatory manipulations in the 6 months before the diagnosis [Pigrau et al. Medicine (Baltimore) 2015; 94:e365]. We compared the clinical characteristics and outcomes of HCA-HVO with community-acquired HVO (CA-HVO) cases.

Results
In total, 358 patients with microbiologically diagnosed HVO were included in final analysis. Of these 358 cases, 256 (63.1%) were CA-HVO and 132 (36.9%) were HCA-HVO according to the predefined criteria. The main causative pathogens identified were methicillin-susceptible Staphylococcus aureus (32%), followed by methicillin-resistant S. aureus (MRSA) (26%), aerobic gram-negative bacteria (24%), and Streptococcus species (11%). Compared with CA-HVO cases, patients with HCA-HVO had more neoplasm (13.6% vs. 5.8%, P = 0.01) and end-stage renal disease (8.3% vs. 2.2%, P = 0.007). MRSA was more frequent pathogens in HCA-HVO cases than in CA-HVO (37.1% vs. 17.7%, P = 0.01). Patients with HCA-HVO were more likely to be have the higher rates of persistent bacteremia for ≥7 days (24.2% vs. 15.5%, P = 0.04), 1-year mortality (18.2% vs. 11.5%, P = 0.08) and 1-year relapse (12.1% vs. 6.2%, P = 0.051).

Conclusion
In this study, more than one-third of HVO is health care associated. Patients with HCA-HVO were more likely to have underlying illness, and their causative pathogens were more frequently MRSA. Outcomes of HCA-HVO were poorer, which require prevention measures and early diagnosis.

Disclosures
All authors: No reported disclosures.
Utility of Diagnostic Bone Biopsies in the Management of Osteomyelitis Through Retrospective Analysis: How Golden Is This Gold Standard?
Authors: Hirschfeld Cole , Kapadia Shashi , Bryan Joanna , Jannat-Khah Deanna , May Benjamin , Friedman Tamir , Vielemeyer Ole , Esquivel Ernie 
Published: October 2017

Abstract

Background
Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to identify predictors of a positive bone culture.

Methods
We retrospectively reviewed all cases of non-vertebral OM in patients who underwent image-guided bone biopsies between 2009 and 2016. Data on pathologic and microbiologic yield were collected and logistic regression was used to determine potential factors affecting the microbiologic yield. Post-biopsy empiric antibiotics and final antibiotics were compared with determine if there was a change in antibiotic treatment after biopsy results were reported.

Results
We evaluated 203 bone biopsies in 185 patients. Samples from 115 (57%) cases were sent to pathology, of which 33 (29%) confirmed OM. All samples were sent to microbiology and 57 (28%) yielded a positive result. Diabetes (OR=2.39, P = 0.021) and white blood cell count (OR=1.13, P = 0.006) were significantly associated with positive bone cultures in multivariate analyses. There was no association between positive cultures and number of samples cultured, needle size, prior antibiotic use, or antibiotic-free days. Post-biopsy empiric antibiotics were given in 138 (68%) cases. Therapy was narrowed to target specific organisms in seven cases and changed due to inadequate empiric treatment in three cases. Targeted therapy was initiated in 4/65 cases, in which empiric antibiotics had been initially withheld. While final antibiotics were withheld in 38/146 with negative bone cultures, empiric antibiotics were discontinued in only eight cases.

Conclusion
In patients with non-vertebral OM, bone biopsy cultures rarely yielded results that necessitated changes in antibiotic management. Identified bone organisms were treated by empiric therapy in most patients. While bone biopsy remains the gold standard diagnostic test for OM, further work is needed to identify patients whose management may be impacted by this procedure.

Disclosures
All authors: No reported disclosures.
Comparative Analysis of Initial Antibiotic Dosing Among Healthy Weight, Overweight, and Obese Children with Osteomyelitis
Authors: Waddell Joel , Mcculloh Russell , Goldman Jennifer , Lee Brian , Teachout Warren 
Published: October 2017

Abstract

Background
Acute hematogenous osteomyelitis (AHO) is a common infection of childhood. Inadequately treated AHO can lead to significant morbidity. Small studies have demonstrated alterations in the pharmacokinetics of antibiotics among obese children. Consequently, there is no consensus regarding appropriate dosing of antibiotics among overweight and obese children with AHO.

Methods
This is a single center, retrospective, cohort study of children 2–17 years of age with a discharge diagnosis of acute osteomyelitis admitted between 1/1/2012 and 12/31/2015. Complicated osteomyelitis cases were excluded. Variability of the initial mg/kg antibiotic dose was determined and compared between healthy weight, overweight, and obese children.

Results
142 children were included in the cohort. In total, 83 (58%) were classified as healthy weight, 25 (18%) overweight, and 34 (24%) obese. No difference was found in the variability of mg/kg dosing of vancomycin or clindamycin across the three weight groups. Cefazolin dosing in healthy weight children (median 33.3mg/kg [IQR 32.9–36.7mg/kg]) was significantly higher as compared with obese children (24.4mg/kg &#x2028;[20.0–33.3mg/kg]) (P = 0.041). Cephalexin dosing in healthy weight children (33.0mg/kg &#x2028;[30.6–34.5mg/kg]) was also significantly higher than in obese children (23.0mg/kg [20.0–29.9mg/kg])(P = 0.013).

Conclusion
There was significant variability and lower overall dosing of first-generation cephalosporins among obese children compared with healthy weight children. Given the increasing incidence of invasive methicillin-susceptible Staphylococcus aureus infections, this study highlights the need for practitioners to optimize first-generation cephalosporin dosing in obese children suffering from AHO. These data also call for future studies to determine the clinical outcomes in obese children with AHO in relation to dosing adequacy.

Disclosures
All authors: No reported disclosures.
Factors Associated with Success in Revision Surgery for Infected Hip and Knee Arthroplasties
Authors: Kandel Christopher , Backstein David , Sajja Abhilash , McGeer Allison 
Published: October 2017

Abstract

Background
Patients with prosthetic joint infections (PJIs) often fail treatment. We aimed to describe the characteristics and outcomes of PJIs managed at a tertiary institution in Canada.

Methods
We assembled a cohort of patients undergoing surgical revision for hip or knee PJIs from January 1, 2010 until December 31, 2014 at our referral hospital by searching procedure descriptions from operative listings. Patient characteristics were abstracted by chart review. Treatment failure (TF) was defined by PJI recurrence requiring surgery, receipt of suppressive antimicrobials, amputation, excision or death.

Results
243 individuals with a PJI undergoing a revision surgery were included. Median age was 69 years, 111 (46%) were males, 118 (49%) involved hips, 125 (51%) were knees, incision and drainage was performed in 53 (22%), a two-stage procedure was undertaken in 168 (69%), and a one-stage procedure in 18 (7%). Most PJIs were monomicrobial (50%); with coagulase negative staphylococci (35%) and Staphylococcus aureus (18%) the most common. TF occurred in 85/171 (47%): 53 (62%) required revision surgery, 23 (27%) chronic suppressive antimicrobials, 5 (6%) amputation, and 4 (5%) died (Table 1). On univariate analysis incision and drainage was associated with failure (OR 2.8, 95% CI 1.3–5.8, P = 0.002) while a two-stage procedure (OR 0.4, 95% CI 0.2–0.8, P = 0.009) and chronic symptoms (OR 0.4, 95% CI 0.2–0.8, P = 0.008) were protective. No risk factors for TF were identified on multivariable analysis.

Conclusion
PJIs are challenging to eradicate. New treatment paradigms are needed.

Disclosures
A. McGeer, Hoffman La Roche: Investigator, Research grant. GSK: Investigator, Research grant. Sanofi pasteur: Investigator, Research grant
Variability in Management of Acute Osteoarticular Infections at a Children’s Hospital and Favorable Outcomes with Increasing Early Transition to Oral Therapy
Authors: Biary Nora , Wrotniak Brian , Islam Shamim 
Published: October 2017

Abstract

Background
To date, there is no established guideline for the treatment of acute pediatric osteoarticular infections (OAI), and considerable variability in management exists amongst providers and across institutions. This study analyzed the recent management and clinical outcomes of OAI at a children’s hospital.

Methods
Patients admitted with acute osteomyelitis and septic arthritis [OAI] aged 2 months to 18 years at the Women & Children’s Hospital of Buffalo, between 1/1/2013 and 12/31/2016, were identified via billing databases. Patients with select comorbidities or &gt;2 positive blood cultures were excluded. Patient demographics, antibiotics used, culture results, time from intravenous (IV) to oral (PO) therapy, length of hospitalization (LOH), PICC (peripherally inserted central catheter) line use, and emergency room (ER) visits and readmissions within 6 months of discharge, were collected and analyzed. The study period was divided into 2-year groups, before and after 1/1/15, a juncture when a new provider began to promote early transition to oral therapy (through ID consults and informal discussion).

Results
Thirty-one patients were admitted during Time#1 (2013–14) and 43 during Time#2 (2015–16). Time to PO therapy was widely distributed (Figure 1) throughout the 4 years, with 65% of patients in Time#2 transitioned ≤7 days, vs. 37% in Time#1 (P = 0.02). Specifically for osteomyelitis, mean time to PO decreased from Time#1 to #2 from 11.5 to 8.3 days. Sixty-one percent of patients in Time#1 vs 25% in Time#2 (P &lt; 0.01) received a PICC line, and PICC use was associated with 1.5 day greater LOH (P = 0.02). There was no relationship between time to PO and repeat ER visit/readmission. Nearly 30% of patients in Time#1 had PICC or OAI-related ER visits/readmissions after discharge, while 0% did for Time#2 (P &lt; 0.01).

Conclusion
Length of initial IV therapy and PICC line use continues to vary significantly for pediatric acute OAI. In our children’s hospital, a shift towards earlier transition to PO therapy has been adopted steadily – and prior to national and planned local guidelines – with a general decrease in LOH, duration of IV therapy, PICC line issues following discharge, and overall improved outcomes. Pediatric OAI management represents an ideal focus for institutional quality and antibiotic stewardship efforts.

Disclosures
S. Islam, Qiagen: Speaker’s Bureau, Speaker honorarium and travel support