bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Comparison between Native Vertebral Osteomyelitis with Abscess vs Without Abscess in Clinical Features and Outcomes
Authors: Matsuo Takahiro , Mori Nobuyoshi , Hoshino Eri , Sakurai Aki , Furukawa Keiichi 
Published: October 2017

Abstract

Background
It is well documented that native vertebral osteomyelitis (NVO) is accompanied by abscess formation (epidural, paravertebral, and psoas muscle) that is complicated by neurological deficit. There are few studies comparing between NVO with abscess and NVO without abscess in clinical features and outcomes.

Methods
We conducted a retrospective cohort study at St. Luke’s Intl. Hosp. in Tokyo, Japan (acute care hospital, 520 beds) from 2004 to 2015. Diagnosis of acute NVO was made by clinical signs and symptoms, and MRI. Clinical features and outcomes of NVO patients with abscess were compared with ones without abscess. Fisher’s exact test, Mann–Whitney U-test, and Kaplan–Meier curve with log-rank test were used in univariate analysis and the association to length of stay was analyzed by Cox-regression model controlling confounding.

Results
Among 122 patients with NVO, 83 patients (68%) had abscess (group A) and 39 patients (32%) had no abscess (group B). Median age: (group A: 69 vs. group B: 66, P = 0.641). Median length of stay (LOS) in hosp: (A: 48 vs. B: 43 days, &#x2028;P = 0.007) (Table 1). Group A had higher rate of neurological symptoms (16.9 vs. 2.6%, P = 0.035), blood cultures positivity (62.7 vs. 35.9%, P = 0.007), infective endocarditis (IE) (15.7 vs. 2.6%, P = 0.036), and longer duration of therapy (75 vs. 56 days, P = 0.025) than group B in univariate analysis. Also, group A had trend toward higher rate of methicillin-susceptible S. aureus (28.9 vs. 5.1%, P = 0.056). Kaplan–Meier analysis revealed LOS was significantly longer in group A (P = 0.013) (Figure 1). The result of Cox’s proportional hazards model suggested abscess was associated with longer LOS (Table 2). Blood culture positivity was independently associated with longer LOS. No statistically significant associations were observed between abscess and 90-day mortality (5.1 vs. 3.6%, P = 0.654), or neurological sequelae (6 vs. 0%, P = 0.227).

Conclusion
LOS of NVO patients with abscess was longer than those without abscess. In particular, LOS was significantly longer in patients with positive blood culture than those with negative results.

Disclosures
All authors: No reported disclosures.
The Influence of Obesity on the Infection Risk of Prosthetic Joint Infection in the Geriatric Orthopedic Population
Authors: Nocon Allina , Henry Michael , Russell Celeste , Westrich Geoffrey , Brause Barry , Miller Andy 
Published: October 2017

Abstract

Background
Prosthetic joint infection (PJI) is a dreaded complication of arthroplasty. PJI are more common in the elderly and are associated with a substantial increase in 5-year mortality risk. PJI risk may correlate with increasing body mass index (BMI). However, the effect of BMI on PJI risk in the elderly has not been evaluated, to our knowledge. We sought to evaluate this relationship in a cohort of geriatric arthroplasty patients at an orthopedic specialty hospital.

Methods
A retrospective cohort of hip and knee arthroplasty patients (age &gt;75) from 2009–2014 was identified through administrative hospital data using ICD-9 codes. Patients with a BMI &lt;14 or &gt;60 kg/m2, height &lt;142 or &gt;200 cm, and weight &lt;36 or &gt;226 kg were excluded. The presence of infection was confirmed via chart review; all PJIs met MSIS criteria. Obesity was defined as having a BMI &gt;30. Univariate analyses were done using χ 2 tests and adjusted models were assessed using logistic regression.

Results
13,755 geriatric arthroplasty patients (6,408 total hip arthroplasties [THA] and 7,347 total hip arthroplasties [TKA]) were assessed. Mean age and BMI were 82 (±5.4) and 28.1 (±5.3), respectively. In an unadjusted model, obesity was associated with infection in THA (P = 0.02), but not TKA (P = 0.31). This association remained after adjusting for age, sex, and diabetes. Obesity was associated with an increased risk of infection in THA [OR=1.89 (95% CI 1.12–3.21); P = 0.02]. However, as with the unadjusted model, this relationship was not found in TKA (P = 0.50).

Conclusion
Obesity increases THR PJI risk in the elderly. However, no such association was found for TKA. Future studies are needed to quantify the compounded risk of obesity in the geriatric arthroplasty patient.

Disclosures
All authors: No reported disclosures.
Epidemiology and Clinical Features of Septic Arthritis in Children
Authors: Andrews Shannon , Sharon Bazak 
Published: October 2017

Abstract

Background
Children with acute arthritis are commonly admitted to the hospital in part due to concern for septic arthritis (SA) and its complications. Many noninfectious, non-urgent conditions are more common than SA and present similarly. The epidemiology and clinical presentation of SA influences management of patients with acute arthritis.

Methods
Utilizing the electronic medical record, we reviewed the charts of children (1–18 years old) with joint complaints who presented to the hospitals and clinics of one large academic health organization in the Upper Midwest from January 2011 to July 2016. Query criteria included the presenting symptom (“arthritis”, “joint swelling”, or “joint pain”), diagnosis (“arthritis”, “septic arthritis”, or “Lyme arthritis”), and/or positive synovial fluid culture. SA was confirmed when synovial bacterial culture or PCR were positive. SA was suspected in cases with a positive blood culture or when the patient was treated empirically with 4 weeks of antibiotic with no alternate diagnosis. All other children were excluded from the study cohort.

Results
Of the 705 children whose charts were reviewed, 609 were excluded with a noninfectious diagnosis and 72 with Lyme arthritis (Figure 1). We identified 24 children with SA. Six children diagnosed with SA were immunosuppressed. Among healthy children with SA, seven were diagnosed with contiguous musculoskeletal (MSK) infection and 11 were diagnosed with acute, isolated, monoarticular arthritis. SA was more common in boys. The most common pathogen isolated was S aureus (13). The knee (7) and hip (6) accounted for the majority of joints involved in healthy children.

Conclusion
SA is a rare cause of acute arthritis in children. In healthy children, SA may present with contiguous MSK infection or in an isolated joint. SA is more likely in boys and in the knee or hip joint. S. aureus is the most common cause of SA. Clear understanding of the epidemiology and clinical history of SA should shape clinical decision making in children with acute arthritis.

Disclosures
All authors: No reported disclosures.
Recent Respiratory Tract Infection and Additional Surgeries Increase Risk for Surgical Site Infection in Total Joint Arthroplasty: A Retrospective Analysis of 2255 Patients
Authors: Navalkele Bhagyashri , Krishna Amar , McKelvey George , Perov Samuel , Sood Kunal , Dakallah Youssef , Chopra Teena 
Published: October 2017

Abstract

Background
Surgical site infections (SSI) are one of the most common healthcare-associated infections contributing to high economic burden. Around 658,000 total joint arthroplasties (TJA) are performed annually in the Unites States, estimated 0.9–2.5% develop surgical site infection. Despite following prevention guidelines, SSI continues to occur. The aim of our study was to identify perioperative risk factors for SSI in patients undergoing TJA.

Methods
A retrospective cohort study was performed of patients at the Detroit Medical Center from 2011 to 2015. All adult patients undergoing primary or revision total knee or hip joint arthroplasty were included. Patients were divided into SSI (prosthetic joint infections) and non-SSI group. Baseline characteristics and perioperative variables influencing SSI were assessed. Statistical analysis was performed using SAS software. Continuous variables were compared using Wilcoxon–Rank-sum test and categorical variables using Fischer’s exact test.

Results
Among 2255 included patients, 1203 had knee arthroplasties (53%), 1052 had hip arthroplasties (47%) and SSI occurred in 46 patients (2%). Overall, mean age was 58.81 ± 11 years; 64% were females, 57% were African American, and 41% were smokers. Diabetes did not increase risk for SSI (37% with SSI vs. 26% without SSI; P = 0.09). Administration of general anesthesia, American Society of Anesthesiologists score of ≥2, the presence of hypothermia and hyperglycemia did not statistically increase the risk for SSI. Patients with recent respiratory tract infection in previous 30 days prior to surgery were more likely to develop infection compared with patients without recent infection (20% vs. 6.6%, OR 3.42; 95% confidence interval 1.62–7.22, P = 0.0034). Any additional surgery within 90 days of arthroplasty increased risk for infection (22% vs. 11%, P = 0.03). Among the 46 SSIs, knee surgeries experienced more infections than hip surgeries (67% vs. 33%, P = 0.07).

Conclusion
In this study, recent respiratory tract infection in 30 days prior to surgery and additional surgeries within 90 days after arthroplasty increased risk for SSI. Careful preoperative assessment and sufficient time to postoperative recovery is essential to reduce SSI. Further multicenter studies are needed to validate our findings.

Disclosures
All authors: No reported disclosures.
High-Level Neisseria gonorrhea Resistance Detected in a Newly Implemented Surveillance Program in Kampala, Uganda
Authors: Workneh Meklit , Lamorde Mohammed , Kakooza Francis , Mbabazi Olive , Mugasha Rodney , Walwema Richard , Manabe Yukari , Musinguzi Patrick 
Published: October 2017

Abstract

Background
Neisseria gonorrhea resistance is a growing problem in Uganda with recent data showing increasing ciprofloxacin resistance up to 100% in this population. The WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) was initiated in Uganda in September 2016 to monitor resistance trends.

Methods
Urethral swabs were collected from men presenting with urethral discharge to the five sentinel clinic sites from September 2016 to March 2017. Samples were transported to a reference laboratory site. Presumptive identification of N. gonorrhea was based on growth of typical appearing colonies on Thayer–Martin in 5% CO2, a positive oxidase test, and observation of Gram-negative, oxidase-positive diplococci in stained smears.

Results
116 samples were received to the reference laboratory site of which 70 (60.3%) had positive growth for Neisseria gonorrhea. Mean age was 28.5 (range 17–60). Fifty-one participants (44%) reported at least one prior episode of gonorrhea and 42 (36%) reported antibiotic use within the previous 60 days. Of those with completed Etest (bioMerieux, Marcy-lÕEtoile, France) resistance profiles, 66 (96%) were ciprofloxacin-resistant or intermediate. One isolate was ceftriaxone-resistant by E-test but susceptible by disk diffusion.

Conclusion
Early results from implementation of a gonorrhea surveillance program in Uganda suggest high levels of resistance to ciprofloxacin (90%) by Etest and penicillin (93%) and tetracyclines (100%) by disk diffusion. Prior studies of gonococcal resistance in Uganda have noted increasing levels of resistance, particularly to ciprofloxacin which until 2010 was the recommended first-line empiric therapy for gonococcal infection in Uganda. Of note, discrepancies were occasionally noted between disk diffusion and Etest results, which requires further investigation. Ongoing surveillance efforts will be crucial to shape clinical guidelines and national policy.

Disclosures
All authors: No reported disclosures.
Extragenital Gonorrhea and Chlamydia Testing Among Women Reporting Extragenital Exposure at an Urban STD Clinic: Is It Worth the Cost?
Authors: Caragol Laura , Voegeli Christopher , Mettenbrink Christie , Wendel Karen , Rietmeijer Cornelis 
Published: October 2017

Abstract

Background
Current guidelines only recommend screening for gonorrhea (GC) and chlamydia (CT) at extragenital sites of exposure in men who have sex with men (MSM). With Medicaid reimbursement for GC/CT nucleic acid amplification testing (NAAT) at approximately $48/test, expanding testing to women requires a value assessment. We report the prevalence of extragenital GC/CT in women with extragenital exposure, determine the proportion of disease missed by urogenital NAAT, and estimate additional cost per infection identified by extragenital testing in women vs MSM.

Methods
We conducted a retrospective analysis of women undergoing extragenital NAAT for GC and CT at Denver Metro Health Clinic. Data were analyzed for all women with extragenital testing from 9/11/2015 to 7/8/2016, and for MSM from 9/3/2013 to 7/8/2016. Statistical Package for the Social Sciences and Excel programs were used for data analysis.

Results
In a total 804 female visits, the mean age was 29 (13–67years); 46% were White non-Hispanic; 37% were Hispanic; and 15% were Black. In women, the prevalence of extragenital GC and CT was 2% (16/804) and 5% (38/804), respectively. The rate of GC infection in women was the same at genital and pharyngeal sites (2%, 16/804) but lower at the rectum (0.25%, 2/804). Female chlamydia rates were 11% genital (85/804), 4% pharyngeal (30/804), and 1.4% rectal (11/804). If only urogenital testing had been performed in women, 27% (6/22) of GC infections and 14% (14/99) of CT infections would have been missed. Overall, isolated extragenital infection accounted for 18% (20/111, 95% CI 12–26%) and 65% (943/1453, 95% CI 62–67%) of the combined GC and CT burden in women and MSM, respectively. On average, 40 women and five MSM were screened with extragenital tests to identify one isolated extragenital infection. Estimated additional Medicaid costs for isolated extragenital infection identified in women was $3,851 and in men was $480 for pharyngeal and rectal testing.

Conclusion
Urogenital screening misses a significant number of extragenital infections in women. However, given the high cost of extragenital screening in women, further work is needed to determine whether screening can be limited to the pharynx or if risk factors can be used to target screening for cost savings.

Disclosures
All authors: No reported disclosures.
Association Between Hospital-Onset Clostridium difficile infection and Admission to a Multi-Bed Room: A Case–control Study
Authors: Vaisman Alon , Jula Michael , Wagner Jessica , Winston Lisa G 
Published: October 2017

Abstract

Background
Few studies have directly examined the link between assignment to a multi-bed vs. single-bed room and the risk for hospital onset C. difficileinfection (HO-CDI). Therefore, in this case–control study, we investigated whether assignment to a single-bed room reduced the risk of HO-CDI in adult inpatients on medical/surgical floors.

Methods
Consecutive cases of HO-CDI, defined as adult patients admitted to San Francisco General Hospital with a new positive C. difficile stool test &gt;72 hours after admission, were identified for the period between January 1, 2010 to December 31, 2015. Patients who first tested positive for C. difficilein the ICU or who had a history of CDI within the last 12 months were excluded. Controls were selected from the general medical/surgical inpatient population using incidence density sampling and matched to cases on the basis of admission unit and length of admission. A multi-bed room was defined as any room with one or more roommates. A multivariate cox proportional hazard model was used to estimate the relationship between room assignment (single vs. multi-bed) and development of HO-CDI. Variables included in the model, on the basis of a directed acyclic graph, were length of admission, HIV infection, and age.

Results
184 cases and 373 controls were identified during the study period. The median ages of cases and controls were 60 years and 56 years, and mean Charlson comorbidity scores were 3.8 and 3.7, respectively. The hazard ratio for the development HO-CDI associated with multi-bed room exposure was 2.32 (P = 0.03) with a 95% CI for the hazard ratio of 1.05 to 5.17.

Conclusion
In this study, assignment of patients to multi-bed rooms on general medical and surgical wards was associated with an increased hazard for the development of HO-CDI. This finding, especially if confirmed in other institutions, could have implications for patient room assignment and hospital design.

Disclosures
All authors: No reported disclosures.
Derivation and Validation of a Clinical Prediction Rule for Complications of Clostridium difficile Infection Using a Multicenter Prospective Cohort
Authors: 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
Clostridium difficileinfection (CDI) outbreaks were associated with increase in unfavorable outcomes. Identifying and predicting risk of developing complications (cCDI) early in the course of illness could improve clinical decision-making. We developed and validated a prediction rule for cCDI.

Methods
Adult inpatients with confirmed CDI in 10 Canadian hospitals were enrolled and followed for 90 days. Data within 48h of CDI diagnosis were collected: demographics, underlying illnesses, past medical and drug history, clinical signs, blood tests, and strain ribotype. cCDI was defined as one or more of: colonic perforation, toxic megacolon, colectomy, need of vasopressors, ICU admission due to CDI, or if CDI contributed to 30-day death. Predictors’ selection was supported by experts’ opinion suggesting 17 clinical criteria. Cross-validation technique was used (2:1 ratio) and multivariable logistic regression for predictive modeling in the derivation subset. The optimal model was assessed by area under ROC curve (AUC) and prediction error (PE). A predictive score was built by assigning points proportional to adjusted risk estimates.

Results
Among 1380 patients enrolled, 1050 were used for predictive modeling (median age 70 years and one-third infected by ribotype 027 strains). Cases were split into training (n = 700) and validation sets (n = 350). A cCDI occured in 8% and 6.6% respectively. The optimal model with a PE of 5% and an AUC of 0.84 in the validation set included WCC (&lt; 4, 12–19.9, or ≥20 × 109/L), BUN≥11 mmol/L, serum albumin &lt;25 g/L, heart rate &gt; 90/minute, and respiratory rate &gt;20/minute. A predictive score of min 0 and max 13 points was derived. A score ≥7 points was associated with 70% cases of cCDI, showed 68% sensitivity (95% CI, 55–80) in the derivation set and 70% (51–88) in the validation set, a specificity of 73% (69–76) and 76% (72–81) respectively, 17% PPV (9–25), and 97% NPV (95–99) in both sets.

Conclusion
Using a large multicenter prospective cohort and robust modeling approach, we derived a predictive score that included easily available measures at the bedside. The score showed acceptable performance. Further validation is needed on cohorts with different characterstics (non-outbreak setting, higher rate of cCDI). Other approaches such as combination of biomarkers could be more predictive of cCDI.

Disclosures
J. Powis, Merck: Grant Investigator, Research grant; GSK: Grant Investigator, Research grant; Roche: Grant Investigator, Research grant; Synthetic Biologicals: Investigator, Research grant
External validation of clinical scores to predict complications of 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
Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea. About one in 5 patients with CDI (median 18%) develop a complication (cCDI), including mortality. Many predictive scores have been published to identify patients at risk of cCDI but none is currently recommended for clinical use and few were validated. We conducted an external validation study of predictive tools for cCDI.

Methods
Predictive tools were identified through a systematic review. We included those reporting at least an internal validation process. We performed the external validation on a multicenter prospective cohort of 1380 Canadian adults with confirmed CDI. Most cases were elderly (median age 71), had a healthcare facility-associated CDI (90%), and cCDI occurred in 8%. NAP1 strain was found in 52%. The performance of each scoring system was analyzed using individual outcomes. Modifications in predictors were made to match available data in the validation cohort.

Results
We assessed 3 predictive scores and one predictive model. The performance (95% CI) of higher thresholds are shown in the Table. All scores had a low sensitivity and PPV, and moderate specificity and NPV. The model of Shivashankar 2013 (age, WBC&gt; 15, narcotic use, antacids use, creatinine ratio &gt; 1.5) predicted 25% probability of cCDI. All showed similar AUC (0.63–0.67).

Conclusion
The predictive tools included in our study showed moderate performance in a validation cohort with a low rate of cCDI and high proportion of NAP1 strains. Further research is needed to develop an accurate predictive tool to guide clinicians in the management of CDI.

Disclosures
J. Powis, Merck: Grant Investigator, Research grant; GSK: Grant Investigator, Research grant; Roche: Grant Investigator, Research grant; Synthetic Biologicals: Investigator, Research grant
A Nurse-Driven Protocol to Reduce Hospital-Acquired Clostridium difficile Infections
Authors: Nanayakkara Deepa , Mejia Eveline , Nanda Neha 
Published: October 2017

Abstract

Background
Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections. Timely diagnosis is key to reducing associated morbidity and costs. Healthcare-onset (HO) CDI is defined as infection diagnosed 72 hours after hospitalization. Centers for Medicare and Medicaid Services has established benchmarks for HO-CDI for hospitals, which are based on several factors including type of hospital and case mix index. There is a financial penalty if we are above the benchmark. In 2016, 20% of our community-onset C. difficile (CO-CDI) cases were misclassified as HO-CDI. In order to reduce this misclassification, we established a process to assist in early diagnosis.

Methods
We designed and implemented a nurse-driven C. difficile screening protocol to assist in early identification of CO-CDI. Every patient admitted to Keck Hospital (KH) (401 beds) and Norris Comprehensive Cancer Center (35 beds) was screened for diarrhea within the past 24 hours. If diarrhea was present, additional questions were used to capture CO-CDI cases. A nursing order for C. difficile testing was activated for patients who met any of these criteria. Additionally, we used Bristol stool scale (BSS) to standardize stool collection. Only Bristol stool type 7 was accepted by laboratory for processing. Our study period was January 1st through April 30th, 2017 and our baseline period was January 1st through April 30th, 2016.

Results
Screening protocol and BSS were introduced on January 1st, 2017. During the baseline period, a total of 351 orders were placed with 31% within first 3 days of admission. During the study period, a total of 200 orders were placed with 43% within 3 days of admission. Compliance with using the screening tool was nearly 100%. Inter-rater reliability between nurses and lab for identifying the correct BSS was 100%. Baseline misclassification rate was 16%. With the introduction of this screening tool, misclassification decreased to 9%. The HO-CDI rate for the baseline period was 11.5 per 10,000 patient-days and it decreased to 6.27 per 10,000 patient-days in the study period.

Conclusion
We have demonstrated a reduction in HO-CDI rates by establishing a process to assist in early identification of CO-CDI.

Disclosures
All authors: No reported disclosures.