284. Evaluation of Oral Step-Down Therapy for Enterobacteriaceae Bloodstream Infection

Abstract Background Oral antibiotic stepdown therapy for Gram-negative (GN) bloodstream infection (BSI) appears to be a safe option, though high bioavailability drugs like fluoroquinolones (FQ) and trimethoprim-sulfamethoxazole are often recommended without clear evidence demonstrating superiority. Due to increasing concerns of FQ resistance and collateral damage with an increasing community C. difficile rate, our organization sought to reduce overall FQ use and a shift toward oral beta-lactams (BL) was observed. A review was conducted to assess the outcomes of this shift. Methods This retrospective cohort included all patients within our 3-hospital system who had a positive GN blood culture and were transitioned to oral therapy to complete treatment outpatient for bacteremia between Jan 2017-Sept 2019. The primary outcome was recurrent BSI within 30 days of completing initial treatment. Secondary outcomes included 30-day mortality, 30-day recurrence of organism at an alternate source, 30-day readmission, and 90-day BSI relapse. Results Of 191 GN BSIs, 77 patients were transitioned to oral therapy. The mean age was 68 years, 60% were female. The most common source of infection was described as urine (39/77), intra-abdominal (16/77), unknown (13/77). Mean total antibiotic duration (IV plus PO) was 14 days (range 7–33). Patients received an average of 5 days IV prior to transitioning to PO therapy. The most common PO class was a 1st gen cephalosporin (29/77), followed by BL/BL inhibitor (16/77), and a FQ (13/77). There were no 30-day relapse BSIs observed in this cohort. There was 1 patient discharged to inpatient hospice, and no other 30-day mortality observed. There were 4 recurrent UTIs observed within 30 days, none of which required readmission. Of the twelve 30-day readmissions, 1 was considered by the investigators to be related to the initial infection. Conclusion An opportunity for education regarding duration of therapy was identified. Oral beta lactam use in our limited population appears to be a reasonable option to facilitate discharge. Results should be confirmed in additional, larger studies. Disclosures All Authors: No reported disclosures

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1001. Evaluation of the Clinical Efficacy and Safety of Oral Antibiotic Therapy for Streptococcus spp. Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.838 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S297-S298 ◽

Cited By ~ 1

Author(s):

Amy Kang ◽

Cynthia Bor ◽

Jamie Chen ◽

Michelle Gandawidjaja ◽

Emi Minejima

Keyword(s):

Antibiotic Therapy ◽

Oral Therapy ◽

Bloodstream Infections ◽

Hospital Length Of Stay ◽

Common Source ◽

Oral Antibiotic ◽

Efficacy And Safety ◽

Oral Antibiotic Therapy ◽

Definitive Therapy ◽

Step Down

Abstract Background Despite the severity and frequency of bloodstream infections (BSI), the effectiveness of oral definitive therapy remains unknown. The objective of this study was to evaluate the efficacy and safety of step down oral antibiotics for the treatment of Streptococcus spp. BSI. Methods This was a retrospective cohort study of adult, hospitalized patients with Streptococcus spp. BSI between June 2015 and June 2017. Patients were excluded if received <48 hours of antibiotic therapy or therapy was started >48 hours from first positive culture. Patients were grouped by receipt of step down oral antibiotic therapy (PO group) vs. full course IV therapy (IV group) and compared for demographics, clinical course, and outcomes. The primary outcome was 30-day mortality and hospital length of stay (LOS). The secondary outcomes included 30-day recurrence of BSI and adverse events (AEs). Results One hundred ninety-five patients met inclusion criteria; median age was 51 year old, 68% were male, 57% were Hispanic, and 71% had community-onset BSI. Sixty-four (33%) were treated with step down oral therapy. The most common source of bacteremia was pneumonia (21%); 8% had endocarditis. Comorbidities were similar between the groups, with diabetes being most common (IV 22% vs. PO 19%, P = 0.29). Severity of illness measured by need for ICU admission, initial lactate level, and SOFA score was similar between the two groups. S. viridans was the most frequent pathogen isolated (IV 28% vs. PO 27%, P = 0.87). Ceftriaxone (39%) for the IV group and levofloxacin (30%) for the PO group were the most common definitive therapy prescribed. PO group received 4 days of IV therapy prior to transition to orals. The IV group had significantly higher mortality rate (11% vs. 2%, P = 0.02) and longer LOS (median 9 days [IQR 5–18] vs. 5 days [4–7.75], P ≤ 0.01) compared with the PO group. 30-day recurrence (IV 2% vs. PO 5%, P = 0.40) and AEs (IV 2% vs. PO 3%, P = 0.60) were similar between the two groups. Conclusion In Streptococcus spp. BSI, step down oral antibiotic therapy was associated with a significantly shorter LOS compared with IV only therapy without compromise of clinical outcomes. Larger prospective trials evaluating step down oral therapy are warranted to confirm our results. Disclosures All authors: No reported disclosures.

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308. Re-purposing Beta-lactam Antibiotics as Fluoroquinolone Sparing Stepdown Therapy for the Treatment of Enterobacteriales Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.351 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S151-S152

Author(s):

Matthew Davis ◽

Dayna McManus ◽

Michael Ruggero ◽

Jeffrey E Topal

Keyword(s):

Positive Culture ◽

Retrospective Chart Review ◽

Bloodstream Infections ◽

Central Line ◽

Cost Of Care ◽

Cns Infection ◽

Oral Antibiotic ◽

Beta Lactam ◽

Clostridioides Difficile ◽

Secondary Outcomes

Abstract Background Oral antimicrobial therapy for Enterobacteriales bloodstream infection (EB-BSI) is advantageous to reduce the risk of central line complications, cost of care, and length of stay. Fluoroquinolones (FQ) given their high bioavailability have been utilized as the standard for stepdown therapy (SDT) for EB-BSI. Given the recent increased warnings around FQ use including Clostridioides difficile infection (CDI) and the increasing FQ resistance alternative oral options for treatment are warranted. Recent literature has suggested beta-lactams (BLM) may be an option for EB-BSI. To enhance the antimicrobial stewardship goal of reducing FQ use, our team began recommending de-escalation to a BLM for EB-BSI and the objective of this study is to evaluate the outcomes of this approach. Methods This study was a retrospective chart review of patients with EB-BSI due to ceftriaxone sensitive monomicrobial E. coli, Klebsiella spp., or P. mirabilis who received a BLM or a FQ as SDT. Patients were excluded if < 18 years of age; pregnant; ANC < 1000 cells/µL; had endocarditis, a bone/joint, or a CNS infection; discharged to hospice or expired prior to discharge; anaphylactic BLM allergy; or prior kidney transplant. SDT was defined as a switch to a definitive oral antibiotic after empiric IV therapy. The primary outcome was clinical cure defined as completion of therapy without signs of infection (increase in WBC > 2000 cells/mL if WBC was ≥ 12,000 cells/mL, fever (>38°C), or change in antibiotic due to failure). Secondary outcomes included 30 day re-admission rates, reinfection rate defined as positive culture within 30 days of completion of therapy, antibiotic associated adverse events defined as side effects leading to discontinuation and/or CDI within 90 days from start of treatment. Results A total of 159 patients were included in the study (Figure 1). The BLM patients had a higher median age (78 vs 72, p=0.008), higher median PITT bacteremia score (2 vs 1, p=0.037), were less likely to be immunosuppressed (9% vs 25%, p=0.045), and had shorter median duration of therapy (13 vs 14, p=0.034). There was no difference in the primary or secondary outcomes (Table 2). Conclusion BLM may enhance stewardship efforts as a FQ sparing option for treatment of EB-BSI; however, prospective studies in this area are warranted. Disclosures All Authors: No reported disclosures

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Short Oral Antibiotic Treatment of Osteomyelitis Questioned

Pediatrics in Review ◽

10.1542/pir.2.1.18 ◽

1980 ◽

Vol 2 (1) ◽

pp. 18-18

Keyword(s):

Antimicrobial Therapy ◽

Oral Therapy ◽

Initial Period ◽

Clinical Signs ◽

Signs And Symptoms ◽

Oral Route ◽

Antimicrobial Treatment ◽

Blood Levels ◽

Oral Antibiotic ◽

Cortical Destruction

Dr. Rothman of Haverhill, MA questioned the short duration of antimicrobial treatment and use of oral route for the patient with osteomyelitis presented by Bennett in PIR 1:153, November 1979. He noted that the traditional regimen for osteomyelitis calls for six weeks of intravenous antimicrobial therapy. Dr. Bennett quotes from Telzlaff et al (J Pediatr 92:485, 1978). In this report good results were found when antimicrobial regimens for patients with osteomyelitis and suppurative arthritis consisted of a brief initial period of parenteral therapy of only one to seven days followed by oral antimicrobial therapy begun when there was a definitive decrease in clinical signs of inflammation and continued for three weeks or longer. It is important to note that surgical drainage of pus was carried out, that antimicrobial blood levels were obtained after initiation of oral therapy to ensure adequate levels, that therapy was continued until all signs and symptoms had subsided, that there was no evidence of cortical destruction or sequestrum formation on roentgenogram, and the erythrocyte sedimentation rate was less than 20 mg/hr. When these conditions are met it is clear that oral therapy can be an adequate substitute for prolonged intravenous therapy for osteomyelitis in children.

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Mapping, cluster detection and evaluation of risk factors of ovine toxoplasmosis in Southern Italy

Geospatial health ◽

10.4081/gh.2016.432 ◽

2016 ◽

Vol 11 (2) ◽

Cited By ~ 5

Author(s):

Roberto Condoleo ◽

Vincenzo Musella ◽

Maria Paola Maurelli ◽

Antonio Bosco ◽

Giuseppe Cringoli ◽

...

Keyword(s):

Risk Factors ◽

Geographical Information Systems ◽

Southern Italy ◽

Geographical Information ◽

Economic Losses ◽

Common Source ◽

High Exposure ◽

Campania Region ◽

Source Of Infection ◽

Serological Data

Toxoplasmosis, an important cause of reproductive failure in sheep, is responsible for significant economic losses to the ovine industry worldwide. Moreover, ovine meat contaminated by the parasite Toxoplasma gondii is considered as a common source of infection for humans. The aim of this study was to develop point and risk profiling maps of T. gondii seroprevalence in sheep bred in Campania Region (Southern Italy) and analyse risk factors associated at the flock-level. We used serological data from a previous survey of 117 sheep flocks, while environmental and farm management information were obtained from an analysis based on geographical information systems and a questionnaire purveyance, respectively. An univariate Poisson regression model revealed that the type of farm production (milk and meat vs only meat) was the only independent variable associated with T. gondii positivity (P<0.02); the higher within-flock seroprevalence in milking herds suggests that milking practices might influence the spread of the infection on the farm. Neither environmental nor other management variables were significant. Since a majority of flocks were seasonally or permanently on pasture, the animals have a high exposure to infectious T. gondii oocysts, so the high within-flock seroprevalence might derive from this management factor. However, further studies are needed to better assess the actual epidemiological situation of toxoplasmosis in sheep and to clarify the factors that influence its presence and distribution.

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Epidemiological investigations onCampylobacter jejuniin households with a primary infection

Journal of Hygiene ◽

10.1017/s002217240006486x ◽

1984 ◽

Vol 93 (2) ◽

pp. 325-332 ◽

Cited By ~ 63

Author(s):

J. Oosterom ◽

C. H. den Uyl ◽

J. R. J. Bänffer ◽

J. Huisman

Keyword(s):

Campylobacter Jejuni ◽

Primary Infection ◽

Index Patient ◽

Chicken Meat ◽

Circumstantial Evidence ◽

Common Source ◽

Household Contacts ◽

Control Subjects ◽

Source Of Infection ◽

Spread Of Infection

SummaryFifty-four Rotterdam patients in which a primary infection withCampylobacter jejunihad been detected (index patients) were compared with 54 control subjects with regard to the consumption and preparation of foods 7 days before onset of illness and the keeping of pet animals. Significantly more index patients than controls had eaten chicken meat (47v. 29;P= 0·0002), particularly at barbecues (14v. 2;P= 0·0015). Marginally more index patients had eaten pork (47v. 39;P= 0·048) or inadequately heated meat (13v. 8), though in the last case numbers were too small to be statistically significant. The consumption of beef or mutton and outdoor eating (other than at barbecues) were essentially the same in both groups. There was no significant association with the keeping of pet animals, although a few more index patients had cage birds than controls (18v. 12).Twenty-one (15%) of 130 household contacts of index patients also suffered from diarrhoea during the same period. Circumstantial evidence pointed to a common source of infection with the index patient in 13 instances (nine households) and probable intrafamilial spread of infection in six instances.Campylobacters were isolated from one of 110 swabs of kitchen work surfaces and eight of 107 swabs taken from lavatory bowls in index households.

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Deep Neck Space Infections in Northern Ghana

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i2430778 ◽

2020 ◽

pp. 265-270

Author(s):

Theophilus Adjeso ◽

Mawutor Dzogbefia ◽

Edem Kojo Dzantor

Keyword(s):

Antibiotic Use ◽

Northern Ghana ◽

Common Source ◽

Odontogenic Infections ◽

Source Of Infection ◽

Lethal Complications ◽

Deep Neck Space Infections ◽

Hospital Stays ◽

Age Range ◽

Tamale Teaching Hospital

Background: Deep neck space infections (DNSI) continue to pose a challenge due to its potentially lethal complications that can arise despite the reduced prevalence as a result of widespread antibiotic use and improved dental care. We conducted a review of our experience with DNSI at the Ear, Nose and Throat (ENT) Unit, Tamale Teaching Hospital (TTH). Materials and Methods: We performed a retrospective analysis of patients hospitalized with a diagnosis DNSI at the ENT Unit, TTH from January 2013 to June 2020. Parameters analyzed included the age and sex distribution of patients, source of infection, sites involved, duration of admission and outcomes. Data analysis was done using SPSS version 20.0 (Chicago, IBM 2010). Results: The study involved 135 cases of DNSIs with age range of 5 months to 76 years (35.7± 19.0 years). Majority of the DNSIs cases occurred within the third decade of life and slightly more common among males (50.4%). The duration of hospital stays ranged from a day to 41 days (10.1± 8.2 days). Multi-space abscesses were the most common diagnosed DNSIs with odontogenic infections (63%) being the most common source of DNSIs. Majority (83.7%) of the patients were successfully treated with a mortality rate of 12.6%. Conclusion: DNSIs was most common among males with patients in their third decade most affected. Odontogenic infections were the most common source of DNSI with multi-space abscesses being the most common presentation. Majority of the patients were treated successfully.

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Electrical Impedance Spectroscopy as a Powerful Analytical Tool for Monitoring Microbiological Growth on Medical Implants

Encyclopedia of Healthcare Information Systems ◽

10.4018/978-1-59904-889-5.ch062 ◽

2008 ◽

pp. 487-496

Author(s):

Louise M. Oliver ◽

E. T. McAdams ◽

P. S.M. Dunlop ◽

J. A. Byrne ◽

I. S. Blair ◽

...

Keyword(s):

Electrical Impedance Spectroscopy ◽

Common Source ◽

Hospital Acquired Infection ◽

Hospital Acquired Infections ◽

Source Of Infection ◽

Powerful Analytical Tool ◽

Catheter Surface ◽

Intravascular Catheters ◽

Micro Organisms ◽

Hospital Acquired

Hospital-acquired infections (HAI) are defined as infections that are neither present nor incubating when a patient enters the hospital (Bourn, 2000). Their effects vary from discomfort to prolonged or permanent disability and they may contribute directly or substantially to a patient’s death. HAI’s are estimated to cost the National Health Service (NHS) in England £1 billion annually (Bourn, 2000) with as many as 5,000 patients dying as a result of acquiring such an infection (Anon, 2001). Not all hospital-acquired infections are preventable but Infection Control Teams believe that they could be reduced by at least 15%, with yearly savings of £150 million (Anon, 2001). Central intravascular catheters have been found to be a common source of infection. Catheters can become infected via a number of different routes with the infection proliferating in multiple areas along the catheter surface. It has been reported that over 40% of the identified micro-organisms causing hospital-acquired infection were Staphylococci, an organism that is typically found on the natural skin flora (Bourn, 2000).

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Simultaneous norovirus outbreak in three Portuguese army bases in the Lisbon region, December 2017

Journal of the Royal Army Medical Corps ◽

10.1136/jramc-2019-001242 ◽

2019 ◽

pp. jramc-2019-001242

Author(s):

António Lopes-João ◽

J R Mesquita ◽

R de Sousa ◽

M Oleastro ◽

C Penha-Gonçalves ◽

...

Keyword(s):

Armed Forces ◽

Food Samples ◽

Common Source ◽

Microbiological Analysis ◽

Pcr Assay ◽

Institutional Settings ◽

Enteropathogenic Bacteria ◽

Source Of Infection ◽

Positive Stool ◽

Stool Specimens

IntroductionNorovirus outbreaks frequently occur in communities and institutional settings acquiring a particular significance in armed forces where prompt reporting is critical. Here we describe the epidemiological, clinical and laboratorial investigation of a multicentre gastroenteritis outbreak that was detected simultaneously in three Portuguese army units with a common food supplier, Lisbon region, between 5 and 6 December 2017.MethodsQuestionnaires were distributed to all soldiers stationed in the three affected army units, and stool specimens were collected from soldiers with acute gastrointestinal illness. Stool specimens were tested for common enteropathogenic bacteria by standard methods and screened for a panel of enteric viruses using a multiplex real-time PCR assay. Food samples were also collected for microbiological analysis. Positive stool specimens for norovirus were further genotyped.ResultsThe three simultaneous acute gastroenteritis outbreaks affected a 31 (3.5%) soldiers from a total of 874 stationed at the three units and lasted for 2 days. No secondary cases were reported. Stool specimens (N=11) were negative for all studied enteropathogenic agents but tested positive for norovirus. The recombinant norovirus GII.P16-GII.4 Sydney was identified in all positive samples with 100% identity.ConclusionsThe results are suggestive of a common source of infection plausibly related to the food supplying chain. Although centralisation of food supplying in the army has economic advantages, it may contribute to the multifocal occurrence of outbreaks. A rapid intervention is key in the mitigation of outbreak consequences and in reducing secondary transmission.

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1144. Modern Problem, Medieval Cure-Resistant Aeromonas in Medicinal Leeches

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.977 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S344-S344

Author(s):

Leighanne Olivia Parkes ◽

Kevin Barker ◽

Susan M Poutanen ◽

Jennifer M Grant ◽

Michael Libman ◽

...

Keyword(s):

Preliminary Investigation ◽

Pulse Field ◽

Common Source ◽

Modern Problem ◽

Hospital System ◽

Pulse Field Gel Electrophoresis ◽

Hospital Systems ◽

The Common ◽

Reported Data ◽

Medicinal Leeches

Abstract Background Medicinal leeches are used primarily in plastic and reconstructive surgery when venous congestion threatens tissue viability. The associated infection risk ranges from 4.1 to 20%. Prophylactic antimicrobials such as fluoroquinolones (FQ) or trimethoprim-sulfamethoxazole (SXT) are recommended and target commonly isolated pathogen and gut symbiont, Aeromonas. However, resistance to these agents has been reported and detected in leeches, including at hospital systems across Canada that acquire their stock from the same supplier. Our objective was to describe the local epidemiology of leech-related Aeromonas resistant to one or more commonly used prophylactic agents, and determine if such resistance originates from the common supplier. Methods Six hospital systems across Canada using leech therapy, purchased from the same supplier, were surveyed. A 5-year retrospective review of all antimicrobial resistant leech-related Aeromonas, derived from clinical, leech, and tank fluid specimens was performed. All Aeromonas resistant to either FQ or SXT were included, and retained frozen isolates from each system were analysed by pulse-field gel electrophoresis (PFGE) using a published Aeromonas protocol. Results All six hospital systems reported leech-related Aeromonas resistant to one or more antimicrobials, totalling 15 isolates. Three systems only reported data from the last year. Four systems used FQ and two used SXT as prophylaxis. Fifteen of 15 were either FQ resistant or intermediate, and four of 15 were SXT resistant. Three of 10 isolates tested for ceftriaxone (CRO) susceptibility were resistant. Five of 15 of the isolates were resistant to two or more agents. Of the two leech quality control isolates, 2/2 were FQ resistant and 1/2 was FQ, SXT and CRO resistant. Only three isolates, each from a different, geographically distinct hospital system, had been retained. PFGE analysis indicated 2/3 are closely related (Figure 1). Conclusion Our preliminary investigation suggests that the presence of FQ and SXT resistance in leech-related Aeromonas might be more common than previously suspected, and that such resistance might originate from a common source. A broader study of the molecular epidemiology of leech-related Aeromonas is warranted. Disclosures All authors: No reported disclosures.

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