Oral Antibiotic Treatment Research Articles

Trends in Oral Antibiotic Use for Acne Treatment: A Retrospective, Population-Based Study in the United States, 2014 to 2016.

Antibiotic resistance related to prolonged antibiotic use is an emerging threat to public health. To evaluate recent trends in oral antibiotic use for acne treatment. A retrospective study was conducted from January 2014 through September 2016 using the IBM MarketScan® claims database. Patients were aged ≥9 years, prescribed an oral antibiotic, and diagnosed with acne vulgaris on 2 separate occasions. The primary outcome was the duration of oral antibiotic treatment over 12 months; continuous use was defined as ≤30-day gap between prescriptions. The most commonly prescribed antibiotic treatments (N=46,267) were doxycycline (36.7%) and minocycline (36.5%). Overall, 36%, 18%, 10%, and 5% of patients continuously used any oral antibiotic at 3, 6, 9, and 12 months, respectively. Among patients who continuously used tetracyclines, a similar percentage was prescribed minocycline (40.2%, 18.6%, 10.5%, and 5.1%) vs doxycycline (34.7%, 14.6%, 7.7%, and 3.9%) at 3, 6, 9, and 12 months, respectively. A greater percentage of patients continued use of tetracyclineclass antibiotics than other therapeutic classes. Retrospective analysis of health-care claims data. Relatively short study duration. Nearly 20% of patients continuously used oral antibiotics for ≥6 months, exceeding American Academy of Dermatology guideline recommendations of 3 to 4 months. J Drugs Dermatol. 2023;22(3):265-270. doi:10.36849/JDD.7345.

High-dose cephalexin for cellulitis: a pilot randomized controlled trial

Up to 3% of all Emergency Department (ED) visits are due to skin and soft tissue infections such as non-purulent cellulitis. The current treatment failure rate is approximately 20%. Evidence is lacking regarding the optimal outpatient management of cellulitis. To evaluate the feasibility of a randomized trial comparing high-dose (1000mg) to standard-dose (500mg) cephalexin to treat ED patients with cellulitis. A parallel arm double-blind randomized controlled pilot trial conducted at two EDs in Canada. Eligible participants were adults (age ≥ 18years) presenting to the ED with non-purulent cellulitis and determined by the treating emergency physician to be eligible for outpatient management with oral antibiotics. Participants were randomized to high-dose or standard-dose cephalexin four times daily for 7days. The primary feasibility outcome was participant recruitment rate (target ≥ 35%). The preliminary primary effectiveness outcome was oral antibiotic treatment failure. Of 134 eligible participants approached for trial participation, 69 (51.5%, 95% CI 43.1 to 59.8%) were recruited and randomized. After excluding three randomized participants due to an alternate diagnosis, 33 participants were included in each arm. Nineteen eligible cases (14.2%) were missed. Loss to follow-up was 6.1%. Treatment failure occurred in four patients (12.9%) in the standard-dose arm versus one patient (3.2%) in the high-dose arm. A greater proportion had minor adverse events in the high-dose arm. No patients had an unplanned hospitalization within 14days. This pilot randomized controlled trial comparing high-dose to standard-dose cephalexin for ED patients with cellulitis demonstrated a high participant recruitment rate and that a full-scale trial is feasible. High-dose cephalexin had fewer treatment failures but with a higher proportion of minor adverse effects. The findings of this pilot will be used to inform the design of a future large trial. This trial was registered at ClinicalTrials.gov (NCT04471246).

1981. Alternatives to guideline directed therapy in bacterial endocarditis

Abstract Background Existing society guidelines recommend therapy with intravenous antibiotics for 4-6 weeks for most cases of endocarditis. Recent literature has demonstrated that partial oral antibiotic treatment is non-inferior to intravenous therapy and that partial treatment with dalbavancin or shorter durations of therapy in patients undergoing valve surgery can also lead to positive clinical outcomes. However, there is not currently a standardized approach to how these alternative treatments should be utilized. Methods A standardized protocol for use of shortened duration of antibiotic treatment post-operatively, oral antibiotic therapy, and dalbavancin was developed by the endocarditis consult service in conjunction with the University of Kentucky multidisciplinary endocarditis team. Subsequently, consecutive patients with endocarditis treated with these alternative therapies were identified and reviewed by study investigators. The primary outcomes were 90-day mortality, 30-day readmission, relapsed infection, and completion of therapy. Results Between September 7th, 2021 and April 15th, 2022 we identified 20 cases of endocarditis managed with one of the alternative treatment regimens. Fourteen patients had recent injection drug use. Twelve patients were initially treated with partial oral therapy. Five patients were initially treated with dalbavancin. Three patients received two-week courses of intravenous antibiotics after valve surgery. For all patients, 90-day mortality was 0% and 30-day readmission rate was 10%. Ten patients completed oral treatment. Three patients completed therapy with Dalbavancin with two patients transitioning to the oral group due to side effects. All three patients with shortened durations of therapy completed treatment. One patient treated with dalbavancin with crossover to oral therapy developed relapsed bacteremia with the same organism after self-discontinuing a suppressive oral antibiotic. Conclusion A systematic approach involving a multidisciplinary team can allow for successful utilization of alternative approaches to guideline directed treatment for endocarditis with high rates of therapy completion, low rates of mortality, re-admission, and relapsed infection, including in persons who inject drugs. Disclosures All Authors: No reported disclosures.

1317. Early identification of avascular necrosis in pediatric acute hematogenous osteomyelitis using gadolinium-enhanced subtraction MRI

Abstract Background Current literature cites avascular necrosis as one of the rare and late complications of pediatric acute hematogenous osteomyelitis (AHO). Gadolinium-enhanced subtraction (GES) MRI sequences could potentially detect avascular necrosis more frequently and at an earlier time point in the course of pediatric AHO. Such an advantage could aid in the identification of patients at risk for chronic complications early in the course of disease. GES sequences are produced by subtracting pre-gadolinium images from the corresponding gadolinium-enhanced sequences. Methods Pediatric patients managed at Sultan Qaboos University Hospital between January, 2015 and April, 2022 with a confirmed diagnosis of AHO were reviewed. Patients were included in the analysis if GES MRI sequences were included in the initial diagnostic evaluation. Clinical presentation and outcomes were compared between patients with evidence of avascular necrosis on initial GES MRI and those without. Results Eleven patients were identified with a diagnosis of AHO for whom which GES MRI sequences had been obtained. Median age was 5 years (IQR 4-9), and 10 (91%) patients were males. Evidence of avascular necrosis on initial MRI (Figure 1) was identified in 6 (55%) patients. Patients with avascular necrosis showed a trend towards higher markers of inflammation (median absolute neutrophil count 10.7 vs 5.0, P = 0.052). Patients with avascular necrosis had significantly longer lengths of stay (median 16 days vs 9, P = 0.030), longer IV antibiotic treatment durations (median 14 days vs 7, P = 0.009) and longer oral antibiotic treatment durations (median 206 days vs 26, P = 0.036) (Table 1). Progression to chronic osteomyelitis occurred frequently, and only among patients with evidence of avascular necrosis on initial GES MRI (P = 0.008). Table 1 Comparison of clinical presentation and outcomes between patients whose initial MRI showed evidence of avascular necrosis on gadolinium-enhanced subtraction sequences, and patients whose imaging did not. *Represented as median (interquartile range). **For two patients, follow-up time at the time of writing was insufficient to determine if chronic osteomyelitis had developed. Figure 1Images A, B and C- Coronal MRI of the proximal femur in a child with uncomplicated acute hematogenous osteomyelitis. A- Pre-Gd T1, B- Post-Gd T1 and C- subtraction. Images show bone marrow edema with enhancement without any evidence of ischemia or necrosis (blue parenthesis). Images D, E and F- Sagittal MRI of the distal tibia in a child with complicated acute hematogenous osteomyelitis. D- Pre-Gd FAT SAT T1, E- Post-Gd FAT SAT T1 and F-subtraction. Images show bone marrow edema with a large central non-enhancing region of bone marrow suggestive of ischemia/necrosis (yellow rectangles). Conclusion GES MRI readily detected avascular necrosis in a large percentage of patients during the initial presentation of pediatric AHO, suggesting a much higher prevalence and an earlier presence of this complication than previously thought. The presence of avascular necrosis appeared to correlate highly with later progression to chronic osteomyelitis, providing for a promising early predictor of later complications. The findings of this study need to be validated in a larger, prospective cohort. Disclosures All Authors: No reported disclosures.

Isotretinoin and the risk of inflammatory bowel disease and irritable bowel syndrome: A large-scale global study

Risk of inflammatory bowel disease (IBD) under isotretinoin is a scope of a long-standing controversy. The burden of isotretinoin-related irritable bowel syndrome (IBS) has not been investigated. To evaluate the risk of Crohn`s disease (CD), ulcerative colitis (UC), and IBS in patients with acne starting isotretinoin versus oral antibiotics treatment. A global population-based retrospective cohort study assigned two groups of patients with acne initiating isotretinoin (n=77,005) and oral antibiotics (n=77,005). Comprehensive propensity-score matching was conducted. The lifetime risk of CD (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.89-1.24; P=0.583) and UC (HR, 1.13; 95% CI, 0.95-1.34; P=0.162) was comparable between study groups, whereas the lifetime risk of IBS was lower in isotretinoin-prescribed patients (HR, 0.82; 95% CI, 0.76-0.89; P<0.001). In time-stratified analysis, isotretinoin-related risk of UC was significantly increased during the first 6 months following drug initiation (HR, 1.93; 95% CI, 1.29-2.88; P=0.001), but decreased afterward to level the risk of the comparator group. The absolute risk difference within the first 6 months was clinically marginal (5.0 additional UC cases/10,000 patients starting isotretinoin; 95% CI, 2.5-7.7). Retrospective data collection. Isotretinoin does not confer an elevated risk of CD, whilst it might be associated with a slight and transient increase in UC risk.

Long-term oral antibiotic use in people with acne vulgaris in UK primary care: a drug utilization study.

The inappropriate use of antibiotics is understood to contribute to antimicrobial resistance. Oral antibiotics are regularly used to treat moderate-to-severe acne vulgaris. In practice, we do not know the typical length of oral antibiotic treatment courses for acne in routine primary care and what proportion of people receive more than one course of treatment following a new acne diagnosis. To describe how oral antibiotics are prescribed for acne over time in UK primary care. We conducted a descriptive longitudinal drug utilization study using routinely collected primary care data from the Clinical Practice Research Datalink GOLD (2004-2019). We included individuals (8-50 years) with a new acne diagnosis recorded between 1 January 2004 and 31 July 2019. We identified 217 410 people with a new acne diagnosis. The median age was 17 years [interquartile range (IQR) 15-25] and median follow-up was 4.3 years (IQR 1.9-7.6). Among people with a new acne diagnosis, 96 703 (44.5%) received 248 560 prescriptions for long-term oral antibiotics during a median follow-up of 5.3 years (IQR 2.8-8.5). The median number of continuous courses of antibiotic therapy (≥ 28 days) per person was four (IQR 2-6). The majority (n = 59 010, 61.0%) of first oral antibiotic prescriptions in those with a recorded acne diagnosis were between the ages of 12 and 18. Most (n = 71 544, 74.0%) first courses for oral antibiotics were for between 28 and 90 days. The median duration of the first course of treatment was 56 days (IQR 50-93 days) and 18 127 (18.7%) of prescriptions of ≥ 28 days were for < 6 weeks. Among people who received a first course of oral antibiotic for ≥ 28 days, 56 261 (58.2%) received a second course after a treatment gap of ≥ 28 days. The median time between first and second courses was 135 days (IQR 67-302). The cumulative duration of exposure to oral antibiotics during follow-up was 255 days (8.5 months). Further work is needed to understand the consequences of using antibiotics for shorter periods than recommended. Suboptimal treatment duration may result in reduced clinical effectiveness or repeated exposures, potentially contributing to antimicrobial resistance.

Short Course of Oral Antibiotic Treatment After Two-Stage Exchange Arthroplasty Appears to Decrease Early Reinfection

BackgroundRecent evidence has suggested a benefit to extended postoperative prophylactic oral antibiotics after two-stage exchange arthroplasty for treatment of periprosthetic joint infections. We sought to determine reinfection rates with and without a short course of oral antibiotics after two-stage exchange procedures. MethodsA retrospective review identified patients undergoing two-stage exchange arthroplasty for periprosthetic joint infection of the hip or knee. Patients were excluded if they failed a prior two-stage exchange, had positive cultures at reimplantation, prolonged intravenous antibiotics postoperatively, and/or life-long suppression. This resulted in 444 reimplantations (210 hips and 234 knees). Patients were divided into three cohorts based on the duration of oral antibiotics after reimplantation: no antibiotics (102), ≤2 weeks (266), or >2 weeks (76). The primary endpoint was reinfection within 1 year of reimplantation. ResultsWithin 1 year of reimplantation, there were 34 reinfections. In the no-antibiotic, ≤ 2-week, and >2-week cohorts the reinfection rates were 14.1, 7.0, and 6.4%, respectively. Multivariate Cox regression showed a reduced reinfection rate in the ≤2-week cohort relative to no antibiotics (hazard ratio [HR]: 0.38, P = .01). While the smaller cohort with >2 weeks of antibiotics did not significantly reduce the reinfection rate (HR: 0.41, P = .12), when combined with the ≤2-week cohort, use of oral antibiotics had an overall reduction of the reinfection rate (HR: 0.39, P = .01). ConclusionsThese data support the hypothesis that a short course of oral antibiotics after reimplantation decreases the 1-year reinfection rate. Future randomized studies should seek to examine the efficacy of different durations of oral antibiotics to reduce reinfection. Level of EvidencePrognostic Level IV.

Partial outpatient oral antibiotic treatment of infective endocarditis is non-inferior to inpatient intravenous antibiotic therapy

A clinical decision report using: Iversen K, Ihlemann N, Gill SU, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019; 380:415-424. https://doi.org/10.1056/NEJMoa1808312 for a patient with infective endocarditis and intravenous drug use with desire to leave the hospital.

Complicated infective endocarditis treated with partial oral antibiotic therapy: A case report

Typically, infective endocarditis (IE) is a condition that requires a long duration of intravenous antibiotics for 6 weeks based on current guidelines. We present a case of partial oral antibiotic treatment in an IE patient complicated with intracranial hemorrhage secondary to the mycotic aneurysm.

Enrichment of antibiotic resistance genes within bacteriophage populations in saliva samples from individuals undergoing oral antibiotic treatments.

Spread of antibiotic resistance is a significant challenge for our modern health care system, and even more so in developing countries with higher prevalence of both infections and resistant bacteria. Faulty usage of antibiotics has been pinpointed as a driving factor in spread of resistant bacteria through selective pressure. However, horizontal gene transfer mediated through bacteriophages may also play an important role in this spread. In a cohort of Tanzanian patients suffering from bacterial infections, we demonstrate significant differences in the oral microbial diversity between infected and non-infected individuals, as well as before and after oral antibiotics treatment. Further, the resistome carried both by bacteria and bacteriophages vary significantly, with bla CTX-M1 resistance genes being mobilized and enriched within phage populations. This may impact how we consider spread of resistance in a biological context, as well in terms of treatment regimes.

Impact of suboptimal or inappropriate treatment on healthcare resource use and cost among patients with uncomplicated urinary tract infection: an analysis of integrated delivery network electronic health records

BackgroundAlthough uncomplicated urinary tract infections (uUTIs; occurring in female patients without urological abnormalities or history of urological procedures or complicating comorbidities) are one of the most common community infections in the United States (US), limited data are available concerning associations between antibiotic resistance, suboptimal prescribing, and the economic burden of uUTI. We examined the prevalence of suboptimal antibiotic prescribing and antibiotic resistance and its effects on healthcare resource use and costs.MethodsThis retrospective cohort study utilized electronic health record data from a large Mid-Atlantic US integrated delivery network database, collected July 2016–March 2020. Female patients aged ≥ 12 years with a uUTI, who received ≥ 1 oral antibiotic treatment within ± 5 days of index uUTI diagnosis, and had ≥ 1 urine culture with antimicrobial susceptibility test, were eligible for inclusion in the study. The study examined the proportion of antibiotics that were inappropriately or suboptimally prescribed among patients with confirmed uUTI, and total healthcare costs (all-cause and UTI-related) within 6 months after a uUTI, stratified by antibiotic susceptibility and/or inappropriate or suboptimal treatment. Patient outcomes were assessed after 1:1 propensity score matching of patients with antibiotic-susceptible versus not-susceptible isolates and then by other covariates (e.g., demographics and recent healthcare use). A similar propensity score calculation was used to analyze the effect of inappropriate/suboptimal treatment on health outcomes. Costs were adjusted to 2020 US dollars ($).ResultsAmong 2565 patients with a uUTI included in the analysis, the most commonly prescribed antibiotics were nitrofurantoin (61%), trimethoprim-sulfamethoxazole (19%), and ciprofloxacin (15%). More than one-third of the sample (40.2%) had isolates that were not-susceptible to ≥ 1 antibiotic indicated for treating patients with uUTI. Two-thirds (66.6%) of study-eligible patients were prescribed appropriate treatment; 29.9% and 11.9% were prescribed suboptimal and/or inappropriate treatment, respectively. Inappropriate or suboptimally prescribed patients had greater all-cause and UTI-related costs compared with appropriately prescribed patients. Differences were most striking among patients with antibiotic not-susceptible isolates.ConclusionsThese findings highlight how the increasing prevalence of antibiotic resistance combined with suboptimal treatment of patients with uUTI increases the burden on healthcare systems. The finding underlines the need for improved prescribing accuracy by better understanding regional resistance rates and developing improved diagnostic tests.

Impact of a pediatric infectious disease consultation service on timely step-down to oral antibiotic treatment for bone and joint infections

PurposeIn recent years an earlier step down to oral antibiotic therapy has been advocated for numerous infections. Trained infectious disease specialists regularly consulting their colleagues may speed up the implementation of such recommendations into clinical practice and thus may improve treatment.MethodsWe retrospectively analyzed bone and joint infections in children admitted to the University Hospital of Cologne between 2010 and 2021. We assessed clinical, imaging, and microbiological findings and treatment modalities. Additionally, we assessed both the impact of a newly implemented pediatric infectious diseases consultation service and publications on revised treatment recommendations by comparing antibiotic therapy in two periods (2010–2016 versus 2017 to 2021).ResultsIn total, 29 children presented with osteomyelitis, 16 with bacterial arthritis and 7 with discitis. In period 2 (2017–2021) we observed shorter duration of intravenous treatment (p = 0.009) and a higher percentage of oral antibiotic treatment in relation to the total duration of antibiotics (25% versus 59%, p = 0.007) compared to period 1 (2010–2016).Yet, no differences were identified for the total length of antibiotic treatment. Additionally, biopsies or synovial fluid samples were retrieved and cultured in more children in period 2 (p = 0.077). The main pathogen identified in osteomyelitis and bacterial arthritis was Staphylococcus aureus (MSSA), diagnosis was confirmed predominantly with MRI.ConclusionRecent guidelines addressing the safety of an earlier step-down (to oral) antibiotic therapy have influenced clinical practice in the treatment of bone and joint infections in our hospital. A newly implemented pediatric infectious diseases consultation service might have accelerated this progress resulting in a faster step down to oral treatment.

Behandlung von Staphylococcus-aureus-Blutstrominfektionen

Staphylococcus aureus bloodstream infections (SAB) represent a distinct clinical entity. Due to the frequency and the associated high morbidity and mortality, special requirements apply to the clinical management. Thus, in contrast to coagulase-negative staphylococci, even the detection of S. aureus in a single blood culture bottle is considered to be an infection requiring treatment. A classification into complicated versus uncomplicated bloodstream infections is carried out, with implications for the recommended duration of treatment (2 vs. 4–6 weeks). The use of transesophageal echocardiography to exclude endocarditis is indicated in the vast majority of cases. Because of frequent clinically silent septic metastases, positron emission tomography with computed tomography (PET-CT) is a useful tool for detection of nidi. For methicillin-sensitive S. aureus (MSSA), flucloxacillin and cefazolin are applied as basic treatment and for methicillin-resistant S. aureus (MRSA), vancomycin or daptomycin are used depending on the focus and comorbidity. If foreign material is present, a combination of basic treatment with rifampicin or fosfomycin should be considered. Source control by abscess drainage or removal of infected intravascular catheters, intracardiac devices or if necessary artificial joints is important. Studies show that infectious disease consultations improve the quality of care and mortality in SAB. Current open questions address the identification of subpopulations that benefit from combination treatment, the effectiveness and timing of stepdown oral antibiotic treatment, and a possible reduction in the overall duration of treatment. This review article summarizes the current standards for diagnostics and treatment of patients with SAB and presents recent relevant studies on this condition.

Long-term impact of persistent vegetations at 6 month followup after treatment of infective endocarditis: a substudy of the Partial Oral vs Intravenous Antibiotic Treatment of Endocarditis (POET) tria

Abstract Background Our knowledge of changes in vegetation size throughout the course of infective endocarditis (IE) and the impact of persistent vegetations on mortality or embolization after completed antibiotic treatment is sparse. No study has previously investigated the prevalence or clinical impact of persistent vegetations on transthoracic echocardiography (TTE) at 6-months follow-up after ended IE treatment. Purpose To investigate the association between persistent vegetations at the 6-months TTE after treatment for IE and long-term prognosis as assessed in the POET trial. Methods The POET trial was a nationwide, multicenter RCT, randomizing 400 patients to either partial oral or intravenous (IV) antibiotic treatment of left-sided IE, after initial stabilization of infection using conventional IV therapy. A persistent vegetation was defined as a vegetation seen on 6-months follow-up TTE (4–7 months) after ended antibiotic treatment for IE. In the POET trial, primary outcome was defined as 1) all-cause mortality, 2) unplanned cardiac surgery, 3) embolic events or 4) relapse of bacteremia, in the 5-year follow-up period. Patients without TTE due to death or lack of available TTE were excluded. Results Out of 400 patients, 20 were excluded due to death during 6-months follow-up, and 201 were excluded due to unavailable TTE, leaving 179 TTEs for analysis. At 6-months follow-up, a persistent vegetation was seen in 30 patients (16.7%, 21 males (70%), mean age 69.6 years (SD 7.7)) (Table 1). Seventeen patients (56.7%) had a persistent vegetation on the aortic valve and 13 patients (43.3%) on the mitral valve. More patients without a persistent vegetation had undergone initial surgical treatment of IE than those with a vegetation (57.7 vs 23.3%, p=0.001). In all surgically treated patients with persistent vegetation at 6-months follow-up, the vegetation was found on another valve than the operated valve. The composite primary outcome from 6-months follow-up and until 5-year follow-up occurred in 8 patients (26.7%) with a persistent vegetation, compared to 38 patients (25.5%) (p=1.00) without. (Table 2) In patients randomized for peroral treatment, no significant difference in prevalence of persistent vegetation was found (15 patients (50%) with persistent vegetations vs. 74 patients (49.7%) without, p=1.00). Conclusion The occurrence of persistent vegetations at 6 months follow-up was 16.7%. There was no association between persistent vegetations at 6-months follow-up and the occurrence of the primary outcome after 5 years follow-up, suggesting that the risk associated with residual vegetations after end of antibiotic treatment is negligible after 6-months. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Outcomes of PIPA/DIPA with Retrograde Screw Fixation for Correction of Lesser Toe Deformities

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Hammertoes and other lesser toe deformities represent extremely common foot problems, affecting nearly one-third of the general population. When surgery is indicated, correction of these deformities has traditionally been described using a PIP arthroplasty technique with a smooth, temporary Kirschner-wire for fixation. This method can produce excellent results, but there are well-described risks including deformity recurrence, secondary deformities, painful nonunion, and pin tract infections. Our goal is to describe a more modern technique that includes preparation and arthrodesis of both the PIP and DIP joints with intramedullary screw fixation. Methods: A retrospective chart review was conducted at one tertiary referral center of patients who underwent correction of lesser toe deformity between 2017 and 2021. Inclusion criteria were patient age greater than 18, use of the PIPA/DIPA technique with screw, and a minimum 10 weeks of follow up with radiographs. Charts were reviewed for patient demographics, comorbidities, preoperative characteristics, and postoperative complications. Our primary outcome variable was deformity correction achieved and maintained at minimum 10 weeks postoperatively based on both chart review and radiographs. Secondary outcomes included hardware failure, infection, vascular complication, screw removal for any reason, nonunion, and amputation. Results: 129 patients and 374 operative toes were identified on chart review and met inclusion criteria. Of these patients, 370 toes (98.9%) maintained deformity correction both clinically and radiographically at 10 weeks and did not undergo revision surgery. 17 toes (4.5%) required screw removal for any reason. 3 toes (0.8%) experienced deep infection, and 1 patient experienced superficial infection that resolved with oral antibiotic treatment. Furthermore, in addition to a concomitant deep infection, one toe experienced vascular compromise and required amputation. There were no symptomatic nonunions, and there were 7 (1.8%) asymptomatic nonunions as seen on radiographs. Conclusion: With respect to previously and classically described methods of lesser toe deformity correction, the PIPA/DIPA technique with a retrograde screw presents an acceptable and safe method for sustained deformity correction.

Outcomes of Partial Oral Antibiotic Treatment for Complicated Staphylococcus aureus Bacteremia in People Who Inject Drugs.

Staphylococcus aureus represents the leading cause of complicated bloodstream infections among persons who inject drugs (PWID). Standard of care (SOC) intravenous (IV) antibiotics result in high rates of treatment success but are not feasible for some PWID. Transition to oral antibiotics may represent an alternative treatment option. We evaluated all adult patients with a history of injection drug use hospitalized from January 2016 through December 2021 with complicated S. aureus bloodstream infections, including infective endocarditis, epidural abscess, vertebral osteomyelitis, and septic arthritis. Patients were compared by antibiotic treatment (standard of care intravenous [SOC IV] antibiotics, incomplete IV therapy, or transition from initial IV to partial oral) using the primary composite endpoint of death or readmission from microbiologic failure within 90 days of discharge. Patients who received oral antibiotics after an incomplete IV antibiotic course were significantly less likely to experience microbiologic failure or death than patients discharged without oral antibiotics (P < .001). There was no significant difference in microbiologic failure rates when comparing patients who were discharged on partial oral antibiotics after receiving at least 10 days of IV antibiotics with SOC regimens (P > .9). Discharge of PWID with partially treated complicated S. aureus bacteremias without oral antibiotics results in high rates of morbidity and should be avoided. For PWID hospitalized with complicated S. aureus bacteremias who have received at least 10 days of effective IV antibiotic therapy after clearance of bacteremia, transition to oral antibiotics with outpatient support represents a potential alternative if the patient does not desire SOC IV antibiotic therapy.

Current clinical practice in antibiotic treatment of Staphylococcus aureus bacteraemia: results from a survey in five European countries.

To determine clinical practice variation and identify knowledge gaps in antibiotic treatment of Staphylococcus aureus bacteraemia (SAB). A web-based survey with questions addressing antibiotic treatment of SAB was distributed through the ESGAP network among infectious disease specialists, clinical microbiologists and internists in Croatia, France, Greece, the Netherlands and the UK between July 2021 and November 2021. A total number of 1687 respondents opened the survey link, of whom 677 (40%) answered at least one question. For MSSA and MRSA bacteraemia, 98% and 94% preferred initial monotherapy, respectively. In patients with SAB and non-removable infected prosthetic material, between 80% and 90% would use rifampicin as part of the treatment. For bone and joint infections, 65%-77% of respondents would consider oral step-down therapy, but for endovascular infections only 12%-32% would. Respondents recommended widely varying treatment durations for SAB with different foci of infection. Overall, 48% stated they used 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) to guide antibiotic treatment duration. Persistent bacteraemia was the only risk factor for complicated SAB that would prompt a majority to extend treatment from 2 to 4-6 weeks. This survey in five European countries shows considerable clinical practice variation between and within countries in the antibiotic management of SAB, in particular regarding oral step-down therapy, choice of oral antibiotic agents, treatment duration and use of 18F-FDG-PET/CT. Physicians use varying criteria for treatment decisions, as evidence from clinical trials is often lacking. These areas of practice variation could be used to prioritize future studies for further improvement of SAB care.

LB961 Clinical contexts of long-term antibiotic prescriptions for acne: A qualitative study

Dermatologists prescribe more oral antibiotics per clinician than all other specialties. Despite clinical guidelines that recommend limitation of long-term oral antibiotic treatments for acne, there is little evidence to guide implementation of antibiotic stewardship programs in clinical practice. This study sought to examine provider knowledge, preferences, facilitators, and barriers that underpin oral antibiotic prescriptions for acne with a duration longer than 3 months. Semi-structured interviews were conducted with 30 key stakeholders: 22 academic and community dermatologists, including experts from the American Acne & Rosacea Society and acne clinical guideline authors, 4 infectious diseases physicians with expertise in antibiotic stewardship, 2 dermatology advanced practice practitioners, and 2 dermatology residents.

Economic burden of antibiotic-not-susceptible isolates in uncomplicated urinary tract infection: Analysis of a US integrated delivery network database

BackgroundUncomplicated urinary tract infections (uUTIs) are one of the most common bacterial infections in the United States (US). Contemporary data are important for understanding the health economic impact of antimicrobial-resistant uUTIs. We compared the economic burden among patients with uUTI isolates susceptible or not-susceptible to the initial antibiotic prescription.MethodsThis retrospective cohort study utilized electronic health record data (1 July 2016–31 March 2020) from a large Mid-Atlantic US integrated delivery network database. Patients were females aged ≥ 12 years with a uUTI, who received oral antibiotic treatment and had ≥ 1 urine culture within ± 5 days of diagnosis. The primary outcome was the difference in healthcare resource use and costs (all-cause, urinary tract infection [UTI]-related) among patients with susceptible versus not-susceptible isolates during the 6 months after the index uUTI diagnosis. Secondary outcomes included: pharmacy costs, hospital admissions and emergency department visits, as well as the probability of uUTI progressing to complicated UTI (cUTI) between patients with susceptible and not-susceptible isolates. Patient outcomes were compared using 1:1 propensity score matching. Winsorized costs were adjusted to 2020 quarter 1 US dollars ($).ResultsA total of 2565 patients were eligible for analysis. The propensity score-matched sample comprised 2018 patients, with an average age of 44.0 and 41.0 years for the susceptible and not-susceptible populations, respectively. In the 6 months post-index uUTI event, patients with not-susceptible isolates had significantly more all-cause prescriptions orders (+ 1.41 [P = 0.001]), UTI-related prescriptions orders (+ 0.26 [P < 0.001]) and a higher probability of all-cause inpatient (+ 1.4% [P = 0.009]), outpatient (+ 6.1% [P = 0.006]), or UTI-related outpatient (+ 3.7% [P = 0.039]) encounters. Patients with a uUTI and an antibiotic-not-susceptible isolate were significantly more likely to progress to cUTI than those with susceptible isolates (odds ratio: 2.35 [confidence interval: 1.66–3.33; P < 0.001]). Over 6 months, patients with not-susceptible versus susceptible isolates had significantly higher all-cause costs (+ $426 [P = 0.031]) and UTI-related costs (+ $157 [P = 0.034]).ConclusionsPatients with a uUTI caused by antibiotic-not-susceptible isolates had higher healthcare resource usage, costs, and increased likelihood of progressing to cUTI than those with antibiotic-susceptible isolates.

Moraxella osloensis Bacteremia and Pneumonia in a Seventeen-Year-Old Patient

Moraxella osloensis ( M . osloensis ) is a rare cause of bacteremia and pneumonia in pediatric patients. The published case reports of M. osloensis bacteremia are limited. Among children, there are only seven cases of invasive disease from M. osloensis identified, and specific treatment guidelines are not available. Our case adds to the limited literature on this rare bacterium and highlights the need to better define antimicrobial resistance patterns. Here we report a case of a 17-year-old previously healthy female admitted with M. osloensis bacteremia and pneumonia. The patient initially presented with clinical and radiographic findings consistent with community-acquired pneumonia and was sent home after an emergency department (ED) visit with oral antibiotic treatment. She was advised to return for admission after the blood culture obtained in the ED reported growth and was noted to have persistent symptoms despite antibiotic adherence. Treatment with ceftriaxone for 3 days intravenously followed by 7 days of oral cefdinir resulted in rapid clinical improvement and resolution of her infection. Due to its sparse prevalence in the literature, there is currently no standard antibiotic regimen for treatment of invasive infections with M. osloensis ; a variety of therapies ranging from 7 to 14 days in duration have been successfully employed. While Moraxella species (e.g., Moraxella catarrhalis ( M . catarrhalis )) are typically ?-lactamase producing, reports regarding ?-lactamase production by M . osloensis have been inconsistent. M . osloensis is a rare cause of invasive infection in adolescents. Given limited published data regarding antibiotic sensitivities of this specific organism, microbiologic sensitivities should be obtained if possible and response to therapy should be closely monitored. Int J Clin Pediatr. 2022;11(2):56-59 doi: https://doi.org/10.14740/ijcp483