bluuebunny/crossref_metadata_2025_split huggingface dataset:
2169. Anti-anaerobic Antibiotic Use is Associated With Lower Rehospitalization Rate in Known and Suspected Pleural Empyema in Adults
Authors: Avner Benjamin S , Qiryaqoz Zeena , Mak Justin , Le James , Ginosyan Anush , Huffman Cuyler 
Published: December 2022

Abstract

Background
There is not a prevailing consensus on appropriate antibiotic choice, route, and duration in the treatment of bacterial pleural empyema after appropriate source control. Professional society guidelines identify a wide range of antibiotic durations, and generally recommend an antibiotic with broad-spectrum activity against anaerobes (e.g. clindamycin, metronidazole, carbapenem, or penicillin/beta-lactamase inhibitor combination), while noting the lack of comparative trials with which to guide recommendations.

Methods
We performed a hypothesis-generating retrospective chart review analysis of clinical outcomes in 355 adult inpatients who had pleural drainage, via either chest tube or surgical intervention, for known or suspected empyema. The aims of the investigation were to compare clinical outcomes with regard to 1) the use of antibiotics with broad activity against anaerobes, 2) total antibiotic duration, and 3) IV antibiotic duration. Mann-Whitney U test with Bonferroni multiplicity adjustment was used to compare outcomes with regard to these variables.

Results
A longer course of an anti-anaerobic antibiotic was associated with both lower 30-day readmission rates for empyema (11.9 ± 13.8 antibiotic days in non-readmission group, n = 321 vs 2.2 ± 2.7 days in readmission group, n = 17, p-value 0.003) and lower all-cause 30-day readmission (12.3 ± 14.1 in non-readmission group, n = 290 vs 6.1 ± 7.9 in readmission group, n = 49, p-value 0.003). Longer total antibiotic duration was associated with lower empyema-specific 30-day readmission rates (21.5 ± 20.1 vs 12.4 ± 8.2, p-value 0.010), with a non-significant trend towards lower all-cause 30-day readmission (22.1 ± 20.9 vs 15.0 ± 8.3). IV antibiotic duration was not associated with a difference in 30-day readmission (data not shown).

Conclusion
Our data support the premise that routine use of anti-anaerobic antibiotics is indicated in the treatment of pleural empyema. However, our study casts doubt on the benefits of extended IV rather than oral antibiotics in the treatment of empyema. This represents a target for future investigation with the aim of limiting complications associated with the excessive use of IV antibiotics.

Disclosures
All Authors: No reported disclosures.
2173. Co-Occurring Dysphagia and Frailty are Common and Associated with Increased Disease Severity in Older Adults Presenting with Community-Acquired Pneumonia
Authors: Pulia Michael , Robison Raele , Schwei Rebecca , Gustafson Sara , Broghammer Charles , Herrin Rachelle , Rogus-Pulia Nicole 
Published: December 2022

Abstract

Background
Impaired swallowing (dysphagia) and physical (frailty) function are associated with community-acquired pneumonia (CAP), however, neither are routinely screened for in patients with CAP. We sought to: 1) examine frailty and dysphagia screening profiles in a cohort of older adults with CAP; and 2) determine if these screening profiles differ across CAP severity levels.

Methods
Older adults (≥65) meeting diagnostic criteria for pneumonia are included as participants. During the index encounter, dysphagia (3-ounce water swallow) and frailty (FSQ;4 ≥3 = frailty) screeners are administered. Thirty days post-enrollment, a standardized clinical severity scale is used to document CAP severity (mild (ambulatory management); moderate-severe (hospitalization)). Statistical analysis included descriptives and cross tabulations.

Results
We enrolled 26 participants (13 female) with a mean age of 73 (SD: 7.1). Nine (34.6%) and 17 (65.4%) patients had mild and moderate-severe CAP severity, respectively. Twenty (76.9%) and 14 (53.8%) patients met screening criteria for dysphagia and frailty, respectively. Screening profiles included: no frailty or dysphagia (15.4%), frailty and no dysphagia (11.5%), no frailty but dysphagia (30.8%), frailty and dysphagia (42.3%). No frailty but dysphagia (44.4%) was the most common mild CAP severity profile. When CAP severity worsened (moderate-severe), co-occurring frailty and dysphagia was most prevalent (47.1%). Fig. 1.Combined dysphagia and frailty screening profiles for this cohort.Dysphagia only was highly prevalent (31%), however, the majority of individuals presented with co-occurring dysphagia and frailty (42%).Fig. 2.Screening profiles across CAP severity levels.No frailty/dysphagia (44.4%) was the most common mild CAP profile. Co-occurring frailty/dysphagia was most prevalent (47.1%) in mod-severe CAP.

Conclusion
In this cohort, standardized screenings for dysphagia and frailty revealed both were common and frequently co-occurred, particularly in the high acuity CAP group. These data suggest older adults with pneumonia may have underlying dysphagia and/or frailty that warrant further evaluation. These potential impairments should be considered in care pathways (e.g. antibiotic therapy and rehabilitation services consultation) to mitigate negative sequelae.

Disclosures
All Authors: No reported disclosures.
2178. Microbiological Diagnosis of Ventilator Associated Pneumonia Caused by Gram Negative Bacterias Resistant to Carbapenems Using a Fast Molecular Method.
Authors: Briones-Rugama Thomas , Marenco-Avilés Sunaya , Castillo-Cano Maikelyn A , Porras-Cortés Guillermo D 
Published: December 2022

Abstract

Background
Ventilator-associated pneumonia (VAP) is one of the most important healthcare-associated infections. The burden of VAP regard morbility and mortality is significant. Most of the etiological agents of VAP are Gam negative organisms and a proportion of them could be resistant to carbapenems. GeneXpert Carba-R is a molecular test originally designed to detect rectal colonization by microorganisms expressing resistance genes to carbapenems (NDM, KPC, VIM, IMP, OXA-48). The aim of this study was to determine how useful is to use GeneXpert Carba-R in clinical samples of aspirates of bronchial secretion in patients with VAP.

Methods
This is a prospective observational study in a sample of patients that developed VAP at the intensive care unit in Hospital Dr. Fernando Vélez Paiz (Managua, Nicaragua) between April 2021 and December 2021. The diagnostic criterias of the CDC for VAP were used. Samples of bronchoalveolar secretions were processed using GeneXpert Carba-R and by bacteriological conventional culture. The molecular method GeneXpert Carba-R was able to detect genes as NDM, KPC, VIM, OXA-48 and IMP. The presence of any of them was considered as microorganism resistant to carbapenems and the result was correlated with the final identification and susceptibility pattern obtained in the bacteriological culture using the system Vitek2.

Results
A total of 45 patients were recruited in the study. Twenty-seven patients (60%) had at least one gene of resistance detected by GeneXpert Carba-R. The most frequent gene detected was NDM (81%). The cultures identified Acinetobacter baumannii (36%), Klebsiella pneumoniae (27%), and Pseudomonas aeruginosa (23%). The sensitivity and the specificity of the GeneXpert Carba-R for the diagnosis of a organism resistant to carbapenems were 86.7% (CI95%: 71.1-95-8) and 93.3% (CI95%: 80.7%-100%) respectively. The risk factors to develope a VAP with an organism expressing a gene of resistance were diabetes mellitus, extended staying in ICU, SOFA score &gt; 2 points, mechanical ventilation ≥ 8 days, and to have had septic shock at the admission.
Correlation between GeneXpert Carba-R and bacteriological culture for microbiological diagnosis of VAP caused by carbapenem-resistant bacterias.

Conclusion
To process GeneXpert Carba-R directly of bronchoalveolar secretions was useful in the diagnosis of VAP caused by microorganisms resistant to carbapenems. The most frequent gene detected was NDM.

Disclosures
All Authors: No reported disclosures.
2187. Validation of Local Risk Factors for Antibiotic-resistant Pathogens in Community-acquired Pneumonia at an Urban Community-based Medical Center
Authors: Zafonte Veronica B , Ramdhanie Lisa , Miele Andrew S , Cervellione Kelly L , Liu Emily A , Bagheri Farshad , Daya Andrew 
Published: December 2022

Abstract

Background
The 2019 ATS/IDSA community-acquired pneumonia (CAP) guidelines recommend to abandon the term healthcare-associated pneumonia (HCAP) and to base the use of broad-spectrum antibiotics on local epidemiology and risk factors. Jamaica, NY represents a unique population of ethnically diverse, largely immigrant patients. Several nursing homes, an international airport, along with a low socioeconomic status population feed into the hospital. The purpose of this study is to determine prevalent risk factors for drug-resistant pathogens (DRP) in CAP within an urban population. The secondary objective is to validate the Drug Resistance in Pneumonia (DRIP) score in this population.

Methods
A retrospective study was conducted on adults admitted from August 2018-December 2019 with a diagnosis of CAP, including aspiration pneumonia. Patients with a DRP respiratory culture (collected within 48 hours of admission) were selected, the next consecutively admitted patient with a non-resistant culture was included as a control.

Results
A total of 227 patients were included (114 in the DRP group and 113 in the control group). The DRP group had more patients with tracheostomies (30% vs 3%, p &lt; .001) and chronic pulmonary disease (37% vs 16%, p &lt; .001) (Table 1). Approximately 40% of the DRP patients were admitted from a long term care (LTC) facility compared to 8.8% in the control group (p &lt; .001). Isolation of P. aeruginosa was not associated with LTC residence (Odds Ratio: 0.75) in our population (Table 2). All DRIP score components were associated with the isolation of DRP in our patient population, except for methicillin-resistant S. aureus (MRSA) colonization (Table 3). In our population 50% of the DRP had a DRIP score &lt; 3. DRIP scores &gt; 2, &gt; 3 and &gt; 4 had low negative predictive values (NPV) for the isolation of DRP in CAP (71.9%, 67.4% and 64.2%, respectively).

Conclusion
Demographic risk factors may exist for DRP in CAP, e.g. tracheostomy, pulmonary disease. Using a DRIP score cut off of &gt; 4 missed 50% of the DRP in our study population. Despite a DRIP score &gt; 4 having a specificity of 90.3%, with a NPV of 64.2% this scoring tool may underestimate the prevalence of DRP in our patient population. Based on our findings, institutions should consider local validation of the DRIP score prior to implementing use at their site.

Disclosures
All Authors: No reported disclosures.
2221. Use of PCR and MLST analysis to establish Treponema pallidum as the cause of a painful oral lesion
Authors: Velasquez Espiritu Maria Rosa , Wormser Gary P , Cafferky Kaitlin , Edmondson Diane , Norris Steven , Munzer Eric , Rizk Ciril-Christian , Gelman Irina , Lawler Jacqueline , Boss Heather , Keller Marina 
Published: December 2022

Abstract

Background
A syphilitic chancre is described classically as a single, indurated, and painless ulcer at the site of Treponema pallidum inoculation.

Methods
We present a 39-year-old heterosexual, monogamous, HIV-negative woman with a painful tongue lesion of one month’s duration. To exclude a malignancy, a biopsy was performed.

Results
Histopathology showed intense inflammatory reaction, and T. pallidum immunocytochemistry demonstrated a high density of spirochetes in the subepithelial connective tissue. Subsequent testing revealed a reactive anti-T. pallidum IgG EIA and an RPR titer of 1:8. PCR amplification and multi-locus sequence typing (MLST) confirmed that the visualized spirochetes were T. pallidum. This particular MLST strain pattern has been identified twice before and named ST-109; however, no clinical information is available.
Diagnosis and appropriate treatment were delayed since syphilis was not suspected initially. When the results became available, the patient was treated with 2.4 million units of benzathine penicillin given IM with complete resolution of the lesion. The male partner, who reported no symptoms, had a positive T. pallidum EIA with an RPR titer of 1:64 and was also treated with penicillin. Within four months, a woman from an adjacent town presented to urgent care with three perineal severely painful lesions, testing negative for HIV, Herpes Simplex Virus (HSV) by PCR of an ulcer swab, and chlamydia and gonorrhea on a urine sample by a NAAT. The anti-T. pallidum EIA was reactive, and the RPR titer was 1:4. The lesions resolved with IM penicillin treatment.

Conclusion
The observations reported here indicate that a subset of early syphilis cases may present with painful lesions. Despite the commonly held belief that syphilitic chancres are painless, several case series have reported tender lesions, single or multiple, without evidence of concurrent HSV infection to explain the pain. This is the first PCR and MLST sequencing analysis of a T. pallidum strain within a painful chancre. Given the rise in the number of cases of syphilis in the USA, it is essential that clinicians be aware of this atypical presentation. It remains to be determined whether such painful lesions are only associated with certain T. pallidum genotypes.

Disclosures
All Authors: No reported disclosures.
2223. A comparative analysis of the detection of UTI pathogens via culture method and the Open Array-nanofluidic real time PCR method
Authors: Upadhyay Pallavi , Surar Fahida , Kim Geun , Reddy Jay , Shakir Salika , Alexander Barbara D , Hanson Kimberly , Singh Vijay 
Published: December 2022

Abstract

Background
Urinary tract infections (UTI) are the second most prevalent microbial infection, impacting 150 million people globally every year. Traditionally, urine culture is considered the gold standard for UTI pathogen detection. However, molecular techniques, such as real time multiplex PCR tests targeting multiple pathogens, are becoming the alternative diagnostic tools for rapid detection of pathogens with the potential to provide quick diagnosis and enable targeted treatment. Due to the serious economic and healthcare utilization burden UTIs pose, early pathogen detection with a rapid turn-around-time to results has the potential to be instrumental for improving patient care and outcomes.

Methods
A total of 300 deidentified patient samples that were previously tested via urine culture (ARUP laboratories, Utah) were subjected to real time PCR molecular testing employing the nanofluidic Open Array ® platform (HealthTrackRX, Texas). Statistical analyses were performed using R version 3.6.0.

Results
Among 300 urine specimens studied, culture detected pathogens in 183 patient samples (61%), and 117 samples were deemed negative. Culture and PCR results demonstrated an overall agreement of 75.3% (n=226) with 59% positive (n=177) and 16.3% negative (n=49). Results for 24.7% samples (n=74) were discordant. A total of 2% (n=6) were culture positive and PCR negative, and 22.7% (n=68) were culture negative and PCR positive. Agreement between PCR and culture positive results was 0.97, 95%CI (0.94, 0.99) (177/183). Among the PCR positive samples (n=245), 32.7% were poly-microbial (n=80) and 67.3% were mono-microbial (n=165). In comparison, among culture positive samples (n=183), 33.3% (n=61) were polymicrobial and 65.6% (n=120) monomicrobial.

Conclusion
Our study demonstrates that multiplex real time PCR-based detection of UTI bacterial pathogens has positive agreement with the traditional urine culture method. PCR based testing has the potential to deliver quick pathogen identification to enable targeted treatment options and medication adjustments. Further studies will correlate semi-quantitative cfu/mL culture values with semi-quantitative copies/mL PCR values to further refine result reporting and test performance.

Disclosures
Pallavi Upadhyay, PhD, HealthTrackRx: Stocks/Bonds Fahida Surar, B.S., HealthTrackRx: Salaried Employee Geun Kim, M.S., HealthTrackRx: Salaried Employee Jay Reddy, PhD, HealthTrackRx: Stocks/Bonds Barbara D. Alexander, MD, Astellas: Advisor/Consultant|HealthtrackRx: Advisor/Consultant|HealthtrackRx: Grant/Research Support|Scynexis: Grant/Research Support|UpToDate: Advisor/Consultant Kimberly Hanson, MD, MHS, FIDSA, HealthTrackRx: Advisor/Consultant|HealthTrackRx: Clinical Advisory Board Member Vijay Singh, PhD, HealthTrackRx: Stocks/Bonds.
2241. Methenamine for the Prevention of Recurrent UTIs: A Desirability of Outcome Ranking (DOOR) analysis for the Alternative to Prophylactic Antibiotics for the Treatment of Recurrent Urinary Tract Infections in Women (ALTAR) Trial
Authors: Sherwood Kyla , Ikuta Kevin 
Published: December 2022

Abstract

Background
The Alternative to Prophylactic Antibiotics for the Treatment of Recurrent Urinary Tract Infections in Women (ALTAR) trial demonstrated that twice daily methenamine hippurate was non-inferior to daily low dose antibiotics for the prevention of recurrent UTIs. Non-inferiority trials are frequently misrepresented or misinterpreted by patients and clinicians, and often do not address which treatment approach is preferred. The Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR) superiority methodology has been used as a secondary outcome in selected non-inferiority studies to incorporate antibiotic exposure and clinical outcomes. We applied DOOR/RADAR methodology to the ALTAR trial to evaluate the clinical superiority of methenamine hippurate as compared to antibiotic prophylaxis for the prevention of recurrent UTIs.

Methods
The first step in the DOOR/RADAR analysis was to generate categories to rank clinical outcomes. Using the data supplement of the ALTAR trial, categories were created by comparing the number of UTIs observed during the study period for the antibiotic versus methenamine groups. Participants were assigned a ranking using both clinical outcome and antibiotic use, with the principle that less antibiotic use is preferred as long as the same clinical outcome is achieved. The Mann-Whitney U test was then used to compare outcomes between these groups.

Results
The study included 205 patients, with 103 receiving methenamine and 102 receiving low dose antibiotics. The methenamine and antibiotic prophylaxis groups were divided into categories based on number of UTIs observed during study period (Table 1), with the density of the DOOR/RADAR outcomes displayed in Figure 1. Using the Mann-Whitney U test, the probability of a better DOOR score (i.e. more desirable outcome) for a randomly selected patient from the methenamine group compared to the antibiotic group was 58% (p-value 0.045).
Number of UTIs by Treatment Group Table 1.Number of UTIs observed during study period between groups receiving methenamine as compared to antibiotic prophylaxis. The most desirable outcome (*) and the least desirable outcome (**) are designated above.
Figure 1. The density of DOOR/RADAR outcomes of methenamine as compared to antibiotic prophylaxis group.

Conclusion
Applying the DOOR/RADAR analysis to the data from the ALTAR trial provides evidence to suggest that there is a higher probability for desirable outcomes in women who receive methenamine hippurate as compared to prophylactic antibiotics for the prevention of UTIs.

Disclosures
All Authors: No reported disclosures.
2246. Urine Culture Clinical Decision Support Menu for Reducing Inappropriate Lab Ordering
Authors: Stensgard Erik S , Drekonja Dimitri M , Masoud Bobbie 
Published: December 2022

Abstract

Background
Antibiotic treatment of asymptomatic bacteriuria (ASB) is unnecessary except in pregnant women or those undergoing invasive urologic procedures. Unnecessary treatment of ASB is an important driver of inappropriate antimicrobial use (IAU), leading to antimicrobial resistance, Clostridioides difficile infection, adverse drug events, and increased costs. Because ASB requires detection to be treated, unnecessary urine cultures (UC) are a key cause of IAU. Strong evidence supports not obtaining a UC from asymptomatic patients.

Methods
To reduce unnecessary UC orders at the Minneapolis Veterans Affairs Health Care System (MVAHCS), UC orders within the electronic health record (EHR) were redirected to a UC clinical decision support (CDS) menu (Figure 1). Selection of an indication from the defined list is required to place a UC order and provides tracking. UC order data was obtained from the Corporate Data Warehouse (CDW), the VA’s data program. Patient bed days were collected from a CDW dashboard developed by the Iowa City Veteran’s Affairs Health Care System. Data was visualized using Microsoft Power BITM platform. FIGURE 1.Urine culture clinical decision support menu. Urine culture orders are items numbered 10-26.

Results
The UC CDS menu was implemented at the MVAHCS in September 2020. UC orders from 16 months prior to implementation (9/1/2018 - 12/31/2019) was compared to orders 16 months after implementation (9/1/2020 - 12/31/2021). Data from 1/1/2020 - 8/31/2020 was not included due to atypical patient care patterns during the COVID-19 pandemic.4 The monthly number of UC orders after implementation significantly decreased from an average of 765 to 564, a 26.3% reduction (P &lt; .001; 2-sided t-test) (Figure 2). The average patient bed days prior to and following implementation was not significantly different (Figure 3). Most UC orders came from the UC CDS menu (8103, 89.8%) compared to orders placed from other order menus or directly from the drug file (920, 10.2%). The most common indication selected was dysuria, frequency, and urgency (4050, 44.9%) followed by fever or sepsis (1230, 13.6%) then pre-operative urologic screening (1056, 11.7%) (Figure 4). FIGURE 2.Urine culture lab count before and after urine culture clinical decision support menu intervention.FIGURE 3.Patient bed days before and after urine culture clinical decision support menu intervention.FIGURE 4.Urine culture orders by indication. Non-intervention labs are listed as no indication/other order.

Conclusion
Implementation of a UC CDS menu within the MVAHCS EHR resulted in significantly fewer UC orders. Most UC orders had an appropriate indication suggesting the decrease was primarily due to preventing unnecessary UC orders.

Disclosures
All Authors: No reported disclosures.