bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reexamining BSA as a Preoperative Predictor of Risk of Prosthetic Joint Infection
Authors: Russell Celeste , Nocon Allina , Mayman David , Westrich Geoffrey , Miller Andy , Brause Barry , Henry Michael 
Published: October 2017

Abstract

Background
Prosthetic joint infection (PJI), a dreaded complication of arthroplasty, has been found to correlate with increasing body mass index (BMI) and body surface area (BSA). Recent data suggest that BSA may be a better predictive tool for assessing infection risk. We further evaluated this association in an orthopedic specialty hospital arthroplasty cohort to evaluate whether BSA is a predictor of prosthetic joint infection.

Methods
A retrospective cohort of hip and knee arthroplasty patients between 2009 and 2014 was identified through administrative hospital data using ICD-9 codes. Patients with a BMI &lt;14 or &gt;60 kg/m2, height &lt;142 or &gt;200 cm, and weight &lt;36 or &gt;226 kg were excluded. BSA was calculated using the DuBois formula, and assessed both as a continuous and as a categorical variable. Univariate analyses were done using χ 2 tests and adjusted models were assessed using logistic regression.

Results
17,859 knee and 18,128 hip patients were identified. 1.1% of knees and 0.74% of hips were infected.]Mean BSA was 1.9 m2 (±0.2 m2). BSA was significantly associated with PJI in hips (P = 0.004), but not knees, when analyzed as a continuous variable in unadjusted models. However, this association lost its significance after adjusting for PJI risk factors. Additionally, when assessed as a categorical variable in a multivariate model, BSA in the highest quartile (&gt;2.11) was not associated with PJI.

Conclusion
After evaluating BSA as a continuous and categorical variable, we failed to find an association between BSA and infection risk in THA or TKA. The impact of BSA decreased after multivariate adjustment. BSA may not be optimal as a predictor of preoperative risk.

Disclosures
All authors: No reported disclosures.
Efficacy and Safety of Dalbavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infection (ABSSSI) in Patients with Diabetes Mellitus
Authors: Nowak Michael , Rappo Urania , Gonzalez Pedro L , Chen Jie , McGregor Jennifer S , Bryowsky Jason , Talan David 
Published: October 2017

Abstract

Background
ABSSSIs are common in patients with diabetes and have an increased risk of complications. Dalbavancin is a long-acting lipoglycopeptide with potent activity against Gram-positive pathogens responsible for ABSSSI, including methicillin-resistant Staphylococcus aureus (MRSA), and has demonstrated activity in ABSSSI with single-dose administration. We assessed outcomes in patients with and without diabetes in a clinical trial evaluating the efficacy of dalbavancin for ABSSSI.

Methods
In a double-blind, phase 3 trial, adult patients with ABSSSI involving deeper soft tissue or requiring significant surgical intervention, defined as major abscess, cellulitis, and traumatic wound/surgical site infection were randomized 1:1 to dalbavancin as a single-dose (1500 mg) or as a two-dose regimen (1000 mg on Day 1 and 500 mg on Day 8). The primary endpoint was ≥20% reduction in erythema at 48–72 hours; clinical success on Days 14 and 28 was defined as improvement in lesion size and signs and symptoms. P-values were obtained using Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. In a post-hoc subgroup analysis, outcomes were compared among the subgroups of participants with and without diabetes.

Results
There were 76/698 (10.9%) participants with diabetes and 622/698 (89.1%) participants without diabetes. Participants with diabetes were more likely to be older or obese, and had higher rates of cellulitis, while participants without diabetes had higher rates of abscess (Figure 1). At Days 14 and 28, clinical success was achieved in ≥84% of participants with diabetes, and investigator assessment of cure was achieved in ≥95% of participants with diabetes (Figure 2). Drug-related adverse events were observed in 7 (9.2%) patients with and 44 (7.1%) participants without diabetes.

Conclusion
Dalbavancin has similar rates of clinical response and success for the treatment of ABSSSI in patients with or without diabetes.

Disclosures
M. Nowak, Allergan plc: Employee, Salary. U. Rappo, Allergan plc: Employee and Shareholder, Salary. P. L. Gonzalez, Allergan plc: Employee and Shareholder, Salary. J. Chen, Allergan plc: Employee, Salary. J. S. McGregor, Allergan plc: Employee, Salary. J. Bryowsky, Allergan plc: Employee and Shareholder, Salary.
Clinical Characteristics and Treatment Outcomes of Patients with Sternoclavicular Septic Arthritis Caused by Staphylococcus aureus
Authors: Ryu Byunghan , Jang Young-Rock , Lee Seung Hyun , Hong Jeongmin , Kim Min-Chul , Kim Min Jae , Sung Heungsup , Kim Mi-Na , Kim Sung-Han , Lee Sang-Oh , Choi Sang-Ho , Jeong Jin-Yong , Kim Yang Soo , Woo Jun Hee , Chong Yong Pil 
Published: October 2017

Abstract

Background
Aggressive surgical therapy such as en-bloc resection of the joint is favored in the treatment of sternoclavicular (SC) septic arthritis. However, this practice is based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with S. aureus SC septic arthritis treated with medical therapy alone or with limited surgical therapy.

Methods
All adult patients with SC septic arthritis caused by S. aureus at the Asan Medical Center between September 2009 and December 2016 were retrospectively reviewed. Demographic characteristics, laboratory results, underlying diseases/conditions, patient management, and treatment outcomes were assessed. SC septic arthritis due to S. aureus was defined if patients had positive cultures of specimens from the SC joint, or if blood cultures yielded S. aureus, together with physical findings and imaging studies supporting the diagnosis of SC septic arthritis. Limited surgical therapy was defined as simple incision, drainage, and debridement of infected SC joint.

Results
In total, 22 cases of S. aureus SC septic arthritis were enrolled. Of these 22 patients, 11 received medical therapy alone, 11 underwent limited surgical therapy, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes, and liver cirrhosis, and none had IV drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscess had a tendency to be treated with limited surgery than patients without them (73% vs. 27%, P = 0.09). The median duration of intravenous antibiotics in all patients was 35 days (IQR 25–46 days). After a median follow-up of 31 months (IQR 2–40 months), there was no relapse of SC septic arthritis or deterioration of joint function.

Conclusion
Medical therapy alone or with limited surgical therapy appears to be a successful therapeutic strategy for the complicated S. aureus SC septic arthritis in a selected patient.

Disclosures
All authors: No reported disclosures.
Predictive Factors for Successful Treatment in Candidial Bone and Joint Infection
Authors: Jeong Wooyong , Jung In Young , Choi Heun , Kim Jinnam , Lee Se Ju , Seong Hye , Kim Jung Ju , Ku Nam Su , Choi Jun Yong , Song Young Goo , Kim June Myung , Jeong Su Jin 
Published: October 2017

Abstract

Background
Candidiasis is a major cause of morbidity and mortality, causing a diverse spectrum of clinical diseases. Candidial bone and joint infection (CBJI) is a rare clinical disease, although it is one associated with significant morbidity. As most prior studies were limited to individual cases and small case series, there were insufficient data on the epidemiology and outcome of CBJI. The aim of this study is to identify the predictive factors for successful treatment in CBJI.

Methods
A retrospective review was performed on 33 patients with Candida confirmed on culture, among patients diagnosed with bone and joint infection between January 2006 and December 2016 at a 2400-bed tertiary hospital in South Korea. Unfavorable outcome was defined as recurrence following completion of treatment or mortality. Clinical characteristics, treatment outcome, and medical records were reviewed.

Results
Of the 33 patients, 15 (45.5%) had unfavorable outcomes; recurrence (n = 9) and mortality (n = 6). Median age was 64.0 years (range, 50.5–71.5 years) and there were 14 (42.4%) males. Seventeen (51.5%) patients had arthritis and 16 (48.5%) osteomyelitis. Candida albicans constituted 48.5%, C. parapsilosis 24.2%, C. tropicalis 6.1%, and C. glabrata6.1%. Mechanisms of infection were hematogenous dissemination (57.6%) and direct inoculation (42.4%). There were no significant differences between the favorable outcome group and the unfavorable outcome group for the underlying diseases. The neutrophil percentage in complete blood count at the time of diagnosis showed a difference between the two groups (68.0% vs. 79.6%, P = 0.016). There was a significant difference in neutrophil-lymphocyte ratio (2.2 vs. 4.8, P = 0.023), erythrocyte sedimentation rate (ESR) (40.5 vs. 72.4, P = 0.024) and C-reactive protein (CRP) (15.3 vs. 86.3, P = 0.001) at the end of treatment. The duration of antifungal therapy showed a significant difference (124.9 days vs. 44.3 days, P = 0.041), but there was no difference in the operation. In the multivariate analysis, CRP at the end of treatment &#x2028;(P = 0.028) ws found to be a predictive factor for successful treatment.

Conclusion
CBJI is a rare disease but associated with high treatment failure. Prolonged antifungal treatment is essential for successful treatment of CBJI, and CRP at the end of treatment is a key predictive marker of successful treatment.

Disclosures
All authors: No reported disclosures.
Microbiologic Predictors of Pelvic Osteomyelitis Related to Decubitus Ulcers
Authors: Sharma Neha , Clark Abbye , Derrick Caroline , Al-Hasan Majdi N , Weissman Sharon , Sanasi-Bhola Kamla 
Published: October 2017

Abstract

Background
Management of pelvic osteomyelitis related to decubitus ulcers (PODU) remains challenging, whereas definitive therapy is based on blood, bone, or deep tissue cultures, empirical therapy prior to culture results may be indicated in patients with sepsis or cellulitis surrounding PODU. The objective of this retrospective case series is to develop an institutional protocol for empirical therapy of PODU when indicated based on local microbiology results.

Methods
Hospitalized adults with PODU from 1 August 2005 to 1 August 2015 at Palmetto Health hospitals in Columbia, SC were identified. PODU was defined based on clinical, radiographic, and microbiology criteria. Descriptive statistical methods (Fisher’s exact) were used for preliminary analysis.

Results
Seventy-five cases with PODU were included with a mean age of 53 years and male predominance (48; 64%). The most common comorbidities were paraplegia (45, 60%), diabetes (23, 31%) and previous strokes (17, 23%). Forty-nine cases (65%) received antibiotics within a year of PODU. Prior infections or colonization with P. aeruginosa within the past year was present in 24/75 (32%) cases. Most cases had multiple sources of cultures: blood (61; 81%), bone/deep tissue (37; 49%), and/or superficial (73; 97%). Among a total of 99 clinical isolates, 56 (57%) were Gram-positive cocci (GPC) and 43 (43%) were Gram-negative bacilli (GNB). The most common organisms were Enterobacteriaceae (26; 26%), coagulase negative staphylococci (CONS) (20, 20%), Stapylococcus aureus (19, 19%), [12 (12%) methicillin-resistant S. aureus], and P. aeruginosa (9, 9%). Of the Enterobacteriaceae, 69% (18/26) were susceptible to ciprofloxacin and 88% (23/26) to ceftriaxone. All cases (9/9) of PODU due to P. aeruginosa had a prior infection/colonization with P. aeruginosa within 1 year as compared with 15/66 (23%) in those with PODU due to other organisms (P = 0.001).

Conclusion
The microbiology of PODU is diverse (including GPC and GNB). Prior positive P. aeruginosa culture was a predictor of P. aeruginosa PODU. When empirical antimicrobial therapy is indicated, data support the use of intravenous vancomycin plus ceftriaxone in the absence of prior infection/colonization with P. aeruginosa, or intravenous vancomycin plus an anti-pseudomonal agent in the presence of prior P. aeruginosa within the past year.

Disclosures
All authors: No reported disclosures.
Comparative In Vitro Activity of Ciprofloxacin and Sitafloxacin Against Neisseria gonorrheae
Authors: Thamlikitkul Visanu , Tiengrim Surapee 
Published: October 2017

Abstract

Background
Most of Neisseria gonorrhoeae strains isolated from Thai patients are resistant to ciprofloxacin and ciprofloxacin is no longer recommended for therapy of gonococcal infection in Thailand. Sitafloxacin is a new generation of fluoroquinolones that contains in vitro activities against many bacteria that are resistant to ciprofloxacin. Sitafloxacin has a high concentration in urine. The objective of the study was to determine in vitro activity of sitafloxacin against ciprofloxacin-resistant N.gonorrheae.

Methods
Antimicrobial susceptibility tests for 52 strains of Neisseria gonorrhoeae isolated from patients attended Bangrak Hospital in Bangkok were performed. The tested antibiotics were ceftriaxone, cefixime, ciprofloxacin, and sitafloxacin. The minimum inhibitory concentrations (MICs) and inhibition zone diameters were determined by standard agar dilution and disk diffusion method, respectively, according to the Clinical and Laboratory Standards Institute (CLSI) 2013.

Results
All 52 N.gonorrheae isolates were susceptible to ceftriaxone (MIC &lt; 0.025 mg/l, zone diameter &gt; 35mm) and cefixime (MIC &lt; 0.025 mg/l, zone diameter &gt; 31mm). All N. gonorrheae isolates were resistant to ciprofloxacin (MIC &gt; 1 mg/l, zone diameter &lt; 27 mm). The inhibition zone diameters of sitafloxacin (5 microgram disk) against 52 isolates of N. gonorrhoeae were &gt; 41 mm in 35 isolates (67%) and between 28 and 40 mm in 17 isolates (33%). If the cut-off value of inhibition zone diameter of resistance to ciprofloxacin (&lt;27 mm) is applied, no isolates of N. gonorrheae is considered to be resistant to sitafloxacin.

Conclusion
Sitafloxacin seems to be active against ciprofloxacin-resistant N. gonorrheae. A clinical study on therapy of gonococcal urethritis due to ciprofloxacin-resistant N. gonorrheae should be considered.

Disclosures
All authors: No reported disclosures.
The Impact of Recent Antibiotic Usage on Oropharyngeal Neisseria spp. in MSM of Hanoi, Vietnam
Authors: Dong Huan , Nguyen Hoa Thi , Nguyen Minh Binh Xuan , Nguyen Trung Vu , May Folasade , Le Giang Minh , Klausner Jeffrey 
Published: October 2017

Abstract

Background
Neisseria gonorrhea (NG) has a long history of gaining resistance to nearly all antimicrobials used for treatment since the 1930s, which makes susceptibility to last-line cephalosporins of dire importance. Horizontal gene transmission is highly prevalent among the Neisseria genus, with genetic fragments from common commensal Neisseria having been found in resistant NG strains. Globally, NG disproportionately affects men-who-have-sex-with-men (MSM) and nearly all ceftriaxone-resistant cases have been reported from pharyngeal samples. Our study aims to assess the impact of antibiotic usage on the antimicrobial susceptibility of oropharyngeal Neisseria spp.

Methods
MSM from Hanoi, Vietnam, were surveyed regarding antibiotic usage. Pharyngeal swabs were collected and cultured on chocolate and modified-Thayer–Martin agar. Neisseria spp. were subcultured, identified using MALDI-TOF, and antimicrobial susceptibility determined by E-test using NG CLSI MIC breakpoints to ciprofloxacin (CIP), cefixime (CFM), ceftriaxone (CRO), and cefpodoxime (CPD).

Results
The 225 MSM surveyed were young (mean age 23.9 years, std 4.4). In the past 6 months: 41.6% participants used any antibiotics, among whom 62.4% did not have a prescription; 6.6% used CFM (16.4% more were unsure), among whom 55.6% did not have a prescription; and 4.5% received CRO.
From 72 swabs, 102 Neisseria isolates were obtained; N. flavescens (n = 59), N. perflava (n = 14), N. macacae (n = 8), N. sublfava (n = 7), N. gonorrhoeae (n = 5), N. mucosa (n = 3), N. meningitides (n = 3), N. cinerea (n = 2), and N. lactamica (n = 1). &#x2028;“Reduced susceptibility” status for any Neisseria spp. was 35.3, 10, 8, and 30% to CIP, CFM, CRO, and CPD, respectively; 61.8% were “resistant” to CIP. MSM who took any antibiotics in the past 6 months were almost twice as likely to have Neisseria spp. with reduced susceptibility to cephalosporins (CFM, CRO, or CPD), RR 1.8 (95% CI 1.1–3.2; P = 0.026) compared with non-antibiotic users.

Conclusion
Many MSM in Hanoi used antibiotics recently, often without a prescription. Antibiotic use was associated with antimicrobial “reduced susceptibility” of commensal Neisseria spp. to cephalosporins, possibly potentiating resistance acquisition by NG.

Disclosures
All authors: No reported disclosures.
Risk factors for healthcare-associated Clostridium difficile infection in pediatric hematopoietic stem cell transplant recipients
Authors: Drew Richard H , Ni Clara , Kelly Matthew , Wilson Dustin , Sarubbi Christina , Steinbach William 
Published: October 2017

Abstract

Background
Limited published literature exists to identify unique risk factors for Clostridium difficile infection (CDI) in pediatric hematopoietic stem cell transplantation (HSCT) recipients. Our objective was to describe the epidemiology of CDI in pediatric patients undergoing HSCT and to identify potential risk factors for CDI.

Methods
This IRB-waived, single-center retrospective review included Duke University Hospital (DUH) patients 12 months of age or older admitted to pediatrics between March 1, 2012 and August 23, 2016 undergoing initial HSCT during the index hospitalization. The primary endpoint (PCR-confirmed CDI within 100 days post-transplantation) was characterized using descriptive statistics. Transplant type, prior CDI history, days of total parenteral nutrition (TPN), and antibiotic use intensity scores were compared between occurrence groups using Pearson’s chi-square, Wilcoxon rank-sum or Student’s t tests as appropriate.

Results
207 subjects (most Caucasian [55%] and male [61%]) were included, and 15 (7.2%) died. CDI occurred in 24 (12%) within a median (interquartile range) of 35 (9, 47) days since HSCT, and most (92%) were hospital-onset. All cases were healthcare-associated and mild-moderate in severity. None of the patients experienced CDI-related complications. CDI-positive and CDI-negative patients were similar with regards to demographics. Higher median (adjusted) days of TPN (80.6 vs. 29, P &lt; 0.0001) and antibiotic use intensity scores (382.8 vs. 191.0, P &lt; 0.0001), respectively, were associated with CDI. No significant differences between these groups were observed with regard to transplant type (P = 0.28) and prior CDI history (P = 0.10).

Conclusion
CDI occurred in 12% of pediatric patients within 100 days of undergoing initial HSCT. Onset of this mild-moderate, uncomplicated disease occurred within a median of 35 days and commonly during hospitalization. Patients with CDI were more likely to have increased use of TPN and a higher antibiotic use intensity score.

Disclosures
All authors: No reported disclosures.
Use of Electronic Data to Identify Risk Factors Associated with Clostridium difficile Infection (CDI) and to Develop CDI Risk Scores
Authors: Aukes Laurie , Fireman Bruce , Lewis Edwin , Timbol Julius , Hansen John , Yu Holly , Cai Bing , Gonzalez Elisa , Lawrence Jody , Klein Nicola P 
Published: October 2017

Abstract

Background
Clostridium difficile is a major cause of severe diarrhea in the U.S. We described characteristics of Kaiser Permanente Northern California (KPNC) members with C. difficile infection (CDI), identified risk factors associated with CDI, and developed risk scores to predict who may develop CDI.

Methods
Retrospective cohort study with all KPNC members ≥18 years old from May 2011 to July 2014 comparing demographic and clinical characteristics for those with and without lab-confirmed incident CDI. We included CDI risk factors in logistic regression models to estimate the risk of developing future CDI after an Identification Recruitment Date (IRD), a time when an individual might be a good candidate for a C. difficile vaccine clinical trial. Two risk score models were created and cross validated (70% of the data used for development and 30% for testing).

Results
During the study period, there were 9,986 CDI cases and 2,230,354 members without CDI. CDI cases tended to be ≥65 years old (59% vs.. 21%), female (61% vs. 53%), and white race (70% vs. 53%), with more hospitalizations (42% vs. 3%), emergency room visits (51% vs. 14%), and skilled nursing facility stays (25% vs. 0.6%) in the year prior to CDI compared with members without CDI. At least 10 office visits within the prior year (53% vs. 16%), use of antibiotics in last 12 weeks (81% vs. 11%), proton pump inhibitors in the last year (36% vs. 7%), and multiple medical conditions within the prior year (e.g., chronic kidney disease, congestive heart failure, and pneumonia) were important risk factors for CDI. Using a hospital discharge event as the IRD, our risk score model yielded excellent performance in predicting the likelihood of developing CDI in the subsequent 31 – 365 days (C-statistic of 0.851). Using a random date as the IRD, our model also predicted CDI risk in the subsequent 1–30 days (C-statistic 0.658) and 31–365 days (C-statistic 0.722) reasonably well.

Conclusion
CDI can be predicted by increasing age, medications, comorbidities and healthcare exposure, particularly ≥10 office visits, hospitalizations, and skilled nursing stays in the prior year and recent antibiotics. Such risk factors can be used to identify high-risk populations for C. difficile vaccine clinical studies.

Disclosures
H. Yu, Pfizer, Inc.: Employee, Salary; B. Cai, Pfizer, Inc.: Employee, Salary; E. Gonzalez, Pfizer, Inc.: Employee, Salary; J. Lawrence, Pfizer, Inc.: Employee, Salary; N. P. Klein, GSK: Investigator, Grant recipient; sanofi pasteur: Investigator, Grant recipient; Merck & Co: Investigator, Grant recipient; MedImmune: Investigator, Grant recipient; Protein Sciences: Investigator, Grant recipient; Pfizer: Investigator, Grant recipient