bluuebunny/crossref_metadata_2025_split huggingface dataset:
1664. The Impact of Levofloxacin Prophylaxis on Empiric Intravenous Antibiotic Use in Pediatric Hematopoietic Stem Cell Transplant Recipients
Authors: Prodanuk Michael , Timberlake Kathryn E , Koo Alicia , Chopra Yogi , Wall Donna , Science Michelle 
Published: November 2023

Abstract

Background
Clinical trials have demonstrated that levofloxacin prophylaxis during periods of neutropenia in hematopoietic stem cell transplantation (HSCT) reduces the frequency of bacteremia in adults and febrile episodes in children. Therefore, levofloxacin prophylaxis may also have a role in reducing empiric intravenous antibiotic (EIA) use.

Methods
This retrospective review assessed the impact of levofloxacin prophylaxis for patients &lt; 18 years undergoing HSCT at a Canadian children’s hospital. The primary outcome was antibiotic days of therapy (DOT) during the pre-engraftment period comparing the pre-levofloxacin era (Jan 1, 2019–Jun 30, 2020) to the levofloxacin era (Jul 1, 2020–Dec 31, 2021). Patients were excluded if they were receiving EIA at the time of transplant, received chimeric antigen receptor T-cell therapy, or if levofloxacin use was discordant with their era. Secondary outcomes included the number of positive blood cultures and clinical deterioration episodes (clinical change resulting in blood culture draw and initiation/change of EIA).

Results
Fifty-four of 152 patients (36.5%) and 55 of 147 patients (37.4%) were included in the pre-levofloxacin and levofloxacin eras respectively. The most common reasons for exclusion were EIA use at the time of transplant and levofloxacin use discordant with the patient's era (Figure 1). Baseline characteristics were not significantly different between groups (Table 1). Mean DOT/pre-engraftment days (%) were significantly lower in the levofloxacin era for piperacillin-tazobactam (53.3 vs. 38.3, p=0.004) and amikacin (1.7 vs. 0.1, p=0.03), while there was no significant difference for meropenem, vancomycin, or all other antibiotics combined. There was also no significant difference in the number of positive blood cultures (11 vs. 7, p=0.35) or clinical deterioration episodes (55 vs. 66, p=0.1).

Conclusion
Levofloxacin prophylaxis in children undergoing HSCT reduced percent pre-engraftment days on piperacillin-tazobactam and amikacin, with no significant impact on the number of positive blood cultures or clinical deterioration episodes. Therefore, levofloxacin prophylaxis may facilitate antimicrobial stewardship activities through reduced use of certain broad-spectrum antibiotics.

Disclosures
Kathryn E. Timberlake, PharmD, Avir Pharma: Advisor/Consultant
1669. Impact of Required Durations of Therapy for Antibiotic Orders at the Time of Order Entry
Authors: Wright Megan R , Gillon Jessica , Katz Sophie E , Banerjee Ritu 
Published: November 2023

Abstract

Background
At this large academic children’s hospital, providers were required to select a stop date at the time of antibiotic order entry beginning in May 2022. There currently is limited to no published data surrounding the implementation of this practice and its effect on antimicrobial stewardship. This study aims to determine if requiring stop dates on antibiotic orders impacted antibiotic utilization.

Methods
This was a retrospective, pre- post-interventional study of antibiotic usage at a large academic children’s hospital. The pre-invention period was June – November 2020 and 2021. The post-intervention period was June – November 2022. Normalized days of therapy were based on the National Healthcare Safety Network (NHSN) definition. The following indications were selected: empiric for suspected infection, respiratory tract infection (RTI), intraabdominal/gastrointestinal infection, and skin and soft tissue infection. The secondary objective was to subdivide days of therapy, by drug according to the NHSN classifications. Statistical analysis with the Mann-Whitney U test was completed.

Results
The pre-invention group consisted of 3004 patients and the post-intervention group consisted of 1803 patients. There were no major differences between groups, Table 1. The implementation of stop dates decreased total days of therapy per 1000 days present (DOT) from 251 to 235 (p&lt; 0.001) for the entire sample population as well as DOT for empiric indications (153 DOT vs. 124 DOT, p&lt; 0.001), Table 2. For RTI, there was an increase from 42 DOT to 49 DOT (p=0.011). Further analysis revealed an increase in patients with RTI indications and a decrease in duration of therapy from 6 days to 4 days. There was an overall decrease in use of hospital-onset antibiotics (81 DOT vs. 66 DOT, p&lt; 0.001) as well as vancomycin (33 DOT vs. 28 DOT, p &lt; 0.001), Table 3.

Conclusion
After implementation of stop dates, DOT was significantly lower overall and for empiric indication. Decreased usage in hospital onset antibiotics and vancomycin was also seen. The increase in DOT for RTI can be attributed to the increased prevalence in the post-intervention group. Requiring stop dates at the time of antibiotic order entry was associated with lower antibiotic utilization and is a useful tool for stewardship programs.

Disclosures
Sophie E. Katz, MD MPH, Dolly Parton Pediatric Infectious Diseases Research Funds: Grant/Research Support|Optum: Advisor/Consultant|Pfizer: Grant/Research Support Ritu Banerjee, MD, Ph.D, bioMerieux: Grant/Research Support|bioMerieux: company is providing partial support for an ongoing trial unrelated to submitted abstract
1672. Applying Spatial Analyses to Identify Pediatric Risk Factors for Recurrent Staphylococcal aureus Skin and Soft Tissue Infections
Authors: Anderson Daria , Lin Xiting , Mohamed Noor , Immergluck Lilly , Thornton Kevin , Sanders Langdon 
Published: November 2023

Abstract

Background
Community onset Staphylococcus aureus (S. aureus) disproportionately cause skin and soft tissue infections (SSTI) among African Americans (AA). Recurrence of S. aureus SSTI can be seen in &gt;50% of pediatric cases. Risk factors associated with recurrent infections in children are not well reported. We hypothesize that recurrence of S. aureus SSTI in AA children living in Atlanta, Georgia may be related to location-based risks.

Methods
Patients with S. aureus infections from 2011-2019 were included in this retrospective study, using electronic health records (EHR). We included patients who had community-onset S. aureus SSTI, were &lt; 19 years old, and were Georgia resident. Sociodemographic variables collected included race, ethnicity, age, sex, and health insurance. Area-level variables from US Census Bureau included proxies for poverty, education, unemployment, and household crowding. Infections were stratified into MRSA and MSSA by oxacillin susceptibility. Recurrent SSTI was defined as an initial SSTI with one or more subsequent SSTI documented more than 14 days from initial infection within a calendar year. Home address was geocoded and assigned a census tract. Statistical analyses included chi-squared tests and multiple logistic regression to detect differences between patients with recurrent SSTI from non-recurrent SSTI using SPSS. Hotspot analyses were performed at the census tract level to identify hot and cold spots for recurrent SSTI stratified by methicillin susceptibility using ArcGIS Pro.

Results
5,784 unique children presented with S. aureus SSTIs; 64 patients had recurrent SSTI (42 MRSA and 22 MSSA). Females had high proportion (64.1% ) of recurrent SSTIs compared to 48.0% of females with single SSTI (p = 0.011). Females also were significantly more likely to have recurrent MSSA (81.8%) compared to 54.8% of females with recurrent MRSA (p = 0.032). Spatial analysis demonstrated hotspots of recurrent SSTIs in the northern counties of metropolitan Atlanta, whereas single episode SSTIs did not demonstrate this type of spatial distribution.
SSTI Recurrence by County Level

Conclusion
In Georgia, children who are female are at increased risk for recurrent SSTI, and hotspots of patients with recurrent SSTIs are distinct from those with single episodes of SSTIs.

Disclosures
Lilly Immergluck, MD,MS, Melinta: Grant/Research Support|Melinta: Grant/Research Support
1684. Clinical Comparison of Pertussis Infected with Macrolides-resistance and Macrolides-sensitive Bordetella Pertussis
Authors: Guo Fengwei , Deng Jikui 
Published: November 2023

Abstract

Background
To analyze the clinical characteristics and therapeutic outcome of pertussis infected with macrolides-sensitive and macrolides-resistant Bordetella pertussis.

Methods
The clinical data of 154 hospitalized children with pertussis diagnosed by culture in Shenzhen Children's Hospital infectious Department from December 2015 to December 2017 were collected. All children were divided into macrolides-sensitive (MS) group and macrolides-resistant group (MR) according to the results of antimicrobial susceptibility testing. The clinical characteristics and curative effect indexes were compared between these two groups.

Results
From December 2015 to December 2017, 154 children with pertussis diagnosed by culture were admitted to Shenzhen Children's Hospital infectious Department. The median age of children in MR group was 4 (3, 6) months, which was older than that in MS group (Z= 4.38, P&lt; 0. 05). 38 cases (48.71%) in MR group had been vaccinated, which was significantly higher than that in MS group (χ2= 7.24, P&lt; 0.05). 25 cases (32.05%) in MR group had wheezing, which was higher than 12 cases (15.79%) in MS group (χ2= 5.58, P&lt; 0.05). 24 cases (30.77%) in MR group were treated with gamma immunoglobulin, which was more frequently than that in 12 cases (15.79%) in MS group (χ2= 4.82, P&lt; 0.05). Gamma immunoglobulin was used in 24 cases (30.77%) in MR group, which was more common than that used in 12 cases (15.79%) in MS group (χ2= 4.82, P&lt; 0.05). 13 cases (16.67%) in MR group were treated with SMZ-TMP, which was more common than that in MS group (χ2= 13.8, P&lt; 0.05). The logarithmic value of PCR copy number of pertussis in MR group (5.86 ± 1.07) was higher than that in MS group (t= 5.67, P &lt; 0.05).

Conclusion
The macrolides-resistance of Bordetella pertussis was common. Except wheezing, there was no significant difference in other clinical manifestations of children infected with macrolides-resistant or macrolides-sensitive Bordetella pertussis. The infection of macrolides-resistant strains was more common in children who had been vaccinated, and as to the patients infected with macrolides-resistant strains, most of them could be cured effectively with the treatment of erythromycin. Only small part of them need to be treated with SMZ-TMP.

Disclosures
All Authors: No reported disclosures
1689. Comparison of Antibiotics Use between Patients with Kawasaki Disease and Propensity Score-matched Controls: a Cohort Study of 106,908 Patients
Authors: Kim Tae-Hwan , Shin Ji Seong , Kim Sin Young , Jang Min Sik , Kim Jihye 
Published: November 2023

Abstract

Background
The etiology of the Kawasaki disease (KD) has been explained by the influence of infectious agents that interfere with the immune function in genetically susceptible children. In addition of this infectious etiology, we hypothesized that microbial imbalance in the gut from antibiotics use may be an important etiologic factor. We aimed to assess the association between antibiotics use and the development of KD.

Methods
A population-based, case-control study was performed using data from 2010 to 2019 from the Health Insurance Review and Assessment Service (HIRA) database. Various profiles regarding prior antibiotics use since birth were compared between patients with KD and matched controls. Children aged &lt; 5 years who were diagnosed with initial episode of KD from 2016 to 2019 were identified. Propensity score-matched controls without KD were selected from the general population in a 1:5 ratio. Four separate study cohorts according to four different periods of antibiotics use were created: 1) within 28 days after birth; 2) within 12 months after birth; 3) within 6 months from the index date; and 4) within 12 months from the index date. The occurrence of KD were compared between KD cases and controls.

Results
Overall, 17,818 patients with KD and 89,090 matched controls were included in the analysis. Use of antibiotics within 6 months (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.12–1.26) and 12 months (OR, 1.23; 95% CI, 1.14–1.32) from the index date were associated with the development of KD. The association between antibiotics use and KD (OR, 1.26; 95% CI, 1.17–1.37) was most prominent in patients who had received more than three classes of antibiotics within 12 months from the index date. No significant association was observed between the duration of antibiotics use, use of all three major antibiotics classes, or use of any specific antibiotics class and KD.

Conclusion
The development of KD is associated with antibiotics use. However, evidence suggesting that antibiotics use in the neonatal period or within the first 12 months of life is associated with KD is weak.

Disclosures
All Authors: No reported disclosures
1690. Acute Hematogenous Osteoarticular Infections in Children at Siriraj Hospital, Thailand: A 20-Year Retrospective Review
Authors: lertamornkitti nichkamol , Wittawatmongkol orasri , Chokephaibulkit Kulkanya 
Published: November 2023

Abstract

Background
Acute hematogenous osteomyelitis (AHO) and septic arthritis (SA) lead to significant morbidity and sequelae. There are limited data in Thai children.

Methods
This is a single-center retrospective study of patients aged &lt; 18 years who were diagnosed with AHO and SA between 2002- 2021. The acute onset of AHO and SA was defined as the diagnosis of bone and joint infection within 4 weeks after the onset of symptoms or signs in a previously uninfected bone. Data were collected and factors associated with sequelae were determined by using multiple logistic regression analyses.

Results
Of the 110 patients identified, 19 were AHO, 81 were SA, and 10 were combined AHO and SA. The median (IQR) age was 6.7 (1.4-11.9) years and 66 (60%) were male. Fifteen (13.6%) patients were immunocompromised. The most common sites of AHO were tibia (27.6%) and femur (27.6%), and of SA were hips (41.8%) and knees (31.9%). The pathogens were identified in 68 of 106 (64.1%) patients with specimen submission. The positivity rate of hemoculture, synovial fluid, synovial tissues, bone biopsies and vaginal/urethral culture in patients with suspected disseminated gonococcal infection were 32.1%, 40%, 61.9%, 60% and 50% respectively. The most common organisms were methicillin-sensitive Staphylococcus aureus (30.2%) and non-typhoidal Salmonella (9.4%). We found only one case with community-acquired, methicillin-resistant S.aureus. Non-typhoidal Salmonella was responsible for 22.7% of 22 infants. The one-year sequelae were found in 15.8% of AHO, 18.5% of SA, and 20% of combined. In multivariate models, factors associated with sequelae were being immunocompromised (adjusted OR 14.16, 95%CI 1.96-102.35, P=0.009) and infection of the hips (adjusted OR 6.25, 95%CI 1.45-14.59, P=0.025).
Patients' characteristics
Pathogens according to age groups
Factors associated with sequalae

Conclusion
Methicillin-sensitive S. aureus was the most common pathogen among Thai children with acute hematogenous osteoarticular infections. However, Salmonella was the predominant causative organism among infants. Appropriate empirical antibiotic therapy should be effective against both pathogens in infants. Long-term follow up is needed particularly in immunocompromised children and infection of the hip.

Disclosures
All Authors: No reported disclosures
1691. Use of multiplex PCR in pleural effusion: a case series study in a pediatric reference center in Colombia
Authors: Londono-Ruiz Juan Pablo , Vargas-Garcia Andrea , Cardenas-Muller Adriana , Bejarano-Quintero Ana Maria , Mantilla Maria Ximena , Gutierrez-Tobar Ivan Felipe 
Published: November 2023

Abstract

Background
The microbiological diagnosis of pleural effusion (PE) is largely based on methods of classical microbiology. Culture-based methods allow for testing of bacterial susceptibility tests, but these methods take time and frequently have false negative results. We describe the utility of multiplex PCR in pleural fluid for the diagnosis of complicated pneumonia in children using a commercial platform for respiratory samples.

Methods
We conducted a case series of children with complicated pneumonia by PE, empyema or necrotizing pneumonia. Pleural fluid was sent for laboratory to culture, cytochemical and molecular biology testing analysis between 2021 and 2022 in a reference children hospital in Bogotá, Colombia. We used BIOFIRE® FILMARRAY® Pneumonia Panel plus (BioFire Diagnostics, Salt Lake City, Utah). The results were strictly analyzed by a multidisciplinary team. Any change in patient’s therapeutics was decided by this group.

Results
We identified 17 samples that were processed for multiplex-PCR from 16 patients (Table 1). Median age was 3 years (IQR 2-4 years). Pleural empyema was the most common presentation (7/17, 41%), followed by free pleural effusion (6/17, 35%) and necrotizing pneumonia with empyema (4/17, 23,5%). Pathogens were documented in 16 out of 17 (94%) molecular panels performed. Streptococcus pneumoniae was detected in 11/17 (64.7%) multiplex PCR tests, adenovirus was detected in 7/17 (41.1%), and H. influenzae in 2/17 (11.7%) tests. Pneumococcus was isolated in classical cultures in 4 patients (23.5%), of which only one was in pleural fluid. Changes in antibiotic management in 9/17 (52.9%) of the patients. In 5 patients, there was an increase in the antibiotic spectrum, and in 4 patients, there was a decrease in it.

Conclusion
Although the use of this multiplex PCR device is not approved by the FDA for use in pleural fluid samples (off-label), this case series described its usefulness and importance in contexts where there is no other approved PCR technology for these samples.

Disclosures
All Authors: No reported disclosures
1695. Epidemiology of Positive Blood Cultures with Negative BioFire® Blood Culture Identification Panel Results at a Pediatric Center
Authors: Patel Pratik A , Locsin Miguel A , Liu Katie , Jaggi Preeti , Gonzalez Mark D 
Published: November 2023

Abstract

Background
The BioFire® Blood Culture Identification (BCID) Panel is a rapid multiplex PCR assay designed to identify common bloodstream infection (BSI) organisms from positive blood cultures (Figure 1). Although a positive BCID result can identify and often guide pathogen-directed treatment, a negative result may lead to uncertainty. Therefore, we aimed to describe the organisms isolated from cultures with negative BCID tests in pediatric patients.
Figure 1
Targets on the BioFire Blood Culture Identification Panels 1 vs. 2

Methods
In this retrospective study of children (≤ 21 years) in our health system, we extracted all BCID tests performed 01/01/2018 to 03/12/2023 from the electronic medical record (EMR). We excluded positive BCID tests and from the negative tests, excluded duplicates, those with no growth and isolated Gram-positive rod Gram stain. Demographic, clinical, and culture data were abstracted from the EMR. Host status was categorized as previously healthy (PH), chronic condition (CC), and immunocompromised (IC). Descriptive statistics were used to summarize the data.

Results
Of the 4049 BCID tests (3123 BCID1, 926 BCID2) performed, 387 resulted negative (327 BCID1 [10.4%], 61 BCID2 [6.6%]). After applying exclusion criteria, 351 negative BCID tests (296 BCID1, 55 BCID2) from 325 patients were included in the dataset. Among the 351 negative tests, 81 (23.1%) were in PH hosts, 151 (43.0%) in CC hosts, and 119 (33.9%) in IC hosts. The majority (n=208, 59.3%) of negative test results were from cultures drawn peripherally. Eighteen tests (5.1%) resulted in polymicrobial growth, and 156 (44.4%) were not treated as BSIs by the clinician (Table 1).
After the BCID negative result, the median delay in organism identification using conventional methods was 28.9 hours. The 351 cultures from negative BCID tests yielded 372 organisms with the most common Micrococcus spp. (Figure 2).
Table 1
Demographic and culture characteristics of patients with negative BioFire BCID test results: a comparison between BCID1 and BCID2
Figure 2
Top 3 organisms isolated from positive cultures with negative BioFire BCID tests, stratified by patient host status and reported Gram stain

Conclusion
In this large pediatric cohort, the BioFire® BCID1 was negative in 10.4% of tests, decreasing to 6.6% with BCID2. We provide clinicians with a useful resource of organisms isolated from cultures with negative BCID results based on underlying host status. With an identification delay of &gt; 24 hours for the majority of BCID negative tests and many not ultimately treated as BSIs, the impact of negative BCID results on antimicrobial stewardship efforts remains an area of future study.

Disclosures
Pratik A. Patel, MD, Cardinal Health Inc: Advisor/Consultant
1696. Urinary tract infection due to Aerococcus urinae in children
Authors: Sato Eri , Iijima Hiroyuki , Shoji Kensuke , Ogimi chikara , Ishiguro Akira 
Published: November 2023

Abstract

Background
Aerococcus urinae is a rare Gram-positive and catalase-negative coccus. A. urinae is primarily associated with urinary tract infection (UTI). It is responsible for urosepsis and occasionally complicated diseases, including endocarditis and osteomyelitis. The clinical presentations of adult patients with A. urinae have been described. However, there are very few reports in children. The clinical course of UTI due to A. urinae and the associated risk factors remain unclear. The aim of this study was to describe the clinical characteristics of UTI due to A. urinae in children.

Methods
We conducted a retrospective observational study at a tertiary children’s hospital in Tokyo, Japan. We included pediatric patients (&lt; 18 years old) who had positive urine cultures for A. urinae (≥ 104 CFU/HPF) between June 1, 2006, and May 31, 2022. Information regarding clinical characteristics, including age, sex, underlying disease, laboratory test results, antibiotic susceptibility of A. urinae, treatment, and outcomes were collected from the electronic medical records.

Results
A total of 22,769 urine cultures were submitted during the study period, of which A. urinae was isolated in 35 (0.15%). We found 17 patients who were positive for A. urinae with greater than 104 CFU/HPF. Among them, 13 patients (76.5%) were male and 16 (94.1%) had underlying bladder dysfunction. The main clinical symptoms were fever (n=6, 35.3%), urine odor (n=4, 23.5%), and nausea (n=2, 11.8%). Five patients had diagnosed pyelonephritis due to A. urinae. All five patients were male, and the median age at presentation was 4.6 years (range 2.1-11.0 years). Four of them had underlying bladder dysfunction. All bacterial isolates were susceptible to the majority of antibiotics, including penicillin G, sulfamethoxazole, or ciprofloxacin. All patients had favorable outcomes following 10-14 days of ampicillin/amoxicillin-based antimicrobial therapy.

Conclusion
A. urinae was isolated in urine cultures primarily in male patients with underlying bladder dysfunction. All of the outcomes of antibiotic treatment were favorable.

Disclosures
Kensuke Shoji, MD, PhD, AstraZeneca K.K.: Honoraria|Gilead Sciences, Inc.: Honoraria|KYORIN Pharmaceutical Co.,Ltd.: Honoraria|Meiji Seika Pharma Co., Ltd.: Honoraria|Nippon Becton Dickinson Company, Ltd.: Honoraria|Novartis Pharma Co., Ltd.: Honoraria|Viatrs, Inc: Honoraria chikara Ogimi, MD, bioMerieux Japan Ltd.: Honoraria|Horiba: Honoraria|Pfizer: Honoraria