bluuebunny/crossref_metadata_2025_split huggingface dataset:
2812. Clinical Impact of the Ceftolozane-Tazobactam Shortage on Difficult-To-Treat Resistant Pseudomonas aeruginosa Infections at an Academic Medical Center
Authors: Vance Mary K , Cimino Christo , Ereshefsky Benjamin , Humphries Romney , Nelson George E 
Published: November 2023

Abstract

Background
Difficult-to-treat resistant Pseudomonas aeruginosa (DTR PA) infections are a serious threat, requiring treatment with ceftolozane-tazobactam (C/T), ceftazidime-avibactam, or imipenem-cilastatin-relebactam due to extensive resistance. C/T was unavailable January to December 2021 so alternative agents were used. This study compared clinical outcomes in patients with documented DTR PA infections during periods of availability and shortage.

Methods
This retrospective cohort study included adult patients admitted to Vanderbilt University Medical Center January 2019 to December 2022 who were treated for DTR PA. Patients admitted January to December 2021 were included in the C/T shortage group and all others were included in the C/T available group. DTR PA was defined as nonsusceptibility to fluoroquinolones and traditional antipseudomonal β-lactams. Patients who received antibiotics &lt; 48 hours or were transferred to an outside facility or hospice prior to completing therapy were excluded. The primary outcome was a composite of 90-day survival and clinical success, defined as improvement or resolution of signs of infection such that no further treatment was needed. Secondary outcomes included infection-related mortality, emergence of resistance, and adverse events.

Results
A total of 29 patients were included, 22 in the C/T available group and 7 in the C/T shortage group. DTR PA was most commonly isolated from respiratory (31%) and wound cultures (31%). Significantly more patients in the C/T shortage group received combination therapy (57% vs. 9%, p=0.018). The primary outcome occurred in 50% of those in the C/T available group versus 71% of those in the C/T shortage group, which was not a significant difference (p=0.41). There were also no significant between group differences in any of the secondary outcomes, including infection-related mortality (14% vs. 14%, p=1), resistance development (5% vs. 0%, p=1), and adverse events (18% vs. 14%, p=1).

Conclusion
No significant differences were seen in clinical outcomes between patients with DTR PA treated during C/T shortage and available periods. This analysis was limited by a small sample size. Further studies are needed to assess the efficacy of C/T compared to alternative therapy and the role of combination therapy for DTR PA.

Disclosures
Romney Humphries, PhD, D(ABMM), M(ASCP), Melinta: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Ventorx: Advisor/Consultant
2821. A Comparison of Empirical Therapy with Cefazolin Versus Ceftriaxone for the Treatment of Complicated Urinary Tract Infections in a Tertiary Care VA Medical Center
Authors: Carcamo Paola , Hopkins Teri L , Yang Linda , Frei Christopher R , Cadena-Zuluaga Jose , Walter Elizabeth 
Published: November 2023

Abstract

Background
Limited data exist regarding the utilization of a narrow-spectrum agent such as cefazolin for the treatment of complicated urinary tract infections (cUTIs). The objective of this study was to evaluate cefazolin compared with ceftriaxone for the empirical treatment of cUTIs in an inpatient setting.

Methods
We conducted a single center, retrospective cohort study of Veteran patients who received ≥24 hours of cefazolin or ceftriaxone for the empirical treatment of cUTIs between November 1, 2019 and September, 30 2022. The primary outcome was clinical success, defined as resolution of signs and symptoms of infection without re-initiation of antibiotics during hospitalization or relapse, at 30 days after cUTI diagnosis. Secondary outcomes included hospital length of stay and Clostridioides difficile infection (CDI) within 30 days of the end of antibiotic therapy. A multivariate logistic regression analysis was also conducted to identify independent factors associated with 30-day clinical success.

Results
We identified 118 patients (median age, 72 years; 97% men) with cUTI treated with cefazolin (n = 57) or ceftriaxone (n = 61) who met study criteria. Both study groups had similar demographics, although patients treated with ceftriaxone more frequently had subjective fever on admission or nephrolithiasis while cefazolin-treated patients had more urinary catheters or receipt of another antibiotic prior to study drug. Clinical success was achieved in 51 (90%) and 53 (87%) in the cefazolin and ceftriaxone groups, respectively (P = 0.66). Multivariate analysis identified patients with urinary catheters as an independent predictor of decreased clinical success, with an odds ratio at 30 days of 0.21 (95% CI, 0.06-0.75). Patients treated with cefazolin had a significantly longer length of hospital stay (median 0.4 days longer) compared with ceftriaxone-treated patients (P = 0.02). There were no patients in the cefazolin arm and 4 (7%) patients in the ceftriaxone arm who had CDI within 30 days (P = 0.12).

Conclusion
Cefazolin was similar to ceftriaxone for the treatment of cUTI based on the outcome of clinical success. Local susceptibility patterns to urinary pathogens should guide empiric treatment.

Disclosures
Christopher R. Frei, PharmD, FCCP, BCPS, AstraZeneca: Grant/Research Support
2830. Clinical Characteristics, Outcomes and Antimicrobial Resistance of Non-aeruginosa Pseudomonas Infection in Adult Cancer Patients
Authors: Gu Hyundam , Aslam Sadaf , Horn Cody , Greene John 
Published: November 2023

Abstract

Background
Pseudomonas aeruginosa a gram-negative bacteria that is known to cause severe nosocomial infections. Other species of Pseudomonas are considered to be part of the human indigenous microbiota, commonly found in sites such as the gastrointestinal tract and skin. Although believed to be non-pathogenic for many years, these species can cause diseases in immunocompromised patients, albeit less virulent than P. aeruginosa. In this report, we will discuss the characteristics of non-aeruginosa Pseudomonas infections in cancer patients.

Methods
We conducted a retrospective study investigating culture results of adult inpatients with Pseudomonas spp. infections, excluding P. aeruginosa, at a Florida cancer center from 2012-2022. Data collected included infection source, antibiotics used, resistance against fluoroquinolones, surgical procedures or chemotherapy in the past month, polymicrobial infection, and 30-day mortality.

Results
Of 104 cases, P. putida was the most common species, followed by P. fluorescens, P. stutzeri, and P. mendocina. P. putida infections were often associated with urine (44%), respiratory and skin wounds (16% each). Respiratory tract was the most common source for P. fluorescens infections (38%). Solid tumors accounted for 71% of malignancies in the P. putida group, while hematologic malignancies accounted for 29%. For P. fluorescens, solid tumors and hematologic malignancies accounted for 62% and 38%, respectively. P. stutzeri and P. mendocina were mostly associated with solid malignancies. All groups were susceptible to quinolones (86-100%), and polymicrobial infections were frequently observed (68%, 73%, 63%, and 50%, respectively). P. putida and P. fluorescens had 7% and 19% 30-day mortality rates, respectively. P. stutzeri and P. mendocina had no observed mortality.

Conclusion
Our study highlights non-aeruginosa Pseudomonas infections are rare but notable in cancer patients. In the majority of cases, the disease course is less severe, and treatment with appropriate antibiotics, such as fluoroquinolones, leads to complete recovery.

Disclosures
All Authors: No reported disclosures
2832. Gepotidacin Efficacy in E. coli Drug-Resistant Phenotypes: A Pooled Analysis of the EAGLE-2 and EAGLE-3 Randomized Controlled Trials in Uncomplicated Urinary Tract Infection
Authors: Hooton Thomas M , Perry Caroline R , Janmohamed Salim , Sheets Amanda , Dennison Jeremy , Millns Helen , Jarvis Emily , Scangarella-Oman Nicole E , Huang Chun 
Published: November 2023

Abstract

Background
Uncomplicated urinary tract infections (uUTI) are among the most common community-acquired infections in women worldwide. Recommended treatment is largely empiric. Rates of antimicrobial resistance among Escherichia coli (E. coli) isolates, specifically extended-spectrum beta-lactamase positive (ESBL+) and multidrug-resistant (MDR) strains, are increasing worldwide. Gepotidacin is a first-in-class, triazaacenaphthylene, bactericidal antibiotic that inhibits bacterial DNA replication by inhibiting two enzymes, where a target-specific single mutation does not significantly impact susceptibility. We report gepotidacin efficacy against E. coli drug-resistant phenotypes in a pooled analysis of the EAGLE-2 and EAGLE-3 trials in uUTI.

Methods
EAGLE-2 and EAGLE-3 were near-identical global, Phase 3, randomized, double-blind, double-dummy, active-controlled noninferiority trials comparing gepotidacin with nitrofurantoin. Females aged ≥ 12 years with ≥ 2 UTI symptoms were eligible and were randomized 1:1 to oral gepotidacin (1500mg) or nitrofurantoin (100mg), twice daily for 5 days. Therapeutic success at test-of-cure visit (Day 10–13) was defined as combined clinical success (complete symptom resolution) and microbiological success (from ≥ 105 to &lt; 103 CFU/mL) without the need for other systemic antimicrobials. Analysis of the pooled microbiological intent-to-treat (micro-ITT) population was performed.

Results
The pooled micro-ITT population comprised 1421 patients (732 gepotidacin, 689 nitrofurantoin). Table 1 shows E. coli drug-resistant phenotypes at baseline. Therapeutic, clinical and microbiological success rates at test-of-cure numerically favored gepotidacin over nitrofurantoin for clinically important E. coli drug-resistant phenotypes: ESBL+, fluroquinolone-resistant (FQ-R), trimethoprim/sulfamethoxazole-resistant (SXT-R), and MDR (Figure 1). Adverse events were reported in 35% (gepotidacin) and 23% (nitrofurantoin) of patients.

Conclusion
Gepotidacin showed consistent efficacy (therapeutic, clinical and microbiological success) versus nitrofurantoin in patients with E. coli drug-resistant phenotypes (ESBL+, FQ-R, SXT-R, MDR). Gepotidacin has potential as a novel oral treatment for uUTI in key patient subgroups.

Disclosures
Thomas M. Hooton, MD, GSK: Advisor/Consultant Caroline R. Perry, PhD, GSK: Employee and shareholder Salim Janmohamed, MD, GSK: Employee and shareholder Amanda Sheets, PhD, GSK: Employee and shareholder Jeremy Dennison, MD, GSK: Employee and shareholder Helen Millns, PhD, GSK: Employee and shareholder Emily Jarvis, MSc, GSK: Employee and shareholder Nicole E. Scangarella-Oman, MS, GSK: Employee and shareholder Chun Huang, PhD, GSK: Employee and shareholder
2841. Skipping the Urine Culture before Genitourinary Surgeries May Not be Associated with Increased Risk of Postoperative UTI
Authors: Plasencia Juan Teran , O’Brien William , Lerner Lori , Schweizer Marin , Strymish Judith , Gupta Kalpana 
Published: November 2023

Abstract

Background
Detection of bacteriuria prior to most genitourinary (GU) procedures is a guideline-supported standard of care for prevention of postoperative UTI. Little is known about the frequency of concordance with guidelines and impact on outcomes. We hypothesized that GU surgeries in which a preoperative urine culture was indicated but not performed would be associated with an increased rate of postoperative UTI.

Methods
We obtained national data on all elective GU surgeries performed in VHA operating rooms during 2015-2022. CPT codes were flagged as indicated for preoperative urine culture based on risk of mucosal injury and AUA guidelines. Surgeries not indicated for urine culture were excluded. We identified urine cultures performed within 45 days before surgery. UTI outcome was defined as occurrence of ICD-10 code N39.0 within 30 days after surgery.
Multiple logistic regression estimated the independent association of preoperative culture performance with the outcome of UTI. Other independent variables included age, sex, ASA Class, antibiotics, and the 29 Elixhauser comorbidities.

Results
The study population included 221,018 surgeries at 123 VA Medical Centers. Mean (SD) age was 69.4 (11.0), 96.0% were men, and 76.1% were ASA Class 3-5. The most common surgeries were cystoscopy (62.8%), lithotripsy (9.9%), and TURP (8.7%). The comorbidity burden was typical for VA population studies (Table 1).
Preoperative urine cultures were performed in 65.5% of surgeries. In regression analysis controlling for comorbidities and antibiotics, the risk for postoperative UTI in those who did not have a urine culture performed despite being indicated, compared with those who did, was OR 0.56 [95%CI 0.53-0.58] (Table 2).
Multivariate Logistic Regression to Predict 30-day Postoperative UTI in GU Surgery Patients

Conclusion
In this large national cohort covering 8 years of GU surgeries, we found that non-performance of an indicated urine culture was common but was not independently associated with increased risk of postoperative UTI. The finding of significantly reduced risk was surprising and suggests that confounding patient factors, rather than procedure type, are driving the risk of postoperative UTI. Further work is warranted to identify these factors and explore the potential for de-implementation of standardized preoperative urine cultures for lower risk GU surgery patients.

Disclosures
Lori Lerner, MD, Janssen Pharmaceutical: Grant/Research Support Kalpana Gupta, MD, MPH, GSK: Advisor/Consultant|IDSA UTI Guidelines: Advisor/Consultant|qiagen: Advisor/Consultant|UpToDate: Advisor/Consultant
2842. Characteristics and Outcomes of Urinary Tract Infections (UTIs) Caused by Enterococci at a Tertiary Academic Medical Center in Saudi Arabia
Authors: Thabit Abrar K , Alharthi Khalid F , Baotab Salem M , Bankhar Abdullah M , Mahrous Ahmad J 
Published: November 2023

Abstract

Background
Enterococci are Gram-positive coccus bacteria that are normally present in the gastrointestinal tract and ordinarily function commensally with humans. They are generally considered opportunistic and often associated with healthcare-associated infections. We aimed to characterize patients with UTIs due to Enterococci and their outcomes.

Methods
This was a retrospective cohort study between June 2012 and November 2022 of patients who had clinically and microbiologically confirmed Enterococcal UTI. Inclusion criteria included a urine culture positive for E. faecalis or E. faecium with a count of ≥ 105 CFU/mL and having urinary tract symptoms.

Results
Of 4,094 patients screened, 125 were eligible and included. Patients had a median age of 63.3 years and were mostly females (60%). The most common characteristics were having a catheter, hospitalization in a non-ICU ward, and recent use of antibiotics within 90 days. Infection with E. faecalis was more common than E. faecium (78.4% vs. 21.6%). However, the latter exhibited higher rates of antibiotic resistance (P &lt; 0.001) and was associated with significantly higher median temperature (38 vs. 37.1°C; P &lt; 0.001), mortality rates (24% vs. 6.9%; P = 0.020), and median length of stay (32 vs. 13 days; P &lt; 0.001).

Conclusion
Most patients with enterococcal UTIs had a history of catheter and recent antibiotic use and were mostly females and hospitalized in non-ICU wards. Patients infected with E. faecium had more severe episodes compared with patients infected with E. faecalis. Therefore, patients infected with E. faecium should be followed more closely and have their antibiotics evaluated by infectious diseases experts of physicians and clinical pharmacists to potentially improve their outcomes.

Disclosures
All Authors: No reported disclosures
2843. Risk Factors for Unplanned Healthcare Encounters in Patients Discharged from the Emergency Department with Extended-spectrum β-lactamase Urinary Tract Infections
Authors: Brochu Jessica M , Kenney Rachel M , Herbin Shelbye , Gunaga Satheesh , Veve Michael 
Published: November 2023

Abstract

Background
The management of extended spectrum β-lactamase (ESBL) urinary tract infections (UTIs) in the emergency department (ED) has not been well documented in literature. The purpose of this study was to describe treatment and outcomes of patients with ESBL UTIs in the ED, which can inform best practices for antimicrobial stewardship.

Methods
This IRB approved, retrospective cohort analysis included patients who were discharged from the ED with an ESBL UTI between January 2020 and November 2022. The primary outcome of interest was any unplanned healthcare encounter related to the UTI within 30 days of the index ED visit, which included phone/virtual visits, clinic visits, ED visits, and hospitalizations. Patients ≥18 years of age treated for symptomatic UTI with a monomicrobial urine culture were included, while those with altered mental status, history of renal transplant, abnormal urinary tract, or were on active antibiotic therapy prior to the ED visit were excluded. Patient characteristics, initial and definitive antibiotic therapy, culture results including pathogen and susceptibilities were described. Logistic regression analysis was used to identify any exposures that were independently associated with unplanned healthcare encounters related to the UTI.

Results
162 patients were included; 103 (64%) had an unplanned healthcare encounter. Patient characteristics are depicted in Table 1. Complicated lower UTI was most frequent occuring in 71 patients (44%). Susceptibility data revealed that nitrofurantoin was effective in 121 (75%) patients, aminoglycosides in 117 (72%) patients, TMP/SMX in 66 (41%) patients, and quinolones in 62 (38%) patients. 76 (74%) patients with unplanned encounters received an inactive empiric prescription: β-lactams being prescribed to 52 (51%) patients with cephalexin used for 49/52 (94%). Of the 81 patients with lower UTI, 20 (25%) initially received a prescription for nitrofurantoin. Factors associated with an unplanned healthcare encounter are described in Table 2.Table 2.Factors Associated with Unplanned Healthcare Encounters. Abbreviations: Un-Adj OR = unadjusted odds ratio; Adj OD = adjusted odds ratio

Conclusion
Patients discharged from the ED with an ESBL UTI were at higher risk for unplanned healthcare encounters if they had CKD or were initially prescribed an oral β-lactam. Prescribing first line therapy with nitrofurantoin for lower UTI is a potential area for improvement.

Disclosures
Michael Veve, PharmD, MPH, National Institutes of Health: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support
2844. Impact of Altered Mental Status on Antibiotic Prescribing in Patients with Pyuria
Authors: Boerckel Haley , Dumkow Lisa E , Worden Lacy , Salvati Lisa , Jameson Andrew 
Published: November 2023

Abstract

Background
The Infectious Diseases Society of America’s guidelines for the management of asymptomatic bacteriuria state that altered mental status (AMS) is non-specific and alone should not be classified as a symptom of urinary tract infection (UTI). Careful observation, rather than treatment, is recommended to avoid adverse medication events and antibiotic resistance. The purpose of this study was to evaluate the burden of antibiotic overtreatment, patient outcomes, and risk factors for treatment of AMS patients with asymptomatic pyuria within a community teaching hospital.

Methods
This retrospective cohort study evaluated adult inpatients admitted with AMS and pyuria (10 WBC/hpf) between February 1, 2020 and October 1, 2021. The primary objective was to compare outcomes between patients with AMS treated for asymptomatic pyuria (AMS+Tx) vs. those without treatment (AMS-NoTx) using a composite endpoint of readmission for AMS or development of
Clostridiodes difficile within 30-days, or development of new antibiotic resistance within 90 days. Secondary outcomes included characterizing the burden of overtreatment and identifying risk factors for treatment of pyuria in patients with AMS. Multi variate logistic regression identified risk factors independently associated with treatment of asymptomatic pyuria in patients with AMS. Patients were excluded who had noted urinary symptoms, admission to critical care, history of renal transplant, urological surgery, co-infection, pregnancy, or neutropenia.

Results
A total of 200 patients were included (AMS+Tx, n= 160; AMS-NoTx, n=40). No difference was observed between groups in the composite primary outcome (AMS+Tx 23.5% vs AMS-NoTx 18.1%, p=0.465). The burden of overtreatment was 80%. An alternative diagnosis of AMS occurred more frequently when antibiotics were withheld (AMS+Tx 65.6% vs.AMS-NoTx 87.5%, p=0.007). Urinalyses showing bacteria (OR 2.63; 95% CI 1.15-6.03) and positive urine culture (OR3.76; 95% CI 1.67-8.48) were associated with the use of antibiotics.

Conclusion
Patient-related outcomes were similar between groups highlighting the burden of antibiotic overtreatment and need for stewardship interventions in inpatients with AMS and pyuria presenting without other urinary symptoms.

Disclosures
All Authors: No reported disclosures
173. Staphylococcus Aureus Bacteremia at a Community Hospital in the Southeastern United States June 2021-June 2022
Authors: Arnoczy Gretchen S , Gibson Heather , Starr Kimberly 
Published: November 2023

Abstract

Background
Staphylococcus aureus bacteremia is a common condition with high risk for mortality. Recent COVID-19 infection may influence the incidence and outcome of S. aureus bacteremia.

Methods
We performed a retrospective chart review of individuals with Staphylococcus aureus bacteremia from June 2021-June 2022 in a rural community health care system in the Southeastern United States. Primary outcome was mortality—variables included methicillin resistance, persistent bacteremia, ID consult, history of injection drug use, cardiac imaging, and COVID-19 infection within the previous 90 days.

Results
172 individuals experienced 188 episodes of Staphylococcus aureus bacteremia. 79 were MRSA, 99 were MSSA. 57 individuals were deceased within 6 months of the positive blood culture (33% mortality). 31 individuals had known injection drug use complicating their illness, endocarditis was confirmed in 18 (58%) of these individuals compared to 33 (19%) of the entire population. 116 individuals (67%) had an ID consult. This study occurred during the delta and omicron COVID-19 surges in the region – 18 episodes of S. aureus bacteremia occurred within 90 days of a positive COVID-19 test, and 10 (56%) of those individuals were deceased within 6 months of the positive blood culture.

Conclusion
S. aureus bacteremia carries a high risk for mortality. Endocarditis was confirmed more frequently in individuals with known injection drug use. Six month mortality in S. aureus bacteremia was higher when bacteremia occurred in the 90 days post COVID-19 infection.

Disclosures
All Authors: No reported disclosures