bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Hospital-Onset Clostridium difficile Infection Rates and Antibiotic Use in US Acute Care Hospitals, 2006–2012: An Ecologic Analysis
Authors: Kazakova Sophia , Baggs James , McDonald Lawrence , Yi Sarah , Hatfield Kelly , Guh Alice , Reddy Sujan , Jernigan John A. 
Published: October 2017

Abstract

Background
This study investigated the association between facility-level rates of hospital-onset CDI (HO-CDI) and inpatient antibiotic use (AU) in a large group of U.S. acute care hospitals over a 7-year period.

Methods
We used adult discharge and antibiotic use data from 552 acute care hospitals participating in the Truven Health MarketScan Hospital Database from January 1, 2006 to December 31, 2012 to determine facility-level CDI rates and AU. HO-CDI was defined as a discharge with a secondary ICD-9-CM diagnosis code for CDI (008.45) and inpatient treatment with metronidazole or oral vancomycin. The relationship between facility-level HO-CDI (HO-CDI per 10,000 patient-days (PD)) and AU (days of therapy (DOT) per 1,000 PD) was examined through multivariate general estimating equation models that accounted for the correlation between annual HO-CDI rates within a hospital. The models controlled for hospital characteristics and a facility-level rate of community-onset CDI (CO-CDI), defined as a discharge with a primary ICD-9-CM code for CDI and inpatient treatment.

Results
During 2006 to 2012, the mean HO-CDI rate was 11 per 10,000 PD (interquartile range (IQR): 5.7–14.7) and mean AU was 811 DOT/1,000 PD (IQR: 710–932). After controlling for facility-level CO-CDI and other hospital characteristics, overall AU was significantly associated with facility-level HO-CDI rate; for every 50 DOT/1,000 PD increase in AU, there was a 4.4% increase in the HO-CDI rate. Similarly, the only antibiotic classes significantly associated with HO-CDI were third- and fourth-generation cephalosporins (P &lt; 0.0001) and carbapenems (P = 0.0011) with respective increases of 2.1% and 2.4% of HO-CDI per 10 DOT/1,000 PD increase. Fluoroquinolones and β-lactam/β-lactamase inhibitor combinations were not significantly associated with HO-CDI.

Conclusion
In this ecologic analysis of over 500 hospitals, overall antibiotic use was associated with increased rates of HO-CDI. In contrast to recent patient-level analyses in the United States and national observations in England, only third- and fourth-generation cephalosporins and carbapenems were associated with HO-CDI.

Disclosures
All authors: No reported disclosures.
Mitigating Candida auris at a Busy Community Hospital: A Quasi-Experimental Near Real-Time Approach
Authors: Lesho Emil , Bronstein Melissa , McNamara Jodi , Callahan Megan , Kwak Yoon , Campbell Jean , Vargas Roberto L , Hinkle Mary , Walsh Edward 
Published: October 2017

Abstract

Background
Candida auris, an emerging multidrug-resistant pathogen associated with increased mortality, can disseminate on hospital surfaces and resist disinfection. Transmission dynamics remain poorly understood at community hospitals. Immediately following identification of a C. auris infection in an unsuspected patient admitted to a semi-private room 6 days previously, we sought to limit and determine the extent of C. auris contamination at Rochester General (RG), a 528-bed hospital in New York, using available resources.

Methods
The index and roommate were placed on enhanced contact precautions and moved to private rooms. Their former room was terminally cleaned with peracetic acid/hydrogen peroxide (PAHP) and UV light. Ten high-touch environmental surfaces in the new rooms of the index and roommate, the nursing stations, and throughout the ward were sampled immediately before and after, and between daily cleaning. The nares, axillae, and groin of the index, the roommate, and all concurrent ward patients were also sampled. All patients on the involved ward were sequentially moved from their initial rooms into vacated rooms that were terminally cleaned with PAHP and UV light. Prior to the index event, RG laboratory began sending all possible C. auris isolates to the state public health laboratory for confirmation, and using PAHP for all cleaning. RG also leverages preexisting agreements with other referral laboratories to support outbreak investigations. Hand-hygiene compliance averaged 80–90% on the ward. Hospital leaders, laboratory, nursing, environmental services, and local public health personnel regularly participate in infection prevention efforts.

Results
C. auris was isolated from 3 of 132 surface samples on the eighth, nineth, and 15th day of ward occupancy, and 0 of 48 patient samples from 18 co-located patients. The index remained colonized until death on hospital Day 21. No surfaces were C. auris-positive 1 month later.

Conclusion
Compared with prior reports, dissemination at RG was limited. This, the first such quantitative assessment, illustrates how community hospitals can enhance surveillance and patient safety when formal agreements, vigilance, and multi-disciplinary and interagency teamwork exist before outbreaks occur.

Disclosures
All authors: No reported disclosures.
Safety and Efficacy of Anidulafungin in the Treatment of Invasive Candidiasis in Children
Authors: Roilides Emmanuel , Carlesse Fabianne , Leister-Tebbe Heidi , Conte Umberto , Yan Jean Li , Liu Ping , Tawadrous Margaret , Aram Jalal , Queiroz-Telles Flavio 
Published: October 2017

Abstract

Background
Treatment with an echinocandin is recommended as first-line therapy of patients with invasive candidiasis including candidemia (ICC). Little is known about the efficacy and safety of anidulafungin (ANID) for the management of ICC in children.

Methods
Subjects aged 1 months to 17 years with ICC were enrolled into a prospective, open-label, non-comparative, multi-center, global study (NCT00761267) to receive ANID (3 mg/kg on day 1, 1.5 mg/kg daily thereafter). An interim analysis was completed in children 2–17 years. Subjects were to receive ANID for at least 10 days up to 35 days. A central venous catheter suspected as a site of infection was to be removed. A switch to oral fluconazole could be made after day 10. Treatment was required for at least 14 days after two negative cultures separated by 24 hours. Efficacy, based on a determination of global response (combination of clinical and microbiological response), was assessed at end of IV treatment (EOIVT), end of treatment (EOT), 2- and 6-week follow-up. Safety was assessed through 6-week follow-up.

Results
In total, 48 subjects (18, 2 to &lt;5 years; 30, 5–17 years) received at least 1 dose of ANID (mean 11 days; range 1–35 days) and were assessed for safety. Forty-seven subjects had microbiologically confirmed ICC and were evaluated for efficacy. The most common baseline pathogens were C. albicans (38%) and C. parapsilosis (26%). Forty-four (93.6%) subjects had candidemia only. Global response success rates at EOIVT and EOT were 72.3 and 74.5%, respectively. All subjects reported at least one treatment emergent adverse event (AE) with diarrhea (22.9%), vomiting (22.9%), and pyrexia (18.8%) being most frequent. Five subjects discontinued treatment due to AEs of which four [increased transaminases (2), vomiting, pruritus generalis] were considered related to ANID. All-cause mortality by the 2- and 6-week follow-up visit was 12.5 and 14.6%, respectively. Of the seven deaths during the study, one was considered related to ICC; two were related to disease progression (Ewing’s sarcoma, medulloblastoma); the remaining were related to other conditions (intracranial hemorrhage, sepsis/septic shock, and respiratory failure).

Conclusion
Anidulafungin was effective with an acceptable tolerability and safety profile in children aged 2–17 years diagnosed with ICC.

Disclosures
E. Roilides, Pfizer: Grant Investigator, Investigator, Research Contractor and Speaker’s Bureau, Grant recipient, Research grant and Speaker honorarium. H. Leister-Tebbe, Pfizer: Employee, Salary. U. Conte, Pfizer Inc.: Employee, Salary. J. L. Yan, Pfizer: Employee, Salary. P. Liu, Pfizer: Employee, Salary. M. Tawadrous, Pfizer: Employee, Salary. J. Aram, Pfizer Inc.: Employee, Salary. F. Queiroz-Telles, Pfizer: Grant Investigator, Research grant
Outcomes Comparing Initial Short vs Long Course Echinocandin Therapy in Patients with Candidemia Caused by Fluconazole Susceptible Strains
Authors: Small-Saunders Jennifer L , Loo Angela , Theodore Deborah , Singh Amrita , Sobieszczyk Magdalena , Kubin Christine J 
Published: October 2017

Abstract

Background
Guidelines for candidemia (CAND) treatment recommend initial echinocandin (ECHINO) therapy with transition to fluconazole (FLUC) after 5–7 days in patients with clinical stability, FLUC-susceptibility, and negative cultures; however, optimal timing for transition is unknown. In the era of rapid diagnostics and antimicrobial stewardship programs (ASP), studies are needed to evaluate the impact of earlier transition in CAND due to routinely FLUC-susceptible species.

Methods
Retrospective study of adult patients at NewYork-Presbyterian Hospital from 2012 to 2014. Inclusion criteria included ≥1 blood culture with C. albicans, C. tropicalis or C. parapsilosis, ≥1 dose ECHINO initial therapy, ≥3 days total treatment, and no prior episode of CAND within 30 days. Patients with polymicrobial bloodstream infection excluded. Patients de-escalated from ECHINO at ≤3 days (short-course; SC-ECH) were compared with those who received ≥4 days of ECHINO (long course; LC-ECH). The primary outcome was 14-day complete response (CR), defined as survival with clinical improvement and sterilization of blood cultures. Secondary outcomes included day 7 microbiological success (MicroS) and 28-day survival (SURV).

Results
76 patients included: 21 in SC-ECH, 55 in LC-ECH groups. C. albicans (58%) most common species. Majority were male (59%) with median age 64 years (IQR 49–74), 62% were in ICU at time of CAND, 50% had recent surgery. No significant baseline differences between SC-ECH and LC-ECH groups, including in PITT bacteremia score ≥4 (43% vs. 42%; P = 0.4) or median APACHE (20 vs. 20; P = 0.684). There was no difference between SC-ECH vs. LC-ECH in CR (52% vs. 49%; P = 1.0), early MicroS (81% vs. 87%; P = 0.484), or SURV (62% vs. 73%; P = 0.523). On multivariable analysis with duration of ECHINO therapy forced into the model, only PITT bacteremia score &lt;4 remained an independent predictor of CR (OR 6.1, 95% CI 2.1, 17.9; P = 0.001).

Conclusion
In adult patients with CAND due to routinely FLUC-susceptible species, early de-escalation from ECHINO was associated with similar outcomes, including day 7 MicroS. Early de-escalation based on early species identification has the potential to be a target for ASPs to optimize antifungal therapy without compromising clinical outcomes.

Disclosures
All authors: No reported disclosures.
Epidemiology and Prognostic Factors of Non-albicans Candida species Candidemia: A Multicenter Study
Authors: Lee Yu-Lin , Liu Chun-Eng , Lin Szu-Han , Hou I-Lun , Lai Huei-Wen , Wang Fu-Der , Chuang Yin-Ching , Liu Wei-Lun 
Published: October 2017

Abstract

Background
The incidence of Non-albicans Candida (NAC) fungemia has increased over the past decades with high mortality rates. However, the epidemiology and prognostic factors have seldom been investigated between species of NAC.

Methods
Patients with NAC fungemia between 2011 and 2014 from five tertiary hospitals in Taiwan were enrolled. The epidemiology data and factors associated with mortality including antifungal agents were collected by a standardized case-record form. A multivariate regression model was applied to analysis the factors associated with mortality.

Results
In total, 611 non-duplicated patients were enrolled. Candida tropicalis (n = 245, 42.3%) was most common followed by Candida glabrata (n = 213, 34.9%), Candida parapsilosis (n = 106, 17.3%) and others (n = 47, 7.7%). The overall 30-day mortality of all NAC candidemia was 47.7%. C. tropicalis infection had higher 30-day mortality (54.6%) than C. glabrata (42.8%) and C. parapsilosis (36.8%) (P &lt; 0.05). In general, Charlson Comorbidity Index (CCI), liver cirrhosis, double lumen use, and recent steroid exposure predicted a poor prognosis. Instead, central line infection was a protective factor (OR 0.42; 95% CI 0.24–0.71; P = 0.001) because removal of central line was a most effective method for infection source control. In individual species of NAC, patients with C. parapsilosis infection took advantage from favorable host factors including younger age, lower CCI, fewer steroid exposure and more from central line infection than other two species. On the other hand, though the host factors were similar between C. glabrata and C. tropicalis infection, patients with C. grabrata infection took benefit from more echinocandin or high dose fluconazole (≥10 mg/kg/day) use, which was associated lower mortality than those with usual dose fluconazole (6–10 mg/kg/day). However, the echinocandin or high dose fluconazole did not improved outcome of C. tropicalisi infection.

Conclusion
The epidemiology and prognostic factors were different among NAC species. Risk assessment and therapeutic strategy should be individualized according to species when facing the rising threat of NAC infection.

Disclosures
All authors: No reported disclosures.
The Risk Factors and the Characteristics of Fungal Endophthalmitis Following Candida Blood Stream Infection, a Case–Control Study
Authors: Kato Hideaki , Sano Kayoko , Sugiyama Yoshifumi , Sakai Risa , Samukawa Sei , Nakajima Hideaki 
Published: October 2017

Abstract

Background
Fungal endophthalmitis is one of the severe complications following Candida blood stream infection (Candidemia).

Methods
To analyze the risk factors of Candidemia-related fungal endophthalmitis, total 50 Candidemia cases underwent ophthalmology examination between April 2011 and March 2016 were retrospectively collected from the medical records. Ten Candidemia with endophthalmitis cases were compared with 40 Candidemia cases without endophthalmitis were reviewed to analyze the risk factors and characteristics; patients’ age, gender, causative Candida species, the presence of shock, the highest sequential organ failure assessment (SOFA) score and the predisposing factors including diabetes, steroid use, hematological malignancy, cancer, central venous catheter (CVC) placement and neutropenia.

Results
By bivariate analysis, candidemia caused by C. albicans (40% vs. 6.7%, P = 0.009), the presence of shock (36.4% vs. 15.4%, P = 0.197), CVC placement (25.7% vs. 0%, P = 0.092), and neutropenia (40% vs. 15%, P = 0.097) were found higher endophthalmitis group. By logistic regression analysis, C. albicans candidemia was only found to be a significant risk factor (adjusted odds ratio 9.41 [95% CI, 1.42–64.76]).

Conclusion
C. albicans is most responsible causative agent for candidemia-related endophthalmitis. Candidemia cases with the presence of shock, CVC placement, and neutropenia should be closely monitored to early detect Candidemia-related endophthalmitis.

Disclosures
All authors: No reported disclosures.
Phaeohyphomycosis: A 10-Year Review (2006–2016)
Authors: Sundaramoorthy Varun , Duarte Frederico , Raj Promila Mohan , Michael Joy S , Rupali Priscilla 
Published: October 2017

Abstract

Background
Phaeohyphomycosis is a rare infection caused by dematiaceous (pigmented) fungi, frequently reported in tropical and sub-tropical countries. Data regarding this infection is sparse and comprises mainly of case reports. This study was carried out to review epidemiology, causative spectrum, clinical features, and treatment outcomes in patients with Phaeohyphomycosis.

Methods
We reviewed 20 cases of culture proven Phaeohyphomycosis over a 10-year period at Christian Medical College, Vellore, South India.

Results
In our cohort, 16 of the 20 patients were male (80%) with an average age of 42 (range 17–66 years). Most of them (35%) were from Tamil Nadu, India and some from Bhutan and Nepal. Eighty-five percent presented with cutaneous lesions, 5% with involvement of the paranasal sinuses, and 5% each had organ involvement in brain and liver. Possible predisposing factors included type II diabetes mellitus (35%), renal transplantation (30%), long-term use of steroids (15%), and human immunodeficiency virus (5%). For all the patients, the direct microscopy and the culture positivity was 100%. The common species isolated were Cladophialophora bantiana, Cladosporium cladosporoides, Cladosporium sphaerospermum, Phialophora oxyspora, and Exophiala spinifera. Most patients (60%) received monotherapy with itraconazole. Five patients were cured, four had recurrence, one patient died (due to leukemia), and 10 were lost to follow-up.

Conclusion
Phaeohyphomycosis, though an uncommon infection, causes life-threatening disease in both the immunocompetent and immunocompromised hosts. To our knowledge, this is the largest single-centre retrospective study on Phaeohyphomycosis. Though our follow-up was sub-optimal and possible in only 50%, it was noteworthy that disease recurrence was common. Better understanding of pathogenesis and newer antifungals are needed for optimal cure of this disease.

Disclosures
All authors: No reported disclosures.
Epidemiology, Risk Factors and Outcomes of Candida Empyema: A 5-Year Single-Centered Experience
Authors: Williams Jonathan , Lanfranco Odaliz Abreu , Lemos-Ramirez Juan , Bhargava Pallavi , Alangaden George , Ramesh Mayur 
Published: October 2017

Abstract

Background
Candida empyema is a rare manifestation of invasive candidiasis and can occur as a result of candidemia or direct inoculation of the pleural space after thoracic or abdominal surgeries. The risk factors and outcomes of candida empyema are poorly defined.

Methods
We performed a retrospective descriptive analysis of all patients that had Candida species isolated from pleural fluid, from May 2012 to April 2017 at our institution.

Results
Sixty patients with Candida empyema were identified. Patient characteristics are shown in Table 1. The majority of patients 68% had contiguous surgery and 25% had recent solid organ transplantation most of these were lung/heart transplants. The majority isolates were non-Candidia albicans species (52%). Fifty-two patients (86.7%) received antifungals treatment for empyema: 72% received an azole and 13% received an echinoncandin. Fluconazole was the most frequent antifungal (63.3%). Mean duration of treatment was 4 weeks. Of these patients 78% underwent chest tube drainage (40% before diagnosis, 39% after diagnosis) and 22% required VATS/decortication. The overall 30-day mortality was 30%. Candidemia was noted in seven patients (11.7%). Thirty-day mortality was associated with sepsis OR 1.04–11.4, P = 0.049, history of diabetes P = 0.045 and sepsis at the time of candida isolation. A history of solid organ transplantation had a negative effect on mortality OR 0.01–1.07.

Conclusion
Candida empyema was associated with recent contiguous surgery in the majority of cases including lung/heart transplants. Candida empyema is associated with significant mortality despite antifungal treatment and drainage as was associated with sepsis syndrome and diabetes.

Disclosures
All authors: No reported disclosures.
Clinical Experience with Telavancin for the Treatment of Patients with Bone and Joint Infections: Preliminary Results from the Telavancin Observational Use Registry (TOUR™)
Authors: Sims Charles , Bressler Adam , Lacy Melinda , Osmukhina Anna , Castaneda-Ruiz Bibiana 
Published: October 2017

Abstract

Background
Telavancin (TLV) is a lipoglycopeptide antibacterial active against a wide range of Gram-positive pathogens, including methicillin-sensitive and -resistant Staphylococcus aureus (MSSA and MRSA). Bone and joint infections represent a complex set of diseases requiring prolonged antimicrobial therapy and are commonly caused by Gram-positive pathogens, including S. aureus.

Methods
The Telavancin Observational Use Registry (TOUR™) is a multicenter chart review study designed to characterize infection types, pathogens, and outcomes of patients treated with TLV in clinical practice. Data from TOUR were used to characterize a subset of bone and joint patients. Clinical data including patient demographics, pathogens, outcomes, and adverse events (AEs) were analyzed. Clinical outcomes were determined by investigators’ assessment.

Results
As of March 31, 2017, data for more than 1000 patients were collected from 46 sites. Of these, 286 patients were treated for bone and joint infections. Among these 286 patients, median age was 57 years (range 18−92 years) and 27% (n = 76) were aged ≥65 years, 66% (n = 189) were male, and 84% (n = 241) were White. The median body mass index was 30.0 kg/m2 (range 19.2−62.7 kg/m2). MRSA was the most commonly isolated pathogen at baseline (38%; n = 108). The median TLV daily dose and duration of treatment were 750 mg (range 300−1500 mg) or 8.3 mg/kg (range 3.7−16.9 mg/kg) and 26.5 days (range 1−119 days), respectively. Telavancin was used as second-line therapy in 71% (n = 202) of patients, and the majority of patients (66%; n = 189) were treated as outpatients. Overall, 71% (n = 203) of patients were cured or improved to step-down therapy, 9% (n = 25) failed treatment, 10% (n = 30) had an indeterminate clinical outcome at end of therapy (EOT), and 10% (n = 28) had missing or undocumented outcomes. Among the patients who had outcome assessment (n = 258) at EOT, 79% were cured or improved to step-down therapy and 10% failed therapy. AEs were reported in 45 patients; six reported a serious AE, and 32 had AEs leading to TLV discontinuation.

Conclusion
In a real-world setting, once-daily TLV produced a positive clinical response in &gt;70% of patients with difficult-to-treat bone and joint infections and may represent an alternative treatment option.

Disclosures
C. Sims, Theravance Biopharma US, Inc.: Investigator and Speaker’s Bureau, Research grant, Research support and Speaker honorarium. A. Bressler, Theravance Biopharma US, Inc.: Investigator, Scientific Advisor, Shareholder and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. M. Lacy, Theravance Biopharma US, Inc.: Employee, Salary. A. Osmukhina, Theravance Biopharma US, Inc.: Employee and Shareholder, RSU, Stock Options and Salary. B. Castaneda-Ruiz, Theravance Biopharma US, Inc.: Employee and Shareholder, Salary