bluuebunny/crossref_metadata_2025_split huggingface dataset:
975. Dalbavancin for the Treatment of Vertebral Osteomyelitis
Authors: Streifel Amber C , Strnad Luke , Sukerman Ellie , Makadia Jina T , Lewis James S , Douglass Alyse H , Young Kathleen , Mayer Heather , Sikka Monica K 
Published: December 2022

Abstract

Background
Dalbavancin (DAL) provides an alternative to daily intravenous (IV) antibiotics for the treatment of infections when treatment in the outpatient setting is not practical. While clinical outcomes data for the treatment of osteomyelitis (OM) with dalbavancin has expanded, data specifically addressing vertebral OM remains limited.

Methods
We conducted a retrospective single center study to evaluate DAL use at our institution for patients with vertebral OM, including relevant treatment details and follow-up to 90 days post last DAL dose. All patients aged&gt; 18 years who received at least one dose of DAL between 2015 and 2021 via medication records were included.

Results
Twenty-eight patients with vertebral OM (24 with native vertebral OM) were treated with DAL for at least a portion of a treatment course. The most commonly isolated organisms were methicillin-resistant Staphylococcus aureus (MRSA) (10; 35.7%) and methicillin-sensitive S. aureus (MSSA) (7; 25%). Cultures were negative for 7 patients (25%). Eight (28.5%) patients were bacteremic upon presentation, 5 (17.8%) with MRSA, 2 (7.1%) with MSSA, and 1 (3.6%) due to Enterococcus faecalis. All included patients had a history of substance use and 18 (64.2%) endorsed injection use. DAL was most commonly selected due to a history of injection drug use (19, 67.9%), lack of a safe home environment (6, 21.4%) or prior non-adherence to outpatient antibiotics (5, 17.9%). For the 11 patients who received one dose of 1500 mg, the mean duration of antibiotics prior to DAL was 29.3 days, 2 of these patients were intended for 2 dose regimens but did not complete a second dose. For the 17 patients who received 2 doses of 1500 mg, mean duration of antibiotics prior to DAL was 13.8 days. Adverse reactions were documented for 7 patients (25%), most commonly infusion reactions. Readmission for any reason at 30 days occurred for 1 patient (3.6%) and 2 patients (7.1%) at 90 days. Mortality at days 30 and 90 post-treatment were 0. Recurrence or relapse of infection at 30 and 90 days occurred for 1 (3.6%) patient each.

Conclusion
DAL appears to be safe and well-tolerated for the treatment of vertebral OM, although clinical data comparing it to standard of care regimens, especially for vertebral OM due to S. aureus is needed before it can be recommended as standard of care.

Disclosures
James S. Lewis, PharmD, FIDSA, Cidara: Advisor/Consultant|Merck: Advisor/Consultant|SeLux Diagnostics: Advisor/Consultant Monica K. Sikka, MD, F2G: Site research investigator.
976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year
Authors: Polascik Breanna A , Bethell Mikhail A , Briggs Damon V , Adu-Kwarteng Kwabena , Kim Billy I , Case Ayden , Prado Isabel P , Wixted Colleen M , Hendershot Edward F , Jiranek William A , Seidelman Jessica , Seyler Thorsten M 
Published: December 2022

Abstract

Background
Escherichia Coli (E coli) is a gram-negative rod that can cause devastating periprosthetic joint infections (PJIs) in patients with total hip and knee replacements (THA/TKA). Minimal literature exists on outcomes of E coli PJIs.

Methods
Retrospective review of our institution’s electronic medical record from 2009-2020 identified 21 patients that met MusculoSkeletal Infection Society criteria for E coli hip or knee PJI. Primary outcome was 1-year infection clearance - eradication of infection off antibiotics with no further surgeries for 1 year after completion of standard postoperative antibiotics. Minimum followup was 1 year.

Results
We analyzed 21 patients (mean age 66.6 yrs, 47.6% male, 23.8% nonWhite, 38.1% knee PJIs). There were 11 acute, 8 acute hematogenous (AH), and 2 chronic PJIs. Several patients had recent gastrointestinal/urinary tract surgery (14.3%), recurrent urinary tract infections (9.5%), or &gt;1 E coli urine culture &lt;1 mo pre-PJI (14.3%). Surgical treatments included DAIR (66.7%), 2-stage revision (14.3%), Girdlestone/Resection Arthroplasty (G/RA; 14.3%), and fusion (4.8%), with 7.1%, 100%, 66.7%, and 100% 1-year infection clearance, respectively, and 33.3% 1-year infection clearance overall (p=.001). Common reasons for treatment failure were reinfection requiring surgery (57.1%) and chronic antibiotics (38.1%). Patients clear at 1 year had a longer mean time from most recent surgery to index PJI surgery (48.7 vs 7mo;p=.043) and more AH than acute or chronic infections (54.6% vs 27.3% vs 18.2%;p=.0412). Patients who were not clear at 1 year had more acute infections (80% vs 20% AH;p=.0412). The E coli PJI persisted in 23.8% of patients. Outcomes at final followup included G/RA (28.6%), original prosthetic (28.6%), new prosthetic (19%), above knee amputation (9.5%), destination spacer (9.5%), and arthrodesis (4.8%).

Conclusion
E coli PJI 1-year infection clearance is poor, with DAIR being the most common yet least effective surgical treatment. Most E coli PJIs occurred postoperatively as opposed to hematogenously, as is sometimes assumed. This serves as a foundation for future studies evaluating E coli treatment outcomes.

Disclosures
William A. Jiranek, MD, Biomech Holdings LLC: Stocks/Bonds|DePuy, A Johnson & Johnson Company: IP royalties Thorsten M. Seyler, MD, PhD, Heraeus: Paid consultant|Pattern Health: IP royalties|Restor3d: IP royalties|Smith & Nephew: Paid consultant|Total Joint Orthopedics: Paid consultant|Zimmer: research.
984. Pediatric acute hematogenous osteoarticular infections in central Missouri
Authors: Andrade Heather J , Ohler Adrienne , Padhye Amruta 
Published: December 2022

Abstract

Background
Acute hematogenous osteoarticular infections (AOI), including osteomyelitis (OM) and/or septic arthritis (SA), are a frequent cause of hospitalization and morbidity in children. In this retrospective observational study, we aim to describe the epidemiology, presentation, and management of children diagnosed with AOI at a Midwest academic healthcare center in central Missouri.

Methods
Systematically reviewing medical records from July 2015 to March 2021, we identified 73 pediatric patients (age &lt; 18 years) diagnosed with AOI. Cases related to trauma, surgery, or chronic recurrent multifocal osteomyelitis were excluded. Information was collected on clinical course and management, and a descriptive analysis was performed.

Results
Children meeting the inclusion criteria included 46 males (63%) and a median age at presentation of 6.9 years (IQR 2.8 – 11.9). Presenting symptoms included localized pain (n=72, 99%), refusal to move or bear weight (n=64, 88%) and fever (n=49, 63%); 42 (56%) had all three symptoms. 32 (44%) had OM, 17 (23%) had SA, and 24 (33%) had both; lower extremity long bones/joints were often involved. Definitive bacterial etiology was identified in 49 (67%) patients: 39 (76%) Staphylococcus aureus (16 methicillin resistant [MRSA], 23 methicillin susceptible [MSSA]), 4 (8%) Streptococcus pyogenes, and 3 (6%) Kingella kingae; and blood cultures identified an etiology in 29 of the 69 obtained (42%; 25 MSSA, 2 MRSA, 2 S pyogenes). Surgical management in an operating room was performed in 44 (60%). Median hospitalization was for 5 days (IQR 4-8), and 5 cases (7%) required intensive care, with no mortality. 62 were successfully transitioned from intravenous (IV) antibiotics to oral at discharge (85%) – 10 were discharged with IV antibiotics and one infant received full IV course in hospital. Definitive oral antibiotics used included cephalexin (35), clindamycin (24), and amoxicillin (3). 8 (11%) required hospital readmission for various reasons.

Conclusion
Our trends in AOI are comparable to those reported nationally – blood cultures remain key in identifying etiology and empiric therapy should continue to target S aureus. Most children can be successfully transitioned to oral antibiotics at discharge. This data will guide us in preparing a clinical pathway at our center.

Disclosures
All Authors: No reported disclosures.
994. A Novel Informatics Tool to Detect Antibiotic Allergies in Patients Undergoing CIED Procedures
Authors: Dassum Samira Reyes , Mull Hillary J , Golenbock Samuel , Lamkin Rebecca P , Epshtein Isabella , Shin Marlena , Strymish Judith , Blumenthal Kimberly G , Colborn Kathryn L , Branch-Elliman Westyn 
Published: December 2022

Abstract

Background
Antibiotics are one of the leading causes of emergency room visits for adverse drug events, yet surveillance for antimicrobial allergy adverse events is limited and identifying true cases is challenging. As part of a larger study to improve antimicrobial use, we sought to develop and validate a tool for near real-time measurement of antimicrobial allergy adverse events.

Methods
An existing cohort of patients undergoing cardiac device procedures with known antimicrobial exposure was split into a development and validation set. Candidate triggers for identifying allergic reactionswere identified a priori, using disease phenotype codes “phecodes”, allergy documentation on allergy module of the electronic medical record (EMR), and keyword searches applied to clinical notes (e.g., “anaphylaxis,” “rash”), medication administration (e.g, corticosteroids alone or with antihistamines) and administrative codes (ICD-10 codes and phecodes). Cases were reviewed for presence of a true event, and the tool was iteratively updated based on chart review findings. The tool was then applied to the validation cohort and a sample of trigger-flagged and unflagged cases underwent manual review. Data were analyzed in SAS and model triggers were selected using a LASSO technique.

Results
Among 34,703 patients, N=431 cases underwent manual review (350 development; 120 validation), and 104 true allergy adverse events were identified. Among chart reviewed cases, the most frequently detected flags were keywords in unstructured clinical notes (35%), phecodes (26%), corticosteroid administration (15%), observed allergy documentation in EMR (14%) and reported allergy documentation in EMR (13%). The final model contained 7 triggers and had an AUC of 0.95, and a positive predictive value of 67% (Figure). The strongest predictors of true adverse events were the allergy health factors (aOR 358, 95% CI 76.3-999) and specific Phecodes (Table1).

Conclusion
We developed an antibiotic allergy measurement tool using structured and unstructured data that can be applied to detect antimicrobial adverse events in near-real time. This model may be applied to provide near real-time feedback to clinicians about antimicrobial allergy adverse events and may be useful for antimicrobial stewardship programs.

Disclosures
Westyn Branch-Elliman, MD, MMSc, DLA Piper,LLC/Medtronic: Advisor/Consultant|Gilead Pharmaceuticals: Grant/Research Support.
1000. Clinical significance and antimicrobial susceptibilities of Roseomonas species infections
Authors: Kim Chang Hyup , Lee Se Ju , Kim Jinnam , Lee Ki Hyun , Lee Jung Ah , Yeom Joon-sup , Choi Jun Yong , Ku Nam Su , Jeong Su Jin , Ahn Jin Young , Kim Jung Ho 
Published: December 2022

Abstract

Background
Roseomonas species are slow-growing Gram-negative cocobacillus, and were first reported in 1993. Roseomonas have been isolated from environmental sources and can cause bacteremia in humans, especially in immunocompromised patients. Since these species were difficult to isolate and infections with these species are not common, there are only a few studies on their characteristics. Therefore, we aim to expand our knowledge of clinical features, antimicrobial susceptibility patterns, and treatment outcomes for Roseomonas human infections.

Methods
From January 2006 to March 2022, patients with Roseomonas isolated from blood and other aseptic sources were extracted from three tertiary hospitals in South Korea. Underlying conditions, clinical manifestations, antimicrobial susceptibility patterns, and outcomes were reviewed through the medical records.

Results
During the study period, a total of 39 patients (46.2% were male) with Roseomonas infections were included. The median age was 50 (interquartile range, 33.5-62.5) years old, and seven patients (17.9%) were under age 18. Of the 39 patients, 13 patients (33.3%) had malignancies, five patients (12.8%) had neutropenia with an absolute neutrophil count of fewer than 1000 cells/mm3. Blood isolates were the most common (26 cases), followed by catheter blood (3 cases), and soft tissue (3 cases). Twenty-one cases (53.8%) were cultured after 48 hours of incubation, and co-infection with other bacteria was identified in nine cases (23.1%). Twenty-eight patients (71.8%) were symptomatic, with fever (30.8%) being the most common symptom. Amikacin showed a high susceptible rate (95.7%) to isolated Roseomonas. Tigecycline also showed high susceptible rates (92.9% , respectively). The susceptible rate of levofloxacin was 85.0%. On the other hand, the susceptible rate of piperacillin-tazobactam (5.9%) and meropenem (47.6%) were below 50%. There were two cases (5.1%) of in-hospital mortality.

Conclusion
Although not common, Roseomonas species can cause bacteremia and even death, especially in immunocompromised individuals. Since Roseomonas are challenging to isolate and generally show resistance to antibiotics commonly used for Gram-negative bacterial infections, careful attention is warranted in selecting antibiotics.

Disclosures
All Authors: No reported disclosures.
1004. Dalbavancin Use and Associated Cost-Savings: An Update
Authors: Streifel Amber C , Sikka Monica K , Lewis James S 
Published: December 2022

Abstract

Background
Dalbavancin provides an alternative to standard of care intravenous (IV) antibiotics for the treatment of complicated infections, although clinical data continues to evolve In the United States, the use of dalbavancin as an alternative for patients requiring long courses of IV therapy can result in reduction of hospital days, and thus significant cost-savings to health systems.

Methods
We conducted a retrospective review of dalbavancin use at our institution and resulting cost avoidance from 2015 to 2021. We identified all patients age 18 years or older who received &gt; one dose of dalbavancin via medication records. Cost calculation was based on the number of outpatient dalbavancin days as a measure of avoided inpatient days.

Results
189 patients received at least one dose of dalbavancin over the study period. The mean age 47.6 years and the most common infections were non-vertebral bone and joint infections (85; 45%), vertebral osteomyelitis (28; 14.8%) and skin and soft tissue infections (27; 14.3%). The most commonly isolated organism was Staphylococcus aureus (109; 57.6%), MRSA (60; 31.7%) and MSSA (49; 25.9%). Dalbavancin dosing regimens varied over the study period. Reasons for selection of dalbavancin included history of injection drug use (67; 35.4%), lack of a safe home environment to receive daily IV antibiotics (26; 13.8%), and patient declining PICC or daily outpatient IV antibiotics (26; 13.8%). 84 patients (44%) received at least one dose of dalbavancin in the inpatient setting. Adverse effects were documented for 21 (11%) of patients. Readmission within 30 days of dalbavancin dose occurred for 27 (14.2%) patients, 14 (7.4%) of which were related to either infection or dalbavancin adverse effect. Relapse or recurrence of infection at 30 days was documented for 9 patients (4.8%). A total of 4,273 out-of-hospital dalbavancin days were identified, resulting in a cost savings of $10,464,382 or a mean of $55,367.10 per patient.

Conclusion
As the use of dalbavancin for complicated infections continues to increase, the potential for health system cost-savings increases, driven by reduction in length of hospital stay. Prospective cost-analysis research is needed to further describe the cost benefits associated with dalbavancin use to patients and health systems in the United States.

Disclosures
Monica K. Sikka, MD, F2G: Site research investigator James S. Lewis, PharmD, FIDSA, Cidara: Advisor/Consultant|Merck: Advisor/Consultant|SeLux Diagnostics: Advisor/Consultant.
1006. High Adherence and Cost Savings with Home OPAT Provided through Infectious Disease Physician Office Infusion Centers
Authors: Martin Clifford P , Sleweon Thomas K , Luu Quyen , Prokesch Richard C , Dretler Robin H , Statner Barry , Stock Kent J , Schroeder Claudia P , Van Anglen Lucinda J 
Published: December 2022

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be safe and effective for self-administration but can lead to non-adherence without supervision. A physician office infusion center (POIC) with pharmacy services provides a unique opportunity to impact adherence and OPAT management. Patients (pts) typically come to the POIC weekly for catheter care, laboratory collection, medication pick-up and as needed provider visits. Often, close provider oversight allows for de-escalation of OPAT. We evaluated adherence to therapy, visits and associated cost saving in pts receiving self-administered OPAT through POICs.

Methods
Pts receiving home OPAT in 2021 were randomly selected from participating sites based on annual pt volume. Adherence was assessed as % of OPAT doses dispensed vs. doses missed. Frequency of office visits for routine catheter care and labs along with OPAT completion were collected. Cost savings were calculated in days of OPAT saved due to therapy de-escalation and response to therapy, based upon published daily costs of OPAT. Pt characteristics, OPAT duration, infection type and regimen were captured.

Results
A total of 125 of 2180 pts from 13 POICs nationally were included (mean age 50±18 years, 52% male). Mean OPAT duration was 38±9 days. Predominant infections were bone and joint (38%), complicated skin (18%), intra-abdominal (15%) and bacteremia (14%). The most common antimicrobials were cephalosporins (54%) with 20 pts self-administering ≥2 drugs. Pts had a mean of 6±3 POIC visits during the therapy course with completion as scheduled in 703/706 visits (99.6%). OPAT was completed as planned in 118 pts (94%), with discontinuations for adverse events (n=3), hospitalization (n=2), or non-adherence (n=2). Overall adherence rate was 99.3% with 51 missed of 7315 doses dispensed. De-escalation during OPAT saved 533 doses equating to 307 days of OPAT (2.4 days/pt). Based on an average daily OPAT cost of $140, this saved $42,980 in the randomized cohort and an estimated $749,571 annually in the entire population.

Conclusion
Home OPAT through an ID POIC was associated with a very high rate of adherence and compliance to scheduled visits in pts. ID oversight resulted in healthcare cost savings through onsite antimicrobial stewardship and therapy management.

Disclosures
Lucinda J. Van Anglen, PharmD, Merck & Co.: Grant/Research Support|Paratek: Grant/Research Support.
1025. Utility of a Risk Assessment Model in Predicting 30-day Unplanned Hospital Readmission in Adult Patients Receiving Outpatient Parenteral Antimicrobial Therapy
Authors: Brenneman Ethan , Funaro Jason , Dicks Kristen , Yarrington Michael E , Drew Richard H 
Published: December 2022

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) is used for patients that require prolonged durations of intravenous (IV) antimicrobials and who are healthy enough to receive the medications in the outpatient setting. While OPAT is both efficacious and cost-effective, hospital readmission rates are high. Durojaiye and colleagues in the UK developed a 30-day unplanned readmission risk prediction model for OPAT patients. Given differences in patient mix and methods of OPAT delivery, we validated the established risk assessment model for Duke University Health System (DUHS) patients receiving OPAT.

Methods
A retrospective review of 606 OPAT episodes of adult patients who were enrolled in the DUHS OPAT program between July 1, 2019 and February 1, 2020 was conducted. The review captured the 6 risk predictors of the established model: age, Charlson Comorbidity Score, number of admissions in the preceding 12 months, concurrent receipt of more than one IV antimicrobial agent, type of infection, and mode of OPAT delivery. Additional risk predictors were captured: aminoglycoside use, vancomycin use, OPAT delivery in a skilled nursing facility, and history of IV drug abuse. The discriminative ability of the model to predict 30-day unplanned readmission as well as 30-day OPAT-related unplanned readmission was validated with the collected data using scaled Brier score, Hosmer-Lemeshow goodness-of-fit, and area under the receiver operating curve. A logistic regression model fitted with the additional risk factors was conducted to determine their impact on the model.

Results
When comparing DUHS OPAT patients with those of the UK model, DUHS patients were sicker (mean Charlson Comorbidity Score 3 vs 1), were treated for deeper seated infections, and received OPAT through different modes. Overall the 30-day unplanned readmission rate was 20.0% (94/470), with 59.5% of those being OPAT-related. The UK model was unable to discriminate between patients with readmission and those without, both overall and OPAT-related. The additional risk factors were also non-significant between the groups and the updated model could not predict 30-day readmission risk.

Conclusion
The UK 30-day unplanned hospital readmission model did not predict patient risk of readmission for the Duke OPAT population.

Disclosures
Richard H. Drew, PharmD MS, American College of Clinical Pharmacists: Publication royalties|Takeda: Advisor/Consultant|UpToDate: publication royalties.