bluuebunny/crossref_metadata_2025_split huggingface dataset:
1272. Teaching the ABCs of ASB in a 60-minute educational intervention. A quality improvement project.
Authors: Enriquez Paulina Vega , Bouls Ruayda , Alvarado Ed W , Maldonado Jose Campo 
Published: November 2023

Abstract

Background
Asymptomatic bacteriuria (ASB) refers to the presence of bacteria in the urine of individuals that do not present with symptoms of urinary tract infection (UTI). Treatment for ASB is not recommended in most cases. [1] Previous studies have shown that provider education on proper antibiotic use has been effective in mitigating the ongoing wave of antimicrobial-resistant organisms across hospitals in the United States.[2] We aimed to decrease the proportion of cases classified as having asymptomatic bacteria by 20% in four months after the intervention using a small group discussion and a presentation.

Methods
We evaluated the rates of inappropriate antimicrobial prescribing for asymptomatic bacteriuria (ASB) for 4 months before educational intervention and 4 months after. Data was extracted from the electronic medical record (Cerner®), imported into REDCap®, and with standardized manual chart review. Data analysis was completed using STATA® 17 & 18.

Results
The mean duration of antibiotic therapy was 7.9 days in the pre-intervention group and 6.1 days in the post-intervention group. See Table 1 for more details on demographics. Following the intervention, the rate of inappropriate use of antimicrobial therapy in ASB was reduced by 29.8% (p-value 0.035). The mean duration of antibiotic therapy decreased by almost 2 days in the post-intervention group.

Conclusion
This quality improvement project suggests that focused interventions of short interactive educational sessions in small groups may reduce the inappropriate use of antibiotics in ASB by almost 30%. The mean duration in days of antibiotic treatment decreased from 7.9 days to 6.1 days in the pre and post-intervention groups (p-value 0.060). Of note the total number of cases with providers selecting UTI as an indication was also lower in the post-intervention group and although we can’t determine causality, it provided evidence of a lower number of cases, providers initially classified as UTI between the pre and post-intervention period from 33 to 19. Further research may include incorporating small groups and interprofessional educational interventions to help implement good antimicrobial stewardship in inpatient care facilities. [4,5,6]

Disclosures
All Authors: No reported disclosures
1283. Native Wrist Septic Arthritis: a 10-year Single Center Experience
Authors: Damronglerd Pansachee , Khodadadi Ryan B , Zein Said El , McHugh Jack W , Suh Gina A , Tande Aaron J , Yuan Brandon J , Abu Saleh Omar M 
Published: November 2023

Abstract

Background
Native joint septic arthritis (NJSA) of the wrist is a rare condition, with published literature suggesting an incidence of approximately 1.5% among patients presenting with acute painful and swollen wrist. The aim of this study was to investigate the characteristics, management, and outcomes of wrist NJSA at our institution.

Methods
We conducted a retrospective study of all adults diagnosed with wrist NJSA who underwent surgical intervention at Mayo Clinic facilities from January 2012 to December 2021. The diagnosis was confirmed based on clinical presentation, synovial fluid white blood cell count, and aspiration or operative cultures.

Results
A total of 557 patients developed NJSA during the study period, of whom 55 (9.9%) were diagnosed with wrist NJSA, median age was 63, with the associated demographics (Table 1). 12 (21.8%) had a history of antecedent trauma or procedure, 11 (20%) had synchronous joint infections, and 22 (40%) had positive blood cultures. The median synovial white blood cell count was 94,050/mm3 (IQR 51,920 – 139,941 /mm3). Crystals were detected in 5 patients (8.8%). Additional diagnostic data are available in Table 2. Open debridement was performed in 35 (61.4%) patients, and the rest underwent arthroscopy. Positive Gram stain results were detected in the preoperative synovial fluid of 12 (21.8%) cases. The most common pathogen isolated was Staphylococcus aureus in 13 (24%) of cases. The median duration of antimicrobial therapy was 31 days (IQR 26 – 45 days). There was no statistically significant difference in the incidence of complications between patients who underwent open debridement and those who underwent arthroscopy (Table 3). The most common complication of both groups was compromised range of motion of the wrist joint.

Conclusion
Native wrist septic arthritis comprised 9.9 % of all NJSA during the study period. Concomitant bacteremia and synchronous joint infections were common, highlighting the importance of obtaining blood cultures and comprehensive joint exam in this setting. Crystals and Gram stains were detected in 10 % and 22% of cases, respectively. These findings should not rule out NJSA. Decreased range of motion was common complication, affecting 21% of all cases.

Disclosures
Gina A. Suh, M.D., Adaptive Phage Therapeutics: Grant/Research Support|Adaptive Phage Therapeutics: IP royalties|Phagelux: Grant/Research Support Aaron J. Tande, M.D., Musculoskeletal Infection Society: Board Member|Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support Brandon J. Yuan, M.D., American Association of Orthopaedic Surgeons: Board Member|DePuy, A Johnson & Johnson Company: Advisor/Consultant|Mid America Orthopaedic Association: Board Member|Stryker: Advisor/Consultant
1285. Risk Factors for Infection Following Revision Hip and Knee Arthroplasty
Authors: DeBiase Joseph , Carroll Ryan , Colburn Nora , Day Shandra R 
Published: November 2023

Abstract

Background
Patients undergoing revision total hip (THA) and knee (TKA) arthroplasties are at increased risk for surgical site infections (SSI) with prior infection representing a common indication for revision. Our aim was to evaluate patient characteristics and risk factors in patients with THA and TKA infection following revision arthroplasty.

Methods
A single center retrospective review of patients with THA or TKA SSIs from 01/01/2017 to 11/01/2022 was performed utilizing National Healthcare Safety Network (NHSN) definitions and surgical revision codes. Index surgery was defined as the THA or TKA to which the SSI was attributed per NHSN guidelines. Patients meeting NHSN PATOS (present at time of surgery) definition were excluded. Pertinent demographics data, surgical histories and microbiology were collected and the determination of new vs. persistent infection was made based on microbiologic data.

Results
Forty-seven cases were included with median age of 62, 45% male and 51% current/former smokers. BMI was ≥35 in 36% of patients, with 33% having diabetes mellitus and 13% were immunocompromised. Twenty-seven (57%) patients had a prior infection at the involved joint with 18/27 (67%) occurring within 1 year of the index surgery. Table 1 includes index surgery details and infection data. Median time to infection was 25 days. Leading pathogens were S. aureus 16 (34%), Enterococcus species 11 (23%), enterobacterales 10 (21%), and polymicrobial infections 10 (21%).

Conclusion
Over half of patients that developed revision THA/TKA SSI had a prior infection but less than 15% had a persistent infection. Most patients had multiple prior surgeries which may contribute to longer operative times and delayed wound healing. S. aureus was the most common pathogen identified but many cases involved less typical SSI pathogens. These results highlight the importance of focusing on patient specific risk factors, surgical infection prevention strategies and wound care, rather than additional pathogen specific antibiotics. While more study is needed to delineate SSI risk factors following revision arthroplasty, our study highlights the multitude of potential factors involved in these highly morbid infections.

Disclosures
All Authors: No reported disclosures
1290. Impact of Implementing an IV to PO Antibiotic Treatment Protocol for Orthopedic Infections
Authors: Gray Julie , Benefield Russell J , Cummins Heather , Certain Laura 
Published: November 2023

Abstract

Background
Oral (PO) regimens have been utilized more frequently for orthopedic infections in place of intravenous (IV) regimens at our center following publication of the OVIVA trial. Given limited published experience of this approach at US medical centers, we reviewed safety and effectiveness outcomes at ours.

Methods
This was a retrospective, propensity-score matched, cohort study of adult patients hospitalized for orthopedic infections from 9/30/2020 to 4/30/2022. Patients discharged on PO antibiotics were matched to patients discharged on IV antibiotics, using a 1:1 nearest neighbor approach without replacement. Variables expected to be associated with treatment selection and/or outcome were included in the propensity score (Table 1). Primary outcomes were early (60-day) and late (1-year) treatment failure following discharge. Secondary outcomes were incidence of adverse drug events (ADE), readmissions, and ED encounters within 60 days of discharge. Outcomes were assessed through chart review.Table 1:Baseline Characteristics

Results
Six hundred sixty-four patients were screened and 401 met criteria for inclusion. Of these, 123 PO-treated patients were matched to 123 IV-treated patients. Baseline characteristics were similar in the two groups after matching, although there were differences in microbiological indication, and patients discharged on PO regimens were treated for shorter durations and were more likely to be discharged home (Table 1). There was no significant difference in the proportions of patients on PO vs IV antibiotics experiencing treatment failure at 60 days (14% vs 9%, P = 0.23), treatment failure at 1 year (21% vs 20%, P = 0.75), ADE within 60 days (6% vs 11%, P = 0.16), 60-day readmission (26% vs 33%, P = 0.26), or 60-day ED encounter (11% vs 10%, P = 0.83). Survival analyses identified no significant differences in time-to-event between PO and IV treatment for any of the outcomes assessed (Figure 1).Figure 1:Kaplan-Meier Survival Plots

Conclusion
There was no appreciable difference in outcomes between patients discharged on PO compared to IV regimens. Quality-improvement interventions to increase prescribing of PO antibiotics for the treatment of orthopedic infections should be encouraged.

Disclosures
Russell J. Benefield, PharmD, BCPS-AQ ID, Paratek Pharmaceuticals: Grant/Research Support
1300. Comparison of the Clinical Characteristics and Outcomes of Anaerobic Prosthetic Joint Infections (PJI) and Aerobic PJIs : A Retrospective Review
Authors: Non Lemuel R , Sekar Poorani 
Published: November 2023

Abstract

Background
PJI is an uncommon but serious complication of joint arthroplasties that can result in significant morbidity and cost. There is a paucity of studies in the literature on PJIs caused by anaerobic organisms either as the sole pathogen or part of a polymicrobial infection. The purpose of this study was to compare the clinical presentation and outcomes of PJI caused by anaerobes as opposed to aerobes.

Methods
This was a retrospective review of 306 patients who met Musculoskeletal Infection Society (MSIS) criteria for PJI from 2014 to 2020 at the University of Iowa Hospitals and Clinics (UIHC). 38 patients with anaerobic PJI were compared to 268 patients with aerobic PJI. Statistical analyses were performed using Pearson’s Chi square, Fisher exact test, t-test, and binary logistic regression.

Results
PJI with anaerobes represented 12.4% of all PJI cases in our institution, which is higher than the 3-6% reported in literature. Patients with anaerobic PJI had longer duration of symptoms (19.4 weeks vs 10.9 weeks, p = 0.012), were more likely to have a sinus tract on exam (23.7% vs 5.9%, p &lt; 0.001), less fever on presentation ( 13.2% vs 30.2%, p = 0.029), more radiographic abnormalities (50.0% vs 31.1%, p&lt; 0.001), lower erythrocyte sedimentation rate (49.0mm/hr vs 67.7 mm/hr, p = 0.003), lower C-reactive protein (6.6 mg/dL vs 12.1mg/dL, p = 0.004), and more likely to be polymicrobial (42.1%vs 8.0%, p &lt; 0.001) compared to aerobic PJI. There was a higher proportion of anaerobes in shoulder PJIs compared to other joints (39.5% vs 5.5%, p&lt; 0.001). Two-stage exchange was the most common surgical treatment in patients with anaerobic PJI (39.4%) whereas debridement and implant retention was the most common (44.5%) surgical treatment done in patients with aerobic PJI. No significant differences were seen between the two groups in terms of recurrences. Independent factors associated with anaerobic infection were shoulder prosthetic joint (AOR 10.5, CI 3.4 - 32.8) and presence of sinus tract (AOR 10.1, CI 3.1 - 32.6).

Conclusion
Anaerobic cultures should be performed in patients with PJI, and they should especially be considered on the differential in patients with shoulder PJI, longstanding symptoms, sinus tract on examination and abnormalities noted on radiographs.

Disclosures
All Authors: No reported disclosures
1310. Prediction of Surgical Site Infection Following Ankle Fracture: A Machine Learning Approach
Authors: Nassour Nour , Tatara Alexander M , Jones Sumner V , Leatherman Hadley , DiGiovanni William , Ashkani-Esfahani Soheil , Nelson Sandra B 
Published: November 2023

Abstract

Background
Surgical site infections (SSI) are a common complication in foot and ankle surgery. In the US, ankle fracture incidence is 4.22/10,000 person-years. The development of a predictive model for SSI in foot and ankle surgery may provide insights that would enable the prevention of wound complications to reduce their burden. In this study, we analyzed a patient data set to compare 5 different machine learning models and determine which is most effective in determining the risk for surgical site infection after ankle fracture.

Methods
We included 935 ankle fracture patients, of whom 114 patients developed SSI in the case group. We used the risk factors for SSI obtained from univariate analysis to develop 5 sets of models using the following machine learning (ML) methods: Decision Tree (DC), Random Forest (RF), Neural Network (NN), Gradient Boosting (GB), and Adaboost.

Results
In univariate analysis, older mean age (58.1 y.o. vs 49.3 y.o, p&lt; 0.001), higher mean American Society of Anesthesia score (2.1 vs 1.9, p&lt; 0.001), and longer hospital stay relating to the ankle fracture (6.3 days vs 4.1 days, p&lt; 0.001) were correlated with SSI risk when compared to non-infected patients. We also demonstrated that factors such as the presence of an external fixation prior to the ORIF (OR=2.91, p&lt; 0.001), diabetes (OR=2.00, p=0.03), oral steroid use (OR=3.45, p&lt; 0.001), multiple fractures (OR=2.29, p=0.003), liver disease (OR=2.76, p=0.02), hypertension (OR=2.05, p&lt; 0.001), illicit drug use (OR=2.31, p=0.01), smoking (OR=1.71, p=0.02), open wounds (OR=3.32, p&lt; 0.001), and CCI (OR=1.73, p=0.04) were also correlated with a higher incidence of SSI as compared to our control group. Our machine learning models performed well, with AUCs ranging from 0.74 to 0.86. GB had the highest AUC (0.86) and other favorable metrics including an accuracy of 0.88, F1-score of 0.89, precision of 0.91, sensitivity of 0.88, and specificity of 0.77 (table 1).Table 1.Performance Metrics of the Machine Learning Prediction Model for SSI following Ankle Fracture

Conclusion
Early prediction of SSI risk may lead to strategies to prevent complications in high-risk patients after ankle fracture fixation. With the goals of enhancing patient outcomes, lowering healthcare costs, and optimizing the use of healthcare resources, machine learning models may enable the identification of patients at high risk of SSI for tailored preventive treatments.

Disclosures
All Authors: No reported disclosures
1320. Pneumococcal Meningitis Before and During Covid – 19 Pandemic in Uruguay, South America (2017 – 2022).
Authors: Delfino Marcos , Méndez Ana P , Ferrer Monica Pujadas , Pírez María Catalina 
Published: November 2023

Abstract

Background
In Uruguay, universal vaccination of children with 7/13 valent pneumococcal conjugate vaccines was introduced between 2008 and 2010 (2 + 1 schedule), achieving nationwide coverage of 95%. This has caused a significant decrease in pneumococcal meningitis (PM).
The Covid-19 pandemic led to worldwide quarantines and isolation during 2020 and 2021. This resulted in a significant decrease in other infections. With the mass vaccination campaign worldwide, in 2022 we could return to a society life like before 2020. However, in 2022 there was an unusually high circulation of infections caused by other viruses and bacteria.
The objective of this study is to compare the number of cases of PM before and during the early and late pandemic of Covid-19 in the general population in Uruguay.

Methods
This descriptive, retrospective study includes all cases reported to the Department of Health Surveillance of the Ministry of Public Health with PM between January 1, 2017, and December 31, 2022. It also includes all SARS CoV 2 infections informed in Uruguay. PM variables are cases per year, sex, age (≤ 15 years and &gt; 15 years), and deaths by period. The PM average rates of cases per 100,000 inhabitants are described in three periods: Period 1 or pre – pandemic (P1, 2017 to 2019); Period 2 or early – pandemic (P2, 2020 and 2021), and Period 3 or late – pandemic (P3, 2022). Statistical analysis were established based on frequency distribution and statistical significance tests as appropriate, considering a value of p equal to or less than 0.05 as statistically significant. The institutional Ethics Committee approved the research.

Results
The total number of cases PM is 100, 62% are men. The N for P1 is 59, for P2 it is 12 and 29 in P3.
Table 1 shows the main incidence and mortality results by age group in the three periods. Graph 1 shows the evolution of PM in relation to the development of the Covid-19 pandemic in our country. Lethality remains high (24% average for the total period).

Incidence rates of pneumococcal meninigtis and mortality by period and age.

Conclusion
There was statistically significant changes in cases of PM in the general population, in individuals &gt; 15 and mortality. It is very likely that social distancing and the use of facemasks influenced these phenomena. These measures cease after the massive vaccination campaign against Covid-19, which could explain the 2022 increase in PM.

Disclosures
Marcos Delfino, Pediatrician, Pediatric Infectious Diseases, Pfizer: Finna María Catalina Pírez, Pediatrician, Pediatric infectologist, microbiologist Professor of pediatric, Degree V, Merck, Pfizer: Expert Testimony|Merck, Pfizer: Honoraria
1321. CT Brain Prior to Lumbar Puncture in Patients with Suspected Meningitis: A Single Centre Study of Compliance with Expert Guidelines and Diagnostic Yield of Imaging.
Authors: Dempsey Philip J , O’Herlihy Fergus , Gibney Brian Thomas 
Published: November 2023

Abstract

Background
Neuroimaging prior to lumbar puncture (LP) in suspected meningitis was once thought necessary to outrule raised intracranial pressure (ICP) which would risk brainstem herniation. However, the frequency of a lesion causing raised ICP is low and the risk of herniation post LP is minimal. The inappropriate use of neuroimaging prior to LP can delay diagnosis and reduce the diagnostic yield of CSF culture results. Several expert groups have published guidelines to reduce unnecessary neuroimaging in these patients. The purpose of this study was to review the use of CT brain prior to LP in our institution to identify which guidelines can be safely followed and the diagnostic yield of neuroimaging.Table 1:Criteria for CT Brain before Lumbar Puncture
The recommendations for when neuroimaging is indicated before lumbar puncture in suspected meningitis as per the UK, European Society of Clinical Microbiology and Infectious Diseases and Infectious Diseases Society of America guidelines.

Methods
The picture archiving and communications system was retrospectively reviewed from March 2013 to March 2023 to identify patients who had been referred for CT brain to facilitate LP for suspected meningitis. The referral information was reviewed and compared to the UK, Infectious Disease Society of America and European guidelines. The imaging findings were recorded to assess for any abnormality and the patient EMR was reviewed to assess for any clinical deterioration post LP.

Results
196 patients were included. The mean time from presentation to CT was 6.5 hours. 19, 28 and 65 of the 196 studies were indicated as per the UK, EU and IDSA guidelines respectively, resulting in a 90%, 85% and 67% reduction in imaging if these guidelines were followed. Of the 177 studies deemed inappropriately performed by the UK guidelines, 164 (93%) were normal. 12 (7%) had findings that did not preclude LP. One patient (&lt; 1%) had a perimesencephalic haemorrhage. 19 (10%) studies were indicated, 16 of which were normal (84%). Of the remaining 3 (2%), none of the CT findings precluded LP. The application of the IDSA and European guidelines did detect any additional findings that precluded LP.

Conclusion
The use of expert guidelines is an important tool in reducing unnecessary neuroimaging and delays to lumbar puncture and treatment for patients with suspected meningitis. This study supports the use of the UK guidelines over other guidelines, which resulted in higher numbers of patients imaged without any additional clinical benefit. Red flag symptoms for intracranial haemorrhage should be carefully screened for.

Disclosures
All Authors: No reported disclosures
1324. Impact of Implementation of CSF PCR Panel in Patients with Meningitis
Authors: Hsu Eric , Abeydeera Nirusha , Faiz Samia , Ayutyanont Napatkamon , Meadows Robyn , Mallela Sudhakar 
Published: November 2023

Abstract

Background
Cerebrospinal fluid (CSF) Polymerase chain reaction (PCR) panel is routinely used for etiologic diagnosis of meningitis. While its role in this setting has been proven, there is no data on its benefits on duration of antibiotic use and hospital length of stay.

Methods
Retrospective cohort study was performed to compare meningitis patients who received the CSF PCR panel versus those who did not in a large database of HCA hospitals across the United States.
Data was collected from January 2014 to May 2022 on all patients diagnosed with meningitis with a CSF WBC greater than 10. Using logistic regression and negative binomial regression, the study compared utility of CSF PCR panel use versus non-use with regards to length of stay, antibiotic duration, resolution of fever and leukocytosis, and hospital readmission rate.
Demographics by Panel Use
A total of 4895 patients were included in the study, of which 379 received the CSF PCR Meningitis Panel.

Results
A total of 4895 distinct patient encounters were included, of whom 379 patients had the CSF PCR panel. CSF PCR use was associated with a significant decrease in readmission rates within 30 days (x2 5.64, p&lt; 0.05) and had decreased log count days of antibiotic duration (x2 17.56, p&lt; 0.0001) with a mean duration of antibiotic use of 73.91 hours in CSF PCR panel patients versus 82.05 hours. Panel use was not significantly associated with length of stay (x2 0.96, p 0.328). The likelihood of fever resolution and leukocytosis resolution was the same for those who received the CSF PCR Panel versus those who did not.
Antimicrobial Medications Received by Panel Use
Antimicrobial Duration and Clinical Presentation by Panel Use
There was a decrease in antibiotic use of 73.91 hours in CSF PCR panel patients versus 82.05 hours. There was also a significant decrease in hospital readmission rates within 30 days

Conclusion
CSF PCR panel benefits included reduced antibiotic duration of use and reduced 30-day readmission rates. Fever resolution and leukocytosis or leukopenia resolution was not impacted by CSF PCR panel use.

Disclosures
All Authors: No reported disclosures