bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacist-Directed Use of Dalbavancin in Acute Bacterial Skin and Skin Structure Infections to Reduce Hospital Length of Stay
Authors: Jones Bruce , Hersey Roby , Crosby Joseph , Bland Christopher 
Published: October 2017

Abstract

Background
Acute bacterial skin and skin structure infections (ABSSSI) are a rapidly increasing cause of hospitalization. Prolonged length of stay (LOS) increases the cost burden to health systems due to administration of parenteral antimicrobials. Dalbavancin is a lipoglycopeptide providing a full course of therapy with one dose and is indicated for the treatment of patients with ABSSSI and presents a unique opportunity for cost avoidance by decreasing inpatient LOS and shifting care to the outpatient setting. This study evaluated the practice of a pharmacist-directed model for discharging hospitalized patients with ABSSSI to receive intravenous dalbavancin at a hospital outpatient infusion center.

Methods
A quasi-experimental investigation of an ongoing, prospective process with open enrollment for patients discharged to receive single-dose dalbavancin therapy between March 2016 and March 2017. To be eligible, adult patients must have been admitted with an ABSSSI based upon inclusion and exclusion via International Classification of Diseases codes. Subjects were compared with a cohort of patients from March 2015 through March 2016 (comparator group) meeting the same criteria for inclusion and exclusion. The primary outcome is hospital LOS and secondary outcomes are cost-savings associated with a reduced LOS and hospital readmission within 30 days of discharge.

Results
Fifty-three patients were identified who received dalbavancin during the enrollment period, and 44 were included in the study. In the comparator group 1191 patients were identified of which 945 were included in the study. Hospital LOS (4.3 vs. 8.0, P &lt; 0.001) and total direct cost per case ($7,863 vs. $2,989, P &lt; 0.001) were statistically significantly decreased for the dalbavancin group compared with the comparator group. Readmission rates at 30 days were similar between the dalbavancin and comparator groups (11.4% vs. 8.6%, P = 0.34).

Conclusion
Patients discharged to an outpatient infusion center to receive dalbavancin had a decreased LOS and total direct cost per case in relation to the comparator group of standard of care. No statistically significant difference in readmission rates was observed. Early goal-directed discharge for the treatment of patients with ABSSSI is a safe and effective way to decrease LOS.

Disclosures
B. Jones, Allergan: Speaker’s Bureau, Speaker honorarium
Using Group-Based Trajectory Temperature Modeling to Predict Postoperative Infections after Total Knee Arthroplasty
Authors: Grant Jennifer , Mcnulty Moira C , Kinnard Krista , Nagin Daniel , Robicsek Ari , Bashyal Ravi , Padman Rema , Shah Nirav 
Published: October 2017

Abstract

Background
Fever is common in the postoperative setting and frequently physiologic. Despite this, roughly half of febrile patients undergo testing for infectious complications, of which only a few reveal infection. We analyzed whether temperature trajectories could help optimize postoperative (post-op) risk assessment in total knee arthroplasty (TKA) patients.

Methods
We included adult patients who underwent primary TKA between January 1, 2007–December 31, 2013 within NorthShore University HealthSystem. Patients were excluded if infection was suspected before/during surgery. Patient data were extracted from the Database Warehouse. A physician verified post-op complications by chart review. We performed group-based trajectory modeling (GBTM) with covariates: age, BMI, gender, co-morbid conditions and procedure time (STATA). We compared complications per group by χ2 test and evaluated associations with any post-op complication by multivariable (MV) logistic regression (SPSS).

Results
We identified 5495 independent patients, following three distinct temperature trajectories (Figure 1) – low (group 1), medium (group 2), high (group 3). Noninfectious complications were more likely than infectious complications, and complications were 5x more common in group 3 vs. group 1 (Table 1). In MV logistic regression, membership in group 3 was independently associated with developing a post-op complication, adjusting for age, presence of renal failure and presence of a cardiac arrhythmia (OR 4.4, 95% CI 3.2–6.0, P &lt; 0.01).

Conclusion
GBTM may help identify TKA patients at increased risk of a post-op complication in real-time, thus helping clinicians avoid unnecessary testing and antibiotics in the post-op setting.

Disclosures
All authors: No reported disclosures.
Weighing in: Effect of BMI on Postoperative Fever and Complications in Patients Undergoing Three Distinct Surgeries
Authors: Bhaimia Eric , McNulty Moira C , Lahrman Frances , Parikh Ronak , Saeed Huma , Robicsek Ari , Padman Rema , Shah Nirav , Grant Jennifer 
Published: October 2017

Abstract

Background
Current trends estimate a 33% increase in obesity and 130% increase in severe obesity by the year 2030. It is unclear what the effect of obesity is on postoperative fevers, postoperative complications, and diagnostic workup rates.

Methods
We evaluated 5,330 patients undergoing knee arthroplasty, colectomy, or craniectomy from October 2009 to December 2014 at NorthShore University HealthSystem, in Illinois. Clinical data were extracted from the Enterprise Data Warehouse, including diagnostic testing and complications. Complications were also verified by physician chart review. Χ2 and Mann–Whitney U tests were used to analyze categorical and continuous variables.

Results
Obesity (BMI ≥ 35) was present in 1081 (23.4%) of knee arthroplasty, 38 (16.9%) of colectomy and 55 (12.6%) of craniectomy patients. There was no increase in complications by BMI in each individual surgery except for increased 30-day readmissions in craniectomy patients with BMI ≥ 35 (P = 0.032). Collectively, there was no difference in the relationship between BMI and rate of post-op complications (Table 1). However, patients with BMI ≥ 35 experienced more fevers (P = 0.002), underwent additional workup (0.011), and had higher workup costs (P &lt; 0.001).

Conclusion
Patients with BMI ≥ 35 had more fevers, more workups and higher cost, but not higher complication rates during the index hospitalization after surgery. Awareness of the predisposition towards post-op fever in obese patients in the absence of complication may prevent costly and unnecessary testing. More work is still needed to understand the effect of obesity on more distant complication rates.

Disclosures
All authors: No reported disclosures.
Variation in Reporting of Penicillin Allergy and its Consequences: an Evaluation of 13 Hospitals
Authors: Daragjati Florian , Silver David , Guharoy Roy , Groves Clariecia , Sebastian Danielle , Fakih Mohamad 
Published: October 2017

Abstract

Background
Penicillin allergy is the most common antibiotic allergy noted within medical records, and its inaccurate reporting leads to increased use of alternative antibiotics that may be less effective, broader in spectrum, more toxic, and costly.

Methods
We retrospectively reviewed the reported allergies to penicillin in patients cared for at 13 hospitals within one health system over a 3 month period (June-August 2016). The data were abstracted from the electronic medical records on penicillin allergy status for both inpatient and outpatient visits. Hospitals were compared on their use of systemic antibiotics for inpatients. The proportions of total defined daily doses (DDD) for quinolones, aztreonam, carbapenems, cephalosporins, and penicillins were compared. Spearman’s rank and Pearson’s correlation were used to evaluate the strength of the relation between increased penicillin allergy reported and the use of the different antibiotic classes.

Results
23,290 of 169,912 (13.7%; range 8%–20%) patients from 13 hospitals were reported penicillin allergic. There was a strong correlation between the proportion of patients with penicillin allergy and quinolone use (rho=0.77; P = 0.002; Figure 1), cephalosporins excluding fourth-generation (r=0.70; P = 0.007; Figure 2), and a weaker correlation with carbapenem use (rho=0.52; P = 0.168) and aztreonam (r=0.53; P = 0.06). On the other hand, penicillins had a moderate negative correlation (r=-0.58; P = 0.036; Figure 3), and extended spectrum penicillins had a strong negative correlation (r=-0.72; P &lt; 0.005). Fourth-generation cephalosporin use did not correlate with the penicillin allergy rate (rho=-0.03; P = 0.92).

Conclusion
Reported penicillin allergy varies between hospitals and higher reported allergy is associated with more quinolone and cephalosporin use, and less use of penicillin-based regimens. Adequate documentation of penicillin allergy may promote the choice of more optimal regimens when treating patients.

Disclosures
All authors: No reported disclosures.
The Utility of Repeat Blood Cultures for Bacteremic Urinary Tract Infections and Associated Durations of Therapy
Authors: Sayood Sena , Sutton Jesse , Baures Timothy , Spivak Emily 
Published: October 2017

Abstract

Background
Urinary tract infections (UTIs) are common among hospitalized patients with 10–40% of cases complicated by bacteremia. Recent literature suggests limited utility in repeating blood cultures for non-Staphylococcus aureus bacteremia; however, clinicians often repeat blood cultures to document clearance prior to selecting definitive therapy for bacteremias. Additionally, comparative data evaluating treatment duration for bacteremic UTIs are lacking and clinical practice guidelines do not address optimal duration for bacteremic UTIs. We aimed to evaluate local practice patterns and utility of repeat blood cultures and their influence on treatment durations for bacteremic UTIs.

Methods
We identified patients with bacteremia from a urinary source at the Salt Lake City Veterans Affairs (VA) hospital from a previously compiled cohort of inpatients with bacteremia from any source between November 2013 and October 2015. Demographic and clinical information including presence of comorbidities, source of infection, number of repeat blood cultures collected, repeat blood culture positivity, planned duration of antibiotic therapy and recurrent bacteremia with the same organism within 30 days of discharge were collected by manual chart review.

Results
Fifty-three bacteremic UTIs were included during the study period. Ninety-four percent of patients were male with a median age of 77. Repeat blood cultures were drawn in 77% (41/53) of cases; however, only 7% (3/41) of repeats were positive, all with Enterococcus faecalis. Median duration of therapy was 14 days (IQR 14, 15), with a longer mean duration in patients with repeat blood cultures as compared with not (15 vs.. 12 days, P = 0.03). Two patients had recurrent bacteremia with the same organism within 30 days; both with negative repeat blood cultures at the time of initial bacteremia and undetected metastatic complications.

Conclusion
Patients with bacteremic UTIs are at low risk of persistent bacteremia. Repeat blood cultures are of low utility, specifically with Gram-negative organisms, and may lead to prolonged durations of therapy. The impact of reducing repeat blood culture collection on outcomes, length of stay, and antibiotic durations warrants further evaluation.

Disclosures
All authors: No reported disclosures.
Urinary Tract Infections After Combat-related Genitourinary Trauma
Authors: Jackson Brendan , Liang Stephen Y , Kuhn Janis , Shaikh Faraz , Blyth Dana M , Whitman Timothy J , Petfield Joseph L , Carson Leigh , Tribble David R , McDonald Jay R 
Published: October 2017

Abstract

Background
Genitourinary (GU) trauma accounted for 5% of combat-related injuries sustained by U.S. military personnel during Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Incidence and risk factors for long-term infectious complications, including urinary tract infections (UTI), have not been described in this unique population.

Methods
Demographics, injury patterns, initial and long-term medical care, urologic complications, and infectious complications involving the urinary tract for enrollees within the Trauma Infectious Disease Outcomes Study (TIDOS) were collected from Department of Defense (DOD) and Department of Veterans Affairs (VA) data sources. Statistical analyses were conducted to identify candidate predictors for UTIs after GU trauma.

Results
Among the 530 TIDOS enrollees who entered VA care, 90 (17%) sustained GU trauma. Blast injury (93.3%), injury during dismounted operations (56.7%), and lower extremity amputation (56.7%) were common characteristics among those with GU trauma. Higher median injury severity scores (ISS) were associated with GU trauma vs. non-GU trauma [33 (IQR: 21–38) vs. 17 (IQR: 9–26), P &lt; 0.001]. Of those with GU trauma, 21 (23.3%) had ≥1 UTI (range 1–9) during DOD-VA care. A total of 42 unique UTI episodes were identified, with 11 (26.2%) occurring during initial DOD care, 19 (45.2%) during subsequent DOD care after initial hospital discharge, and 12 (28.6%) during VA care. The median time to first UTI episode was 49 days (IQR: 40.5–171.8). Having an UTI was associated with bladder (P = 0.002) and posterior urethral injury (P = 0.002), pelvic fracture (P &lt; 0.001), urinary catheterization (P = 0.001), and urologic complications, including urinary retention or incontinence (P = 0.001) and stricture (P = 0.007). Pseudomonas aeruginosa (61.5%) was commonly isolated in urine cultures obtained within 6 months of the initial injury.

Conclusion
UTIs are a common infectious complication after combat genitourinary trauma, particularly in the setting of severe injury and urologic sequelae. Episodes of UTIs typically occur early on after the initial injury while in DOD care; however, recurrent infections may continue well into long-term VA care.

Disclosures
All authors: No reported disclosures.
Antibiotic Bladder Irrigation in Preventing and Reducing Chronic Urinary Catheter-Related Urinary Tract Infections (UTI)
Authors: Harmon Christian , Hassoun Ali 
Published: October 2017

Abstract

Background
Recurrent UTI is a common complication of chronic urinary catheter use. We report our experience with the use of antibiotic bladder irrigation to reduce catheter associated UTI and systemic antibiotics use.

Methods
Retrospective chart review of patients treated with antibiotic bladder irrigation for recurrent UTI related to chronic urinary catheter (2013–2016). Data collected include demographic, co-morbidities, urological anomalies, symptoms, documented pathogens during episodes of infection, and irrigation medication used. Antibiotic regimen included: gentamicin, gentamicin alternated with piperacillin-tazobactam, or tobramycin once weekly. Parameters for successful therapy and alleviation of symptoms included complete relief of symptoms for six months and no systemic antibiotics use for six months post initiation of therapy, or reduced frequency of infections for one year post initiation of therapy.

Results
39 patients were enrolled, all were patients who had been referred to infectious disease physicians after persistence of symptoms despite multiple rounds of systemic antibiotics and had at least 6 episode of documented UTI despite following guideline for aseptic urinary catheter insertion and care. Mean age 66.5 y (range 27–92), 69% male. Most common urologic problem was neurogenic bladder in 48% and prostate or bladder surgery. 5 self-catheterize, 12 had suprapubic catheter and 22 had chronic indwelling catheter. Most common co-morbidities include: DM, BPH, paraplegia, spina bifida and multiple sclerosis. Most common presenting symptoms were abdominal pain 49% and fever 34%. Most common organisms were Escherichia coli 38%, Pseudomonas aeruginosa 23% and Enterococcus faecalis 18%. 67% used gentamicin bladder irrigation. 26 (66.67%) met the criteria for alleviation of symptoms and success with antibiotic irrigation therapy, and a further four featured improvement of frequency of symptoms despite not successfully meeting the study’s pre-set criteria for full improvement. Patient did not report any associated side effect.

Conclusion
Use of antibiotic bladder irrigation was successful in reducing symptom frequency and requirement of systemic antibiotics. Further Studies needed to assess the benefit of this mode of therapy.

Disclosures
All authors: No reported disclosures.
Impact of Culturing All Uncomplicated Urinary Tract Infections on the Estimated Prevalence Of Resistance in the Primary Care Setting
Authors: Tallman Gregory B , Elman Miriam R , Irwin Adriane N , Noble Brie N , Atkins Peter K , Ham YoungYoon , Waldrip Kallie , McGregor Jessina C 
Published: October 2017

Abstract

Background
Urine cultures to confirm a urinary tract infection (UTI) are not consistently collected in the primary care setting; thus estimates of the prevalence of resistance in uropathogens may be biased. As part of an ongoing study, microbiologic cultures were collected for all patients presenting with uncomplicated UTI at primary care clinics over a six-month period to assess the potential misclassification in frequency of resistance.

Methods
Data from an electronic health record repository were used to identify clinic encounters for women with a diagnosis code for unspecified UTI or cystitis from six primary care clinics between October 1, 2015 and February 28, 2017 in this cross-sectional study. Prior to August 22, 2016, urine microbiology cultures were collected at the discretion of the provider (usual care period), and from August 22, 2016 to February 28, 2017 urinary microbiology cultures were collected from all patients suspected of having uncomplicated UTI (full culturing period). Urinary microbiology culture and pharmacy data occurring within three days of the encounter were collected. Antibiotic susceptibility data was summarized for isolated Enterobacteriaceae. Frequency of susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX), nitrofurantoin, and fluoroquinolones were compared between usual care vs. the full culturing periods using a chi-square test.

Results
We identified 131 urine microbiology cultures in the usual care period and 104 in the full culturing period with 61.1% and 55.8%, respectively, being positive cultures. Enterobacteriaceae were isolated from 85.0% of positive cultures in the usual care period and 86.2% in the full culturing period. Between the usual and full culturing periods, antibiotic susceptibility in the Enterobacteriaceae did not differ statistically for TMP-SMX (85.1% vs.. 88.0%; P = 0.65), nitrofurantoin (98.5% vs. 94.0%; P = 0.19), and fluoroquinolones (89.6% vs. 90.0%; P = 0.94).

Conclusion
Full culturing did not significantly change estimates of the prevalence of antibiotic resistance among Enterobacteriaceae isolated from urine samples. Current urine culturing practices provide adequate susceptibility information to inform empiric prescribing for women with uncomplicated UTIs.

Disclosures
J. C. McGregor, Merck & Co.: Grant Investigator, Research grant
Comparison of Inflammatory Markers Between Adult and Pediatric Brucellosis Patients
Authors: Tekin Recep , Aktar Fesih , Ayaz Celal 
Published: October 2017

Abstract

Background
Brucellosis is still endemic in many developing countries and frequently leads to misdiagnosis and treatment delays. Indirect inflammatory markers such as mean platelet volume (MPV), platelet distribution width (PDW), red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been identified as markers of inflammation. The present study aimed to evaluate and compare the levels of these markers for prognostic purposes, and to assess the correlation of C-reactive protein (CRP) with brucellosis in adults and children.

Methods
The study included 137 adults and 141 age- and gender-matched healthy controls, as well 71 children and 81 age- and gender-matched healthy controls. Hematological parameters and CRP were retrospectively recorded and compared between the adult and pediatric patients.

Results
The mean age of the adult patients (54% female) was 43.1 ± 15.4 years, whereas the mean age of the pediatric patients (50.7% male) was 9.5 ± 3.6 years. Significantly higher lymphocyte count, and lower neutrophil count, platelet count, RDW, MPV, NLR and PLR values were found in adult brucellosis patients compared with their healthy subjects, whereas higher lymphocyte count, PDW and lower neutrophil count, platelet count, MPV, NLR and PLR values were observed in pediatric brucellosis patients compared with the control subjects. Significantly higher neutrophil count (p=0.019) and NLR (p&lt;0.001) were found in adult patients compared with the pediatric patients. Positive correlation was found between CRP and NLR (R2 = 0.052, P = 0.011), PLR (R2 = 0.061, P = 0.006) in adult patients.

Conclusion
Based on our findings, we consider that the use of complementary indirect markers such as MPV, NLR, PLR and RDW together with the CRP test – which is used concomitantly with serological diagnostic tests in situations where brucellosis is suspected – might be helpful in the diagnosis and follow-up of brucellosis, as well as in the evaluation of complications and response to therapy, in both adult and pediatric brucellosis patients.

Disclosures
All authors: No reported disclosures.
Serial Procalcitonin Levels Correlate with Microbial Etiology in Hospitalized Patients with Pneumonia
Authors: Ankomah Pierre , Mccluskey Suzanne , Abers Michael , Bearnot Benjamin , Patel Shreya , Schuetz Philipp , Chiappa Victor , Lewandrowski Kent , Vyas Jatin , Mansour Michael 
Published: October 2017

Abstract

Background
Procalcitonin (PCT) is a biomarker that is finding increasing diagnostic and prognostic utility in lower respiratory infections. It remains unclear, however, whether it can be helpful in predicting the bacterial etiology of pneumonia, with a view to informing antibiotic choice and duration. This study examines the relationship between serial PCT measurements and microbial etiology in patients hospitalized for pneumonia to determine whether changes in PCT levels provide discriminatory information on microbial etiology.

Methods
We performed a subgroup analysis of data from a prospective cohort study of 505 patients admitted to a tertiary care center with findings concerning for pneumonia. Microbial etiology of pneumonia was determined from high quality respiratory samples, blood cultures or other relevant diagnostic tests according to standard protocols. Procalcitonin levels were measured serially during the first four days of hospitalization. We compared procalcitonin levels between different bacterial etiologies over the first four days of admission, using the Mann–Whitney-U test to assess for statistical significance.

Results
Out of 505 patients, the diagnosis of pneumonia was adjudicated in 317, and bacterial etiology determined in 62 cases. The predominant pathogens were Staphylococcus aureus (N = 18), Streptococcus pneumoniae (N = 6), Pseudomonas aeruginosa (N = 11) and Haemophilus influenza (N = 5). Admission levels of PCT were lowest in Pseudomonas infections and highest in pneumococcal infections, though not reaching statistical significance. On hospital days two and three, pneumococcal procalcitonin levels were significantly higher than all other etiologies, but on day four, there was no statistically significant difference in PCT values for different microbial etiologies.

Conclusion
Serial procalcitonin levels during the early course of bacterial pneumonia reveal a difference between pneumococcal and other bacterial etiologies, and may have an adjunct role in guiding antibiotic choice and duration.

Disclosures
All authors: No reported disclosures.