bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blastomyces helicus, an Emerging Dimorphic Fungal Pathogen Causing Fatal Pulmonary and Disseminated Disease in Humans and Animals in Western Canada and United States
Authors: Schwartz Ilan S , Wiederhold Nathan P , Patterson Thomas F , Sigler Lynne 
Published: October 2017

Abstract

Background
Blastomyces helicus (formerly Emmonsia helica) is a recently described dimorphic fungus first isolated from a man who died of encephalitis in Alberta, Canada. The geographic range, epidemiology and clinical features are unknown.

Methods
We reviewed clinical and veterinary isolates of Blastomyces and Emmonsia at the University of Alberta Microfungus Collection and Herbarium and the UT Health San Antonio Fungus Testing Laboratory. Isolates were selected based on low B. dermatitidis DNA probe values and/or atypical morphology. DNA sequence analysis was performed. Epidemiological and clinical data were analyzed.

Results
Isolates of B. helicus were identified from eight human (Table 1) and five veterinary cases (Table 2). Mycelial and yeast-like phases of typical clinical isolates are shown in Figures 1 and 2, respectively. Isolates were referred from provinces and states shown in Figure 3.

Conclusion
Blastomyces helicus caused pulmonary and fatal disseminated disease, mainly in immunocompromised persons, and lung disease in companion animals in western Canada and US. Epidemiological investigations are needed to establish the burden of disease and geographic range of this pathogen.

Disclosures
All authors: No reported disclosures.
Ocular Candidiasis in Patients with Candidemia at a Large Tertiary Care Center
Authors: Lee Bonny , Breskin Lydia , Reddy Laya , Iliceto Alessandro , Ashcraft Deborah , Pankey George , Nussdorf Jonathan , Garcia-Diaz Julia 
Published: October 2017

Abstract

Background
Bloodstream infections (BSI) caused by Candida sp. have a high mortality rate and have been increasing in recent years. Ocular candidiasis (OC) is one systemic manifestation of Candida infection; either chorioretinitis or endophthalmitis, and may lead to vision loss. Therefore, IDSA recommends an ophthalmology exam for all patients with Candida BSI. However, reported incidence of OC varies from 1 to 25%, questioning routine eye exams in these patients. The purpose of this study was to evaluate the number of patients who undergo ophthalmological exams and those diagnosed with OC at Ochsner Medical Center, New Orleans (OMC-NO).

Methods
One hundred and forty-four patients were identified from January 2013 to December 2015 with at least one positive blood culture for Candida sp. (only albicans, glabrata, and parapsilosis were included). Records were reviewed through the EPIC system.

Results
Of the 144 patients, 65 were females and 79 males; average age 58 years old. Seventy-six (52.8%) had an ophthalmological exam at Ochsner; excluding one patient who refused an exam, one patient who was excessively combative, and one patient in whom exam was deferred due to medical condition. Three patients (3.9%) showed Candida chorioretinitis; none endophthalmitis.

Conclusion
OC can have devastating consequences if left untreated and early diagnosis is imperative. Our analysis reveals that OC is present in 3.9% of ophthalmology exams, but this may be biased towards patients who are cooperative and can tolerate a dilated eye exam. Critical patients with multiple co-morbidities may be at higher risk for OC. A weakness of our study is that it is limited to ophthalmology records at Ochsner, and there may be records at outside facilities. Further data is required to make recommendations in patients with Candida BSI.

Disclosures
All authors: No reported disclosures.
Antifungal Resistance and Predictors of Response in Patients with Hematologic Malignancy
Authors: Wey Shiuan (Shannon) , Kriengkauykiat Jane , Chan Ayla , Tegtmeier Bernard , Ito James , Dadwal Sanjeet 
Published: October 2017

Abstract

Background
Invasive aspergillosis (IA) causes significant morbidity and mortality in patients with hematologic malignancies (HM). Azole resistance has emerged as a therapeutic challenge in managing IA. The aim of this study was to investigate Aspergillus susceptibility to antifungals over the past decade among HM patients, and correlate susceptibility to clinical outcomes.

Methods
All Aspergillusisolates banked from 2002 to 2014 isolated from HM patients with probable/proven IA were tested for antifungal susceptibility. Patients with hematopoietic cell transplant, duplicate and non-viable isolates were excluded. Data were collected on demographics and clinical factors that could affect the treatment response, antifungal susceptibility (MICs/MECs), and treatment response at 14, 30, and 90 days.

Results
Forty patients were identified. MICs for amphotericin B slightly increased over the past decade (R = 0.32, P = 0.09), but were stable for voriconazole (R = −0.08, P = 0.61). The MIC50 during the first 3 years (2002–2004) and last 3 years (2012–2014) for amphotericin B were 0.5 and 1 mg/l, and for voriconazole 0.5 and 1. Mean age 56 years, 48% male, 82% had active HM and 45% had received chemotherapy within 14 days of IA. 50% were neutropenic and 30% had circulating blasts. Forty percent were on antifungal prophylaxis. Seventy-five percent of isolates were A. fumigatus. Fourteen responded to treatment (TR) and 26 were non-responders (NTR), and they did not differ in baseline characteristics. However, neutropenia (14% TR vs. 58%, NTR, P &lt; 0.017) and circulating blasts (0% TR vs. 35% NTR, P &lt; 0.02) at 14 days differed. The MIC50 for voriconazole was 0.5 mg/l in both groups, and for amphotericin B was 0.25 in TR vs. 1 mg/l in NTR. Fourteen-day response correlated with 90-day response (R = 0.74, P &lt; 0.01) which validated the use of 14-day response for clinical outcome. All responders on amphotericin B at 14, 30, and 90 days had isolates with MIC &lt; 1, whereas no apparent MIC-response correlation was found for voriconazole.

Conclusion
Although not statistically significant, a trend of increasing Aspergillus amphotericin B MICs was observed over the past decade. Neutropenia and persistent disease correlated with treatment failure. Clinical response was not affected by the azole or polyene MICs.

Disclosures
J. Ito, Astellas: Speaker’s Bureau, Speaker honorarium. S. Dadwal, Merck: Investigator, Research support. GlaxoSmithKline: Investigator, Research support. Ansun Biopharma: Investigator, Research support. Oxford Immunotec: Investigator, Research support. Gilead Sciences: Investigator, Research support
Candida parapsilosis Candidemia Resistance Patterns and Treatment Outcomes: An Opportunity for Antifungal Stewardship
Authors: Fong Gary , Ngo Kim , Russo Hannah , Beyda Nicholas 
Published: October 2017

Abstract

Background
Candida parapsilosis has emerged as an important fungal pathogen with mortality rates up to 30%. Recent studies show no difference in treatment outcomes for patients treated both empirically and definitively with either echinocandins or fluconazole. However, the impact of antifungal susceptibility testing and opportunities for antifungal stewardship are less clear in this patient population. The purpose of this study was to assess antifungal susceptibility rates, treatment patterns, and outcomes among patients with C. parapsilosis candidemia.

Methods
This was a single-center, retrospective cohort review of adult patients with a positive blood culture for C. parapsilosis hospitalized at Baylor St. Luke’s Medical Center, between 2006 and 2016. Patients with mixed or breakthrough candidemia were excluded as well as patients who expired within 3 days of candidemia onset.

Results
Eighty patients with C. parapsilosis candidemia were identified of which 48 met inclusion criteria. Nine patients had infections caused by fluconazole non-susceptible isolates (19%). The most common empiric treatment choice was an echinocandin (33/48, 69%), followed by fluconazole (9/48, 19%), and combination therapy (6/48, 13%). Of the 39 patients with fluconazole susceptible isolates, only 17 were treated with fluconazole definitively (44%). Among patients who received empiric echinocandin vs. fluconazole therapy, there was no difference in 14-day mortality (9% vs. 11%, P = 1.00) or in-hospital mortality (12% vs. 11%, P = 1.00). Empiric combination therapy was the only independent risk factor for treatment failure (OR, 13.8; 95% CI, 1.4–138.3; P = 0.03).

Conclusion
Treatment outcomes for patients receiving echinocandins were similar for those receiving fluconazole. At our institution, the increased incidence of fluconazole non-susceptible isolates warrants the use of echinocandins empirically. Patients were more likely to remain on echinocandin therapy even when fluconazole susceptible isolates were identified. This study reinforces the guideline suggestion that neither echinocandins nor fluconazole treatment leads to superior outcomes, but also identifies a cohort of patients in need of antifungal stewardship.

Disclosures
N. Beyda, Astellas: Grant Investigator and Scientific Advisor, Research grant
Epidemiology of Invasive Fungal Disease by Aspergillus in a University Hospital in Santiago – Chile, During the Period 2005–2015
Authors: Valenzuela Pablo , Rabagliati Ricardo , Legarraga Paulette 
Published: October 2017

Abstract

Background
In Chile, there is little information on invasive fungal disease (IFD) due to filamentous fungi. A study of our institution showed 41 episodes in hemato oncological patients between the years 2004 and 2008, being the main cause Aspergillus, but the epidemiological characteristics of this infection in Chilean patients are not currently known. The objective describes the epidemiology of IFD by Aspergillusin our center.

Methods
Retrospective study in adults patients hospitalized in our center, diagnosed with IFD by Aspergillus between 2005 and 2015. Medical records of identified cases were review, incidence were calculated with the discharges numbers and total numbers of IFD. The study was approved by the Institutional Ethics Committee.

Results
Sixty-seven cases were identified, with an incidence of 2.53 per 10,000 discharges between 2005 and 2015, with 35 cases of IFD in the period 2005–2010 and 32 cases in the period 2011–2015. The etiologies were A. fumigatus 42%, A. flavus 7%, A. terreus 7%, A. niger 3%, and Aspergillus spp. 40%. According EORTC/MSG criteria, 39% were proven, 52% probable, and 9% possible. The 55% of patients were male, the mean ± SD age was 51 ± 18 years, 57% had hematological conditions, mainly acute leukemias, rheumatological conditions in 15% and solid organ transplant in 13%, neutropenia under 500/mm3 in 37% and serum galactomannan test &gt;0.5 in 67%. The clinical focus was 73% pulmonary and 17% rhinosinusal. The treatment was 81% monotherapy, 73% with voriconazole, 15% with liposomal amphotericin B and 6% with caspofungin. The 30 days mortality was 39%.

Conclusion
The epidemiology of IFD by Aspergillus is similar to that described in developed countries, in highly vulnerable patients with a mortality close to 40%. More epidemiological information from other hospitals is necessary to complete the epidemiology of Aspergillus infections in our country.

Disclosures
All authors: No reported disclosures.
Improved Survival of Candida CLABSI by Adherence to Standard of Care and Involvement of Infectious Diseases Consultant: A 5-Year Experience in a Single Academic Center
Authors: John Blessy , Malinis Maricar , Fairweather Iyanna , Aniskiewicz Michael , Rivera-Vinas Jose , Baltimore Robert , Martinello Richard 
Published: October 2017

Abstract

Background
Candidemia is the fourth most common nosocomial blood stream infection with significant morbidity and mortality. Central lines have been considered a risk factor for invasive fungal infection. We evaluated the epidemiology, management, and outcomes of Candida CLABSI in an academic medical center.

Methods
We conducted a retrospective cohort study in a single academic center from January 1, 2011 to December 31, 2016 of patients who had positive blood cultures for Candida sp. and met CDC criteria for CLABSI. Outcomes measured were 30-day mortality and relapse or recurrence. Descriptive statistics were used to compare the outcomes of patients who had infectious diseases consult and managed per standard of care (SOC) as defined by IDSA guidelines and those without.

Results
Of 722 CLABSI cases, 82 (11%) were due to Candida sp. Candida species isolated were as follows: C. glabrata (40%), C. albicans (32%), C. parapsilosis (9%), and others (19%). Median age of pediatric patients was 2.25 years (range 0.5–6) and median age of adults was 59 years (19–92). Most common comorbidities were malignancy (35%) and end-stage renal disease (21%). Non-tunneled catheters were present in 58% of cases. Median time from line placement to candidemia was 15 days (IQR 8–29). Sepsis was present in 34 (42%) cases. Seventy-four (90%) cases were initiated on antifungal therapy (AFT) when culture turned positive. After Candida speciation, AFT was adjusted appropriately for 82 (100%) cases. IDC was present in 56 (68%), of which 41 (73%) followed SOC, whereas 15 (27%) did not. Two of 26 patients (8%) without IDC received SOC. Complications occurred in 11/82 (13%) (three endocarditis, two osteomyelitis, three endophthalmitis, and four septic thrombophlebitis). Cure was achieved in 26/82 (32%). Relapse or recurrence occurred in 15/82 (18%). The 30-day mortality for the cohort was 50%. Patients with IDC who received SOC had lower mortality compared with those who did not (35% vs. 67%, respectively; P = 0.03).

Conclusion
Candida CLABSI was infrequent but had significant mortality in our cohort. Our results suggest that adherence to SOC per IDSA guidelines and involvement of IDC may improve survival of patients with Candida CLABSI. Future studies are needed to validate these findings.

Disclosures
All authors: No reported disclosures.
Septic Arthritis of Native Joints: Are Outcomes Better with Medical or Surgical Management?
Authors: McConnell Ian , Baghban Adam , Holleck Jurgen , Gupta Shaili 
Published: October 2017

Abstract

Background
There is limited evidence to support medical vs. surgical management of native joint septic arthritis (SA) with no established guidelines for care. Advantages of medical (antibiotics with or without serial needle aspiration) and surgical (arthroscopic or arthrotomic drainage) treatments are unknown.

Methods
We conducted a single-center retrospective chart review of veterans diagnosed with SA over 10 years at the West Haven VA Hospital. Demographic, clinical, laboratory, imaging, and outcome data were extracted. Cases meeting inclusion criteria (positive culture or synovial fluid WBC &gt;50,000) were stratified by surgical vs. medical management. Evaluated outcomes included joint recovery, time to recovery, sterilization of synovial fluid, duration of antibiotics, length of stay, recurrence of SA, and mortality. Odds ratios were calculated by multivariate analyses for correlation of outcomes to risk factors and to management approach taken.

Results
Sixty-one cases of SA met inclusion criteria. Average age was 67, 95% of patients were men, 89% White, 11% Black, 43% diabetic, and 43% had preexisting joint disease. 69% (41/61) of cases were managed surgically. Average length of stay for surgical group was 20 days compared with 14 days for medical group (P = 0.28). Duration of antibiotics was longer in surgical group (60.3) than medical group (35.4), (P = 0.09). S. aureus was the most common pathogen isolated (56%), followed by Streptococcus (11%) and gram-negative organisms (8%). Six (10%) patients had culture-negative SA. Mortality rate at 1 year was 3.2%. Full recovery of joint function at 1 year was achieved equally in both groups (P = 1.0), by 15/20 medically managed (75%) and 31/41 surgically managed (76%), with no significant differences by pathogen. Full recovery at 3 months was noted in 10/20 (50%) medically managed vs. 8/41 (19.5%) surgically managed (P = 0.02). Poor outcomes were not associated with joint location, pathogen, type of joint drainage, number of days to OR, or duration of antibiotics. Blacks had increased odds of poor outcome (OR 9.5; 95% CI 1.3–65.4).

Conclusion
We detected no statistically significant difference in outcomes at 12 months between patients managed medically vs. surgically for native joint septic arthritis. Full recovery at 3 months was significantly higher among the medical group.

Disclosures
All authors: No reported disclosures.
Time-to-Report of the Bone Culture and Microbiologic Adequacy of Empiric Antibiotics in Patient’s with Diabetic Foot Osteomyelitis
Authors: Kim Hyun Kyung , Vasylyeva Olga 
Published: October 2017

Abstract

Background
Bone cultures in diabetic foot infection is the most accurate method to identify causative pathogen, while there is only 30% concordance between superficial wound swab and bone biopsy cultures. Diabetic foot infection is commonly polymicrobial, therefore report on the bone biopsy culture may come with several updates before it is finalized. Our study is aimed to describe how often additional pathogens were identified after patients’ discharge on antibiotics therapy for diabetic foot osteomyelitis, and evaluate microbiological appropriateness of antibiotic regimen upon discharge based on the final result of the bone culture.

Methods
Medical records of the patients 18 years old or older, who had inpatient bone biopsy, deep tissue debridement or amputation for diabetic foot infection, were reviewed from January 2014 through Dec 2015 in Rochester Regional Health System. Antibiotic regimens for the patients discharged before final culture result were evaluated for microbiological appropriateness by two reviewers trained in infectious diseases.

Results
In total, 198 procedures were screened, 158 procedures met inclusion criteria, out of which 74 patients with 80 procedures (51%) were discharged before the final culture result was available. Average time from procedure to the final culture report was 6 days, and from discharge to the final culture was 3.7 days. In most of the cases (70%, 56 out of 80) the patients were discharged on empiric regimen discordant with final culture result. Predominant organisms were Gram-positive bacteria 74%, with Gram negatives 24%, and yeast 2%. Most infections were polymicrobial (81%), mixed with anaerobic bacteria in 37%. The most frequent isolates were Staphylococcus aureus (15%), Corynebacterium (14%), anaerobic Gram-positive cocci (12%), and Staphylococcus epidermidis (8%). All negative Gram stains (31%, 25 out of 80) had positive growth on culture.

Conclusion
Half of the patients with diabetic foot osteomyelitis, who underwent bone biopsy, were discharged before final culture results were available. Most of them were discharged on empiric regimen discordant with final culture. This data suggests that careful outpatient follow-up on the final culture would likely result in modification of antibiotics therapy to target newly reported pathogen.

Disclosures
All authors: No reported disclosures.
Microbiological Epidemiology Depending on Time to Occurrence of Prosthetic Joint Infection (PJI): Impact on the Empirical Antimicrobial Strategies
Authors: Ferry Tristan , Triffault-Fillit Claire , Laurent Frederic , Dupieux Céline , Lustig Sébastien , Fessy Michel-Henri , Chidiac Christian , Valour Florent 
Published: October 2017

Abstract

Background
Empirical antimicrobial therapy of prosthetic-joint infection (PJI) is a major clinical challenge and current guidelines recommend the combination of vancomycin plus a broad-spectrum β-lactamin. As Gram-negative bacilli (GNB) are probably less represented in late infections, we evaluate the microbiological epidemiology in patients with PJI according to the chronology of infection.

Methods
All patients managed in a reference center for complex bone and joint infections in France (2011 and 2016) were included in a prospective cohort study. Microbiological data at the time of diagnosis were collected and analyzed according to the chronology of infection.

Results
We included 567 PJI (284 males, 50.1%; median age 70.3 years). The median occurrence time was 23.4 weeks after prosthesis implantation (285 hip and 255 knee PJI, which were revision prosthesis in 216 [40.3%] cases). Microbiological bone samples found 164 [28.9%] S. aureus (including 26 [16.3%] MRSA), 162 [28.6%] coagulase-negative Staphylococci (CoNS, including 80 [58.8%] methicillin-resistant CoNS), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) Streptococci, and 85 (15.0%) anaerobes (including 60 [10.6%] Propionibacterium). Infection was plurimicrobial in 10 [18.2%] cases. Among the 183 patients (32%) with late PJI (occurring &gt;1 year), obtained after exclusion of the 59 patients (10.4%) with hematogenous origins, Enterobacteriacecae &#x2028;(n = 8; 4.4%; P &lt; 10–3) were much less represented than in patients with early PJI occurring &lt;1 year. No difference was observed regarding the the presence of non-fermenting GNB, with a prevalence of 4.6 and 2.7% in early and late PJI, respectively. Taken together, these data suggest that a broad-spectrum β-lactam antibiotic might be useful in only 12 (6.6%) patients with late PJI, compared with 66 (20.3%) patients with early PJI (P &lt; 10–3). Of note, there were statistically more anaerobes (n = 40; 21.9%) in late PJI, including 32 Propionibacterium (17.5%; P &lt; 10–3).

Conclusion
Considering the minority amount of GNB in late post-operative PJI and the overrepresentation of anaerobes including P. acnes, the empirical treatment should be reconsidered, especially when a two-stage exchange is planned. In those situations, another acceptable option could be the vancomycin+clindamycin combination.

Disclosures
T. Ferry, HERAEUS: Consultant, Speaker honorarium. S. Lustig, Heraeus: Consultant, Consulting fee.
Oral vs. Intravenous Antibiotics for the Treatment of Acute Bacterial Osteomyelitis in the Veteran Population
Authors: Turnbull Caitlin , Young Lisa , Lowery Sheryl 
Published: October 2017

Abstract

Background
The optimal route for administration of antibiotics in the treatment of acute bacterial osteomyelitis (ABOM) has not been clearly defined. Based on pharmacokinetic data and expert opinion, intravenous (IV) antibiotics are considered the standard of care. Studies demonstrate reasonable oral (PO) absorption and bone penetration of certain antibiotics, supporting the potential efficacy of their use in the treatment of ABOM. The purpose of this study was to determine whether a difference exists in treatment outcomes in Veterans with ABOM treated with PO vs. IV antibiotics.

Methods
This is a retrospective, electronic chart review of patients diagnosed with ABOM between October 1, 2008, and September 30, 2013. Subjects were evaluated and placed into two groups: (1) IV antibiotics for at least 4 weeks or (2) PO antibiotics for at least 4 weeks. The primary endpoint was treatment failure within one year of diagnosis. Treatment failure was defined as recurrence of infection, amputation of the infected bone, or if they were lost to follow-up.

Results
In total, 83 patients, accounting for 89 episodes of ABOM were included in this study; 41 in the IV group and 48 in the PO group. Treatment failure occurred in 14 patients in the IV group (34.15%) and 17 patients in the PO group (35.42%), P = 0.90. Subgroup analysis of subjects with diabetes mellitus, peripheral vascular disease, body mass index ≥ 30 kg/m2, and those ≥ 65 years also found no difference between groups. After at least 4 weeks of antibiotic therapy, 10 patients in the IV group and five patients in the PO group had an amputation of the infected bone, P = 0.14. Mean length of hospital stay was significantly longer in the IV group at 8.55 days as compared with the PO group at 2.23 days, P &lt; 0.0001.

Conclusion
Treatment of ABOM with PO antibiotics may serve as a reasonable alternative to IV antibiotics, showing similar efficacy and reduced hospital stay.

Disclosures
All authors: No reported disclosures.