Recent Advances in Presentation, Diagnosis and Treatment for Mixed Vaginitis

Mixed vaginitis is the simultaneous presence of at least two types of vaginitis, contributing to an abnormal vaginal milieu and leading to vaginal symptoms and signs. However, associations between symptoms and the type of mixed vaginitis have not been clearly elucidated, and research on mixed vaginitis is still in the preliminary stage. Therefore, the pathogenic mechanism of mixed vaginitis remains understudied. Mixed vaginitis generally involves the formation of mixed biofilms. The study of polymicrobial interactions and mixed biofilms will provide a new idea for the understanding of mixed vaginitis. Moreover, this review summarizes some effective management and laboratory diagnosis of mixed vaginitis to avoid inappropriate therapy, recurrence, and reinfection. It is of high clinical importance to obtain relevant clinical data to improve clinical knowledge about mixed vaginitis.

53. Optimizing Transitions of Care Antimicrobial Prescribing at a Community Teaching Hospital

Background Antimicrobial stewardship integral to patient care. Institutions with stewardship decrease antibiotic use, cost, and antibiotic-associated infections. However, few efforts have been formally made to address discharge antimicrobial prescribing, even though many patients started on antibiotic therapy in the hospital are prescribed oral antibiotics to complete their regimens. Methods This was an IRB approved, quasi-experimental, pre-post study. Patients were included if they were >18 years and were discharged from the hospital with an oral antibiotic prescription. Patients discharged against medical advice, prescribed indefinite prophylactic antimicrobial therapy for legitimate reasons, or discharged to a skilled nursing facility were excluded. The retrospective group evaluated a random sample of patients discharged in 2/2020. The prospective group included patients discharged between 1/2021 – 6/2021. In the prospective group, a clinical pharmacist assessed the indication for antibiotics and pended discharge antibiotic prescriptions for physician review. Antibiotic choice and duration of therapy were based on local and national guidelines. Patient Screening for Inclusion and Exclusion Breakdown of patients screened, included, and excluded for study Results 86 (53.1%) of 162 retrospective patients from 2/2020 prior to implementation of the program demonstrated were discharged on inappropriate antimicrobial therapy with excessive duration being the principal driver for inappropriateness. In the prospective group of 64 patients, the rate of patients discharged on inappropriate antibiotics decreased to 28.1% (p=0.001). The duration of inappropriate therapy decreased from a mean of 4.6 days to 2.7 days (p=0.001). 45 (70.3%) of 64 prospective pharmacist’s interventions were accepted by providers. Study Outcomes Outcomes including overall appropriate prescribing, appropriate duration, spectrum, frequency, and dose, as well as days of inappropriate therapy Conclusion Literature demonstrates that prospective evaluation of discharge antibiotics by a clinical pharmacist is effective in improving appropriateness of discharge antibiotic prescriptions, optimizing duration of outpatient antibiotics as well as reducing unnecessarily broad-spectrum therapy. The prospective results from this study demonstrate that this innovative approach can improve outpatient oral antibiotic prescribing and provide a framework for other institutions to implement similar programs. Disclosures All Authors: No reported disclosures

A case of acute spontaneous gangrenous balanoposthitis

Gangrenous and phagedenic balanoposthitis are in most cases a complication of ulcers of venereal origin: ulcus durum, ulcus molle and ulcus mixtum. Occasionally they appear after a perverted coitus, with diseases of the oral cavity (stomatitis, angina Vincenti), after coitus per rectum (with a disease of the rectum). In some cases, the reasons can be traumatic, thermal, chemical, inappropriate therapy. Often, with unclean maintenance of the genitals, partners after coitus may experience vulgar erosions, which cause balanoposthitis. But often gangrenous and phagedenic balanoposthitis can occur completely independently (spontaneously), when none of the above reasons can be found, even without previous coitus. Such spontaneous gangrenous balanoposthitis was first described in 1883 by Fournier; it is characterized by the fact that it occurs in full health and is extremely intense.

EXPLORING THE STAPHYLOCOCCUS AUREUS IN PATIENTS INFECTED OF THE TERTIARY-CARE UNIVERSITY HOSPITAL: RESULTS OF THE RETROSPECTIVE COHORT STUDY

Objective: To establish a baseline of knowledge regarding about inappropriate therapy, virulence and resistance in a cohort of patients infected with S. aureus. Methods: Retrospective cohort study in tertiary-care university hospital was employed to evaluate the risk factors and the impact of inappropriate therapy among patients with Staphylococcus aureus infections, resistance and virulence. To assess the presence of the genes was performed PCR. Results: Patients with MRSA were older and hospitalized 17 days longer than those with MSSA infection, which were in ICU with a bloodstream infection. 50.0% received inadequate antibiotic therapy and we found virulence factors associated with MRSA (mecA, LukS, fnbB and clfA genes). Conclusion: These data show that surveillance studies related to Staphylococcus aureus infections remain essential to identify resistance and inform policy on resistance.

The Effect of Insurance on Appropriate Hospital Discharge Antibiotics for Patients with Staphylococcus aureus Bacteremia

Background Inappropriate antimicrobial therapy of Staphylococcus aureus bacteremia (SAB) is associated with worsened outcomes. The impact of insurance coverage on appropriate selection of antibiotics at discharge is poorly understood. Methods We used a retrospective cohort design to evaluate whether patients with SAB at a large academic medical center over 2 years were more likely to receive inappropriate discharge antibiotics, depending on their category of insurance. Insurance was classified as Medicare, Medicaid, commercial and none. Logistic regression was used to determine the odds of being prescribed inappropriate discharge therapy. Results A total of 273 SAB met inclusion criteria with 14.3% receiving inappropriate discharge therapy. In the unadjusted model, there was 2-fold increased odds of being prescribed inappropriate therapy for Medicare, Medicaid, and no insurance, compared to commercial insurance, respectively (OR 2.08, 95% CI 1.39-3.13). After controlling for discharge with nursing assistance and ID consult, there was 1.6-fold increased odds (OR 1.57, 95% CI 0.998-2.53, p=0.064) of being prescribed inappropriate therapy for Medicare, Medicaid, and no insurance, compared to commercial insurance, respectively. We found that being discharged home without nursing assistance resulted in 4-fold increased odds of being prescribed inappropriate therapy (OR 4.16, 95% CI 1.77-9.77, p<0.01) and failing to consult an ID team resulted in 59-fold increased odds of being prescribed inappropriate therapy (OR 59.2, 95% CI 11.4-306.9, p<0.001). Conclusions We found strong evidence that non-commercial insurance, discharging without nursing assistance, and failure to consult ID are risk factors for being prescribed inappropriate antimicrobial therapy for SAB upon hospital discharge.

Abstract 14546: Left Ventricular Sphericity Index as a Predictor of Appropriate Implantable Cardioverter-defibrillator Therapy

Introduction: We assessed the hypothesis that markers of LV wall stress, such as LV sphericity index (SI), may predict appropriate therapy for ventricular arrhythmias (VA) in patients with primary prevention defibrillators, independent of LV ejection fraction. Methods: We performed a retrospective analysis of consecutive patients with new ICD or CRT-D placement for primary prevention at a single hospital from 01/01/2015 to 06/30/2018. TTE images were used for calculating LV SI, which was defined as the ratio of bi-plane LV end-diastolic volume to the volume of a hypothetical sphere with a diameter of LV end-diastolic length in apical 4-chamber view. Device interrogations were reviewed for appropriate therapy for VA and inappropriate therapy for non-VAs. Kaplan-Meier curves stratified by LV SI tertile were constructed, and Cox proportional hazards models were used to evaluate time to appropriate and inappropriate therapy, and all-cause mortality. Results: A total of 282 patients (ICD 154, CRT-D 128) were included. Baseline characteristics are described in the Table. We found a trend towards increased appropriate therapy as LV SI increased in the ICD but not the CRT-D group, but this was non-significant in both (ICD log-rank 0.63, p-value 0.73; CRT-D log-rank 0.07, p-value 0.96). There was no correlation between LV SI and time to all-cause mortality in the ICD (log-rank 0.53, p-value 0.76) or the CRT-D patients (log-rank 0.51, p-value 0.77). LV SI correlated significantly with time to inappropriate therapy in the ICD (log-rank 8.6, p-value 0.01), but not the CRT-D patients (log-rank 2.4, p-value 0.3). Conclusions: LV SI demonstrated a non-significant trend towards increased appropriate device therapy in the ICD but not the CRT-D group. LV SI predicted inappropriate therapy in the ICD but not the CRT-D group. Study power was limited by lower than expected event rates, possibly due to changes in device programming and improvements in heart failure therapies over time.

Thinking about the future – data on adolescent patients with a subcutaneous ICD

Background Implantable cardioverter-defibrillator (ICD) systems are established for the prevention of sudden cardiac death. Long-term data on ICD function in children and adolescents is rare and has suggested higher rates of lead failure as well as oversensing, both leading to inappropriate therapy. The present study displays a long-term single-center follow-up of young patients having received an S-ICD. Methods and results The present study represents a single-center experience of patients younger than 25 years who received an S-ICD (n=49). Follow-up data included regular in-house follow-up as well as unscheduled hospitalisations in our center. Mean age at implantation was 19.2±4.1 years and 33 patients (67.4%) were male. In 21 patients (42.9%) electrical heart disease or idiopathic ventricular fibrillation represented the underlying condition of ICD implantation. 15 patients suffered from HCM (30.6%). Median follow-up duration was 2 years. No patient died during the observation period. Appropriate shocks occurred in 7 patients (14.3%). Inappropriate shock delivery was recorded in 6 patients (12.3%). T-wave oversensing was the main cause for inappropriate shock delivery (5/6 patients), in the other patient myopotentials were the reason for inappropriate therapy. In one patient, operative refixation of the subcutaneous lead was necessary due to hypermobility leading to oversensing. After modification of the sensing vector as well as activation of the SMART pass filter no further oversensing episodes occurred in any patient. Conclusion ICD therapy in children and adolescents is effective for prevention of sudden cardiac death. Every episode was terminated by the first therapy. The rate of appropriate shock as well as inappropriate therapies was quite high compared to typical ICD cohorts. In particular T-wave oversensing seems to be challenging for the S-ICD detection algorithms also in this cohort. Funding Acknowledgement Type of funding source: None