bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-69. What if? Opportunities for IV to PO Antibiotic Transition in Bone and Joint Infection Treatment
Authors: Price Graham , Dance Makeisha , Jackson Patrick E H , Medler Corey 
Published: January 2025

Abstract

Background
Historically, bone and joint infections have been treated with intravenous (IV) antimicrobials. IV to oral (PO) antibiotic transition implementation differs among institutions and prescribers. This practice has increased in recent years as new literature has demonstrated comparable efficacy of PO and IV treatment. Use of outpatient IV therapy often necessitates using a central line. This introduces additional risks, particularly line-related complications such as clots and central line infections. The purpose of this project was to identify opportunities for transitioning from IV to PO therapy in patients discharged on IV antibiotics for bone/joint infections at an academic medical center.
Baseline Patient Characteristics

Methods
We performed a retrospective, cross-sectional study of adults discharged on IV antibiotics between January 2020 and December 2023. Inclusion criteria included age ≥ 18 years, patient followed by institutional outpatient parenteral antimicrobial therapy service, and receipt of at least one IV antibiotic for a bone/joint infection. Patients with axial osteomyelitis were excluded. The primary outcome was the percentage of patients with the potential to transition from IV to PO antibiotics. Secondary outcomes included incidence of adverse drug events (ADE).

Results
324 patients were included. Osteomyelitis was the most common infection (48.5%) followed by joint infection (27.5%). Source control procedures were performed for 83% of patients. Cultures were positive in 75% of patients, and Staphylococcus species were the most common pathogens (45%). In total, 237 (73.1%) of patients qualified for a complete PO regimen. Half of patients (50.3%) received at least one PO antibiotic as part of their discharge therapy. Antibiotic changes occurred after discharge in 15.4% of patients, and 21% of patients experienced an antibiotic associated ADE.

Conclusion
Most patients discharged on IV antibiotics for bone/joint infection at this medical center could have received a complete PO regimen. While PO antibiotics are not benign, there is the potential to reduce adverse effects. These findings highlight opportunities for IV to PO transition at discharge and the potential to reduce line associated complications.

Disclosures
Patrick E H Jackson, MD, Gentiva Hospice: spouse employment|Kindred Hospice: spouse employment|Pfizer: Grant/Research Support
P-72. The Evaluation of Pressure Injury Associated Pelvic Osteomyelitis in Patients with Spinal Cord Injuries in a Veterans Affairs Population
Authors: Kanner Esther H , Cusumano Jaclyn A , Johnson-Kunjukutty Swapna , Sherman Olga , Vest Kirsten 
Published: January 2025

Abstract

Background
Limited data, and thus no clinical guidelines, are available for the treatment of pelvic osteomyelitis with associated pressure injuries (PI) in spinal cord injury (SCI) patients. Treatment of SCI patients with PI-associated osteomyelitis at the Veterans Affairs (VA) involves a multidisciplinary team including SCI, infectious disease, wound care, and surgery specialists. Herein we describe the management and outcomes of an SCI cohort with PI-associated pelvic osteomyelitis.

Methods
A retrospective chart review of patients ≥ 18 years of age, with a culture-positive clinical diagnosis of PI-associated pelvic osteomyelitis, treated by the SCI service between January 1, 2018, and October 1, 2023, was conducted. Patient characteristics, treatment choice, duration, and surgical intervention were compared between those with treatment failure versus success. Treatment failure was defined as having either microbiologic relapse, chronic suppressive therapy, or death due to the osteomyelitis during treatment. Differences between groups were assessed by Fisher’s exact test.

Results
A total of 31 patients were identified, the majority were male (97%) with a median age of 66 years (Table 1). There were 17 patients with histopathology analyzed at diagnosis, of which 88% were positive. Majority of the cultures obtained were bone cultures (71%). The cultures were primarily polymicrobial with 45% growing MRSA (methicillin resistant Staphylococcus aureus) and low Pseudomonas aeruginosa rates (13%). Majority of patients underwent surgical debridement (61%) and received prolonged durations of antibiotics beyond 6 weeks (Table 2). A total 8 (26%) patients experienced treatment failure. Surgical management and prolonged durations of antibiotics did not differ significantly between the groups. Patients in the treatment success group had lower rates of beta-lactam as a component of their treatment regimen.

Conclusion
Only a quarter of the SCI patients with PI-associated pelvic osteomyelitis failed treatment. Significantly more patients in the treatment success group had non-beta lactam containing treatment regimens. Larger studies are warranted to shed light on optimal management of pelvic osteomyelitis in this population.

Disclosures
Jaclyn A. Cusumano, PharmD, BCIDP, Basilea Pharmaceutica: Grant/Research Support
P-76. Risk factors associated with Gram-negative early hip and knee prosthetic joint infections: a single-center retrospective cohort study
Authors: Cullen Grace , Gu Yuan , Salinas Jorge , Furukawa Daisuke 
Published: January 2025

Abstract

Background
Prosthetic joint infection (PJI) is a devastating complication of total joint arthroplasty, occurring in 1-2% of all prosthetic joint surgeries. While rare, Gram-negative (GN) bacteria are important causes of PJIs and can be difficult to treat due to increasing antimicrobial resistance. We looked at cases of early PJIs due to GN bacteria in our institution to identify potential risk factors.

Methods
We conducted a retrospective cohort study using the Center for Disease Control’s National Healthcare Safety Network data report of surgical site infections (SSI) for our institution between January 1, 2011 and June 1, 2023. Procedure codes HPRO and KPRO were used to identify total hip (THA) and knee (TKA) arthroplasty cases. Welch two sample t-test and Chi-square tests were used for between-group comparisons of continuous and categorical outcomes, respectively. Multiple logistic regression was used to identify risk factors and estimate adjusted odds ratios (aOR) for GN PJIs.

Results
Our cohort included 17,725 arthroplasty cases, of which 174 developed a SSI of the implanted joint ≤90 days of index surgery, with a cumulative incidence of 0.98%. Of the SSI cases, 34 (20%) isolated GN bacteria while 140 (80%) were caused by other organisms. The most common GN bacteria were E. coli (11), Klebsiella species (8), P. aeruginosa (8). Patients with GN infections were older, with a median age of 70 (IQR 61-76) compared to 65 (IQR 58-70) in the non-GN infections group (p = 0.090). Duration of index surgery was longer in GN infections, with a median duration of 204 minutes (IQR 121-304) compared to 151 minutes (IQR 110-219, p=0.019). There were no differences between GN bacterial infections and infections due to other organisms for sex, American Society of Anesthesiologists physical status score, surgical risk score, body mass index, or history of diabetes. In the logistic regression, age and duration were associated with increased odds of GN infection with an aOR of 1.04 for age (p=0.05) and 1.05 for duration (p=0.003).

Conclusion
The cumulative incidence of SSI of prosthetic hip and knee arthroplasties was low at &lt; 1% with GN infections making up a minority of cases. Age at time of index surgery and duration of surgery were significantly associated with an increased risk of GN bacterial infection.

Disclosures
All Authors: No reported disclosures
P-83. Corynebacterium Striatum, an emerging community and nosocomial pathogen
Authors: Jimenez Dennys , Cadena-Zuluaga Jose , Hoskins Serene , Reveles Kelly 
Published: January 2025

Abstract

Background
Corynebacterium striatum is part of the normal flora of the skin and nasal mucosa. Cases of C. striatum isolates are commonly neglected and assumed as contaminants, but increasing reports suggests it is the causative pathogen in many community and nosocomial infections. The objective of this study was to review and analyze C. striatum isolates from sterile sites over a 12-year period (2011 -2023)
Corynebacterium Striatum, an emerging community and nosocomial pathogen Table 1
Patient's clinical characteristics divided by type of infection (Monomicrobial vs polymicrobial)

Methods
This was a retrospective, observational study of patients with microbiologically confirmed C. striatum diabetic foot infection or osteomyelitis from July 1, 2011 to January 10, 2023 at the South Texas Veterans Health Care System. We screened all microbiology results using Theradoc (Premier Inc. Charlotte, NC) and reviewed the medical records of all patients 18 years or older that meet criteria. We collected epidemiological, radiological, laboratory and clinical data from each case. Additional variables included patient demographics, comorbidities (including Charlson comorbidity index), exposure to healthcare and antimicrobials within 12 months, presence of catheters or implants at the time of admission/infection, hemodialysis, treatment and outcomes. Variables were presented descriptively and compared between monomicrobial and polymicrobial infections using the chi-square or Wilcoxon rank sum test.
Corynebacterium Striatum, an emerging community and nosocomial pathogen Table 1 continuation
Patient's clinical characteristics divided by type of infection (Monomicrobial vs polymicrobial)

Results
There were 185 potential candidates for inclusion, but 53 cases were included for analysis. Patient and infection characteristics are presented in the Table. Median age was 67 years and 98.1% were male. Most infections were osteomyelitis (79.2%) and polymicrobial (67.9%). Most patients had recent hospital admissions/ER visits (56.6%). and antimicrobial use (90.6%) within the last year. Polymicrobial and monomicrobial infections were similar. Antimicrobial susceptibility was available in 5 cases. All isolates were susceptible to vancomycin, daptomycin, and gentamycin. 4 were tested for linezolid and rifampin and they were all were susceptible. Amputation was frequently required in the management of infections (71.7% of cases).

Conclusion
While relatively uncommon, C. striatum can lead to bone and wound infections that can result in poor patient health outcomes. Larger studies are needed to confirm the clinical relevance of this pathogen.

Disclosures
All Authors: No reported disclosures
P-85. Impact of Magnetic Resonance Imaging on Re-Amputation Rates in Diabetic Foot Osteomyelitis
Authors: Chan Arthur , Charles Cassandre , Xu Jiachen , Mergenhagen Kari A , Wattengel Bethany A , O’Leary Ashley , Puckett Andrew , Nasca Joseph , Russo Thomas 
Published: January 2025

Abstract

Background
Diabetic foot infections constitute 20% of hospital admissions and result in 80% of amputations annually. It is noteworthy that diabetes is more prevalent among U.S. veterans compared to the general population due to age, exposure to environmental factors during service, and mental health conditions which can contribute to unhealthy behaviors and increased risk of diabetes. Magnetic resonance imaging (MRI) is considered the imaging modality of choice for evaluating diabetic foot osteomyelitis given its higher sensitivity. A staging MRI, may decrease subsequent amputation rates in diabetics with osteomyelitis.Table 1:Patient characteristics and comorbiditiesMRI=magnetic resonance imaging, MI=myocardial infarction, CHF=congestive heart failure, PVD=peripheral vascular disease, CVD=cardiovascular disease, DM=diabetes mellitus, COPD=chronic obstructive pulmonary disease, PUD=peptic ulcer disease, HIV=human immunodeficiency virus

Methods
A retrospective chart review was conducted to analyze the risk of re-amputation in patients with diabetic foot osteomyelitis hospitalized between 2005 and 2022. Patients with and without MRI guided treatment were compared. The primary outcome was the rate of re-amputation at specific time intervals: 30-day, 60-day, 180-day, and 365-day. Charlson Comorbidity Index scores were calculated for all patients, and a multivariable logistic regression was used to calculate odds ratios and confidence intervals. Veterans were included if they had a diabetic foot infection complicated by osteomyelitis, and requiring amputation. Patients were excluded if they had an initial above-the-knee amputation (AKA) or below-the-knee amputation (BKA), since these are generally definitive treatment for osteomyelitis.Table 2:Treatment CharacteristicsMRI=magnetic resonance imaging, MSSA=methicillin susceptible Staphylococcus aureus, MRSA=methicillin resistant Staphylococcus aureus

Results
There were 1,463 patients based on ICD-10 codes, of which 475 patients underwent amputation. MRI guided therapy occurred in 106 patients. Multivariable logistic regression analysis revealed a 10-fold decrease in the odds of re-amputation within 30 days (OR=0.1; CI 0.01-0.72), a 3-fold decrease within 60 days (OR=0.32; CI 0.13-0.83), and a 2-fold decrease within the 180-day and 365-day (OR=0.51; CI 0.28-0.94 and OR=0.52; CI 0.3-0.9, respectively) intervals when MRI guidance was utilized.Table 3:Bivariate analysis of re-amputationsMRI=magnetic resonance imaging

Conclusion
These findings suggest that incorporating a pre-amputation MRI into the diagnostic and treatment approach for osteomyelitis associated with diabetic foot infections may reduce the risk for subsequent amputations.Table 4:Multivariable analysis of re-amputationsMRI= magnetic resonance imaging

Disclosures
All Authors: No reported disclosures
P-95. Predictors of bloodstream infection and its impact on mortality in septic arthritis: A 15-year review
Authors: Lee Yongseop , Chan Kim Yong , Seong Jaeeun , Ahn Sangmin , Han Min , Ah Lee Jung , Ho Kim Jung , Young Ahn Jin , Su Ku Nam , Yong Choi Jun , Yeom Joon-sup , Jin Jeong Su 
Published: January 2025

Abstract

Background
Septic arthritis is often complicated by bloodstream infection (BSI), which can lead to metastatin infections and sepsis. In this study, we aimed to identify risk factors for septic arthritis-related BSI and assess its impact on clinical outcomes.Table 1.Comparison of clinical characteristics of septic arthritis patients with and without bloodstream infection.

Methods
A retrospective review spanning 15 years (January 2009 to May 2023) was conducted on patients diagnosed with septic arthritis. Data from patients with positive synovial fluid cultures were analyzed.Table 2.Laboratory and microbiologic findings of patients with septic arthritis according to bloodstream infections.

Results
Among 456 patients with septic arthritis, 16.8% (n=77) developed BSI. The 90-day mortality rate was significantly higher in patients with BSI compared with those without BSI (14.3% vs. 5.3%, P=0.004). Staphylococcus aureus was the most commonly identified organism in synovial fluid cultures and was associated with an increased risk of BSI (adjusted odds ratio [aOR], 2.20; 95% confidence interval [CI], 1.15-4.34; P=0.019). Independent risk factors for BSI included higher Sequential Organ Failure Assessment (SOFA) score (aOR, 1.23; 95% CI, 1.06–1.44; P=0.009), lymphopenia (aOR, 2.84; 95% CI, 1.38–6.15; P=0.006), and elevated C-reactive protein (CRP, mg/dL) levels (aOR, 1.07; 95% CI, 1.05–1.10; P&lt; 0.001). Age ≥70 years (aOR, 3.96; 95% CI, 1.49–11.85; P=0.009) and higher SOFA score (aOR, 1.36; 95% CI, 1.12–1.67; P=0.002) were significant predictors of 90-day mortality, although BSI itself was not.Table 3.Multivariable analysis of risk factors for bloodstream infection and 90-day mortality in patients with septic arthritis.Variables with a P-value &lt;0.05 in the univariable analysis were included in the multivariable analysis.

Conclusion
Mortality in patients with septic arthritis was primarily associated with systemic sepsis resulting from BSI rather than the BSI itself. Understanding the relationship between septic arthritis-related BSI and clinical outcomes can aid physicians in managing systemic infections and improving patient care.Figure 1.Distribution of causative organisms of septic arthritis.

Disclosures
All Authors: No reported disclosures
P-110. Promoting Optimal Treatment for Community-Acquired Pneumonia in the Emergency Room: a Before-After Study of a Novel Care Pathway
Authors: Pernica Jeffrey , Kam April J , Eltorki Mohamed , Ewusie Joycelyne , Khan Sarah , Goldfarb David M , Smaill Fiona , Elliott Shakeap , Wong Jacqueline , Sung Melani , Smieja Marek , Mertz Dominik , Thabane Lehana , Loeb Mark 
Published: January 2025

Abstract

Background
Community-acquired pneumonia (CAP) in young children is mainly caused by viral pathogens; for this reason, Infectious Disease Society of America guidelines explicitly state that antibiotic treatment of non-severe CAP in this population is not obligatory. However, the vast majority of non-severe pediatric CAP episodes diagnosed in North America prompt antibiotic prescription anyway.

Methods
A before-after prospective study was done in a Canadian emergency department (ED) enrolling children aged 6+ months without comorbidities diagnosed with CAP and managed as outpatients. In the before (control) phase, participants were managed as per routine care. In the after (intervention) phase, participants were managed using a novel care pathway. This care pathway used imaging results, a point-of-care C-reactive protein (POC CRP) assay, and other already-available data (eg. O2 saturation, respiratory rate, age) to categorize participants as ‘appreciable risk’ or ‘low risk.’ Those at ‘appreciable risk’ were given a prescription for antibiotics, whereas those at ‘low risk’ were simply discharged home. The next day, caregivers of ‘low-risk’ participants were informed of results of nasopharyngeal viral/atypical pathogen testing. Follow-up was done at day 2-5, 14-21, and 30.

Results
There were 84 participants recruited in the control phase (Mar-Nov 2022) and 78 in the intervention phase (Nov 2022-Mar 2024). Control phase participants had a median age of 2.8 y (IQR 2.1 – 4.4y) and 13% had normal chest imaging, whereas intervention phase participants had a median age of 3.7 y (IQR 1.9 – 6 y) and 5.1% had normal chest imaging. All 84 of the participants in the control phase were prescribed antibiotics at ED discharge, as compared to only 51% of those in the intervention phase (49% less, 95%CI 38-60% less, p&lt; 0.001). There were no significant differences in clinical cure at day 2-5, re-presentation to the ED, later hospitalization, or caregiver satisfaction with the care plan.

Conclusion
A simple novel care pathway incorporating POC CRP testing as well as other available data facilitated a very clinically important decrease in antibiotic prescribing without compromising clinical outcomes. This care pathway should be evaluated in the context of a multicentre randomized trial.

Disclosures
Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support Dominik Mertz, MD, MSc, KCI Inc. USA: Grant/Research Support
P-136. Epidemiological Shifts in Histoplasmosis Hospitalizations Across the United States, 2012-2021: A Retrospective Analysis
Authors: Barghout Mohamed , Almaghlouth Nouf K 
Published: January 2025

Abstract

Background
Histoplasmosis represents a substantial public health concern in the United States, especially prevalent in the Ohio and Mississippi River Valleys where seroprevalence rates range from 60% to 90%. Building on data indicating rising hospitalization rates from earlier studies covering 2001 to 2012, this research aims to further investigate the trends in histoplasmosis-associated hospitalizations post-2012, focusing particularly on mortality outcomes.Table 1:Demographic and Clinical Characteristics of Patients with Histoplasmosis (Unweighted) Categorized by Mortality

Methods
We conducted a retrospective cohort study using the National Inpatient Sample (NIS) to assess trends in histoplasmosis-associated hospitalizations from 2012 to 2021. We analyzed a total of 351,321,656 hospitalizations, identifying cases of histoplasmosis either as a primary or any diagnosis. Histoplasmosis diagnoses were identified using ICD codes, and trends were analyzed using simple linear regression to calculate annual rates per 100,000 hospitalizations, with significance tested at a p-value ≤ 0.05.Figure 1:Trend of Histoplasmosis as Primary Diagnosis per 100,000 Hospitalizations (2012 - 2021)

Results
There were 50,860 weighted hospitalizations with histoplasmosis listed as any diagnosis and 7,616 as the primary diagnosis over the study period. Analysis revealed a significant decline in hospitalizations, from an annual rate of 2.9 per 100,000 in 2012 to 1.9 in 2021 (p=0.0118). Patients who died were older on average compared to those who survived (59.86 years vs. 54.45 years, p&lt; 0.001) and had significantly longer hospital stays and higher healthcare costs. The overall mortality rate was 4.7%. The most common presentations were pulmonary (5.8% died, p=0.0054) and disseminated forms (6.0% died, p=0.0436). Comorbid conditions had varied impacts on patient outcomes; particularly, patients with HIV had a higher mortality rate (6.67%, p=0.0031). Notably, an upward trend was observed in the incidence of histoplasmosis among diabetic patients (p=0.0113), while other comorbidities did not show significant trends.Figure 2:Trend of Histoplasmosis in Diabetic Patients per 100,000 Hospitalizations (2012 - 2021)

Conclusion
The significant reduction in histoplasmosis-associated hospitalizations between 2012 and 2021 reflects advancements in public health initiatives and enhancements in clinical management. Nonetheless, our study highlights an increased mortality rate linked to older age, the presence of comorbidities such as HIV, prolonged hospital stays, and elevated healthcare cost.

Disclosures
All Authors: No reported disclosures