Mean Duration Of Antibiotic Treatment Research Articles

Antimicrobial Treatment in Hospitalized Adults With Community-Acquired Pneumonia: Compliance and Factors Impacting Duration

To assess compliance with national and international guidelines for the initial empirical selection of antimicrobials, the duration of antimicrobial treatment in hospitalized patients with mild-to-moderate community-acquired pneumonia (CAP), and to analyze potential factors that could influence the duration of antimicrobials use. A retrospective study was conducted to collect medical records of patients admitted to the Department of Respiratory and Critical Care Medicine of Beijing Tongren Hospital with mild-to-moderate CAP from January 1, 2020 to November 30, 2022. The rationality of antimicrobial therapy was evaluated by comparing national and international guidelines, and the factors influencing the duration of antimicrobial therapy were analyzed by logistic regression. A total of 177 patients were enrolled. The age of patients was mainly distributed between 46 and 65 years old (38.42%). There were 82.49% of patients with basic diseases. In compliance with national, US, and European guidelines for the initial empirical antimicrobial selection in 177 CAP patients was 87.01%, 77.97%, and 78.53%. The mean duration of antibiotic treatment was 11.77±4.30 days, and patients switched from intravenous antimicrobial therapy to oral therapy within 2-10 days (5.15±2.84). Logistic regression analysis showed that the C-reactive protein (CRP) level at admission was an independent factor affecting the duration of antimicrobial use in hospitalized patients with mild-to-moderate CAP (OR=0.963, 95%CI: 0.947~0.979, p < 0.05). The results of this study indicated that the patients with a CRP level of 43.89mg/L on admission to the hospital were more likely to require antimicrobial therapy for longer than 7 days.

Pyogenic spondylodiscitis in HIV-positive patients under antiretroviral therapy: A case series.

Background: The incidence of pyogenic spondylodiscitis has been increasing in countries of Europe and North America, probably due to an increasing number of persons with risk factors for this infection. It is unclear whether HIV infection in the era of antiretroviral therapy (ART) increases the risk for spondylodiscitis. Method: We present 7 cases of pyogenic spondylodiscitis of the cervical, thoracic, and lumbar spine in six individuals living with HIV under ART with suppressed viral load. Results: All patients presented with severe non-radicular pain and elevated inflammatory markers. Diagnosis was confirmed by magnetic resonance imaging (MRI) scan and isolation of the pathogen. Staphylococcus aureus was the causative pathogen in five patients. One patient suffered from an infection with Klebsiella pneumoniae followed by a mixed infection with Cutibacterium acnes and Bacillus circulans 18months later. All patients needed surgical intervention, and the mean duration of antibiotic treatment was 17weeks (range 12-26). Five patients recovered fully, including two persons who also suffered from endocarditis. One patient died from multi-organ failure. Conclusion: Spondylodiscitis may be seen more frequently in persons living with HIV as they grow older and suffer from comorbidities which put them at risk for this infection. HIV physicians should be aware of the infection and its risk factors.

Two-stage reconstruction using a vancomycin-impregnated cement spacer for finger osteomyelitis with bone and joint destruction

ObjectivesSeptic arthritis and osteomyelitis are serious infections. Several treatment methods for the small joints and bones of the hands have been reported. We hypothesized that antibiotic-impregnated cement spacers could be useful for purulent finger osteomyelitis with bone and joint destruction. Patients and methodsSeven patients with finger osteomyelitis with bone and joint destruction were treated using vancomycin (VCM)-impregnated cement spacers. During the first surgery, a cement spacer was placed in the space created after debridement, maintaining finger length. Intraoperative specimens were tested for bacterial growth. Systemic antibiotic treatment was administered. A second surgery was performed 6–8 weeks after the first. After spacer removal, reconstruction surgeries were performed: arthrodesis using the Masquelet technique (n = 5), vascularized bone grafting (n = 1), and silicone implant arthroplasty (n = 1). We assessed the pathogenic bacteria, duration of antibiotic treatment, infection control, time to bone union, pain on visual analogue scale (VAS) (0 − 100), total active motion (TAM) of the affected fingers, and grip strength. ResultsThe pathogenic bacteria were methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and unknown in 3, 3, and 1 patients, respectively. Mean duration of antibiotic treatment was 6.4 weeks. In all patients, infection resolved without recurrence. One patient underwent joint arthroplasty; otherwise, bone union was achieved in 6 patients. Mean VAS score for pain was 0.9. Mean TAM was 147° for the index and middle fingers and 50° for the thumb. Mean grip strength was 86.4% of that of the unaffected side. ConclusionVCM-impregnated cement spacers could be useful for finger osteomyelitis, facilitating effective infection control and the maintenance of finger length, even in severe conditions.

Antibiotic Use among Patients Hospitalized with COVID-19 and Treated in Three Different Clinics.

In this study, we aimed to determine and compare the rates of empirical antibiotic use and duration between the chest diseases clinic (CDC), infectious disease clinic (IDC), and internal medicine clinic (IMC) among patients hospitalized because of COVID-19. This cross-sectional study was performed in a single university hospital. The study included all patients aged 18 years and older hospitalized with a PCR-confirmed COVID-19 between May 30, 2021, and August 30, 2021. Clinical and laboratory findings were recorded from the electronic medical records database. The study included a total of 581 inpatients, of whom 310 (53.4%) were women. Of the 581 patients, 475 (81.8%) were prescribed antibiotics. The rate of antibiotic prescription was 71.6% for IDC, 88.5% for CDC, and 87.4% for IMC. The most commonly used antibiotic was moxifloxacin in all groups. The mean treatment duration was 8.9±6.16 days. The mean duration of antibiotic treatment was 11.1±5.90 days for CDC, 11.3±6.74 days for IMC, and 5.3 days±3.76 for IDC. Patients with COVID-19 who were treated in IDC had a lower rate and shorter duration of antibiotic use compared to the other clinics. However, the rate of antibiotic prescription in all three groups was very high. Therefore, antimicrobial management programs should be meticulously conducted to reduce unnecessary antibiotic use.

Oral Nystatin Prophylaxis for the Prevention of Fungal Colonization in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

We conducted this systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the prophylactic role of oral nystatin in the prevention of fungal colonization in very low birth weight (VLBW) infants compared with placebo or no treatment intervention. From inception until June 2022, we screened four major databases for pertinent RCTs and examined their risk of bias. The main outcomes were the rate of fungal colonization, rate of invasive fungal infection, rate of mortality, mean length of stay in the neonatal intensive care unit (NICU), and mean duration of antibiotic treatment. We summarized data as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI), using the fixed-effects model. Five RCTs met our inclusion criteria. One RCT was evaluated as having "high risk," one RCT was evaluated as having "some concerns," and three RCTs were evaluated as having "low risk" of bias. Compared with the control group, oral nystatin prophylaxis was correlated with substantial decrease in the frequency of fungal colonization (n=4 RCTs, RR=0.34, 95% CI {0.24, 0.48}, p<0.0001), the rate of invasive fungal infection (n=4 RCTs, RR=0.15, 95% CI {0.12, 0.19}, p<0.0001), and the mean duration of antibiotic treatment (n=3 RCTs, MD=-2.79 days, 95% CI {-5.01, -0.56}, p=0.01). However, there was no significant difference between both groups regarding the rate of mortality (n=4 RCTs, RR=0.87, 95% CI {0.64, 1.18}, p=0.37) and mean length of stay in NICU (n=3 RCTs, MD=-2.85 days, 95% CI {-6.52, 0.82}, p=0.13). In conclusion, among VLBW infants, the prophylactic use of oral nystatin was correlated with favorable antifungal benefits compared with placebo or no treatment intervention.

The value of administering intravenous antibiotics during haemodialysis in the treatment of diabetic foot infections.

People with diabetes who are on haemodialysis (HD) are at a high risk of diabetic foot infections (DFI) and related complications. We explored the value of treating DFI with intravenous (IV) antibiotics during HD. This was an observational study of consecutively treated patients with DFIs with IV antibiotics during HD. Data collected included baseline characteristics, IV antibiotics used, details of multidisciplinary interventions and DFI treatment outcome. A cohort of 11 patients, mean (±standard deviation) age 62.4±12.7 years, had 15 episodes of treatment with IV antibiotics during HD. Of the patients, six (54.5%) were male and nine (81.8%) had type 2 diabetes. The estimated mean glomerular filtration rate (eGFR) was 11.4±3.9ml/minute. All patients had infected foot ulceration, soft tissue infection, six (54.5%) patients had osteomyelitis, and two (18.2%) had wet gangrene. The commonest IV antibiotic used was vancomycin (10/15 episodes, 66.7%). Other IV antibiotics used were daptomycin and meropenem. In three episodes, oral ciprofloxacin was used with IV antibiotics. The mean duration of antibiotic treatment was 9.2±4.9 weeks. Of the episodes, 11 (73.3%) were treated successfully with IV antibiotics alone and two (13.3%) episodes required minor surgical debridement/amputation. Some 10 (90.9%) members of the cohort had peripheral arterial disease and of those, five (50%) underwent angioplasty during IV antibiotic treatment. HD provides a good opportunity for treatment with IV antibiotics in DFI. This mode of administration of IV antibiotics, along with multidisciplinary intervention, is associated with ulcer healing and resolution of infection in over three-quarters of patients with DFI. The authors have no conflicts of interest to declare.

Eradication and graft retention can be achieved in the treatment for acute septic arthritis after primary posterior cruciate ligament reconstruction: analysis of 1561 reconstructions.

Acute septic arthritis after arthroscopic posterior cruciate ligament (PCL) reconstruction is a rare but severe complication. Optimal management has not been established. The purposes of this study were to analyze clinical findings and to retrospectively evaluate the graft-retaining treatment regimen. From 2010 to 2021, a total of 1561 primary PCL reconstructions were performed at our institution. Seven patients with septic arthritis were identified and retrospectively analyzed with regard to incidence, clinical manifestations, treatment, postoperative clinical course and follow-up results. The mean interval from PCL reconstruction to the onset of symptoms was 11.0 ± 4.0days. Staphylococcus aureus was the most commonly found pathogen. Eradication was achieved in all patients after a mean of 1.1 ± 0.4 procedures, with graft retention in all patients. The mean duration of antibiotic treatment was 5.7 ± 1.5weeks. At the last follow-up, there was no recurrence, graft insufficiency or osteoarthritis. Arthroscopic graft-retaining treatment combined with individual antibiotic therapy, eradication and good to excellent functional results can be achieved, which might encourage surgeons to try to retain the graft as much as possible. Level IV.

Antibiotic Prescribing Pattern in Paediatric Emergency Department at Tertiary Care Teaching Hospital in Nepal

Background and Objectives: The indiscriminate use of antibiotics often results in an increased incidence of adverse drug reactions (ADR), suboptimal therapy, treatment failure, polypharmacy and most importantly, the emergence of antibiotic resistance. Thus, the objective of this study was to assess the paediatric emergency department, antibiotic prescribing pattern at a tertiary care teaching hospital, Universal College of Medical Sciences (UCMS), Bhairahawa, Rupandehi, Nepal.&#x0D; Material and methods: A prospective, cross-sectional, observational study was carried out on 152 paediatric patients of ages between 2 months to 12 years at the paediatric emergency department of UCMS. The data were collected by reviewing the prescription paper, and the required information was recorded using a structured data collection sheet prepared for study. The prescribing pattern was assessed through the World Health Organization (WHO) prescription indicators using the WHO Children Formulary 1993 AD.&#x0D; Results: This study revealed that out of 152 patients, average number of drugs prescribed was 5.13 and antibiotic per patient was 2.10±.540. Antibiotics were prescribed at least once for 93.4% of patients. Drugs prescribed from Essential drug list (EDL) was 46.46% and that encountered with injectable was 92.1%. There was a significant difference between the patients age group and the number of drugs prescribed (χ2 = 21.553, p = 0.010). The mean duration of antibiotic treatment was 6.95±3.145. Cephalosporin’s (36.6%) followed by aminoglycosides (28.8%) were most frequently prescribed antibiotics.&#x0D; Conclusion: Multiple courses of antibiotics are most frequently prescribed, which could increase antibiotic resistance in future. Continuous audits, training and new treatment protocols should be developed for prescribing and using antibiotics in paediatric patients.

Impact on antimicrobial consumption of procalcitonin-guided antibiotic therapy for pneumonia/pneumonitis associated with aspiration in comatose mechanically ventilated patients: a multicenter, randomized controlled study

BackgroundIn comatose patients receiving oro-tracheal intubation for mechanical ventilation (MV), the risk of aspiration is increased. Aspiration can lead to chemical pneumonitis (inflammatory reaction to the gastric contents), or aspiration pneumonia (infection caused by inhalation of microorganisms). Distinguishing between the two types is challenging. We tested the interest of using a decisional algorithm based on procalcitonin (PCT) values to guide initiation and discontinuation of antibiotic therapies in intubated patients.MethodsThe PROPASPI (PROcalcitonin Pneumonia/pneumonitis Associated with ASPIration) trial is a multicenter, prospective, randomized, controlled, single-blind, superiority study comparing two strategies: (1) an intervention group where threshold PCT values were used to guide initiation and discontinuation of antibiotics (PCT group); and (2) a control group, where antibiotic therapy was managed at the physician’s discretion. Patients aged 18 years or over, intubated for coma (Glasgow score ≤ 8), with MV initiated within 48 h after admission, were eligible. The primary endpoint was the duration of antibiotic treatment during the first 15 days after admission to the ICU.ResultsFrom 24/2/2015 to 28/8/2019, 1712 patients were intubated for coma in the 5 participating centers, of whom 166 were included in the study. Data from 159 were available for intention-to-treat analysis: 81 in the PCT group, and 78 in the control group. Overall, 67 patients (43%) received antibiotics in the intensive care unit (ICU); there was no significant difference between groups (37 (46%) vs 30 (40%) for PCT vs control, p = 0.432). The mean duration of antibiotic treatment during the first 15 days in the ICU was 2.7 ± 3.8 days; there was no significant difference between groups (3.0 ± 4.1 days vs 2.3 ± 3.4 days for PCT vs control, p = 0.311). The mean number of days under MV was significantly higher in the PCT group (3.7 ± 3.6 days) than in controls (2.7 ± 2.5 days, p = 0.033). The duration of ICU stay was also significantly longer in the PCT group: 6.4 ± 6.5 days vs 4.6 ± 3.5 days in the control group (p = 0.043). After adjustment for SAPS II score, the difference in length of stay and duration of mechanical ventilation between groups was no longer significant.ConclusionThe use of PCT values to guide therapy, in comparison to the use of clinical, biological (apart from PCT) and radiological criteria, does not modify exposure to antibiotics in patients intubated for coma.Trial registration Clinicaltrials.gov Identifier NCT02862314.

Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs.

BackgroundUrinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL) producing pathogens have increased and are treated with carbapenem in general. Carbapenem use is associated with prolonged hospitalization or daily outpatient visit. The aim of this study was to investigate patients with UTIs by ESBL-producing pathogens for early discharge using an old oral antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), which is susceptible to ESBL-producing pathogens.MethodsData on UTIs caused by ESBL-producing pathogens from a single tertiary hospital were collected retrospectively. Patients who had been treated with intravenous carbapenems or oral TMP/SMX were included. Patients’ clinical and microbiological outcomes were compared between oral TMP/SMX and ertapenem treatment groups.ResultsA total of 103 patients were included, 21 of whom had been treated with TMP/SMX, whereas 82 with ertapenem. Clinical outcomes between the two groups were not significantly different (TMP/SMX: 90.5%; ertapenem: 84.1%, p = 0.73). The microbiological cure rate was higher in the TMP/SMX group than in the ertapenem group (90.5% vs 58.5%, respectively, p = 0.01). The mean duration of hospitalization was significantly shorter in the TMP/SMX group than in the ertapenem group (8.00 ± 10.50 days vs 14.00 ± 37.00 days, p = 0.07). The mean duration of antibiotic treatment was longer in the ertapenem group than in the TMP/SMX group (16.45 ± 4.77 vs 12.76 ± 5.37 days, p = 0.006).ConclusionFor susceptible pathogens, TMP/SMX may enable early discharge as an effective oral antibiotic treatment option for UTIs caused by ESBL-positive pathogens. Additionally, use of oral antibiotics can shorten hospital stays and reduce medical costs.

Use of antibiotics in COVID-19 ICU patients

The role of antibiotics in the treatment in COVID-19 cases has not yet been adequately defined, and no criteria have been established for antibiotic treatment, type and duration. This paper reports the results of an observational study on the extent of antibiotic use in 52 randomly selected patients in the intensive care unit (ICU) at the University Hospital in Pristina, Kosovo with severe forms of COVID-19. Antibiotics were prescribed in all the cases (52; 100%). Of the 52 patients, 1) 13 (25%) were given antibiotics before hospitalisation, 2) 49 (94.2%) during treatment in the ward and 3) 52 (100%) during treatment in the ICU. Most often, empirical antibiotics were administered in 32 cases (61.5%) to treat methicillin resistant Staphylococcus aureus (MRSA) infections, and in 23 patients (44.2%) to treat atypical pathogens. The most prescribed antibiotics were ceftriaxone/cefotaxime plus macrolide in (17 cases; 32.7%), ceftriaxone/cefotaxime in (15 cases; 28.8%), ampicillin/amoxicillin plus clavulanic acid or sulbactam (five cases; 9.6%), and quinolones (five cases; 9.6%). Imipenem was the most frequently used antibiotic in the ICU (30 cases; 57.7%), followed by ceftriaxone (28 cases; 53.8%), and piperacillin/tazobactam and fluoroquinolone (17 cases; 32.7%). In 18 cases (34.6%), three antibiotics were given simultaneously; two antibiotics in 29 cases (55.8%) and in five cases (9.6%) only one antibiotic was given. The mean duration of antibiotic treatment was 12.71 days (3-22 days; SD 4.026). The study showed unrestricted use of broad-spectrum antibiotics in the treatment of severe cases with COVID-19.

Broad-Spectrum Antibiotics for Breast Expander/Implant Infection: Treatment-Related Adverse Events and Outcomes.

Despite best practices, infection remains the most common complication after breast reconstruction with expanders and implants, ranging from 2% to 29%. Empiric broad-spectrum antibiotics are frequently used in nonsurgical treatment of implant-associated infections in an effort to salvage the reconstruction. Pitfalls of antibiotherapy include adverse events, vascular access site complications, and drug resistance. Our goals were to describe management of implant infections with broad-spectrum antibiotics, review treatment related adverse events, and report on outcomes of therapy. A retrospective review was carried out to identify patients who were treated with intravenous (IV) antibiotics for periprosthetic infection. Patient characteristics, surgical details, and antibiotic therapy-related adverse events were collected. Eventual outcome related to expander/implant salvage was noted. A total of 101 patients (111 treatment episodes) were identified. Mean duration of antibiotic treatment was 18 days (range, 1-40 days). The most commonly used parenteral treatment was a combination of daptomycin with piperacillin-tazobactam (65%) or an alternative agent (16%). Fifty-nine percent of treatment episodes resulted in salvage of the expander or implant. Thirty-five percent treatment episodes were associated with 1 or more adverse events: diarrhea (12.6%), rash (10%), vaginal candidiasis (3.6%), agranulocytosis/neutropenic fever (3.6%), nausea (3.6%), urinary complaint (0.9%), myositis (0.9%), headache (0.9%), vascular line occlusion (1.8%), deep vein thrombosis (1.8%), and finger numbness (0.9%). No patients developed Clostridium difficile colitis. Five episodes (4%) needed discontinuation of antibiotics because of severe adverse events. The prosthesis was explanted in 3 of the cases of discontinued treatment. Our findings show favorable outcomes and well-tolerated adverse effects with broad-spectrum parenteral antibiotherapy for periprosthetic infection. However, every effort should be made to deescalate therapy by narrowing the spectrum or limiting the duration, to minimize adverse events and development of bacterial resistance. Treating surgeons need to carefully weigh benefits of therapy and be aware of potential complications that might necessitate discontinuation of treatment.

Effects of an In-House Antibiotic Stewardship Initiative on Diagnosis and Management of Community-Acquired Pneumonia in Childhood and Adolescence

Pediatric community-acquired pneumonia (pCAP) often leads to prescription of antibiotics and hospital admission of children. Unfortunately, adherence to diagnosis and treatment guidelines is inconsistent, and misuse of antibiotics may occur. Antimicrobial stewardship interventions, which were started in many hospitals during the last decade, can optimize management of pCAP without negative patient outcomes. The objective of this retrospective analysis was to assess the influence of a newly implemented in-house pediatric antibiotic stewardship (ABS) initiative on guideline adherence and treatment quality. Retrospective, patients' file-based analysis of the effects of an ABS initiative in a pediatric university hospital from January 2017 until March 2020. ABS initiative included creation of a local pCAP guideline for hospitalized children aged 90 days - 18 years, periodic training and continuous ABS support. A total of 230 patients with pCAP were included (145 before and 85 after intervention). Implementation of the ABS program led to reduction of antibiotics prescription without clear indication from 26 % to 10 % (p < 0.05). The inappropriate use of antibiotics decreased from 64 % to 27 % (p < 0.05), the rate of incorrect doses declined from 17 % to 10 % (p < 0.05) and the mean duration of antibiotic treatment declined from 10 to 7 days (p < 0.05). There were no differences between the two groups regarding length of stay, treatment failure or readmissions for respiratory infection. Pediatric antibiotic stewardship is an appropriate and safe method, and is beneficial to hospitalized patients with pCAP. Application of ABS programs may increase adherence to clinical guidelines and improve appropriate antimicrobial use without negative impact on patient outcomes. Multicenter follow-up studies are needed to clarify long-term effects of ABS programs.

A Retrospective Study on the Avoidability of Ventriculoperitoneal Shunt Infections in a University Hospital in Al-Khobar, Saudi Arabia.

Ventriculoperitoneal shunt infection is a major complication and the main cause of shunt failure, contributing to a high rate of morbidity and mortality among patients requiring prolonged hospitalization. Shunt infection-related complications are considered a global burden of hydrocephalus worldwide. In our hospital, King Fahad Hospital of the University, the rate of infections in similar cases reached 8% during the period from 1999 to 2001; an increase in this rate was observed in the past two years.This study analyzed the infections that occur after ventriculoperitoneal shunt placement in patients with hydrocephalus and related conditions during the period from January 2012 to April 2017. The objectives of this study were to analyze the rate of cerebrospinal fluid infections in different age groups at the King Fahd Hospital of the University and to identify the causative pathogens and methods of reducing the rate and consequences of such infections. In this retrospective study, the electronic medical records of 266 patients were reviewed and those of 131 patients were included and analyzed. We found that the prevalence rate of shunt-related infections was 24.4%, which indicates the importance of this problem. Staphylococcus epidermidis is the most commonly implicated microorganism. The most affected age groups were those of preschool children and infants. Individuals who were older than 74 years were the least affected. It was found that delayed infections were the most common type of VP shunt infection among the study population and there was no difference in the most common organisms between early, delayed, and late infections. The mean duration of antibiotic treatment used was 19.76 days. In conclusion, postoperative infections are significantly common in patients who undergo shunt-related surgeries.

288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

BackgroundAs opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood.Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes.MethodsWe conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment.Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant.Results482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001)Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics ConclusionObtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB.Disclosures All Authors: No reported disclosures

Septic Arthritis of Facet Joint in Children

Due to the low resolution of historical imaging technologies, descriptions of Septic Arthritis of Facet Joint (SAFJ) in children are scarce, though severe cases are known. We first aimed to estimate the incidence rate of SAFJ in children; we further aimed to specify SAFJ clinical, imaging and laboratory findings, and identify avenues for appropriate management. A 10-year consecutive SAFJ case series using our imaging center database combined with a 50-year systematic review of literature cases. The mean ± SD incidence of pediatric SAFJ was 0.23 ± 0.4/100,000 children-years. The key symptoms were potty refusal (in toddlers) or painful sitting (78%) and lateralized signs (paravertebral tenderness and/or swelling, 88%). SAFJ diagnosis and extension were obtained using magnetic resonance imaging (MRI) (94%), and found an epidural extension in 8/16 cases. The mean duration of antibiotic treatment was 5.1 weeks. The compliance with guidelines was 79% for empiric and 62% for targeted antibiotic therapies. SAFJ incidence in children is much greater than expected from the literature. Half of cases were complicated by an epidural infection. Simple clinical symptoms detected as early as the bedside allow a strong suspicion of SAFJ, justifying the use of a first-line MRI to confirm the diagnosis and precisely describe the extension. Focusing on simple clinical signs is key to justify the transfer of a child or the shortening of the delay to obtain an MRI. However, as MRI availability increases in most Western countries, and the capacity for diagnosis increases, the awareness of SAFJ must be spread to avoid missed cases.

PERIANAL INFECTIOUS COMPLICATIONS IN PATIENTS WITH GRANULOCYTOPENIA AND HAEMATOLOGICAL MALIGNANCIES

AIM : to study the perianal infection (PI) in patients with granulocytopaenia (GCP) and hematological malignancies (HM). PATIENTS AND METHODS: the prospective study (2016-1018) includes 95 episodes of PI in 76 patients with HM (male/female 35/44; mean age of 35 (17-69)). 43(54.4%) of the patients were detected to develop acute leukemia (AML – 34 (43%); ALL – 9(11.4%); NHL – 17(21.5%). The comparison of PI episodes within the GCP period (number of granulocytes less than 0.5x10 9 /l) and without it was done. RESULTS: PI episodes within the period of GCP were significantly much more often than those without GCP (77.9% vs 22.1%, relative risk 3.5 (95% CI: 2.4-5.2). The biggest number of PI episodes in the setting of GCP was registered within the period of chemotherapy (ChT): in the phase of consolidation (28.4%) and induction (13.3%) of acute leukemia ChT and lymphomas’ ChT (20.3%). Anal fissures were the most frequent source of PI within GCP period (66.2% vs 19.1% without GCP, p&lt;0.001). Inflammatory changes in perianal tissues were clinical features of PI in the setting of GCP in 89.2% of the cases: inflammatory mass in 71.6% (vs 23.8% without GCP, p&lt;0.001), abscess in 8.1% (vs 66.7% without GCP, p&lt;0.001). In 10.8% of the cases of PI with GCP only perianal pain and fever were registered. No tissues change was detected with the lowest WBC count (Me 0.2 (0.1-0.5) x10 9 /l). Bloodstream infections were detected in 15 (20.3%) episodes within the period of GCP only, of them in 6 (8.1%) cases the species matching of microorganisms in blood and in rectum was noticed. Within the period of GCP antibacterial therapy was carried out in 98.6% of the cases: antibacterial therapy alone was applied in 87.8% of the episodes (vs 7.2% without GCP, p&lt;0.001); both antibacterial therapy and surgical treatment were carried out in 10.8% (vs 61.9% without GCP, p&lt;0.001) of the cases. Mean duration of antibiotic treatment of patients with GCP was drastically longer in the group of postoperative patients in comparison with the group of those who had conservative treatment (25.5 vs 15.1 days, p=0.05). Antimicrobial therapy within GCP period resulted into inflammation regress in 83.1% of the cases; abscess or fistula formation, hence surgical treatment in 13.8% of the cases; progression of infection in 3.1% of the cases. Increase of GCP duration up to 30 and more days is connected with bacteremia rate increase (12.5% vs 28%, p&lt;0.05); combinations of PI with other infections (25% vs 52%, p&lt;0.05); requirement of antimicrobial therapy modification (16.7% vs 40%, p&lt;0.05). CONCLUSION: GCP significantly raises risk of PI. PI that develops in the setting of GCP, is characterized by abnormal, often low clinical manifestations and high risk of sepsis. Invasion of microorganisms through affected tissue seals is the basic mechanism of perianalinfection within the period of GCP. Antibacterial therapy is the prior method of PI treatment in the settings of GCP; antibacterial therapy efficiency is 83.1%. Need for surgery in the period of GCP is associated with the infectious episode and antibacterial therapy duration increase. Lengthening of GCP is a negative predictor in PI treatment.

Clinical outcomes of otogenic skull base osteomyelitis.

Skull base osteomyelitis (SBO) is an uncommon and a potentially life-threatening condition if not promptly recognized and properly treated. The aim of our study was to present a 32-case series of patients diagnosed with SBO at a single center. In this retrospective study, we reviewed the data of patients diagnosed with otogenic SBO between January 2011 and January 2020. 32 patients were enrolled in the study. SBO diagnosis was based on a combination of symptoms and physical examination, bone scan, brain magnetic resonance imaging, and pathologic examination findings. The following clinical data were collected during the follow-up period: types of antibiotics used, duration of antibiotic treatment, C-reactive protein level, presence of disease control, duration from the onset of symptoms to diagnosis, and patient survival. The mean follow-up period was 11 (1-110) months. The mean duration of antibiotic treatment was 115 (19-223)days. The mean C-reactive protein levels at the time of diagnosis and at the endpoint of follow-up were 3.05 (0.56-18.31) and 0.21 (0.03-33.61)mg/dL, respectively (P < 0.001). Disease control rate was 34.9% at 1-year and 83.7% at 5-year follow-up. Patient survival rate was 90.6% at 1- and 3-year follow-ups. At the endpoint of follow-up, three patients died. The mean durations from the onset of symptoms to diagnosis were 50 (5-360) and 90 (30-480) days in patients with the controlled disease and in those with the uncontrolled disease, respectively, at the endpoint of follow-up (P = 0.043). Comprehensive assessment and aggressive treatment of patients exhibiting symptoms suggestive of SBO would help in the rapid diagnosis of otogenic SBO, resulting in an improvement in prognosis.

Cat bite: an injury not to underestimate

Domestic cat bites are common and are often treated by simple wound care with good outcome. However, delayed presentation may lead to significant morbidity or even mortality. Twenty cases of cat bites to the hand and wrist were retrospectively reviewed between 2014 and 2018. Data included patient demographics, anatomical site of injury, microbiology results, method of treatment and surgical outcome. The subjects were 18 females and two males aged 27–86 years (mean age of 58 years). Eleven patients (Group A) were presented within 48 hours of their injury. Nine patients (Group B) presented later than 48 hours. Of these, 78% (n = 7) underwent multiple operations secondary to septic arthritis, osteomyelitis, necrotising fasciitis and deep collection. Mean length of hospital stay was 3.4 days in Group A, and 9.2 days in Group B, (p < .01). Four patients underwent digital or ray amputations. The index finger was the most common site of injury (45%). Almost 40% of cases had flexor tendon sheath infection of the fingers. Pasteurella species was isolated from 35% of infected wounds. Mean duration of antibiotic treatment and length of hospital stay were significantly longer in Group B (p < .05). Delayed presentation of infected cat bites increased the likelihood of more complicated surgeries such as amputation. Diabetic fingers with established peripheral neuropathy were more likely to undergo amputation. We recommend that any symptomatic cat bites to the upper limb, especially hand and wrist, must be treated promptly, essentially within 48 hours of injury, particularly in immunocompromised population.

S1641 INFECTIOUS COMPLICATIONS IN PATIENTS RECEIVING ANTI‐CD 19 CHIMERIC ANTIGEN RECEPTORS T‐CELLS (CAR T) FOR DIFFUSE LARGE B CELL LYMPHOMA (DLBCL). A MONOCENTRIC PRELIMINARY EXPERIENCE

Background:Autologous anti‐CD19 chimeric antigen receptor (CD19 CAR) T‐cell immunotherapy showed significant benefit and satisfactory safety in relapsed/refractory DLBCL. Expected toxicities are neurologic events, cytokine release syndrome (CRS), hypogammaglobulinemia, cytopenias and B‐cell aplasia, the 3 latter being consequences of both CD19 CAR T‐cells and the lymphodepleting chemotherapy regimen (fludarabine+cyclophosphamide).Aims:Infectious complications during the first 30 days after CD19 CAR T‐cells infusion are not well defined yet. Differential diagnosis between fever and CRS might be difficult. The purpose of the present study is to evaluate infectious risk during treatment with CAR T‐cells.Methods:We retrospectively analyzed febrile events and infectious complications in 29 patients (pts) who received CAR T‐cells from June 1st 2018 to January 31st 2019 for R/R DLBCL. Pts were studied from day (D) 0, time of the injection, to D30.Results:Characteristics of pts are summarized in table 1. Mean age was 49.8 y.o. (23–77), 62% pts were male. A mean of 4 lines of treatment was previously administered (2–8). At admission, 83% of pts presented lymphopenia (≤1G/L, mean 0.43 G/L, 70–980). No grade (G) 3–4 neutropenia was observed before the beginning of lymphodepletion. Hypogammaglobulinemia was present in 28% of pts (mean 5 g/L, 2–11). Elevated C reactive protein before lymphodepletion was found in 55% pts (16/29) (mean 14 mg/L, 0–62). Anti‐pneumocystis prophylaxis was administered in 97% pts (28/29, 25 Cotrimoxazole, 3 Atovaquone), as well as antiviral prophylaxis (Valaciclovir). One pt suspended treatment without approval. Twenty‐four pts presented fever (83%), mean time of onset was D3 (0–13). 90% of pts presented neutropenia during the study period. Severe neutropenia (≤0.5G/L) was observed in 20/29 pts (70%) and mean duration was 6 days (2–19). 10% of the patients were still in severe neutropenia at D30. A microbiological documentation was found in 8 episodes occurring in 4 pts. For bacteria: 2 bloodstream infections (BSI) caused by Gram+ (1pt E.fecalis + S.epidermidis during cholangitis, 1 pt S.epidermidis with concomitant infection of indwelling catheter), 1 E.coli pneumonia and 1 C.difficilis enteritis. Antibacterial empirical treatment was administered in 22/24 pts presenting fever (92%). Mean duration of antibiotic treatment was 10 days (4–22). Four viral infections were observed: 1 Rhinovirus upper respiratory tract infection, 1 Norovirus enteritis and 1 pt presented CMV reactivation together with BK virus cystitis. No invasive fungal infections were observed. Only 2 pts received empiric systemic antifungal treatment. Hospitalization in intensive care unit was necessary for 10/29 pts (34%) and mean stay was 7 days (3–12). Only 2 out of 24 pts with a febrile event presented poor outcome at D30. In one pt death occurred because of disease progression and infection (BSI) and one pt had still positive CMV at D30 while receiving Foscarnet. No mortality was attributable to infectious complications alone.Summary/Conclusion:Febrile neutropenia is frequent in pts receiving CAR T‐cells and often cannot be distinguished from the onset of CRS. Diagnostic work‐up should be carried out following standard procedures. Bacterial and viral infection have low incidence and fungal infections did not occur in our population. Infectious complications appear mild and not fatal but broader studies deserve to be implemented to better define infectious risk in this subset of patients.image