Early Antibiotic Research Articles

Defining Clinical and Microbiological Nonresponse in Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is a severe complication of mechanical ventilation, with mortality reduced most effectively by adequate early antibiotic treatment. The clinical and microbiologic response can be assessed easily from 72 hours after starting antibiotic treatment. Evidence of nonresponse is based on several factors: (1) lack of clinical improvement, (2) radiographic progression, (3) an impaired Sequential Organ Failure Assessment (SOFA) score, (4) no improvement by days 3 to 5 on the Clinical Pulmonary Infection Score (CPIS), (5) no decreased in biomarkers on day 3, and (6) isolation of a new pathogen on day 3. Among the clinical markers of treatment failure, physicians should consider no improvement in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), persistence of fever or hypothermia, persistence of purulent respiratory secretions, and new-onset septic shock or multiple-organ dysfunction syndrome. Microbiological isolation of a new pathogen on day 3 is also associated with higher mortality, but persistence of the original pathogen does not seem to be associated with a worse prognosis. The real impact of changes to treatment after diagnosing nonresponsive VAP is unknown. Physicians must evaluate whether treatments are adequate in terms of sensitivity, dose, and route. Pharmacokinetically and pharmacodynamically optimized doses are recommended in these patients. Clinical stabilization of comorbidities or underlying conditions may be of benefit.

Antibiotics Versus Surgery in Treatment of Early Flexor Tenosynovitis.

Treatment of pyogenic flexor tenosynovitis (FTS) historically involved surgical debridement supplemented with antibiotic therapy. No consensus exists on either: (1) the treatment algorithm for this infection; or (2) the clinical definition of "early" FTS. We performed a retrospective study to clarify indications for nonoperative management. We identified 40 patients with a diagnosis of FTS using Current Procedural Terminology and International Classification of Diseases, Tenth Revision, codes and a keyword search from an electronic medical record between 2011 and 2019. Patients underwent either surgical management (SG) (n = 20) or early antibiotics only (EAG) (n = 20). The surgical group was divided into patients with intraoperative purulence within the tendon sheath (PU) and those without purulence (NP). The number of Kanavel signs and duration of days of symptoms were significantly greater in SG compared with EAG. Subgroup analysis of SG showed a greater number of days of symptoms in the NP group when compared with the PU group. No statistical significance was found with respect to age, smoking, or specific individual Kanavel signs between SG and EAG. Both duration of symptoms and number of Kanavel signs should be considered in suspected early FTS. Patients with shorter duration of symptoms and fewer Kanavel signs were treated successfully with antibiotics alone. Operatively confirmed FTS presented more acutely with fewer days of symptoms and a higher number of Kanavel signs. Patients with subacute presentations may represent inflammatory conditions and hand infections other than FTS.

English

BACKGROUND Mechanical ventilation is a life-saving procedure for most patients in ICUs. But it has a risk of acquiring respiratory tract infections resulting in high morbidity and mortality. If not treated early, it may lead to ventilator-associated pneumonia (VAP). Early diagnosis and appropriate antibiotic therapy at right time in the right dosage is essential for better clinical outcome. The objectives of the study were to analyse the microbiomes of endotracheal samples and their antimicrobial susceptibility pattern in mechanically ventilated patients in ICUs and to frame an institution based local antibiotic policy especially for them. METHODS A retrospective study was conducted in a tertiary care hospital and sample data was collected which included all adult patients who were mechanically ventilated for various co-morbid conditions in ICUs from January 2019 to December 2019. All the samples were processed for microscopy, culture and antimicrobial susceptibility pattern. RESULTS Among 848 endotracheal samples, 673 (79.4 %) samples were culture positive and 175 (20.6 %) samples were sterile. Most common organism was Acinetobacter spp (N=240) followed by Klebsiella spp (N=225) and Pseudomonas spp (N=97). In our study, polymicrobial infections were 186(21.7 %). Sixty-eight percent of organisms were multidrug-resistant. Carbapenem resistance was 58 %. CONCLUSIONS The most common complication of mechanical ventilation is an endotracheal infection which in turn leads to prolonged stay in hospital, morbidity and mortality. It is essential to know about the local microbiome and its antibiotic susceptibility pattern. KEY WORDS Microbiome-human, Antibiogram, Endotracheal Intubation.

Head and neck infection, clinicopathological outline

<p><strong>Background: </strong>Despite the antimicrobial drugs, a significant percentage of head and neck infection still can be recorded, this study try to identify the causes of recorded cases of head and neck infection in antibiotics era by focusing on the clinical presentation and the predisposing factors. <strong></strong></p><p><strong>Methods:</strong> A retrospective study was conducted in the department of otolaryngology in university of Benghazi including 84 patients who were diagnosed as head and neck infection. Clinical data, risk factors and managements were discussed in this study. </p><p><strong>Results:</strong> The 84 patients with deep cervical infection were studied. The mean age of our patients was 33 years, most of them were males. Some had other co-diseases. Their main complains was severe throat pain. The most common space involved was peritonsillar space and the most common source of infection was tonsillar infection. Only third of the cases showed positive culture results. The most common organism cultured was <em>Staphylococci</em>. The range of hospital stay was 4-11 days. There was no mortality in our series of patients.</p><p><strong>Conclusions:</strong> Cervical infection is associated with high rate of morbidity and mortality specially in immune-compromised patients, therefore early detection of the disease followed by quick and appropriate management are life-saving measurements. All patients need early broad-spectrum intravenous antibiotics, and most of them need different surgical intervention. As bad oral hygiene, smoking and low immunity are the major risk factors for neck infection, education of the community, especially in rural area, is required.</p>

Features on Computed Tomography That Correlate With Acute Appendicitis.

Background: The purpose of this study is to investigate the relevant findings in adult patients admitted to Cabell Huntington Hospital who were diagnosed with acute appendicitis. Methods: Patients who had the postoperative diagnosis of acute appendicitis and a preoperative computed tomography (CT) scan from January 2011 through December 2016 were included in this retrospective chart review. Results: There were 592 patients. A thick, edematous appendix was the most common CT finding in acute appendicitis. The average diameter was 12.6mm. The wall thickness correlated to the diameter of the appendix (P < 0.001). For comparison, we reviewed the CT scans of 50 trauma patients who had normal abdominal CT scans. The average diameter of a normal appendix was 4.9mm (SD 1.139) with a range of 4-7mm. Interestingly, the admission white blood cell count (P = 0.0372) as well as the thickness of the appendix (P < 0.0001) were strongly associated with increased length of stay. Conclusions: An appendiceal diameter greater than 9mm should be considered abnormal and associated with acute appendicitis. Appendiceal size, white blood cell count, and age correlate with length of stay. Early antibiotics and early surgical intervention may decrease length of stay.

Scrub typhus, a rare of cause of fulminant hepatic failure: A common disease with uncommon presentation

Scrub typhus (bush typhus) is a potentially lethal mite-borne, acute febrile infectious illness caused by Orientia tsutsugamushi, reported precipitating frequent outbreaks in the Asia-pacific belt. Usual presentation after a median incubation period of 10–14 days, stretches from pathognomonic eschar, high-grade fever, centrifugal skin rash, jaundice, regional lymphadenopathy to frontal headache, nevertheless complicated at times with myocarditis, acute respiratory distress syndrome, acute kidney injury, encephalitis, and shock. Although patients with scrub typhus invariably do display mild liver injury, fulminant hepatic failure (FHF) is rarely reported. We describe herein, a case of FHF in an elderly male that responded well to antibiotics. Early diagnosis and sensitive antibiotic administration aids in mortality prevention of the former.

Best practice for the treatment of descending mediastinitis: A review of review articles and studies looking at cause, diagnosis, treatment and outcomes of head and neck descending necrotizing mediastinitis

Introduction: Descending necrotizing mediastinitis (DNM) is a rare but serious infection. The aim of this review is to highlight the common pathogens and risk factors associated with DNM as well as depicting both the medical and surgical treatments. Methods: A literature search of the Cochrane libraries and PubMed libraries for articles published between January 2000 and December 2020 reporting on DNM were reviewed. The key words used: descending necrotizing mediastinitis, odontogenic infection, cervical infection. 3 surgeons evaluated 40 abstracts. Only literature reviews and studies were included. Results: The total number of papers included were 14, 8 articles were reviews of the literature and 6 articles were original studies. Patient outcomes are better the earlier that the condition is diagnosed and treated. CT neck and thorax was the best imaging modality. Odontogenic with streptococcal species is most common cause and the most effective antibiotic sensitivity is a third-generation cephalosporin or clindamycin combined with metronidazole. An alternative is a penicillin with metronidazole. Prompt surgical management is required to effectively debride necrotic tissue. Airway management is an important consideration. Hyperbaric oxygen can be an useful adjunct to treatment. Conclusions: Early treatment of descending mediastinits is imperative for best outcome. Imaging of choice is a CT neck and thorax. Early broad-spectrum antibiotics and surgical intervention is key. Introduction: Descending necrotizing mediastinitis (DNM) is a rare but serious infection. The aim of this review is to highlight the common pathogens and risk factors associated with DNM as well as depicting both the medical and surgical treatments. Methods: A literature search of the Cochrane libraries and PubMed libraries for articles published between January 2000 and December 2020 reporting on DNM were reviewed. The key words used: descending necrotizing mediastinitis, odontogenic infection, cervical infection. 3 surgeons evaluated 40 abstracts. Only literature reviews and studies were included. Results: The total number of papers included were 14, 8 articles were reviews of the literature and 6 articles were original studies. Patient outcomes are better the earlier that the condition is diagnosed and treated. CT neck and thorax was the best imaging modality. Odontogenic with streptococcal species is most common cause and the most effective antibiotic sensitivity is a third-generation cephalosporin or clindamycin combined with metronidazole. An alternative is a penicillin with metronidazole. Prompt surgical management is required to effectively debride necrotic tissue. Airway management is an important consideration. Hyperbaric oxygen can be an useful adjunct to treatment. Conclusions: Early treatment of descending mediastinits is imperative for best outcome. Imaging of choice is a CT neck and thorax. Early broad-spectrum antibiotics and surgical intervention is key.

Idiopathic necrotizing fasciitis of the breast

Necrotizing fasciitis of the breast is extremely rare. This is a report of a 41-year-old woman with idiopathic necrotizing fasciitis of the breast, who was managed successfully with a good index of clinical suspicion, early surgical intervention, parenteral antibiotics, and nutritional support. This helped in further spread of local infection, minimizing the damage to the breast parenchyma.

Bacterial etiology and antibiotic sensitivity patterns in late-onset neonatal blood infection: A 6-year retrospective study

Introduction: The incidence and etiology of neonatal bloodstream infections vary globally. Early appropriate antibiotic therapy is crucial. An empiric antibiotic choice should be driven by accurate knowledge of the local spectrum of pathogens and susceptibilities. Methodology: A retrospective observational study was conducted on neonates born at local tertiary center from January 1, 2013, to December 31, 2018, with late-onset bloodstream infection (LBSI). Trends of causative organisms and antibiotic susceptibilities were analyzed. Results: A total of 696 LBSI occurred in 469 neonates. Overall incidence over the 6 years was 122/1000 admissions. The median time to LBSI was 13 days of life. Majority of infections occurred in infants <32 weeks. About 75.9% were caused by Gram-positive and the rest by Gram-negative bacteria. The most common organism was coagulase-negative staphylococcus (CoNS) which showed an increase in resistance to amikacin over time, but with stable sensitivity patterns to teicoplanin. Klebsiella and Escherichia coli were the most common Gram-negative organisms. There was improving sensitivity to cephalosporin in Klebsiella species. Sixteen percent of Gram-negative isolates were extended spectrum beta-lactamase (ESBL) producing. Majority of the Gram-negative bacteria including ESBL-producing strains remained sensitive to amikacin. An empiric antibiotic combination of teicoplanin and amikacin was appropriate to cover the majority of LBSIs. Conclusions: The majority of late-onset neonatal bloodstream infections in this study cohort were caused by Gram-positive organisms of which CoNS was the most common. The empiric antibiotic choices for LBSI on our unit seem appropriate based on the data. In units where the organism and susceptibility patterns are similar, the same antibiotic choices may be justified.

Ceftaroline in severe community-acquired pneumonia.

Severe community-acquired pneumonia (SCAP) is associated with high mortality. Factor such as early adequate antibiotic therapy, delay in intensive care unit (ICU) care and pneumonia caused by resistant pathogens are associated with worse outcomes in SCAP patients. Ceftaroline is a fifth-generation cephalosporin with bactericidal activity against Gram-positive pathogens (including methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant Streptococcus pneumoniae) and common Gram-negative organisms. The efficacy and safety for the treatment of pneumonia was evaluated in three randomized control trials were ceftaroline demonstrated superiority against ceftriaxone for the treatment of pneumonia in hospitalized patients with Pneumonia Severity Index (PSI) III – IV.

Bring it on: Top five antimicrobial stewardship challenges in transplant infectious diseases and practical strategies to address them.

Antimicrobial therapies are essential tools for transplant recipients who are at high risk for infectious complications. However, judicious use of antimicrobials is critical to preventing the development of antimicrobial resistance. Treatment of multidrug-resistant organisms is challenging and potentially leads to therapies with higher toxicities, intravenous access, and intensive drug monitoring for interactions. Antimicrobial stewardship programs are crucial in the prevention of antimicrobial resistance, though balancing these strategies with the need for early and frequent antibiotic therapy in these immunocompromised patients can be challenging. In this review, we summarize 5 frequently encountered transplant infectious disease stewardship challenges, and we suggest strategies to improve practices for each clinical syndrome. These 5 challenging areas are: asymptomatic bacteriuria in kidney transplant recipients, febrile neutropenia in hematopoietic stem cell transplantation, antifungal prophylaxis in liver and lung transplantation, treatment of left-ventricular assist device infections, and Clostridioides difficile infection in solid-organ and hematopoietic stem-cell transplant recipients. Common themes contributing to these challenges include limited data specific to transplant patients, shortcomings in diagnostic testing, and uncertainties in pharmacotherapy.

Osteomyelitis of the spine: treatments and future directions.

Background:Osteomyelitis of the spine is a serious condition that has been increasing with the intravenous drug pandemic and aging population. Multiple different organisms can cause osteomyelitis and mainstay of treatment is early recognition and antibiotics. The course can sometimes be indolent leading to delayed presentations. Once suspected, comprehensive workup and initiation of management should be employed. In rare circumstances, surgical evacuation or deformity correction is indicated. Continued antibiotic treatment should be considered post-operatively.Methods:Emerging treatment solutions are being developed to help target osteomyelitis in a more effective manner. In this review, we highlight the epidemiology and pathophysiology of spinal osteomyelitis. We overview the diagnostic workup and treatment options. Finally, we present new options that are currently being investigated and are on the near horizon.Conclusion:This review offers a user friendly resource for clinicians and researchers regarding osteomyelitis of the spine and will serve as a catalyst for further discovery.

Evaluasi Ketepatan Antibiotik pada Pasien Sepsis

The administration of early intravenous antibiotics was one of the fundamental procedures in sepsis. Inappropriate of antibiotics in septic patients has an impact on mortality and prolongs treatment. The purpose of this study was to evaluate the appropriateness of antibiotics therapy in hospitalized sepsis patients in Central Java based on the parameters right indication, right patient, right drug, and the right dose. This study was observational. Data collected retrospectively and analyzed descriptively. Sampling was done by purposive sampling. The inclusion criteria were inpatients diagnosed with sepsis who received antibiotics therapy with complete medical record data. The exclusion criteria were patients who died of sepsis. Antibiotics analyzed using the DIH 25th edition 2016, IONI 2014, Tata Laksana Sepsis Pada Anak IDAI 2016, Neofax 2014, Kepmenkes PNPK Tata Laksana Sepsis 2017, PPK RS, and SHC Antimicrobial Dosing 2017. Based on data from 108 patients who fulfilled the inclusion criteria obtained results right indication 100%, right patient 97.22%, right drug 90.74%, and the right dose 48.15%. The most used antibiotic was a combination of ampicillin and gentamicin (41.67%), while the single antibiotic was ceftriaxone (12.96%).

Impact of Extended and Restricted Antibiotic Deescalation on Mortality.

Background: More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. This study aims to compare the survival curve of patient de-escalated (early or late) against those not de-escalated on antibiotics, to determine the association of patient related, clinical related, and pressure sore/device related characteristics on all-cause 30-day mortality and determine the impact of early and late antibiotic de-escalation on 30-day all-cause mortality. Methods: This is a retrospective cohort study on patients in medical ward Hospital Kuala Lumpur, admitted between January 2016 and June 2019. A Kaplan–Meier survival curve and Fleming–Harrington test were used to compare the overall survival rates between early, late, and those not de-escalated on antibiotics while multivariable Cox proportional hazards regression was used to determine prognostic factors associated with mortality and the impact of de-escalation on 30-day all-cause mortality. Results: Overall mortality rates were not significantly different when patients were not de-escalated on extended or restricted antibiotics, compared to those de-escalated early or later (p = 0.760). Variables associated with 30-day all-cause mortality were a Sequential Organ Function Assessment (SOFA) score on the day of antimicrobial stewardship (AMS) intervention and Charlson’s comorbidity score (CCS). After controlling for confounders, early and late antibiotics were not associated with an increased risk of mortality. Conclusion: The results of this study reinforce that restricted or extended antibiotic de-escalation in patients does not significantly affect 30-day all-cause mortality compared to continuation with extended and restricted antibiotics.

Early Antibiotic Exposure and Adverse Outcomes in Very Preterm Infants at Low Risk of Early-Onset Sepsis: The EPIPAGE-2 Cohort Study

To assess the association between early empirical antibiotics and neonatal adverse outcomes in very preterm infants without risk factors for early-onset sepsis (EOS). This is a secondary analysis of the EPIPAGE-2 study, a prospective national population-based cohort that included all liveborn infants at 22-31 completed weeks of gestation in France in 2011. Infants at high risk of EOS (ie, born after preterm labor or preterm premature rupture of membranes or from a mother who had clinical chorioamnionitis or had received antibiotics during the last 72hours) were excluded. Early antibiotic exposure was defined as antibiotic therapy started at day 0 or day 1 of life, irrespective of the duration and type of antibiotics. We compared treated and untreated patients using inverse probability of treatment weighting based on estimated propensity scores. Among 648 very preterm infants at low risk of EOS, 173 (26.2%) had received early antibiotic treatment. Early antibiotic exposure was not associated with death or late-onset sepsis or necrotizing enterocolitis (OR, 1.04; 95% CI, 0.72-1.50); however, it was associated with higher odds of severe cerebral lesions (OR, 2.71; 95% CI, 1.25-5.86) and moderate-severe bronchopulmonary dysplasia (BPD) (OR, 2.30; 95% CI, 1.21-4.38). Early empirical antibiotic therapy administrated in very preterm infants at low risk of EOS was associated with a higher risk of severe cerebral lesions and moderate-severe BPD.

A Case Report on Acute Necrotizing Pancreatitis and Nursing Management

Introduction: Necrotizing pancreatitis (NP) is a health problem in which part of pancreas dies. This is because of inflammation or injury. If the dead tissue gets infected, it can cause serious issues. Pancreatitis is inflammation of the pancreas. During recurring attacks of pancreatitis, tissues within pancreas may die and later become infected. This condition is called as acute necrotizing pancreatitis.&#x0D; Case Presentation: A 48 yr old male visited in AVBRH with the chief complaints of pain in epigastric region, recurrent vomiting, and abdominal distention since 7 days. Otherwise client was alright. After undergoing investigations such as complete blood count, liver function test, kidney function test, CT Scan (Computed tomography) and sonography etc. He was diagnosed with Acute Necrotizing Pancreatitis and was admitted to male medi- cine ward No.29. He had past medical history of pain in epigastric region, fever, abdominal distention, since 5days. For these complaints his family members referred him in “Get Life Hospital” at Amravati. He was treated with antibiotics, analgesic, After CT scan, Sonography it was found that there was Acute pan- creatitis. That’s why his family members admitted him at A.V.B.R Hospital for further treatment.&#x0D; Conclusion: These results support nonsurgical management, including early antibiotic treatment, in patients with sterile pancreatic necrosis. Patients respond well to treatment.

138. Tele-COVID Rounds and Tele-Stewardship Surveillance Reduces Antibiotic Use in COVID-19 Patients Admitted to 17 Small Community Hospitals

BackgroundEarly bacterial co-infection is rare in hospitalized COVID-19 patients, yet antibiotics are commonly prescribed. Antibiotic stewardship (AS) intervention is needed, especially in small community hospitals (SCHs), which often lack access to AS expertise.MethodsWe implemented daily remote multidisciplinary tele-COVID rounds (synchronous case review between SCH providers and ID clinicians) and tele-stewardship surveillance (ID pharmacist review of COVID patients on antibiotics) on 6/24/2020 in 17 SCHs. We retrospectively included adult symptomatic COVID-19 admissions between 3/2020 and 4/2021. The primary outcome was early use of antibiotics for pneumonia (started within 48 hours of admission); mean monthly days of therapy per 1,000 patient days (DOT) were compared pre- (3/2020-6/2020) and post-intervention (7/2020-4/2021). Secondary outcomes were early use of antibiotics for any indication, estimated days of antibiotics avoided (comparing pre- and post-intervention DOT), and in-hospital mortality. Analyses were conducted using a two-tailed unpaired t-test (antibiotic use) or Fisher’s exact test (mortality).ResultsOf the 1,976 patients included (124 pre- vs. 1852 post-intervention), 55.4% were male and 85.5% were white. Patients in the pre-intervention group were more likely to require hospital transfer [21.8% vs 8.8% (p< 0.001)] and ICU admission [18.5% vs. 9.7% (p=0.003)]. We observed a significant decrease in mean use of early antibiotics for pneumonia [656.9 vs. 240.1 DOT (p< 0.001)], including among non-ICU patients only [603.6 vs 240.2 DOT (p< 0.001)]. Early antibiotic use for any indication also decreased [686.2 vs. 359.3 DOT (p< 0.001)]. An estimated 3,697 days of unnecessary antibiotics for pneumonia were avoided in the 10-months post-intervention [370 days per month (95% CI 304 – 435)]. Unadjusted in-hospital mortality was not different pre- vs post-intervention (0.8% vs. 2.0%, p=0.511), but was higher among those prescribed early antibiotics (4.4% vs 0.5%, p< 0.001). ConclusionA significant, sustained reduction in antibiotic use among COVID-19 patients at 17 SCHs was observed after implementation of tele-COVID rounds and tele-stewardship surveillance without an observed difference in mortality.Disclosures All Authors: No reported disclosures

Preventing death following unsafe abortion: a case series from urban Uganda

BACKGROUNDMaternal deaths from unsafe abortion continue to occur globally, with particularly high rates in Sub-Saharan Africa where most abortions are classified as unsafe. Maternal death reviews are an effective part of cohesive strategies to prevent future deaths while abortion remains illegal.OBJECTIVEThis study aimed to conduct maternal death reviews for all deaths occurring following unsafe abortion during the study period, to assess preventability, and to synthesize key learning points that may help to prevent future maternal deaths following unsafe abortions.STUDY DESIGNFull case reviews of all maternal deaths (350 cases from Jan 2016 to Dec 2018) at the study center (a national referral hospital in urban Uganda) were conducted by specially trained multidisciplinary panels of obstetricians and midwives. We extracted the reviews of women who died following unsafe abortions (13 [2.6%]) for further analysis.RESULTSMost maternal deaths owing to unsafe abortion were found to be preventable. The key recommendations that emerged from the reviews were (1) that clinicians should maintain a high index of suspicion for delayed presentation and rapid decompensation in cases where unsafe abortion has occurred, (2) that a low threshold for early intravenous antibiotic therapy should be applied, and (3) that any admission with complications following an unsafe abortion merits review by an experienced clinician as soon as possible.CONCLUSIONPostabortion care is part of essential emergency medical care and should be provided with high standards, especially in areas where there is limited or no legal access to abortion care. Implementing the recommended learning points is likely to be feasible even in low-resource obstetrical settings and, given the high rates of preventability found in maternal deaths owing to unsafe abortion, is likely to be effective.

244. Risk Factors Associated with Complications/Sequelae in Pediatric Patients with Osteomyelitis

BackgroundOsteoarticular infections are serious invasive pathologies in the pediatric population. They have high morbidity, especially if antimicrobial treatment is inadequate and late. Based on pediatric series patients with osteomyelitis require prolonged antibiotic schemes, long stay and high hospital costs, multiple surgical procedures and develop short and long-term sequelae. MethodsA retrospective, observational, longitudinal and analytical study was conducted in patients under 17 years of age diagnosed with osteomyelitis at the National Institute of Pediatrics from January 2009 to January 2019. Demographic information, clinical presentation, microbiological, treatment and six-month follow-up were recorded. ResultsA total of 109 patients were included, 57 (52%) males with median age of 98 (1-205) months with predominance in previous healthy (66%). By temporality, the chronic form predominated in 72%. The history of trauma was identified in 26% and fracture 19%. The most affected bone was femur 26%. Blood culture was performed in 55%, secretion culture in 52.2% with isolation in 56%. Methicillin-susceptible Staphylococcus aureus (MSSA) was the main agent identified. Complications occurred in 37%, the most frequent was surgical wound infection in 13% followed by fracture 11%. Risk factors for complications were chronic osteomyelitis RR 5.7 (CI 1.8-17.9), Sepsis/Shock RR 3.8 (CI 1.08-13-8) and MSSA infections RR 2.7 (CI 1.01-7.5); Risk factors for surgical site infection included initial fracture RR 3.5 (CI 1-11), local ulcer RR 4.2 (CI 1.3-13.06) and MSSA infection RR 5.9 (CI 1.8-19.4). Risk factors for limitation to movement included chronic osteomyelitis RR 4.87 (CI 1.6-14), fever RR 2.5 (CI 1.15-5.5), Sepsis/shock RR 5.3 (CI 1.3-20) (p 0.013) and MSSA infection RR 4.1 (CI 1.4-11.9).ConclusionOsteomyelitis is still a health problem in our country. The diagnosis of osteomyelitis may be challenging as lack of suspicion often leads to delayed diagnosis. Knowledge of the risk factors for complications in pediatric patients could be useful to give early and proper antibiotic and surgical treatment. It is a priority to have a multidisciplinary team for the diagnosis and treatment of osteoarticular infections. Disclosures All Authors: No reported disclosures

Early Antibiotic Administration is Independently Associated with Improved Survival in Traumatic Brain Injury

Central and systemic immune dysfunction after traumatic brain injury (TBI) can lead to infectious-related complications, which may result in delayed mortality. The role of early empiric antibiotics after TBI has not been characterized to date, but is recommended in select cases to decrease complications. We aimed to determine the relationship between early antibiotic use and in-hospital mortality in TBI patients. A retrospective review was conducted of TBI patients requiring ICU admission at an urban, academic, Level I trauma center from 01/2014 to 08/2016. Data collection included demographics, injury characteristics, details regarding antibiotic use, and outcomes. Early antibiotic administration was defined as any antibiotic given within 48 hs from admission. Patients given early antibiotics (EARLY) were compared to those who received their first dose later or did not receive any antibiotics (non-EARLY). Of the 488 TBI patients meeting inclusion criteria, 189 (38.7%) received early antibiotics. EARLY patients were younger (EARLY 54.2 versus non-EARLY 61.5 ys, P <0.01) and more likely to be male (71.4% versus 60.9%, P=0.02). Injury severity scores (23.6 versus 17.2, P <0.01) and regional head abbreviated injury scale scores (3.9 versus 3.7, P <0.01) were significantly higher in patients who received early antibiotics. Unadjusted in-hospital mortality rates were similar, however EARLY was associated with a lower mortality rate (AOR 0.17, 95% CI: 0.07 - 0.43, adjusted P <0.01) after adjusting for confounders. Despite presenting with a higher injury burden, TBI patients who received early antibiotics had a lower associated mortality rate compared to their counterparts. Future investigations are necessary to understand the underlying mechanisms that result in this potential survival benefit.