bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes of Antipseudomonal vs. Non-Antipseudomonal Therapy in Patients with Osteomyelitis
Authors: Jansen Jeffrey W , Moenster Ryan P 
Published: October 2017

Abstract

Background
Osteomyelitis (OM) in diabetics is frequently a polymicrobial infection that rarely involves Pseudomonas (4–5% of cases). Bone cultures have a low-positive yield of 34–50% and, as a result, many patients receive antimicrobial regimens which include antipseudomonal (AP) therapy.

Methods
A retrospective cohort analysis of adult Veterans with OM treated with AP compared with non-antipseudomonal (NAP) therapy was conducted. Patients managed by the VA St. Louis outpatient parenteral antimicrobial therapy (OPAT) service from 1/1/2009 to 7/31/2015 were identified and screened for inclusion. Patients with culture negative (CN) or non-pseudomonal superficial swab cultures (SCx) were included. Figure 1 presents the study profile and exclusion criteria. The primary outcome was clinical failure, defined as a composite of: (1) extension of antibiotics beyond 1 week of the planned duration, (2) recurrence of OM at the same anatomical site within 12 months, or (3) any unplanned surgery or amputation at the anatomical site within 12 months of ABx completion.

Results
Overall, 104 patients with 109 OM encounters were included; there were 29 CN encounters and 80 SCx encounters. Table 1 presents baseline demographics. The overall failure rate was 55/109 (50.5%). The results of the analysis are shown in Table 2. While not included in the primary analysis, Pseudomonas was isolated from 8/88 (9.1%) swab cultures and 5/33 (15%) deep cultures.

Conclusion
Empiric AP therapy did not improve clinical outcomes in patients with either CN or SCx OM.

Disclosures
All authors: No reported disclosures.
Microbiological Epidemiology in Patients Experiencing Microbiological or Clinical Failure Following Reimplantation After a Two-Stage Exchange Strategy for Hip or Knee Prosthetic Joint Infection (PJI)
Authors: Ferry Tristan , Serrier Hassan , Laurent Frederic , Mabrut Eugenie , Fessy Michel-Henri , Chidiac Christian , Huot Laure , Lustig Sébastien , Valour Florent 
Published: October 2017

Abstract

Background
Patients with late PJI are at risk for superinfection at the time of reimplantation. Different commercially available antibiotic-loaded cements (gentamicin, vancomycin, gentamicin+clindamycin [G+C], gentamicin+vancomycin [G+V]) could be used for the fixation of the new prosthesis and could be effective to treat or prevent superinfection. We aim to determine the microbiological epidemiology in patients experiencing failure following reimplantation to establish, based on the drug susceptibilities, which cement could be the most active.

Methods
Prospective cohort study including all patients with a two-stage exchange in 2013–2015. Microbiological failure was defined by positive culture at the time of reimplantation. Clinical failure was defined by patients with clinical signs of infection requiring a new surgery.

Results
We included 117 patients (median age 70 years). Fourteen patients (12%) experienced a failure: seven patients with microbiological failure (four CoNS, one P. acnes, one corynebacterium, and three Candida albicans); seven patients with a clinical relapse requiring a new surgery (three Enterobacteriaceae, two P. aeruginosa, one streptococcus spp., one CoNS, one P. acnes, one E. faecalis). Considering the use of a vancomycin-loaded cement, this antibiotic was inactive on Candida (n = 3) and Gram-negative isolates (n = 5). Considering the use of gentamicin, this antibiotic was inactive on Candida (n = 3) and five bacterial isolates. These five letter isolates were also not susceptible to Clindamycin. Considering the use of G+V, this combination was inactive on Candida (n = 3) and only one bacterial isolate (a gentamicin-resistant K. pneumonia). Consequently, the vancomycin-, gentamicin- and G+C-loaded cements may effectively treat or prevent 42.9% of superinfections, only. Conversely, the G+V-loaded cement may effectively treat or prevent 71.4% of them.

Conclusion
Considering the commercially available antibiotic loaded: none of the Candida albicans superinfection could be locally treated, and the G+V-loaded cement could treat or prevent most bacterial superinfections.

Disclosures
T. Ferry, HERAEUS: Consultant, Speaker honorarium. S. Lustig, Heraeus: Consultant, Consulting fee
The Use of Rifampin Therapy to Treat Diabetic Patients with Osteomyelitis of the Foot in the Veterans Health Administration: Patient Characteristics and Clinical Outcomes
Authors: Wilson Brigid , Saade Elie , Doros Gheorghe , Hermos John , Bessesen Mary , Bonomo Robert A 
Published: October 2017

Abstract

Background
Nearly 25% of Veterans Health Administration (VHA) patients are diagnosed with diabetes mellitus (DM). Among DM patients, the lifetime incidence of foot ulcers is 15%. Infection is a common complication of foot ulcers and 20–60% of infections result in diabetic foot osteomyelitis (DFO). Current treatment guidelines do not endorse any specific antibiotic agent for DFO, but small clinical trials suggest the addition of rifampin to antimicrobial regimens results in improved cure rates for osteomyelitis.

Methods
Using VHA databases, we identified index DFO cases from 2009 to 2013 and extracted patient and infection characteristics including demographics, comorbidities, chronic medications, antibiotic regimens, and microbiology data when present. We analyzed the subset of patients alive, without high-level amputation, and treated with antibiotics at 90 days after diagnosis. We summarized patient characteristics and compared a composite endpoint of amputation or death within 2 years of DFO diagnosis among those treated with rifampin to those not treated with rifampin.

Results
In total, 10,736 DFO cases met our criteria (Figure). Of these, 151 were considered treated with rifampin, based on 14 or more days of rifampin initiated within 90 days of diagnosis; 10,551 were unexposed to rifampin; and 34 were excluded for late or short treatment with rifampin. We observed significant differences between patients treated with and without rifampin (Table) and 44% of rifampin-treated patients were seen in 14 facilities.
Amputation or death at 2 years was observed in 44 (29%) of patients treated with rifampin and 4,007 (38%) of patients not treated with rifampin (P = 0.03).

Conclusion
Rifampin was rarely used in the treatment of DFO in the VHA and a few facilities accounted for a large proportion of rifampin-treated cases. We observed higher rates of amputation-free survival in patients treated with rifampin, but in the presence of notable confounders including age, comorbidities, and organism.

Disclosures
E. Saade, Steris: Grant Investigator, Grant recipient. Janssen: Grant Investigator, Research grant. Sequiris: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. R. A. Bonomo, Entasis: Grant Investigator, Research grant. Allecra: Grant Investigator, Research grant. Wockhardt: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. GSK: Grant Investigator, Research grant. Allergan: Grant Investigator, Research grant. Shionogi: Grant Investigator, Research grant
The Detection Rates of Urogenital Chlamydia trachomatis and Neisseria gonorrhoeae in Chinese Population Applying for U.S. Immigration
Authors: Wu Jian , Chen Jiandong , Chen Chen , Zhu Yunfeng , Huang Yongxin , Liang Shaojun , Zeng Kui , He Hongtao 
Published: October 2017

Abstract

Background
Medical screening for gonorrhea is under the mandatory requirements of the Center for Disease Control and Prevention for aliens applying for U.S. immigration. Gonorrhea is frequently associated with Chlamydia trachomatis (CT) infection. There is limited data on the detection rates of urogenital CT and Neisseria gonorrhoeae (NG) in Chinese population.

Methods
Data on physical examinations of applicants in Guangdong International Travel Health Care Center, China were collected and retrospectively analyzed. The nucleic acids of urogenital CT and NG from urine specimens were detected by fluorescent probe PCR using cobas 4800 CT/NG Amplication Detection Kit (Roche Molecuar Systems, Inc.). The detection rates of CT and NG among the overall population were assessed. In addition, the detection rates of CT by age and gender were also evaluated.

Results
In total, 10,549 applicants underwent physical examinations from September 2016 to March 2017. Mean (SD) age was 41.4 (15.6) years, ranging from 15 to 90 years. The proportion of females (56.17%) was higher than that of males (43.83%). Of the 10,512 people who completed the detection of CT, 369 (3.51%) were CT-positive. The detection rate of CT was significantly higher in females (4.15%) than males (2.69%) (Table 1). The highest CT-positive rate was observed in the age group of 25–29 years (24/344, 6.98%) among males, while in a slightly younger age group of 20–24 years (34/524, 6.49%) among females (Figure 1). Of the 10,510 applicants who completed the detection of NG, 10 (0.10%) were NG positive. The detection rate of NG in males and females was 0.11 and 0.08%, respectively (Table 1).

Conclusion
Our study first reported the detection rates of urogenital CT (3.51%) and NG (0.10%) among Chinese applicants for U.S. immigration. The highest positive rate of CT was observed among young and middle-aged people, which should gain more attention.

Disclosures
All authors: No reported disclosures.
Macrolide Resistance in Mycoplasma genitalium in Singapore
Authors: Barkham Timothy , Tang Wen Ying , Mansoor Siti Aminah , Chio Martin Tze-Wei 
Published: October 2017

Abstract

Background
Mycoplasma genitalium was first reported as a cause of non-gonococcal urethritis in 1980. It has progressed from being an ‘emerging’ sexually transmitted infection (STI) to an accepted STI. Prevalence of infection has been reported as the Netherlands 4.5%, Sweden 6.3%, UK 1.2% and France 4%. M. genitalium has the smallest known bacterial genome and was the second bacterial genome fully sequenced. It has minimal requirements and is said to approach the minimum possible for a living cell. It is extremely fastidious; only a few strains have been cultured worldwide. Diagnosis relies on direct detection. It does not have a cell wall so it is not susceptible to antibiotics such as penicillins and cephalosporins. Therapy depends on fluoroquinolones and macrolides but resistance to macrolides has been widely reported: 13% France, 18% Sweden, 40% UK, Australia and Denmark, 100% Greenland, 30% Japan.

Methods
Ethics approval was granted. DNA extracts left over after routine clinical diagnostics at the Department of STI Control (DSC) Clinic, Kelantan Lane, Singapore were harvested. DNA had been extracted on a Cobas 4800 instrument (Roche) from urine and urethral swabs collected for testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). A 2-plex real-time PCR assay targeting the pdhD and mgpB genes was used to screen for M. genitalium. Samples were deemed positive if both targets were detected. If only one target was detected, the sample was retested; if reactive in either target upon retest, the sample was considered positive for M. genitalium. Positive DNA preps were then screened for macrolide resistance mutations after Sanger sequencing of the 23S rRNA gene.

Results
368 anonymised DNA elutes from 254 urines and 114 urethral swabs were collected between May and July 2016. One hundred eighty-four were CT/NG positive and 184 were CT/NG negative. Sixteen (4.3%) were positive for M. genitalium. Four (25%) of these 16 samples contained macrolide resistance associated mutations; A2058T (x2), A2058G (x1), and A2059G (x1).

Conclusion
M. genitalium was detected in 4.3% of samples. Macrolide resistance mutations were detected in 25%, similar to international rates. Some guidelines recommend testing for resistance to guide therapy and to perform a test of cure.

Disclosures
All authors: No reported disclosures.
Optimizing Screening for Sexually Transmitted Infections in Men Using Self-Collected Swabs — A Systematic Review
Authors: Yared Nicholas , Horvath Keith , Fashanu Oluwaseun , Zhao Ran , Baker Jason , Kulasingam Shalini 
Published: October 2017

Abstract

Background
Sexually transmitted infection (STI) rates are increasing in the US while funding for prevention and treatment programs has declined. Self-collection testing for STI detection in men may provide an acceptable, easy, rapid, and potentially cost-effective method for increasing diagnosis and treatment of STIs. The purpose of this study was to systematically review articles assessing self-collection of anal, oral, or genital tests among adult men for STI detection and/or human papillomavirus (HPV)-related dysplasia.

Methods
We searched for English-language articles involving self-collection tests for STI detection among men aged ≥ 18 years using the following databases: MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials. Three coders used a screening and data abstraction form to record each study’s design, participant demographics, intervention, and primary outcome. The self-collection devices, targeted micro-organisms, and self-collection acceptability measures were also recorded. All studies were double-coded to determine final inclusion in the review.

Results
Self-collection methods were highly sensitive and comparable to clinician-collection for detection of multiple STI pathogens but were of less adequate quality for anorectal cytology. Self-collection was highly acceptable.

Conclusion
Limitations of this systematic review include the fact that studies were small, heterogeneous, and used designs providing lower levels of evidence. Nevertheless, self-collection methods were shown to be a viable option for STI testing in adult men based on their high feasibility, acceptability, and validity. Implementation of self-collection procedures in STI testing venues should be performed to expand opportunities for STI detection and treatment.

Disclosures
All authors: No reported disclosures.
Alcohol Misuse and Associated Risk Factors Across a Shipboard Deployment Among Active Duty US Navy and Marine Corps Personnel
Authors: O’Malley Christopher , Harbertson Judith , Hale Braden , Shaffer Richard , Michael Nelson , Scott Paul 
Published: October 2017

Abstract

Background
Alcohol misuse rates are elevated in the US military. Relevant longitudinal data are rare in deployed shipboard personnel. We examined the prevalence of hazardous and dependent alcohol misuse at 3 months prior to (T1), during (T2), and 3 months following (T3) deployment among shipboard US Navy and Marine Corps personnel.

Methods
Data were collected from 11 local ships. Participants voluntarily completed anonymous surveys, including demographics, Alcohol Use Disorders Identification Test–Consumption (AUDIT–C), drug use, sexually transmitted infection (STI), and sexual risk behavior at T1, T2, and T3. Participants reporting age, gender, and ≥1 AUDIT-C response were included in the analysis. AUDIT-C scoring criteria were ≥3 for women and ≥4 for men (hazardous) and ≥8 (dependent). Data were analyzed using SAS software version 9.3. Proportions of alcohol misuse by time point were reported. Generalized regression model analyses assessed effects of main exposures after adjusting for demographic characteristics (statistical significance of P &lt; 0.05). Generalized estimating equations were used when longitudinal data were included. Models included the longitudinal data’s interaction with time.

Results
Participants in the analyses were: T1 (n = 2,593), T2 (n = 2,010), and T3 (n = 1,556). For T1, T2, and T3, respectively, 38.9, 39.4, and 42.4% screened positive for hazardous and 14.6, 12, and 10.8% for dependent alcohol misuse. Among those aged &lt;21 years, 43.9, 49.3, and 35.4% screened positive for alcohol misuse at T1, T2, and T3, respectively. Longitudinal analysis showed those who screened positive for alcohol misuse were more likely to report an STI diagnosis (OR 2.4; 95% CI 1.44–4.01), exchange or receive money or goods for sex (OR 3.2; 95% CI 2.01–4.94), and use prescription or non-prescription drugs before sex (OR 2.1; 95% CI 1.64–2.61) than those who did not screen positive, after adjusting for other variables.

Conclusion
Alcohol misuse was associated with STIs and sexual risk behaviors across deployment. Improved screening and intervention for individuals who misuse alcohol are needed among deploying shipboard personnel, which may result in a reduction of sexual risk-taking.

Disclosures
All authors: No reported disclosures.
Assessment of the Sexual Violence Situation in a Regional Hospital in Guatemala: The Need for a Multidisciplinary Clinic
Authors: Soto Blanca , Canet Miriam , Erdmenger Diego 
Published: October 2017

Abstract

Background
Sexual violence is a global health problem, in terms of age and sex, showing a significant negative impact on health. Incidence in Guatemala is among the highest of the region reaching an average of 23 cases reported daily nationally per statistics from the Ministry of Health in 2015.

Methods
Retrospective analysis of the database of all sexual violence cases reported from a secondary -level national hospital in Guatemala from January 2005 to September 2015 (period A) and in-depth analysis on demographic and epidemiological data along with information of the follow-up of cases between January 2012 and September 2015 (period B) was performed.

Results
Period A: 500 cases; female (96%; 481/500). Assault occurred between 16–20 years (34%; 163/481) 11–15 years (22.25%; 107/481), and 21–30 years (22.04%; 106/481). From all reported male cases, 73.68% (14/19) occurred under 15 years.
Period B: 154/217 (70.96%) cases included; female (95.45%; 147/154), mean age: 17.87 years. Assault occurred in public spaces (57.14%; 88/154) and victim’s home (29.87%; 46/154). Almost 13% of victims reported history of previous assault, 5.84% by the same aggressor. More than one aggressor participated in 36.37% of assaults. Physical violence was associated in 57.79% of cases. Most victims (92.76%; 141/152) consulted within 72 hours of the assault. HIV, VDRL, and Hepatitis B testing performed in 100, 52, and 33.77%, respectively, were negative.
Follow-up visits at 3, 6, and 12 months after the aggression were attended by 20.78% (30/154), 1.95% (3/154), and 1.95% (3/154) of victims, respectively. Psychology support was completed only in 18.18% (28/154). Emergency contraception was provided when indicated; pregnancy as result of the aggression was reported in nine cases (5.84%).

Conclusion
The study shows that young women were the most vulnerable group for sexual violence. There is a lack of multidisciplinary approach and follow-up. Interventions on infectious diseases screening have to be optimized to reduce the risk of ETS transmission. This evidence supports the need for a specialized clinic to ensure access to comprehensive health services for victims.

Disclosures
All authors: No reported disclosures.
Ocular syphilis: Case Series (2000–2015) from Two Tertiary Care Centers in Montreal
Authors: Vadboncoeur Julie , Rabia Yasmine , Aubin Marie-Josée , Labbé Annie-Claude , Jaworsky Laurence , Serhir Bouchra , Fortin Claude 
Published: October 2017

Abstract

Background
In the past 15 years, a recrudescence of syphilis was observed in Canada, along with a surge in ocular syphilis cases. Without treatment, ocular syphilis can have serious consequences potentially leading to blindness. Our goal was to describe the demographics, clinical presentations, proportion of co-infection with HIV, treatments and visual outcomes of ocular syphilis cases.

Methods
Patients with a confirmed positive syphilis serology between 2000 and 2015 were identified through the reference laboratory database. A retrospective chart review was performed for those who visited the ophthalmology clinic of Hôpital Maisonneuve-Rosemont or Hôpital Notre-Dame to identify ocular syphilis cases.

Results
Among the 119 patients (174 eyes) identified (2.5% of the population screened), 80% were male; of which 63% were MSM. Mean presenting logMAR visual acuity was 0.70 (20/100 Snellen) and unilateral ocular involvement occurred in 54%. Ocular manifestations included interstitial keratitis (24 eyes), anterior uveitis (37 eyes), intermediate uveitis (17 eyes), posterior uveitis (31 eyes), panuveitis (27 eyes), isolated optic nerve involvement (25 eyes), and others (12 eyes) including VI nerve palsy, scleritis, and episcleritis. Cerebrospinal fluid (CSF) examination was done in 65 (55%) patients. Of those, VDRL was positive in 14 (22%) patients; white blood cells and proteins were elevated in, respectively, 28 (43%) and 39 (60%) of patients. HIV status was unknown in 39 (33%) patients; among those whose serology were performed (or previous status was known), 38 (48%) were HIV infected. Intravenous aqueous penicillin G was administered in 69 (58%), intramuscular benzathine penicillin in 25 (21%) and other antibiotics, mainly due to allergy, in three (3%) patients. Treatment allowed a visual improvement of –0.22 logMAR (gain of five lines on Snellen chart) after a mean follow-up period of 19 months.

Conclusion
Syphilis can manifest with a widely diversified array of ocular presentations, especially uveitis and optic nerve involvement. Therefore it is primordial to keep this diagnosis in mind when facing high-risk patients with ocular symptoms. It is of utmost importance that clinicians improve rates of lumbar puncture, HIV screening and intraveinous penicillin treatment when managing ocular syphilis.

Disclosures
All authors: No reported disclosures.
External validation of predictive scores for mortality following Clostridium difficile infection
Authors: Beauregard-Paultre Catherine , Chakra Claire Nour Abou , Mcgeer Allison , Labbé Annie-Claude , Simor Andrew E , Gold Wayne , Muller Matthew P , Powis Jeff , Katz Kevin , Cadarette Suzanne , Pépin Jacques , Garneau Julian R , Valiquette Louis 
Published: October 2017

Abstract

Background
The burden of Clostridium difficile infection (CDI) has increased in the last decade, with more adverse outcomes and related mortality. Although many predictive scores were developed, few were validated and their performances were sub-optimal. We conducted an external validation study of predictive scores or models for mortality in CDI.

Methods
Published predictive tools were identified through a systematic review. We included those reporting at least an internal validation approach. A multicenter prospective cohort of 1380 adults with confirmed CDI enrolled in two Canadian provinces was used for external validation. Most cases were elderly (median age 71), had a healthcare facility-associated CDI (90%), and 52% were infected by NAP1/BI/027 strains. All-cause 30-day death occurred in 12% of patients. The performance of each scoring system was analyzed using individual primary outcomes.

Results
We identified two scores which performances (95% CI) are shown in the table. Both had low sensitivity and PPV, moderate specificity and NPV, and similar AUC/ROC (0.66 vs. 0.77 in the derivation cohort, and 0.69 vs. 0.75 respectively). One predictive model for 30 days all-cause mortality (Archbald-Pannone 2015, including Charlson score, WBC, BUN, diagnosis in ICU, and delirium*) was associated with only 5% increase in odds of death (crude OR = 1.05 (1.03–1.06)) with an AUC of 0.74 (0.7–0.8).

Conclusion
The predictive models of CDI mortality evaluated in our study have limitations in their methods and showed moderate performances in a validation cohort consisting of a majority of CDI caused by NAP1 strains. An accurate predictive tool is needed to guide clinicians in the management of CDI to prevent adverse outcomes.

Disclosures
J. Powis, Merck: Grant Investigator, Research grant; GSK: Grant Investigator, Research grant; Roche: Grant Investigator, Research grant; Synthetic Biologicals: Investigator, Research grant