1521. Evaluation of the Microbiology of Intraabdominal Infections in Children and Implications for Treatment and Outcomes

Abstract Background Acute appendicitis is the most common surgical emergency in pediatric medicine. Pseudomonas aeruginosa has been reported in up to 23% of intraoperative cultures though current recommendations do not specify the need for antipseudomonal coverage for preoperative treatment. Prior to transitioning the empiric antibiotic regimen used in the management of perforated appendicitis from an antipseudomonal agent to a simplified daily antibiotic regimen, we conducted a retrospective review of bacterial cultures obtained from intraabdominal fluid collections and antibiotic regimens in children that underwent surgical treatment of perforated appendicitis and/or intraabdominal abscesses. Methods A retrospective chart review of electronic medical records was conducted for pediatric patients admitted with a diagnosis of perforated appendicitis and/or intraabdominal abscess between April 1, 2016 and April 30, 2018. Results Seventy-two patients met inclusion criteria for the study with abscess identified prior to surgery in 11 patients (42.3%). Intraabdominal cultures were obtained in 48 patients (66.7%). The predominant organisms isolated were Escherichia coli, Bacteroides fragilis, and alpha-hemolytic Streptococcus. P. aeruginosa was identified in 12 (24%) cultures and never as a single organism. The majority of patients received piperacillin/tazobactam empirically (91.7%) with a median duration of 5 days (IQR 2). Forty-four patients (61.1%) received oral antibiotics to continue therapy after discharge and 75% received amoxicillin/clavulanate. Of the 12 patients with P. aeruginosa isolated, all patients received piperacillin/tazobactam empirically and 8 (66.7%) were transitioned to oral antibiotics to complete therapy, of which only two regimens retained antipseudomonal coverage. Conclusion Majority of intraabdominal cultures were polymicrobial and the isolation of P. aeruginosa did not appear to impact the choice of definitive antimicrobial therapy. The predominant organisms identified suggest that a non-antipseudomonal regimen (i.e., cephalosporin with metronidazole) may be considered for empiric antibiotic therapy for cases of perforated appendicitis. Disclosures All authors: No reported disclosures.

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191. Appropriateness of Empiric Antibiotics for Enterobacteriaceae Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.266 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S115-S115

Author(s):

Brandon J Smith ◽

Abigail Kois ◽

Nathan Gartland ◽

Joseph Tholany ◽

Ricardo Arbulu

Keyword(s):

Antibiotic Therapy ◽

Bacterial Resistance ◽

Retrospective Chart Review ◽

Standard Of Care ◽

Academic Community ◽

Empiric Antibiotic Therapy ◽

In Vitro Susceptibility ◽

Empiric Antibiotics ◽

Empiric Antibiotic

Abstract Background Appropriate empiric antibiotic therapy is associated with decreased mortality and recurrence in patients with Enterobacteriaceae bacteremia (EB). Increasing bacterial resistance adds an additional layer to this complex clinical scenario. Swift utilization of appropriate antibiotics is crucial for improved patient outcomes. However, prolonged and excessively broad antibiotic coverage is not without its own complications. Our study aimed to review the appropriateness of empiric antibiotics for EB. Methods A retrospective chart review of all patients >18 years of age who were admitted to a single academic community hospital during 2018 EB anytime throughout their hospitalization. The primary endpoint was the appropriateness of empiric antibiotic therapy, defined as receiving active therapy prior to the return of antimicrobial sensitivities that were susceptible to the empiric agents used. Appropriateness was further adjusted for standard of care (SOC) practices. Specifically, despite in vitro susceptibility of piperacillin/tazobactam and cefepime, carbapenem therapy is preferred for ESBL infections. Results Our study identified 178 patients with EB. Most common organisms included E.coli (64.6%), K. pneumoniae (11.8%) and P. mirabilis (7.3%). Resistance patterns included 1 CRE (0.57%) and 17 ESBL (9.7%) isolates. Most common sources of infection included urinary (63.5%) and intraabdominal (13.5%). Based on the sensitivity reports of tested isolates, 83.7% of patients received appropriate empiric antibiotics. After adjustment for SOC, 11.8% of ESBL patients (2/17) and 0% of CRE (0/1) patients received appropriate therapy. Comparatively 89.0% of patients without ESBL or CRE (137/154) received appropriate care (P < 0.0001). Conclusion The results of this study demonstrate that across our patient population, over 80% of patients received appropriate empiric antibiotics for EB; however, this percentage was dramatically lower for patients with ESBL or CRE infections. This highlights room for improved rapid diagnosis and identification of risk factors predisposing to resistant organisms thereby decreasing the time to appropriate antibiotic therapy. Disclosures All authors: No reported disclosures.

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1555. Evaluation of Local Pathogens and Management of Diabetic Foot Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1735 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S778-S778

Author(s):

Jessica L Seadler ◽

Natalie Tucker ◽

Beth Cady ◽

Praveen Mullangi

Keyword(s):

Antibiotic Therapy ◽

Broad Spectrum ◽

Diabetic Foot ◽

Antimicrobial Agents ◽

Specific Treatment ◽

Retrospective Chart Review ◽

Primary Objective ◽

Empiric Antibiotic Therapy ◽

Diabetic Foot Infections ◽

Empiric Antibiotic

Abstract Background Diabetic foot infections (DFI) are a potentially devastating complication for patients with diabetes. When treating these patients, there is a need for selection of highly effective antibiotics coupled with a need to avoid excessive use of broad-spectrum antimicrobial agents that could lead to adverse patient outcomes. At this institution, it has been observed that there is a lack of compliance with consensus guideline recommendations for the choice of empiric antibiotic therapy for DFI, leading to overuse of broad-spectrum antibiotics. Methods A retrospective chart review was performed for hospitalized patients over 18 years of age that received antibiotics for DFI during the period of August 1, 2018 to July 31, 2019. Patients were excluded if they were continuing outpatient antibiotics for an existing DFI, were being treated with antibiotics for a concurrent infection, or were pregnant. The primary objective was the rate of guideline-compliant empiric antibiotic regimens as broken down by infection severity. Secondary objectives included the duration of antibiotic therapy per patient, and rates of empiric methicillin-resistant Staphylococcus aureus (MRSA) and P. aeruginosa coverage. Results A total of 114 patients were included in the analysis. A majority of patients had an infection of moderate severity (65.8%), followed by 19.3% with severe infections, and 14.9% with mild infections. In the total population, only 26.3% of patients received empiric antibiotic regimens that were guideline-compliant. A large percentage of patients received empiric anti-MRSA antibiotics (95.6%) and empiric anti-pseudomonal agents (89.5%). Use of these broad-spectrum agents did not differ by infection severity. Ninety-nine (86.8%) patients had a site culture collected. S. aureus was the most commonly isolated organism and there was a low rate of P. aeruginosa (10.1%). Conclusion There is room for improvement in the management of DFI at this institution. A specific area that has been identified is the overuse of empiric anti-pseudomonal agents in patients without risk factors for P. aeruginosa. The results of this study will be evaluated alongside consensus guidelines and used to create institution-specific treatment guidance that providers can employ to optimize the management of DFI. Disclosures All Authors: No reported disclosures

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Time to Guideline-Based Empiric Antibiotic Therapy in the Treatment of Pneumonia in a Community Hospital

Journal of Pharmacy Practice ◽

10.1177/0897190014566303 ◽

2016 ◽

Vol 29 (4) ◽

pp. 386-391 ◽

Cited By ~ 2

Author(s):

Beth L. Erwin ◽

Jeffrey A. Kyle ◽

Leland N. Allen

Keyword(s):

Antibiotic Therapy ◽

Guideline Adherence ◽

Community Hospital ◽

Retrospective Chart Review ◽

Empiric Antibiotic Therapy ◽

Adherence Rate ◽

Record System ◽

Empiric Antibiotic ◽

The Mean ◽

Mean Time

Purpose: The 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines for hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care-associated pneumonia (HCAP) stress the importance of initiating prompt appropriate empiric antibiotic therapy. This study’s purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline-based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen. Methods: A retrospective chart review of adults with HAP, VAP, or HCAP was conducted at a community hospital in suburban Birmingham, Alabama. The hospital’s electronic medical record system utilized International Classification of Diseases, Ninth Revision ( ICD-9) codes to identify patients diagnosed with pneumonia. The percentage of patients who received guideline-based empiric antibiotic therapy was calculated. The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline-based therapy. Results: Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was 31.2%. The mean time to guideline-based therapy in hours:minutes was 7:47 for HAP and 28:16 for HCAP. For HAP and HCAP combined, the mean time to appropriate therapy was 21:55. Conclusion: Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP.

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MRSA Incidence and Antibiotic Trends in Urban Hand Infections: A 10-Year Longitudinal Study

Hand ◽

10.1177/1558944717750921 ◽

2018 ◽

Vol 14 (4) ◽

pp. 449-454 ◽

Cited By ~ 5

Author(s):

Justin M. Kistler ◽

Joseph J. Thoder ◽

Asif M. Ilyas

Keyword(s):

Medical Center ◽

Antibiotic Sensitivity ◽

Retrospective Chart Review ◽

Empiric Antibiotic Therapy ◽

Steady Increase ◽

Medical Centers ◽

Empiric Antibiotic ◽

Empiric Antibiotic Treatment ◽

Culture Positive ◽

Polymicrobial Infections

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is the most reported pathogen in hand infections at urban medical centers throughout the country. Antibiotic sensitivity trends are not well known. The purposes of this study were to examine and determine the drug resistance trends for MRSA infections of the hand and to provide recommendations for empiric antibiotic treatment based on sensitivity profiles. Methods: A 10-year longitudinal, retrospective chart review was performed on all culture-positive hand infections encountered at a single urban medical center from 2005 to 2014. The proportions of all organisms were calculated for each year and collectively. MRSA infections were additionally subanalyzed for antibiotic sensitivity. Results: A total of 815 culture-positive hand infections were identified. Overall, MRSA grew on culture in 46% of cases. A trend toward decreasing annual MRSA incidence was noted over the 10-year study period. There was a steady increase in polymicrobial infections during the same time. Resistance to clindamycin increased steadily during the 10-year study, starting at 4% in 2008 but growing to 31% by 2014. Similarly, levofloxacin resistance consistently increased throughout the study, reaching its peak at 56% in 2014. Conclusions: The annual incidence of MRSA in hand infections has declined overall but remains the most common pathogen. There has been an alternative increase in the number of polymicrobial infections. MRSA resistance to clindamycin and levofloxacin consistently increased during the study period. Empiric antibiotic therapy for hand infections should not only avoid penicillin and other beta-lactams but should also consider avoiding clindamycin and levofloxacin for empiric treatment.

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Selection of an Appropriate Empiric Antibiotic Regimen in Culture-Negative Hematogenous Vertebral Osteomyelitis

10.1101/363549 ◽

2018 ◽

Author(s):

Ki-Ho Park ◽

Dong Youn Kim ◽

Yu-Mi Lee ◽

Mi Suk Lee ◽

Kyung-Chung Kang ◽

...

Keyword(s):

Antibiotic Susceptibility ◽

Tertiary Care ◽

Vertebral Osteomyelitis ◽

Retrospective Chart Review ◽

Oral Antibiotic ◽

Empiric Antibiotic ◽

Amoxicillin Clavulanate ◽

Healthcare Associated ◽

Susceptibility Profiles ◽

Culture Negative

AbstractThe aim of this study was to determine which antibiotic combinations are appropriate for culture-negative hematogenous vertebral osteomyelitis (HVO), based on the antibiotic-susceptibility pattern of organisms isolated from cases of culture-proven HVO. We conducted a retrospective chart review of adult patients with microbiologically proven HVO in five tertiary-care hospitals over a 7-year period. The appropriateness of empiric antibiotic regimens was assessed based on the antibiotic susceptibility profiles of isolated bacteria. In total, 358 cases of microbiologically proven HVO were identified. The main causative pathogens identified were methicillin-susceptible Staphylococcus aureus (33.5%), followed by methicillin-resistant S. aureus (MRSA) (24.9%), aerobic gram-negative bacteria (21.8%), and Streptococcus species (11.7%). Extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and anaerobes accounted for only 1.7% and 1.4%, respectively, of the causative pathogens. Based on the susceptibility results of isolated organisms, levofloxacin plus rifampicin was appropriate in 73.5%, levofloxacin plus clindamycin in 71.2%, and amoxicillin-clavulanate plus ciprofloxacin in 64.5% of cases. These oral combinations were more appropriate for treating community-acquired HVO (85.8%, 84.0%, and 80.4%, respectively) than healthcare-associated HVO (52.6%, 49.6%, and 37.6%, respectively). Vancomycin combined with ciprofloxacin, ceftriaxone, ceftazidime, or cefepime was similarly appropriate (susceptibility rates of 93.0%, 94.1%, 95.8%, and 95.8%, respectively). In conclusion, in a setting with a high prevalence of MRSA HVO, oral antibiotic combinations may be suboptimal for treatment of culture-negative HVO and should be used only in patients with community-acquired HVO. Vancomycin combined with fluoroquinolone or a broad-spectrum cephalosporin was appropriate in most cases of HVO in this study.

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Which Type of Empiric Antibiotic Therapy is Appropriate? A 20-Year Retrospective Study of Bloodstream Infections in Childhood Cancer

Infectious Diseases and Therapy ◽

10.1007/s40121-021-00427-5 ◽

2021 ◽

Author(s):

Andreas Meryk ◽

Gabriele Kropshofer ◽

Caroline Bargehr ◽

Miriam Knoll ◽

Benjamin Hetzer ◽

...

Keyword(s):

Retrospective Study ◽

Antibiotic Therapy ◽

Childhood Cancer ◽

Bloodstream Infections ◽

Empiric Antibiotic Therapy ◽

Empiric Antibiotic

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1554. Epidemiology of Adult Bacterial Hand Infections at Two Urban Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1734 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S777-S778

Author(s):

Arsheena Yassin ◽

Christine Stavropoulos ◽

Krystina L Woods ◽

Jiashan Xu ◽

Justin Carale ◽

...

Keyword(s):

New York ◽

Staphylococcus Aureus ◽

Antibiotic Regimen ◽

Gram Positive ◽

Gram Negative ◽

Streptococcus Species ◽

Urban Hospitals ◽

Haemophilus Parainfluenzae ◽

Empiric Antibiotic ◽

Gram Negative Organisms

Abstract Background Hand infections represent a major source of morbidity, which can result in hand stiffness and amputation. Early appropriate empiric antibiotic regimen may reduce the associated morbidity, hence the importance to examine local epidemiology. The aim of this study was to define the current epidemiology of adult hand infections at two urban hospitals in New York City. Methods We performed a double center, retrospective study of adult patients hospitalized from March 2018 to May 2020. Patients with positive cultures associated with the hand infections were included. Retrospectively, 100 patients were reviewed. Data on baseline demographic, clinical, surgical, microbiology, and treatment parameters were collected. Results Of the 100 patients, 76% were male, with median age of 47.5 years (35, 58.25) and average C-reactive protein (CRP) of 50.66 mg/L (± 64.64) on admission (see Table 1). Previous hospitalization within 1 year (38%), previous surgical procedures (39%) and recent IV medication use (26%) were common. 130 bacterial isolates were identified (see Table 2). The most frequent organisms were Gram-positive, with Methicillin susceptible Staphylococcus aureus (MSSA, 25.38%), Streptococcus species (20.08%), and Methicillin resistant Staphylococcus aureus (MRSA, 15.38%) being the most common. Gram-negative organisms were infrequent, with Haemophilus parainfluenzae (3.85%), Enterobacter cloacae (3.85) and Pseudomonas aeruginosa (3.08%) being the most prevalent. Of the 100 patients, 27% had polymicrobial infections, associated with trauma (6%), illicit IV use (6%) and unknown (7%) etiologies. Table 1: Baseline demographics and co-morbid conditions Table 2: Types and numbers of organisms in relation to etiologies Conclusion Within our population, the most common organisms associated with hand infections were Gram-positive, with Staphylococcus aureus and Streptococcus species being the most prevalent. Gram-negative pathogens were infrequently isolated. The results within this study can provide guidance to clinicians on assessing the appropriate empiric antibiotic regimen in patients with hand infections, and can serve as a basis for further studies identifying risk factors associated with isolation of organisms associated with hand infections. Disclosures All Authors: No reported disclosures

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