bluuebunny/crossref_metadata_2025_split huggingface dataset:
2405. Extended Incubation of Blood Cultures in the Identification of Cutibacterium acnes as the Causative Pathogen in Infective Endocarditis
Authors: Garcia Sofia Molina , Shrestha Nabin K , Gordon Steven M 
Published: November 2023

Abstract

Background
Cutibacterium acnes is an uncommon cause of infective endocarditis (IE). Blood cultures are sometimes held for extended incubation (beyond the standard 5 days) with an expectation that such incubation might allow C. acnes to grow. Extended incubation of blood cultures consumes resources, and a justification of such extension requires a demonstration that it increases the likelihood of identifying a causative pathogen.
The purpose of this study was to examine the association between extended incubation of blood cultures and the identification of C acnes as the causative pathogen in patients with IE possibly caused by C. acnes.

Methods
This was a retrospective case-control study. Episodes of surgically treated IE among patients admitted from July 1, 2007, through Jan 1, 2022 were identified from the Cleveland Clinic Infective Endocarditis Registry, were screened for inclusion in the study. Patients with C. acnes IE were case subjects. Controls were selected from patients without an identified pathogen, by propensity score matching on age, gender, admission year, and IE category (native valve endocarditis or prosthetic valve endocarditis), using the nearest neighbor method, from among episodes of IE for whom a causative pathogen was not identified. Extended incubation was defined as incubation of blood cultures for longer than 5 days. The association between extended incubation of blood cultures and C. acnes identification was examined using logistic regression.

Results
Thirty-five subjects with C. acnes IE were matched to 35 control subjects. Nine of 35 subjects in the C. acnes group had at least 1 blood culture held for &gt;5 days compared to only 1 of 35 controls. Five (50%) of those held for extended incubation grew C. acnes. Extended incubation was associated with a significantly higher odds of identification of C. acnes as the cause of IE (OR 11.8, 95% C.I. 2.0 – 224.1, p-value 0.02).

Conclusion
Among patients with possible C. acnes IE, extended incubation of blood cultures is associated with 12-fold higher odds of identifying C. acnes.

Disclosures
All Authors: No reported disclosures
2408. Is Shorter Antibiotic Treatment Feasible in Patients with Cardiac Implantable Electronic Devices (CIED) Infections? Impact of Treatment Duration on 6-Month Recurrence and Mortality
Authors: Ponta Giacomo , Ranzenigo Martina , Marzi Alessandra , Oltolini Chiara , Din Chiara Tassan , Uberti-Foppa Caterina , Spagnuolo Vincenzo , Mazzone Patrizio , Della Bella Paolo , Scarpellini Paolo , Castagna Antonella , Ripa Marco 
Published: November 2023

Abstract

Background
Aim of this study is to compare the 6-month outcomes (recurrence and mortality) of patients with cardiac implantable electronic device (CIED) infections treated with short (SHORT, &lt;14 days) or long (LONG, &gt;14 days) duration of antimicrobial therapy after device removal.

Methods
Retrospective cohort study of patients hospitalized at IRCCS San Raffaele Hospital (Milan, Italy) from June 2011 to June 2021, who underwent device removal for CIED infection. Patients with pocket and lead infections were included, while valve endocarditis and Staphylococcus aureus infection were excluded.
The characteristics of patients in the SHORT and LONG groups were compared using the chi-square test for categorical variables and the Mann-Whitney U-test for continuous variables. A propensity score (PS) was calculated using a logistic regression that considered duration of therapy as the dependent variable; the association between patients’ characteristics and outcomes was evaluated with logistic regression analysis.

Results
The characteristics of the 150 included patients are described in table 1, the microbial etiology in table 2. Patients in the SHORT compared to the LONG group were older (75 [65-80] vs 69 [62-77], p-value=0.047), had a higher Charlson comorbidity index (5 [3-6] vs 4 [3-5], p-value=0.021), had less frequent isolation of coagulase-negative staphylococci (CoNS; 46.7% vs 68.9%, p-value=0.006), and an unknown etiology (36.7% vs 13.3%, p-value=0.001). Moreover, the duration of antimicrobial treatment after device removal was shorter (13 [9-14] vs 20 [16-29] days, p-value&lt; 0.001). At 6 months, recurrence and mortality were not significantly different between the SHORT and the LONG group (recurrences: 2 [3.7%] vs 5 [6.7%], p-value=0.464; mortality: 2 [3.7%] vs 3 [4.0%], p-value=0.931),
At logistic regression analysis (table 3 and table 4) adjusted for PS, treatment duration was not significantly associated with either recurrence (odds ratio [OR] 0.524; 95% confidence interval [95%CI] 0.084-3.263) or mortality (OR 1.402; 95%CI 0.185-10.635).

Conclusion
A shorter duration of antimicrobial treatment after device removal may be an effective approach for treating patients with CIED infections.

Disclosures
Antonella Castagna, MD, Bristol-Myers Squibb: consultancy payments and speaking fees|Gilead: consultancy payments and speaking fees|Janssen-Cilag: consultancy payments and speaking fees|Merck Sharp & Dohme: consultancy payments and speaking fees|ViiV Healthcare: consultancy payments and speaking fees
2409. Potential candidates for partial oral treatment in patients with endocarditis at a US center
Authors: Pries-Heje Mia M , Kim Andy J , Joyce Mary-Ruth M , Hartman Dylan J , Connolly Erin M , Itoh Akinobu , Cunningham Mark , O’Gara Patrick , Sun Yee-Ping , Maguire James , Aghayev Ayaz , Weber Brittany N , Di Carli Marcelo , Suzuki Joji , Ramirez Yesenia Buenrostro , Iversen Kasper K , Baden Lindsey R , Bundgaard Henning , Woolley Ann E 
Published: November 2023

Abstract

Background
In the Danish POET trial, oral step-down oral antibiotics in patients with left-sided infective endocarditis (IE) was non-inferior to traditional intravenous antibiotics (IV-AB). Outpatient parenteral antimicrobial therapy (OPAT) is widely used in the US despite associated adverse events. Our aim was to assess the proportion of US patients that were potential candidates for step-down oral antibiotic treatment, i.e. POET-treatment, and number of days IV-AB antibiotics could have been reduced.

Methods
Retrospective study of patients admitted with left-sided IE at a US single center from January 2021 – June 2022 was conducted. Patients were considered candidates for POET-treatment if they were infected with S. aureus, E. faecalis, Streptococcus spp., or CoNS, had a BMI &lt; 40 kg/m2 and survived until discharge. The primary outcome was a composite of all-cause mortality, symptomatic embolism, unplanned cardiac surgery, and relapse of bacteremia within 6 months.

Results
Out of 111 patients with left-sided IE, 71 (64%) were considered potential POET-candidates (median age 64 years (IQR 54-75), 72% male); 30% had IE caused by S. aureus, and 48% were surgically treated (Table 1). Potential candidates were older (64 vs 60 years), more often infected with Streptococcus spp. (24% vs 0%) or CoNS (23% vs 5%), and had a pacemaker/ICD at baseline (23% vs 5%), as compared to patients who were not candidates for POET-treatment. Of potential POET-candidates, 93% (66/71) were stabilized, allowing discharge to OPAT with a median of 29 days (IQR 20-36) of antibiotic treatment remaining.
The primary outcome occurred in 28% of potential POET-candidates and in 53% of non-POET candidates, compared to the occurrence of the primary outcome in 11% in the Danish POET-trial (Table 2).

Conclusion
More than half of patients admitted with left-sided IE were potential candidates for POET-treatment. For the vast majority of these patients, up to 4 weeks of IV-AB may have converted to oral step-down antibiotics. Prevalence of the primary outcome in potential POET-candidates was almost 3 times higher in this US cohort than in the Danish POET trial, indicating a higher baseline risk. These findings indicate a need for prospective studies of oral step-down antibiotic therapy in US patients with IE.

Disclosures
Joji Suzuki, MD, Indivior: Grant/Research Support
2414. Pulling the Cord: Removal of Urinary Catheters before Urine Culture in a Cardiothoracic-Surgery ICU
Authors: Ben-Aderet Michael , Madhusudhan Meghan , Grein Jonathan , Drucker Carissa , Nurok Michael , Chan Alice , Kalava Sowmya , Vargas Moises R , Cornett Jake , Yaung Jill , Harper-Kirksey Katrina , Granflor Eliza 
Published: November 2023

Abstract

Background
Detection of asymptomatic bacteriuria (ABU) can lead to significant consequences, including over-prescription of antibiotics. Numerous studies have demonstrated that urinary catheters (UCs) are quickly colonized with bacteria, even when UTI is not present, and obtaining cultures from catheters leads to increased detection of ABU and increased Catheter Associated Urinary Tract Infection (CAUTI) rates. In our Cardiac Surgery ICU (CTICU), where UC utilization is high with limited opportunities for removal, we implemented an ABU reduction intervention consisting of replacing UCs prior to urine cultures.

Methods
In July 2021, we implemented a new urine culture stewardship process in the CTICU. When a patient with a UC required a urine culture, a urinalysis (UA) was ordered. If pyuria was present, the UC would be replaced, and a new urine culture (direct culture or a UA with reflex to culture) would be drawn from the new UC. This process was implemented as a recommendation, and compliance was encouraged by physician and nursing leadership, but not prospectively monitored. Retrospective review was done comparing urine culture positivity, antibiotic use and CAUTI rates in the period after the intervention with 2 full calendar years prior to the intervention. We also looked at catheterization rates and urology consultation rates (as a marker for urinary tract injury)

Results
Post-intervention, we saw a 43% reduction in the rate of urine cultures (4.9 to 2.8 cultures / 1000 patient days, p-value &lt; 0.001), a 67% reduction in rate of positive urine cultures (1.2 to 0.4 positive cultures / 1000 patient days, p-value &lt; 0.001), and an 87.5% reduction in CAUTI rate (1.6 to 0.2 CAUTIs / 1000 catheter days, p-value &lt; 0.001). There was no significant change in urinary catheterization rate, gram-negative antibiotic use, or rate of urology consultation.Figure 1:Urine culture, positive urine culture and CAUTI rate before and after the interventionFigure 2:Urinary catheter utilization ratio before and after the intervention.Figure 3:Proportion of encounters with a urology consult before and after the intervention

Conclusion
We observed a dramatic reduction in CAUTI, positive urine cultures and all urine cultures with no increase in Urology consultations or change in UC utilization. While the reduction in reportable CAUTI is important and highly relevant, further work is needed to explore the full potential for this intervention regarding antimicrobial stewardship.

Disclosures
All Authors: No reported disclosures
2416. Outcomes of Patients with Ventilator-Associated Pneumonia in For-Profit Hospitals Compared to Non-Profit hospitals: A National Retrospective Cohort
Authors: Leon Renato Bobadilla , Morel Garry Francis 
Published: November 2023

Abstract

Background
Healthcare-associated infections (HAI) constitute a significant burden to patient outcomes and healthcare costs. Ventilator-associated pneumonia (VAP) carries a high mortality and represents one of the costliest HAI. There is uncertainty if treating this subgroup of patients in For-Profit (FP) hospitals portents better outcomes than Nonprofit (NP) hospitals.

Methods
A retrospective cohort of patients admitted from January 2016 through December 2020 was extracted from the National Inpatient Sample database. We compared two cohorts of patients with a primary diagnosis of VAP: patients admitted to FP hospitals and patients admitted to NP hospitals. The primary end-point was all-cause inpatient mortality. A multivariate logistic regression analysis was conducted. The secondary end-points included: comparing the requirement of vasopressor use and Acute Kidney Injury (AKI) requiring hemodialysis (HD); describing associated comorbidities; and comparing if there was a difference in length of stay (LoS) and hospital cost between the 2 groups. In order to compare LoS and hospital cost, a multivariate linear regression was conducted.

Results
A total of 6 155 hospitalizations under the primary diagnosis of VAP were included. No statistically significant difference in mortality was noted (FP: 4.24 vs. NP:8; p = 0.182), but age (aOR 1.01, p = 0.020) and Charlson Comorbidity Index(CCI) (aOR 1.20; p &lt; 0.001) were modest predictors of mortality for both groups (FP vs. NP). There was no statistically significant difference in mean LoS between these two groups (FP:10.61 days vs. NP: 9.57, p=0.398). CCI (Coef 0.64, p= 0.01) and admission to large-size hospitals (Coef 3.03, p &lt; 0.001) were predictors of LoS for both groups. Admission to for-profit hospitals predicted higher hospitalization costs (p = 0.020). Furthermore, admission to medium-size hospitals, large-size hospitals, and urban hospitals were also predictors of higher hospital cost (p &lt; 0.05). No statistically significant difference was found in vasopressor use and AKI requiring HD among both groups (FP vs. NP) (p &lt; 0.05).

Conclusion
Admission to For-Profit hospitals did not portend better outcomes compared to Nonprofit hospitals. Conversely, admission to For-Profit hospitals predicted higher total hospital costs.

Disclosures
All Authors: No reported disclosures
2417. Epidemiology of Central Line-Associated Bloodstream Infections Present on Hospital Admission: A Multicenter Study
Authors: Ching Patrick R , Oladapo-Shittu Opeyemi , Hsu Yea-Jen , Saunders Heather , Salinas Alejandra B , Helsel Taylor N , Mayoryk Stephanie , Gadala Avinash , Cosgrove Sara E , Rock Clare , Klein Eili , Maragakis Lisa , Pineles Lisa , Harris Anthony , Mejia-Chew Carlos , Keller Sara C 
Published: November 2023

Abstract

Background
National estimates of central line-associated bloodstream infections (CLABSI) focus on acute care hospital settings. Little is known about CLABSI that develop outside of hospitals and are present on admission (CLABSI-POA). We aimed to describe the epidemiology of CLABSI-POA to develop appropriate prevention strategies.

Methods
We performed a retrospective cohort study of all adult and pediatric patients admitted from 11/01/2020 to 10/31/2021 in two large medical systems in the US, one in Maryland and one in Missouri. Adapting the National Healthcare Safety Network acute care CLABSI definition, we included patients who had a central venous catheter (CVC) present on admission (or had a CVC discontinued within 72 hours prior to admission) and a positive blood culture within 72 hours before and/or after admission. We performed descriptive statistics to characterize the epidemiology of CLABSI-POA.

Results
Of 402 patients with CLABSI-POA, 52% were male, 68% were age ≥45 years, and 45% had Medicare insurance as primary payer. Half of the cases had a hospitalization 30 days prior to the index admission, 22% had at least one prior CLABSI, and 40% received chemotherapy in the last 6 months. The most common indications for catheter placement were chemotherapy (34%), total parenteral nutrition (21%), dialysis (15%), and outpatient parenteral antimicrobial therapy (11%). Attribution of CLABSI-POA based on site where the catheter was routinely accessed included oncology clinics (34%), home infusion therapy (32%), hemodialysis centers (12%), and skilled nursing facilities (9%). The most common causative microorganisms were coagulase-negative staphylococci (23%), Staphylococcus aureus (21%), Enterococcus spp. (12%), Candida spp. (11%), Escherichia coli and Klebsiella pneumoniae (10% each), and Pseudomonas aeruginosa (7%). Forty-five (11%) cases were due to multidrug resistant organisms. Overall in-hospital mortality was 10%.

Conclusion
CLABSI-POA were common in those attending oncology clinics and receiving home infusion therapy. Lack of routine surveillance of CLABSI-POAs leads to an underestimation of the burden of CLABSIs in the healthcare system. Tailored prevention strategies should be focused in those groups at higher risk.

Disclosures
Stephanie Mayoryk, MAS BSN RN CIC, PDI: Honoraria Sara E. Cosgrove, MD, MS, Debiopharm: Advisor/Consultant|Duke Clinical Research Institute: Advisor/Consultant Carlos Mejia-Chew, MD, INSMED: Grant/Research Support|RevImmune: Grant/Research Support Sara C. Keller, MD, MPH, MSPH, Pfizer: Advisor/Consultant
2429. Epidemiology and Risk Factors for Vascular Access-associated Infections in Japanese Hemodialysis Patients
Authors: Morikane Keita 
Published: November 2023

Abstract

Background
Surveillance of vascular access-associated infections (VAIs) in patients on hemodialysis has been well established in the United States, but not so in other countries including Japan. Our group established a voluntary VAI surveillance scheme, Dialysis Surveillance Network Japan (DSNJ), which is in operation for over 10 years. The purpose of this study is to describe the epidemiology and identify risk factors for VAI in patients on hemodialysis in Japan.

Methods
Data collected through DSNJ from January 2008 to December 2021 were used. Incidence of VAI was calculated by the number of infection per 1,000 dialysis sessions. Potential risk factors analyzed in this study included type of access, diabetes, indication of catheter use and seasonality

Results
During the study period, 4,919,834 dialysis sessions were surveyed at 52 hospitals and 1,146 VAI were observed, with an overall incidence of 0.23 per 1,000 sessions. The incidence declined over time. The incidences by the type of access were 0.05 (203 VAI in 4,285,758 dialysis sessions) for arteriovenous fistula (AVF), 0.11 (17/157,754) for superficialization of brachial artery (SBA), 0.53 (127/240,289) for arteriovenous graft (AVG), 1.33 (219/164,195) for cuffed catheter (CC) and 8.07 (580/71,838) for non-cuffed catheter (NCC). NCC had significantly higher risk for VAI than any other type of access. The most frequently accountable pathogen was methicillin-susceptible Staphylococcus aureus. The risk of diabetes for VAI was not significant in patients with either NCC or CC (NCC: RR 1.18, 95%CI: 0.98-1.43, CC: RR0.86, 95%CI: 0.64-1.16). NCC inserted at the femoral site had significantly higher risk of VAI compared to that at internal jugular site (RR 1.47, 95%CI: 1.21-1.78). This was also true for CC (RR:2.41, 95%CI: 1.34-4.34). NCC used at the induction of hemodialysis was more likely to be complicated with VAI than NCC used as a temporary substitute (RR 1.50, 95%CI: 1.22-1.84). Fifty-five percent (634/1,146) of VAI occurred in summer (May to October), indicating a seasonal variation in the incidence of VAI.

Conclusion
Our surveillance scheme revealed epidemiology and risk factors for VAI in Japanese hemodialysis patients. These findings might lead to better control VAIs in patients on hemodialysis.

Disclosures
All Authors: No reported disclosures
2430. Risk Factors for Mortality among Patients who Present from the Community with Central Line-Associated Bloodstream Infections
Authors: Oladapo-Shittu Opeyemi , Ching Patrick R , Hsu Yea-Jen , Saunders Heather , Salinas Alejandra B , Helsel Taylor N , Mayoryk Stephanie , Gadala Avinash , Cosgrove Sara E , Rock Clare , Klein Eili , Maragakis Lisa , Pineles Lisa , Harris Anthony , Mejia-Chew Carlos , Keller Sara C 
Published: November 2023

Abstract

Background
Central line-associated bloodstream infections (CLABSI) lead to significant morbidity and mortality. Surveillance has contributed to reductions in the CLABSI rate in acute care hospitals. Although there are increasing numbers of patients with central venous catheters outside of acute care hospitals, the prevalence of and mortality risk associated with CLABSIs present-on-admission (POA) to acute care hospitals is unknown.
To explore the burden of CLABSI POA and the risk factors associated with an all-cause mortality.

Methods
We identified patients presenting to hospitals with CLABSI (regardless of pre-admission location) in two large health systems based in Maryland, Washington DC, and Missouri between November 2020-October 2021. CLABSI was defined using an adaptation of the acute care CLABSI definition.

Results
Out of 402 patients identified with CLABSI POA, in-hospital mortality was 10.4%. Within six months of hospital presentation, 126 patients died (31.3%) (Figure 1). The median Pitt bacteremia score was 1 (interquartile range: 0-2), with 82 (20.4%) admitted to the adult intensive care unit (ICU), and 9 (2.2%) admitted to the pediatric ICU. The mean hospital length of stay was 8 days (interquartile range: 5-14). Compared with patients &lt; 45 years of age, patients aged 45-64 and &gt;65 had increased mortality within 6 months (OR: 3.49, 95% CI: 1.53-7.96; OR: 5.76, 95% CI: 2.24-14.81, respectively). Compared with patients receiving Medicaid, patients who were self-pay had increased mortality within 6 months (OR: 4.18, 95% CI: 1.13-15.43). Receipt of chemotherapy within the last 6 months and hospital discharge ≤ 30 days before presentation were associated with increased mortality within 6 months (OR: 2.53, 95% CI: 1.12-5.71; OR: 1.19, 95% CI: 1.13-3.23; respectively) (Table 1).

Conclusion
CLABSI POA was associated with a high mortality, with almost one in three patients deceased within 6 months. Patients at risk of higher mortality included those over the age of 44, self-pay insurance, receipt of chemotherapy in the last 6 months, and recent hospital discharge. These results underscore the need for CLABSI prevention initiatives outside acute care settings.

Disclosures
Stephanie Mayoryk, MAS BSN RN CIC, PDI: Honoraria Sara E. Cosgrove, MD, MS, Debiopharm: Advisor/Consultant|Duke Clinical Research Institute: Advisor/Consultant Carlos Mejia-Chew, MD, INSMED: Grant/Research Support|RevImmune: Grant/Research Support Sara C. Keller, MD, MPH, MSPH, Pfizer: Advisor/Consultant
132. “Diagnostic and Antibiotic Stewardship based on Urine Culture”
Authors: C Nitheeshwar , Priya Tharsini Mithra , Kumar Dorairajan Suresh 
Published: November 2023

Abstract

Background
Asymptomatic bacteriuria is one of the most common causes of antibiotic use in hospitalised patients. Antibiotic stewardship targeting asymptomatic bacteriuria ( ASB) should focus on diagnostic urine cultures, restricting unnecessary urine cultures, and preventing inappropriate antibiotic use. However, there is limited evidence from developing countries on the impact of the above interventions. This study aimed to assess the appropriateness of urine cultures ordered and also study the antibiotic prescribing pattern for the patient who underwent urine cultures.

Methods
A prospective, observational study was conducted in a tertiary care hospital in south India between February 2023 and April 2023. The medical records of the hospitalised patients who underwent urine culture ( except urological and pregnant women) were reviewed by using the validated audit tool, which contained details of demographic data, indications, results of urine culture, and antibiotics prescribed to the patients. The data was audited by the trained Pharm.D. students to establish the appropriateness of the urine cultures ordered and the antibiotic prescribing pattern for the patients who started antibiotics.

Results
During the study period 329 case records were audited. And the data is given in the table 1.
Table 1: Diagnostic stewardship and antibiotic prescribing practices

Conclusion
Most of the urine cultures ( 90.5%) sent are without any urinary symptoms, and 69.5% of patients with asymptomatic bacteriuria receive antibiotics, which contribute to antibiotic resistance. It is necessary to put effective techniques into practice to increase the appropriateness of ordering urine cultures and the use of antibiotics in hospitals.

Disclosures
All Authors: No reported disclosures