bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilizing a Post-discharge Telephone Call in Outpatient Parenteral Antimicrobial Therapy (OPAT): Findings from a Quality Improvement Project
Authors: Felder Kimberly , Vaz Louise , Barnes Penelope , Varley Cara 
Published: October 2017

Abstract

Background
Transitions of care from hospitals to outpatient settings, especially for patients requiring outpatient parenteral antimicrobial therapy (OPAT) are complex. OPAT complications, such as adverse antimicrobial reactions, vascular access problems, and hospital readmissions are common. Data from transitions of care literature suggest that post-discharge telephone calls (TCs) may significantly decrease re-hospitalization but no studies have assessed the utility of post-discharge TCs as an OPAT program quality improvement process.

Methods
Adult OPAT patients discharged from our hospital between April 1, 2015 and May 31, 2016 were queried for post-discharge concerns. TCs to patients or their caregivers were administered by trained medical assistants within the Department of Infectious Diseases using a standardized script and documented in the electronic medical record (EMR). Feasibility was assessed using call completion rate. The type and frequency of reported issues were analyzed by retrospective chart review.

Results
636 of 689 eligible adult OPAT patients or their caregivers received a TC with responses to scripted questions documented in the EMR (92% completion rate). 302 patients (47%) reported 319 issues, including 293 (92%) relevant to OPAT. Antimicrobial issues included diarrhea/stool changes (58; 9%); nausea/vomiting (27; 4%); and missed antimicrobial doses (22; 3%). Vascular access issues included line patency concerns (21; 3%); vascular access dressing problems (17; 2.6%) and arm pain/swelling (6; 1%). OPAT vendor issues included delays in lab or line care services (23; 4%) and OPAT orders reported as lost/not received (21; 3%). Other ID-related issues included fevers/chills/sweats (27; 4%), wound concerns (16; 2.5%), and pain (15; 2.5%).

Conclusion
Adding a post-discharge TC to an OPAT program was feasible and resulted in frequent and early identification of significant OPAT patient and caregiver concerns. Findings suggest potential high-yield topics for process improvement, as well as anticipatory guidance and patient education in OPAT. Further evaluation and analysis of optimal hospital discharge processes and care coordination in OPAT, as well as their impact on post-discharge adverse events, is needed.

Disclosures
All authors: No reported disclosures.
Impact of an Antimicrobial Stewardship Program Led OPAT Program on Clinical Complications and Frequency of Hospital Readmissions
Authors: Carr J Andrew , Baddley John W , Heath Sonya , Lee Rachael A , McCarty Todd P 
Published: October 2017

Abstract

Background
Treatment of serious bacterial infections with Outpatient Parenteral Antibiotic Therapy (OPAT) has provided patients (patients) the opportunity to complete treatment safely and effectively, while avoiding complications, and prolonged hospitalization. Despite the benefits, considerable risks with drug-related and central venous catheter (CVC)-related complications exist. We sought to improve clinical outcomes of our program by implementing intensive monitoring in partnership with our antimicrobial stewardship program (ASP) with a goal of decreasing the frequency of complications as well as hospital readmission rates and lengths of stay (LOS).

Methods
A retrospective study was conducted including all patients discharged from the Birmingham VA Medical Center on OPAT from January 1, 2015 to December 31, 2016. The start date coincides with ASP development of a physician and pharmacist led OPAT program, working closely with home health agencies. Data collection included baseline demographics, antibiotic indication, antibiotic therapy received, and laboratory monitoring. Clinical outcomes included frequency and types of drug-related complications, CVC complications, hospital admission rate due to complications, and hospital days avoided.

Results
In the study period, 299 patients were discharged on OPAT. They were 96.9% male, and the average age was 64 (Table 1). The average number of hospital days avoided was 32.1. The most common indication was osteomyelitis (Table 1). There were 82 complications in 78 (26%) patients, almost half were acute kidney injury, defined as a rise in serum creatinine requiring a change in antibiotic dosing (Table 2). These led to 25 hospitalizations (32% of patients with complications, 8.3% overall) with another 5 patients being hospitalized for unrelated reasons.

Conclusion
Our medical center instituted an ASP led practice of closely monitoring and directing care with the local home health agencies due to concerns about patient safety. In doing so, we have realized a low rate of complications and an ability to manage the majority while remaining as an outpatient, with the exceptions of CVC-related complications and encephalopathy. Our data supports the center’s efforts and choice to dedicate resources to improving this increasingly popular treatment.

Disclosures
All authors: No reported disclosures.
A Little Bit of Dalba Goes a Long Way: Dalbavancin Use in a Vulnerable Patient Population
Authors: Bryson-Cahn Chloe , Beieler Alison , Chan Jeannie , Senter Steve , Harrington Robert , Dhanireddy Shireesha 
Published: October 2017

Abstract

Background
Serious staphylococcal infections require prolonged courses of intravenous (IV) antibiotics. Weekly IV dalbavancin is an alternative to more frequent IV antimicrobial dosing for homeless patients or persons who inject drugs (PWID), for whom creating a treatment plan can be challenging. We examined the clinical outcomes in patients who were treated with dalbavancin compared with a similar population treated with alternative antibiotics.

Methods
We identified 18 patients who received dalbavancin from June 1, 2015 to December 31, 2016 using pharmacy records and 89 patients receiving IV antibiotics for similar infections treated at Harborview Medical Center from January 1, 2015 to May 31, 2015, before dalbavancin was available. Medical records were reviewed, and patient demographics, length of stay (LOS), readmission, and outcomes were abstracted using REDCap, linked to the University of Washington’s Clinical Data Repository.

Results
Basic demographics in Table 1. The types of infections are in Figure 1. Clinical cure rates were similar between the two groups (Figure 2) although 21% and 28% of the patients were lost to follow-up in the pre and post dalbavancin period. Among the subgroup of PWID, those who received dalbavancin had higher rates of clinical cure (64.7% vs. 29.4%, P = 0.01), a trend toward decreased LOS (11.4 ± 5.8 vs. 20.2 ± 15.1 days, P = 0.04), and fewer 30-day readmissions (0% vs. 29.4%, P = 0.02) (Figure 2). Fewer PWID in the dalbavancin group were lost to follow-up (23.5% vs. 70.6%).

Conclusion
Patients treated with dalbavancin had similar outcomes compared with patients treated in the pre-dalbavancin time period. Among PWID, dalbavancin use led to significantly improved outcomes including a higher clinical cure rate, lower readmission rate, and shorter hospital LOS, which offset the cost of the drug. Dalbavancin is an option for the treatment of serious staphylococcal infections in selected patients.

Disclosures
All authors: No reported disclosures.
Injection Drug Use and Infectious Disease Practice: A National Provider Survey
Authors: Rapoport Alison B , Beekmann Susan E , Polgreen Philip M , Rowley Christopher F 
Published: October 2017

Abstract

Background
The opioid epidemic has swept across the U.S. at a staggering rate, with an estimated half million to one million persons injecting drugs annually. Rates of hospitalization for injection drug use (IDU)-related infection have risen precipitously, comprising an escalating proportion of infectious diseases provider volume in highly impacted regions.

Methods
In March 2017, the Emerging Infections Network surveyed their national network of infectious diseases (ID) physicians to evaluate perspectives relating to the care of persons who inject drugs (PWID), including the frequency of, and management strategies for, IDU-related infection, the availability of addiction services, and the evolving role of ID physicians in the management of addiction.

Results
Over half (53%; N = 672) of 1,276 members with an adult ID practice participated; 78% (n = 526) reported treating PWID. Of 526 respondents, 464 (88%) reported seeing ≥1 patient per month with an IDU-related infection; 228 (43%) reported ≥6 per month. In the past year, 79% of respondents reported the majority of IDU-related infections seen required ≥2 weeks of parenteral therapy and reported frequently encountering skin and soft-tissue infections (61%), bacteremia/fungemia (53%), and endocarditis (50%). Strategies most commonly employed for management of prolonged parenteral antibiotic therapy included: completion of entire course on inpatient unit (by 41%) and transfer to supervised facility for completion (35%). Only 35% of respondents agree/strongly agree their health system offers comprehensive treatment of substance use disorders (N = 181). Though nearly half of respondents felt that ID providers should actively manage substance use disorders (46%; N = 241), only 3% reported being waivered to prescribe buprenorphine for treatment of opioid use disorder.

Conclusion
The majority of infectious diseases physicians frequently care for PWID with serious infections. There is significant diversity amongst providers with regards to the availability of comprehensive addiction services as well as perceptions regarding the role providers should play in the management of addiction. Guidelines for the management of serious infections and concurrent addiction in the midst of the escalating national opioid crisis should be considered.

Disclosures
All authors: No reported disclosures.
Antibiotic Allergies – Is De-labeling Based on Clinical History Feasible?
Authors: Torda Adrienne , Chan Victor 
Published: October 2017

Abstract

Background
Up to 25% of patients admitted to hospital have an antibiotic allergy label (AAL), most of which are towards penicillin. However, up to 90% of patients who claim to be allergic to penicillin are actually able to tolerate them1. Whilst skin testing is safe and efficacious in de-labeling patients with a penicillin allergy label, it is usually not widely available. Therefore, we investigated the feasibility of de-labeling based solely upon clinical grounds. Quality of allergy documentation and subsequent antibiotic use was also assessed.

Methods
This was a cross-sectional study assessing all patients admitted to a tertiary referral teaching hospital over a 5-month period in 2016. All newly admitted patients were prospectively screened for the presence of an antibiotic allergy documented in their electronic medical record. Unless unable to participate, patients were interviewed regarding the detailed nature of their antibiotic allergy. Information regarding allergy documentation, medical condition and antibiotic use was obtained from medical records.

Results
3855 patients were screened, 553 (14.35%) had an AAL, and 352 were interviewed. There were 426 allergies, 276 (64.8%) towards a penicillin. Only 52% of patients had a convincing history consistent with antibiotic allergy, and 48% of these were mild cutaneous reactions. It was felt that de-labeling and direct re-challenge would be relatively safe in 70% (298/42) of AALs (if the mild cutaneous allergic group were included). In patients who were prescribed antibiotics during study admission, 25.6% (41/160) of antibiotic prescriptions in our cohort were found to be inappropriate in patients with AALs.

Conclusion
Direct re-challenge based upon clinical grounds appears to be a feasible clinical option in many patients with AALs and would allow de-labeling of these patients. The major barriers continue to be patient acceptance and risk of severe adverse reactions. Our study also found that major improvements could be made in the specific documentation of allergy and also in selection of guideline-recommended alternate antibiotics.
1. Joint Task Force on Practice Parameters. Drug Allergy: An Updated Practice Parameter. Ann Allergy Asthma Immunol. 2010; 105(4): p. 259–273.

Disclosures
All authors: No reported disclosures.
Case–control Study Evaluating Risk Factors and Treatment Outcomes for Community-Acquired Urinary Tract Infections (UTI) Caused by Extended-Spectrum Β-Lactamase (ESBL)-Producing Pathogens
Authors: Lee Stephen , Fish Douglas N , Barber Gerard , Barron Michelle 
Published: October 2017

Abstract

Background
Community-acquired (CA) infections caused by ESBL-producing pathogens are becoming more common. Risk factors (RFs) for CA ESBLs have not been as extensively studied and remain relatively undefined. Recognition of patient-specific RFs for CA ESBL infections such as UTI can potentially improve patient outcomes through selection of more appropriate initial drug therapy. The objectives of this study were to identify RFs and associated treatment outcomes for CA UTI involving ESBLs.

Methods
Adult patients with CA ESBL UTI (cystitis) seen in the Emergency Department (ED) from 2009 through 2013 were retrospectively matched 1:1 with a control group of non-ESBL CA UTI based on age within 5 years, gender, and organism. The primary outcome was identification of RFs predictive of CA ESBL UTI. Secondary outcomes included comparison of ESBLs and controls in risk of inappropriate initial antibiotic therapy and need for additional follow-up to healthcare facilities (clinics, ED) within 14 days of initial treatment.

Results
Eighty-five patients were matched into each group. Compared with controls, CA ESBL UTI was associated with nursing home stay (P = 0.04), congestive heart failure (CHF, P = 0.04), hospitalization within the previous year (P = 0.04), and receipt of either any antibiotics or specifically, fluoroquinolones within the previous 3 months (P &lt; 0.01 for both) by univariate analysis. Multivariate logistic regression identified hospitalization within 1 year (OR 3.8, 95% CI 1.7–8.7; P &lt; 0.001), antibiotics within 3 months (OR 3.5, 95% CI 1.7–7.6; P &lt; 0.001), and CHF (OR 4.9, 95% CI 1.3–24.7; P = 0.02) as significant RFs for ESBL CA UTI. Patients with CA ESBL infections were more likely to receive inappropriate initial antibiotics (OR 8.9, 95% CI 4.2–18.6; P &lt; 0.0001) and, if treated inappropriately, to require repeat visits to healthcare facilities within 14 days (OR 11.4, 95% CI 2.6–50.8).

Conclusion
Previous hospitalization, previous antibiotics, and CHF were RFs associated with CA ESBL UTI. These patients were significantly more likely to be treated inappropriately and to require additional healthcare follow-up. Recognition of RFs for CA ESBL UTI may facilitate appropriate ED-based management and avoid additional resource utilization.

Disclosures
D. N. Fish, Merck & Co.: Grant Investigator, Research grant M. Barron, Merck & Co.: Grant Investigator, Research grant
Prevalence and Accuracy of Screening Test of Asymptomatic Bacteriuria During Pregnancy in Siriraj Hospital
Authors: Srisompong Jintana , Rahman Suraiya , Russameecharoen Kusol , Tongsai Sasima , Seenama Chakkrapong , Koomanachai Pornpan 
Published: October 2017

Abstract

Background
The early detection and treatment asymptomatic bacteriuria (ASB) during pregnancy prevents maternal and fetal complication. Thus the American College of OB-GYN recommends urine culture should be obtained at the first prenatal visit and the U.S. Preventive Services Task Force obtains urine culture during 12–16 weeks of gestation. The new antenatal care (ANC) model of Thai Ministry of Public Health uses screening at first ANC by urine dipstick. However, neither research nor routine ASB screen in Siriraj Hospital because there was low prevalence and all pregnancy been screened by the obstetricians.

Methods
Prospective cohort study was performed at the ANC clinic, OB-GYN department, Siriraj Hospital. Pregnancies of first antenatal care visit during January to December 2015 were enrolled. Urine culture (UC), Urine dipstick for nitrite (UDN), and Urine dipstick for leukocyte esterase (UDL), were performed. Subjects’ baseline characteristics until birth delivery were collected.

Results
Total 702 subjects were enrolled; median age, 28 yrs (range 16–45) and body mass index, 24.1 (range 14.0–44.3). The ASB prevalence was 2.3% (16 from 702) without significant difference between first, second, and thirdtrimester, P = 0.185. The most common organism was E. coli. Factors related to ASB were heart disease,&#x2028;P &lt; 0.001 and having sexual intercourse during pregnancy, P = 0.005. The sensitivity and specificity of UDN and UDL were 37.5% and 99.0% and 56.3% and 55.7%, respectively. Positive predictive value and negative predictive value of UDN and UDL were 46.2% and 2.9% and 98.5% and 98.2%, respectively. No abnormal maternal and fetal outcomes were reported.

Conclusion
According to very low prevalence of ASB in Siriraj hospital, routine urine culture may be unnecessary for all antenatal pregnancy. However, heart disease and sexual intercourse during pregnancy should be considered for screening and treatment. However, further evaluation of outcome, i.e. UTI, maternal and fetal complication of non-screening for ASB should be studied.

Disclosures
All authors: No reported disclosures.
Are Urinalyses Used Inappropriately in the Diagnosis of Urinary Tract Infections?
Authors: Elshimy Ghada , Mariano Vincent , Joy Christina Mariyam , Kaur Parminder , Singhal Monisha 
Published: October 2017

Abstract

Background
One of the most readily available and cost effective tests in the diagnosis of urinary tract infections (UTI) is the urinalysis. Problems arise when antibiotic treatment is initiated in a patient who does not display typical signs and symptoms of UTI and for whom a urinalysis was obtained for other reasons.

Methods
This was a retrospective observational study carried out on 1000 patients with positive urine nitrite. Medical records were identified with subsequent analysis of urine culture and symptomatology. Recorded and analyzed data included: age, sex, location (emergency room (ER) or hospital ward), findings on urinalysis (pH, presence of leukocyte esterase(LE), epithelial cells, bacteria, and white blood cells (WBCs)) and antibiotic treatment.

Results
Of these 1000 patients with positive nitrite, we excluded 815 patients (81 had missing data, 466 met exclusion criteria and 268 had symptomatic UTI). 185 were found to not have any symptoms of a UTI. Inappropriate antibiotic treatment occurred in 108/185 patients (58.4%) and was significantly associated with greater amounts of bacteria and WBCs in the urinalyses (P = 0.008 and P = 0.029, respectively). It was also significantly more likely to occur in the ER than the hospital wards (92/147 treated in the ER vs. 16/37 treated on the hospital wards, P = 0.033). There was no significant association between antibiotic treatment and age, sex, urine pH, urine LE, and urine epithelial cell amounts (P &gt; 0.05). Urine cultures were not obtained in 69.7% of patients. A positive urine culture was significantly associated with inappropriate antibiotic treatment (P = 0.0006). The two most common presenting complaints were psychiatric complaints (21.6%) and vaginal bleeding (14.6%).

Conclusion
Urinalysis can be an invaluable diagnostic tool, but must be used and interpreted appropriately. There is a misperception that pyuria with bacteriuria defines UTI. However, positive results on a urinalysis alone in an asymptomatic patient is not enough to diagnose a UTI, and antibiotic treatment is only indicated in specific circumstances as outlined by IDSA guidelines for the treatment of asymptomatic bacteriuria. Further education targeting appropriate interpretation of urinalyses and IDSA guidelines is needed to decrease the unnecessary use of antibiotics.

Disclosures
All authors: No reported disclosures.
The prognostic importance of platelet indices in patients with Crimean-Congo Hemorrhagic Fever
Authors: Aksoy Firdevs , Yilmaz Gürdal , Kaya Selcuk , Karahan Süleyman Caner , Koksal Iftihar 
Published: October 2017

Abstract

Background
Platelet count is an important tool for the diagnosis and prognosis of Crimean-Congo Hemorrhagic Fever (CCHF). The platelet indices plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW) are parameters obtained as part of the automated complete blood count. These parameters are of prognostic importance in several diseases. The aim of this study was to evaluate the platelet count and its relations with platelet indices in CCHF patients.

Methods
One hundred and forty-nine patients with confirmed CCHF were included in the study. Patients were divided into two groups (severe cases, patients who exhibited hemorrhage during their hospital stay, and mild/moderate cases with no hemorrhage during hospital stay). The demographic characteristics and laboratory test results of all patients were compared. P &lt; 0.05 was regarded as statistically significant.

Results
Hemorrhaging was observed in 38.3% of patients during hospitalization. Platelet count, PCT and PDW values (respectively) on the first day of hospitalization were 43.3 ± 29.3, 0.06 ± 0.07%, and 17.4 ± 1.5% in the severe cases and 64.5 ± 35.4, 0.08 ± 0.03%, and 16.8 ± 1.5% in the mild/moderate cases, respectively (P &lt; 0.05). The difference between MPV values was not statistically significant. At cutoff values at ROC analysis, platelet count (≤53000) and PCT(≤0.06) exhibited 73.7% and 71.9% sensitivity, respectively, and predicted a hemorrhagic disease course with a 80.9% negative predictive value. Seven of the severe patients died (P = 0.001). At cutoff values, platelet count (&gt;31000) and PCT (&gt;0.03) predicted patient survival with 100% specificity and 100% positive predictive value.

Conclusion
Our study shows that platelet count, PCT and PDW are parameters that may be used to determine disease severity. The platelet index, and particularly PCT, may be at least as useful as platelet count in helping clinicians identify severe cases.

Disclosures
All authors: No reported disclosures.