bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-71. Combined Orthopaedic and Infectious Disease Periprosthetic Joint Infection Clinic: A Survey Study
Authors: Dilbone Eric , Leal Justin , Hendershot Edward F , Gettler Erin , Seidelman Jessica , Seyler Thorsten M , Jiranek William A 
Published: January 2025

Abstract

Background
The rising incidence of total joint arthroplasties being performed is leading to an increased number of prosthetic joint infections (PJI). PJI treatment is complex, thus a collaborative approach involving orthopaedic surgeons and infectious disease (ID) providers is growing. This single institution has a weekly combined Ortho-ID (OID) clinic that sees PJI patients and is staffed by joint replacement fellows and ID attendings. This project sought to survey the joint replacement fellow participants from recent years regarding the impact of this experience on their subsequent clinical practice.
Figure 1

Methods
A survey was distributed to fellows who participated in the combined OID clinic during their single year of fellowship from 2020 through 2023 to evaluate the impact of this experience on their development as clinicians and current clinical practice. An anonymous survey included all current and former fellows since the inception of this clinic in 2020. Institutional review board (IRB) approval was obtained prior to the distribution of the survey.
Table 1

Results
A total of 14 current and former fellows received the survey and 12 responded. The majority of the respondents are currently in an academic practice setting (75%), with the rest being hospital employed (17%) or private practice (8%). Taking care of PJI patients makes up anywhere from 0-40% of the respondents’ practices. 92% of former fellows felt that the multi-disciplinary approach to this clinic helped prepare them for managing PJI patients in practice today. 92% also felt that this experience would be beneficial going forward for future fellows and that the current model of ½ day clinic once per month was sufficient.

Conclusion
A combined OID clinic is increasingly a popular approach to the management of PJI patients, but little is known about the utility of this clinic setting for trainees. This survey of participants in this model of clinic shows that once in practice, many orthopedic surgeons found that this experience gave them tools to better manage their PJI patients. Arthroplasty fellowship programs should consider including a combined OID clinic as part of their fellowship.

Disclosures
Jessica Seidelman, MD, MPH, 3M: Expert Testimony
P-74. Can Laboratory Investigations Predict Relapsing Malignant Otitis Externa ?
Authors: Hammami Fatma , Rekik Khaoula , Smaoui Fatma , Chakroun Amal , Marrakchi Chakib , Koubaa Makram , Ben Jemaa Mounir 
Published: January 2025

Abstract

Background
Malignant otitis externa (MOE) is a life-threatening infection of the external auditory canal. Relapse was reported in 9 to 27% of the cases, mainly due to inadequate length of treatment. We aimed to evaluate the predictor value of laboratory investigations in relapsing MOE.

Methods
We conducted a retrospective study including all patients hospitalized in the infectious diseases department for MOE between 2000 and 2022. Receiver operating characteristic curves and areas under the curves (AUC) were calculated to evaluate the predictor value of laboratory investigations in relapsing MOE.

Results
We included 116 cases, among which 64 were males (55.2%). Relapse was noted in 18 cases (15.5%). The white blood cells count was significantly higher among relapsing MOE cases (10220[8400-10770] /mm3 vs 8290[7020-9600] /mm3 ; p=0.022). The optimal cut-off of white blood cells count for predicting relapse among MOE cases was 8860/mm3, with a sensitivity of 72.2% and a speciﬁcity of 64.2%. The AUC was 0.670 and the 95% conﬁdence interval ranged from 0.544 to 0.796. Neutrophil levels were significantly higher among relapsing MOE cases (6730[5320-7562]/mm3 vs 5260[4420-6740]/mm3 ; p=0.024). The optimal cut-off of neutrophil level for predicting relapse among MOE cases was 5975/mm3, with a sensitivity of 70.6% and a speciﬁcity of 68.4%. The AUC was 0.676 and the 95% conﬁdence interval ranged from 0.545 to 0.806. Creatinine levels were significantly lower among relapsing MOE cases (64[52-91] µmol/L vs 91[70-117] µmol/L ; p=0.013).

Conclusion
White blood cells count and neutrophil levels are a simple blood test that can predict relapsing MOE cases. Such patients require a regular follow-up in order to promptly diagnosis relapse.

Disclosures
All Authors: No reported disclosures
P-75. Factors Predicting Sequelae After Treatment Of Spondylodiscitis
Authors: Hammami Fatma , Rekik Khaoula , Smaoui Fatma , Chakroun Amal , Marrakchi Chakib , Koubaa Makram , Ben Jemaa Mounir 
Published: January 2025

Abstract

Background
The outcome of spondylodiscitis, a serious infection of the intervertebral disc(s) and/or adjacent vertebrae, might be invalidating with the occurrence of sequelae. We aimed to study factors predicting sequelae after treatment of spondylodiscitis.

Methods
We conducted a retrospective study including all patients hospitalized in the infectious diseases department for spondylodiscitis between 2000 and 2022. Tubercular, brucellar and pyogenic spondylodiscitis were included in the study.

Results
We encountered 173 cases, among whom 78 had sequelae (45.1%). No significant difference was noted concerning the age of patients with (54[37-62] years) or without (57[41-67] years) sequelae (p=0.155). Tubercular spondylodiscitis was significantly associated with sequelae (52.6% vs 36.8% ; p=0.038). Anorexia (49.4% vs 31.2% ; p=0.016) and night sweats (57.9% vs 41.9% ; p=0.039) were significantly noted among patients with sequelae. Fever (53.8% vs 64.2% ; p=0.167), back pain (97.4% vs 93.5% ; p=0.295) and asthenia (53.2% vs 44.1% ; p=0.234) were the revealing symptoms among cases with or without sequelae. An accelerated erythrocyte sedimentation rate was noted more frequently among patients with sequelae (90.5% vs 76.5% ; p=0.018). Elevated C-reactive protein level (21.7% vs 20.7% ; p=0.873) and leukocytosis (23.1% vs 24.2% ; p=0.861) were noted among cases with or without sequelae. Treatment duration was significantly longer among patients with sequelae (11[6-15] months vs 7[4-12] months ; p=0.021). Percutaneous abscess drainage was significantly more frequent among patients with sequelae (17.1% vs 6.5% ; p=0.029). Surgery was indicated among patients with or without sequelae (14.3% vs 7.4%), with no significant difference (p=0.141).

Conclusion
The presence of anorexia, night sweats and an accelerated erythrocyte sedimentation rate, especially among tubercular spondylodiscitis cases, were predictor factors of sequelae after treatment. Such patients require a regular follow-up and an adequate treatment duration in order to reduce sequelae.

Disclosures
All Authors: No reported disclosures
P-80. The microbiology of periprosthetic joint infections as revealed by sonicate cultures in Korea: Routine use of fungal and mycobacterial cultures is necessary?
Authors: Park Kyung-Hwa , Sung Jeong Hae , un Shin Sung , Jin Kim Uh , Eun Kim Seong , Kang Seung-ji , In Jung Sook 
Published: January 2025

Abstract

Background
Although sonication is a valuable diagnostic tool for periprosthetic joint infections (PJI), it is not commonly utilized. We analyzed sonicate and intraoperative tissue culture results obtained from three hospitals to define the microbial etiology of PJIs in Korea. Furthermore, we investigated necessity of conducting regular fungal and mycobacterial cultures.

Methods
We retrospectively analyzed data for patients with suspected orthopedic-related infections between 2017 and 2022, who had undergone prostheses removal surgery. We included 193 patients with suspected PJIs, and bacterial (n = 193), fungal (n = 193), and mycobacterial (n = 186) cultures were conducted on both sonicate and intraoperative tissue samples. The diagnosis of PJI was based on the European Bone and Joint Infection Society (EBJIS) criteria.

Results
Out of 193 patients, 121 (62.7%) had positive sonicate cultures, while 112 (58.0%) had positive periprosthetic tissue cultures. According to EBJIS criteria, a total of 181 patients were diagnosed with PJI, and 141 patients received microbiological confirmation through sonicate fluid culture or tissue culture. Of the 181 patients, 28 were classified with acute PJI (within 3 months of implantation) and 153 with chronic PJI. Among 141 patients, staphylococci were the most common organisms, accounting for 51.8% of cases, followed by Gram-negative organisms (15.6%), fungus (8.5%), and mycobacteria (3.5%). Nearly 91.7% of fungal isolates were Candida species, which also grew in bacterial cultures. In total, 11 cases cultured positive only in tissue culture, whereas 20 cases cultured positive only in sonicate culture. The antibiotic treatment plans were adjusted according to culture results.

Conclusion
Utilizing sonicate culture has greatly assisted in identifying pathogens responsible for chronic indolent PJIs, allowing suitable antimicrobial treatment. Based on few cases involving non-Candida and mycobacterial infections, it appears that routine fungal and mycobacterial cultures may not be necessary.

Disclosures
All Authors: No reported disclosures
P-91. Clinical characteristics and analysis of predictors of the outcome of septic arthritis of the shoulder : a 16-year experience
Authors: Eun Seong Jae , Ahn Sangmin , Han Min , Lee Yongseop , Ah Lee Jung , Ho Kim Jung , Young Ahn Jin , Jin Jeong Su , Su Ku Nam , Yong Choi Jun , Yeom Joon-sup 
Published: January 2025

Abstract

Background
The number of septic arthritis cases is increasing due to the increasing number of joint surgeries and lengthened life expectancy. There are few data about the characteristics and risk factors of septic arthritis of the shoulder. As timely diagnosis and treatment are essential, we aim to describe the clinical characteristics and analyze predictors of the outcome of Septic arthritis of the shoulder.
Microorganisms causing septic arthritis of the shoulder

Methods
We performed a retrospective cohort study of patients diagnosed with septic arthritis of the shoulder between June 2007 and June 2023 at a tertiary hospital in Korea, Aged over 19. We excluded patients who did not undergo treatment in this hospital and had tuberculosis isolated from synovial culture.
We analyzed demographic data, comorbidities and underlying conditions, shoulder trauma history, operation history, acupuncture history, previous steroid injection history, rotator cuff tear, clinical presentation, MRI finding, synovial findings, laboratory findings, and culture findings. We analyzed whether each characteristic was associated with unfavorable outcome.

Results
Among 99 patients enrolled in this study, 49 patients showed unfavorable prognosis.
The most frequently identified microorganisms were Staphylococcus aureus (39 cases), 11 of which were Methicillin-resistant S. aureus (MRSA), Streptococcus, and beta-haemolytic (7 cases).
The univariate analysis revealed that elevated blood WBC count at 2 weeks and CRP/Albumin ratio at 2 weeks were significant factors. Additionally, findings of positive culture, blood stream infection and MRSA isolation were statistically significant.
In multivariate analysis, we identified positive culture findings (OR 3.34; 95% CI, 1.01 – 11.12; P = 0.049), the CRP/albumin ratio at 2 weeks (OR 1.07; 95% CI, 1.01 – 1.12; P = 0.012), and the Charlson calculator score (OR 0.32; 95% CI, 0.69 – 0.99; P = 0.037) as risk factors for unfavorable outcomes.

Conclusion
The significance of our study is that we analyzed characteristics of multiple cases for the long term and identified new predictors of the outcome for septic arthritis of the shoulder. In case of identified positive culture findings, elevated CRP/albumin ratio at 2 weeks and high Charlson calculator score, unfavorable outcome can be considered.

Disclosures
All Authors: No reported disclosures
P-107. Serious Injection-Related Infections in Hospitalized Adults with Opioid Use Disorder Enrolled in an Ongoing Randomized Clinical Trial: A Focus on Staphylococcus aureus
Authors: Fanucchi Laura , Thornton Alice C , Villacorta Cari Evelyn , Mynatt Ryan P , VanMeter Connor , Nuzzo Paul , Walsh Sharon , Chang Loui , Kunzelman Wyatt , Kapadia Shashi , Lofwall Michelle 
Published: January 2025

Abstract

Background
Staphylococcus aureus (SA) causes the majority of serious injection-related infections (SIRI) in persons with opioid use disorder (OUD). Invasive SA infections are typically treated with prolonged IV antibiotic courses; increasingly oral transitions are considered though prospective clinical trial data are limited. Outpatient parenteral antibiotic therapy (OPAT) may be denied to persons with OUD and SIRI despite increasing evidence that it may be feasible and safe. Our ongoing study evaluates the efficacy and cost-effectiveness of an integrated outpatient care model combining Buprenorphine for OUD with OPAT (B-OPAT; NCT04677114) compared to Treatment As Usual (TAU) in persons hospitalized with OUD and SIRI. Here we present preliminary data on the prevalence of SA infections, treatment outcomes, and adverse events (AE) in the ongoing B-OPAT study.

Methods
This study is a randomized, 2-arm superiority trial enrolling hospitalized adults with OUD and SIRI. Participants are randomized 1:1 to discharge with B-OPAT or TAU. SIRI details, planned and completed days of IV antibiotic therapy, and AEs are collected at baseline and through the 12-week post-discharge intervention.

Results
From March 2021 – March 2024, 58 persons were randomized (B-OPAT: 29; TAU: 29), with 39 (67%) having SA infections (B-OPAT: 18; TAU: 21), and of those 24 (61%) due to Methicillin-resistant SA (MRSA). Baseline characteristics stratified by SA are shown in Table 1. In patients with SA, average hospital length of stay was longer and fewer days of IV antibiotics were missed in both BOPAT and TAU (Figure 1). In BOPAT 1 person received oral antibiotic transition, and 8 in TAU, all with SA. Over 12-weeks post-discharge, B-OPAT had 13 serious adverse events (SAE) including 1 death in non-SA; 8 SAE were in those with SA. TAU had 17 SAE, 13 in those with SA including 3 deaths (Table 2).

Conclusion
Our ongoing clinical trial enrolling hospitalized persons with OUD and SIRI shows that SA accounts for the majority of infections overall, and that SA may be associated with longer hospitalizations and higher morbidity. Importantly, our study may contribute prospective safety and other clinical trial data to inform the practice of oral transitions for invasive SA infections.

Disclosures
Sharon Walsh, PhD, Astra Zeneca: Advisor/Consultant|Braeburn Pharmaceuticals: Advisor/Consultant|Cerevel Therapeutics: Advisor/Consultant|Lundbeck: Advisor/Consultant|Opiant Pharmaceuticals: Advisor/Consultant Michelle Lofwall, MD, Berkshire Biomedical: Advisor/Consultant|Braeburn Pharmaceuticals: Advisor/Consultant|Journey Colab: Advisor/Consultant
P-129. Evaluation of the Mannheim Peritonitis Index, the Neutrophil/Lymphocyte Ratio, and the Platelet/Lymphocyte Ratio as Predictive Parameters of Clinical Outcomes of Patients with Intra-Abdominal Infection in a Teaching Hospital in Nicaragua
Authors: Alvarado-Malueño Freda L , Porras-Cortés Guillermo D 
Published: January 2025

Abstract

Background
Intra-abdominal infections are associated worldwide with relatively high mortality. Decisions in patient management and clinical outcomes may be determined by specific risk factors that can be assessed in the form of scores or indices, and ratios. The objective of this study was to evaluate the Mannheim Peritonitis Index (MPI), the Neutrophil/Lymphocyte Ratio (NLR), and the Platelet/Lymphocyte Ratio (PLR) as predictors of mortality and other clinical outcomes in this type of patients at a teaching and referral hospital (Dr. Fernando Vélez Paiz Hospital) in Managua, Nicaragua.Table 1.Mannheim Peritonitis Index and Surgical Reintervention, Admission to ICU, and Mortality

Methods
This is a retrospective, cross-sectional, analytical study. Patients hospitalized for complicated intra-abdominal infection (cIAI)an between November 2021 and November 2023 were included. The relationship of MPI, NLR, and PLR with mortality and other clinical outcomes as need for reoperation, requiring admission to intensive care unit, and length of hospital stay was analyzed. The cut-off points of previous reference studies for MPI (≥ 26 points), NLR (≥ 11), and PLR (≥ 222) were used. Sensitivity, specificity and a ROC curve (AUC) were calculated for each of the predictive instruments evaluatedTable 2.Neutrophiles/Lymphocytes Ratio and Surgical Reintervention, Admission to ICU, and Mortality

Results
102 patients with cIAI were included in the study. The mean age was 56.05 ± 21.25 years-old. The most common etiology was acute appendicitis (39.2%). Overall mortality was 34.3%. The need for surgical reintervention was observed in 72.7% of patients with MPI ≥ 26 points, 31.3% of patients with NLR ≥ 11, and 45.0% of patients with PLR ≥ 222. Regarding requiring admission to the intensive care unit, it was observed in 84.0% of patients with MPI ≥ 26 points, 57.8% of patients with NLR ≥ 11, and 27.5% of patients with PLR ≥ 222. Mortality in patients with MPI ≥ 26 points was 75.0%, and 46.9% in patients with NLR ≥ 11 (Table 1 and 2). Theand specificity of MPI for mortality was 94.3% and 47.9% respectively, with an AUC of 0.95. The sensitivity and specificity of NLR for mortality were 85.7% and 49.3% respectively (Table 3).Table 3.Sensitivity and Specificity of MPI and NLR for Mortality Prediction.

Conclusion
The MPI ≥ 26 points predicts mortality, a higher probability of surgical reoperation, ICU admission, and prolonged hospital stay. In the population of this study, the cut-off point with the best diagnostic reliability was MPI ≥ 25 points. The NLR ≥ 11 points is also a significant predictor of mortality.

Disclosures
All Authors: No reported disclosures
P-133. Klebsiella pneumoniae liver abscess as the herald of underlying colon neoplasm
Authors: Lin Yi-Tsung , Chuang Chien , Liao Tsen-En , Chou Sheng-Hua , Ho Yu-Chien , Liu Szu-Yu , Juan Chih-Han 
Published: January 2025

Abstract

Background
Klebsiella pneumoniae liver abscess (KPLA) is an endemic disease in Eastern Asia, especially Taiwan. Hypervirulent K. pneumoniae strain in the gut is able to translocate across the colonic mucosal defects to the portal system, resulting in subsequent liver abscess. Occult colon cancer in patients with KPLA has been described in several case series. However, data regarding colonoscopic findings in patients with KPLA in Taiwan have not been investigated. We aimed to investigate whether the diagnosis of KPLA serves as a marker of underlying colorectal neoplasm.

Methods
Consecutive patients with KPLA in Taipei Veterans General Hospital from April 2011 to January 2024 were included in this retrospective study. Clinical data were collected and colonscopy was recommended within 6 months of diagnosis of KPLA according to the patient’s will. Hypervirulent strains were defined as those with rmpA or rmpA2. In patients receiving colonoscopy, we determined the risk factors of underlying colon adenoma/adenocarcinoma using a logistic regression analysis.

Results
A total of 491 unique KPLA episode was collected during the study period. Most of the available strains (401 of 422, 95%) were hypervirulent strains, and most of them (339 of 422) belonged to capsular type K1 or K2. One hundred and thirteen patients (23%) had undergone colonoscopy within six months of diagnosis of KPLA. Clinical characteristics were similar between patients who had undergone colonoscopy or not. The findings of colonoscopy showed that 48 patients had adenomas (42.5%) and 12 patients had adenocarcinoma (10.6%). Patients with colon adenoma/adenocarcinoma had a higher proportion of age over 50 years (90% versus 62.3%, P&lt; 0.001) and female (45% versus 26.4%, P=0.04), compared with patients without colon adenoma/adenocarcinoma. The proportion of hypervirulent strains and the distribution of capsular types were similar between the 2 groups. In multivariate analysis, age over 50 years was the only independent risk factor for colon adenoma/adenocarcinoma (P=0.002, OR=5.14, 95% CI=1.84-14.36).

Conclusion
Colon adenoma and adenocarcinoma were notably common in patients with KPLA. We recommended colonoscopy be routinely performed in patients with KPLA in the endemic area, especially for those older than 50 years old.

Disclosures
All Authors: No reported disclosures
P-140. A Quality Improvement (QI) Project to Increase Chagas Disease Screening Rates in an At-Risk, Underserved Patient Population Living in Houston, Texas
Authors: Centeno Fernando H , Wetterman-Capo Renatta , Rueda Jaime , Clark Eva 
Published: January 2025

Abstract

Background
Chagas disease (CD), caused by Trypanosoma cruzi, is a neglected disease of poverty affecting &gt;6 million people in the Americas, including &gt;200,000 in the US. While many are asymptomatic, 20-30% develop end-organ damage like Chagas cardiomyopathy. Early diagnosis and treatment are essential to reduce this risk; however, US clinicians generally are unaware of for whom CD screening is recommended (Table 1) and how to order it. &gt;1.5 million people born in continental Latin America live in Harris County, TX, making this an important region in which to establish systematic CD screening. This QI project seeks to improve CD screening rates using electronic medical record (EMR) tools.Figure 1A:HHS Chagas disease testing protocol, Figure 1B: Outpatient clinic visit flow diagram incorporating PDSA Cycle Phase 1 and Phase 2

Methods
This project is set in the Harris Health System (HHS), a public safety-net healthcare system serving &gt;1 million outpatients annually; 52.9% are Hispanic and 45.9% are uninsured. Previous studies support a CD prevalence of ∼1%, suggesting that &gt;5,000 outpatients/year present to HHS with undiagnosed CD. Our HHS CD screening protocol (Figure 1A) is based on US screening recommendations. We assembled a team of stakeholders and identified a HHS primary care clinic (MLK Clinic) as the pilot location. We used Epic Systems EMR tools to evaluate the patient population presenting to MLK Clinic over a 9 month period and develop corresponding QI interventions. The primary outcome is CD screening rate; see Table 2 for secondary outcomes.Figure 2:Plan, Do, Study, Act (PDSA) cycle structure

Results
1,443 patients presented to MLK Clinic between 7/1/2023-4/30/2024, average age 26 years (range 0-95). A sample of 158 showed that 40% were eligible for CD screening based on birth country. Of those, only 12 T. cruzi IgG tests were ordered (2% of eligible patients). Together with stakeholders, we developed 2 interventions to improve CD screening rates (Figure 1B): 1) single-question Epic SmartPhrase used by nursing staff during patient triage and 2) physician CD educational session and Epic SmartPhrase. These will be applied in 2 PDSA cycle phases (Figure 2). We trained nursing staff on 4/2024 and began PDSA Phase 1 on 5/1/24.

Conclusion
Early CD diagnosis and treatment reduce the risk of progression to devastating end-organ damage. This QI project will contribute to improved identification of at-risk patients through use of EMR tools for systematic screening.

Disclosures
All Authors: No reported disclosures