Citations

Abstract Background Staphylococcus lugdunensis (SL) is a coagulase-negative staphylococcus with virulence comparable to that of Staphylococcus aureus. The “skip phenomenon” (SP) is a pattern where blood cultures are intermittently negative before final clearance of bloodstream infection (BSI). SP is well-documented in S. aureus bacteremia but has not been described previously in SL. In this report, we present a cohort with SL BSI and describe its prevalence and their clinical features and outcomes. Methods We conducted a retrospective review of patients with blood cultures positive for SL in samples referred to the Mayo Clinic reference lab between June 2012 and June 2022. We assessed clinical characteristics, including time to positivity, prevalence of the skip phenomenon (defined by a positive culture after 24 hours of negative cultures), patient demographics including Charlson Comorbidity Index, mortality and length of hospital stay. Results We identified 55 patients with SL BSI and 33 of them had enough laboratory data to determine the prevalence of the skip phenomenon. SP was present in 5 of 33 (15.2%) patients. For all patients with SL BSI, the median age was 67 years (interquartile range [IQR] 61-79); mean CCI in the group with SP was 5.6 (standard deviation 2) and those without SP was 5.9 (standard deviation 2.7); median duration of bacteremia was 3 days (IQR 1-4); median hospital length of stay was 14 days (IQR 8-20); and 1-year mortality was 45%. Oxacillin susceptibility was present in 33 of 34 cases. Conclusion A total of 15% of patient cases with SL BSI demonstrated the SP. Recognition of the SP in patients with SL BSI is important as this may impact duration of antibiotic therapy and timing of long-term cardiovascular device placement. Disclosures Larry M. Baddour, MD, UpToDate, Inc.: Royalty payments (authorship duties).

Abstract The skip phenomenon (SP) is a pattern where blood cultures are intermittently positive before final clearance. We report that one-third of patients with Staphylococcus lugdunensis infective endocarditis experienced the SP. Patients with the SP experienced both a longer duration of bacteremia and hospital stay, with a higher 1-year mortality rate.

Background Antibiotics are frequently prescribed at the end of life, though the benefits and harms are not well understood. Methods We abstracted relevant findings from articles published in English in the past 25 years to answer questions generated by discussion among the authors and with stakeholders in Palliative Care and Infectious Diseases. Findings Prescribing practices vary based on individual situation and geographic location. Patients with cancer and those hospitalized receive more antibiotics than those enrolled in outpatient hospice. Urinary tract infections and pulmonary infections are the most common conditions treated with antibiotics at the end of life -most often with penicillin derivatives and vancomycin in the hospital, fluoroquinolones in outpatient, and cephalosporins in both settings. When asked, patients most often prefer limiting antibiotics to symptom management at the end of life. Physicians’ over-estimation of patient preference for antibiotics and the increased probability of misdiagnosis increases antibiotic prescription rates. Antibiotics can improve symptoms when used for specific diseases at the cost of drug reactions, resistant organisms, and delayed discharge. Antibiotic use has variable results on survival duration. Antimicrobial stewardship exists in hospital and long-term care facilities, but not outpatient hospice groups. Stewardship interventions could increase proper use of antibiotics, but more information is needed to apply these interventions to hospice groups. Conclusions Antibiotics at the end of life are impactful and efforts to educate patients and providers will be invaluable in optimizing care.

Abstract Background Urinary tract infections (UTIs) caused by multidrug-resistant Gram-negative bacilli (MDR-GNB) have become increasingly challenging to manage due to the limited number of available effective oral agents. Minocycline, a second-generation tetracycline with a broad antimicrobial spectrum and reasonable urinary concentration, has recently gained attention as a potential treatment option for MDR-GNB UTIs. In this study, we aim to review the in vitro minocycline susceptibility against a wide spectrum of urinary GNB isolates performed at our reference lab. Methods We conducted a retrospective review of all minocycline susceptibility testing performed on urinary GNB isolates performed at the Mayo Clinic reference lab between 2013-2022. We stratified our results for different species based on phenotypic resistance profiles as well as known species-specific resistance association. Results During the study timeframe, we identified 28,388 GNB isolates that underwent minocycline susceptibility testing. Among the Escherichia coli (E.Coli) isolates resistant to ceftriaxone, ciprofloxacin, or meropenem, minocycline susceptibility was noted to be 78%, 46%, 76%, respectively (Fig 1). Among the Klebsiella pneumonia (KP) isolate resistant to ceftriaxone, ciprofloxacin, or meropenem, minocycline susceptibilities were 47%, 40%, and 53% respectively (Fig 1). Among the high risk Amp-C group Citrobacter freundii, Enterobacter Cloacae and Klebsiella aerogenes, minocycline susceptibility rate was noted to be 87%, 77%, and 89%, respectively (Fig 2). Finally, among the isolate group of non-fermenters including Achromobacter spp, Acinetobacter spp & Stenotrophomonas spp, susceptibility rates were noted to be 65%, 94%, and 100%, respectively (Fig 3). Conclusion Minocycline showed in vitro activity against many hard to treat GNB urinary isolates, including ceftriaxone and meropenem resistant E.coli & KP isolates. High-risk Amp-C producing GN species & some of the less common GN including Stenotrophomonas, Acinetobacter, and Achromobacter. Disclosures All Authors: No reported disclosures

OBJECTIVESurgery is the definitive treatment of Chiari malformation Type I (CM-I). It involves posterior fossa decompression, which can be performed along with C-1 laminectomy, reconstructive duraplasty, or tonsil shrinkage. The aim of this study was to provide an updated systematic review and meta-analysis of the latest available evidence regarding posterior fossa decompression only (PFDO) versus posterior fossa decompression with duraplasty (PFDD) in the treatment of CM-I in children.METHODSA literature search was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for article identification, screening, eligibility, and inclusion. Relevant articles were identified from 6 electronic databases from their inception to April 2016. These articles were screened against established criteria for inclusion into this study.RESULTSFrom 12 relevant studies identified, 1492 pediatric patients treated via PFDD were compared with 1963 pediatric patients treated by PFDO for CM-I. PFDD was associated with greater overall clinical improvement (p = 0.009), along with longer length of stay (p < 0.0001) and more postoperative complications (p = 0.0001) compared with PFDO. No difference was observed between PFDD and PFDO in terms of revision surgery incidence (p = 0.13), estimated blood loss (p = 0.14), syrinx improvement (p = 0.09), or scoliosis improvement (p = 0.95).CONCLUSIONSIt appears that the addition of duraplasty to posterior decompression in the definitive treatment of CM-I in children may alter surgical and performance outcomes. In particular, parameters of overall clinical improvement, length of stay, and postoperative complication may differ between children undergoing PFDD and those undergoing PFDO. Current evidence in the literature is of low to very low quality that, as of yet, has not been able to completely control for inherent selection bias both in study design and surgeon preference. Future, large prospective registries and randomized controlled trials are warranted to validate the findings of this study.