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Background When to perform echocardiography to rule out infective endocarditis (IE) in patients with viridans group streptococci (VGS) bloodstream infections (BSIs) is unclear. Objectives We aimed to identify independent risk factors for IE in patients with VGS BSI. Methods This retrospective study conducted at Seoul National University Hospital from January 2013 to December 2022 involved patients with VGS and nutritionally variant streptococcal BSI, excluding single positive blood cultures and polymicrobial BSI cases. Independent risk factors were identified by multivariate logistic regression and sensitivity analyses according to echocardiography results, VGS species or the inclusion of possible IE cases. Results Of 845 VGS BSI cases, 349 were analysed and 86 IE cases were identified (24.6%). In the multivariate analysis, heart valve disease [adjusted odds ratio (aOR), 14.14, 95% CI, 6.14–32.58; P  < 0.001], persistent bacteraemia (aOR, 5.12, 95% CI, 2.03–12.94; P  = 0.001), age (per year, aOR, 0.98; 95% CI, 0.96–1.00; P =  0.015), solid cancer (aOR, 0.26; 95% CI, 0.13–0.53; P <  0.001) and haematologic malignancy (aOR, 0.04; 95% CI, 0.01–0.41; P =  0.006) were independently associated with IE. Sensitivity analyses yielded consistent results; also, infection by a member of the mitis group was independent risk factor for IE (aOR, 6.50; 95% CI, 2.87–14.68; P  < 0.001). Conclusions Younger age, heart valve disease, persistent bacteraemia, absence of underlying malignancy and BSI by a member of the mitis group were independent risk factors for IE in patients with VGS BSI. Echocardiographic evaluation could be prudently considered based on these clinicomicrobiological risk factors. [ABSTRACT FROM AUTHOR]

The profile of antimicrobial resistance (ie, antibiogram) may be disparate between children and adults. An infant developed severe deep neck infection with a multidrug‐resistant microbe. The microbe was more drug‐resistant in children than in adults, in our hospital. Treatment of a child should be guided by the antibiogram obtained from children. [ABSTRACT FROM AUTHOR]

Objectives: The in vitro activity of oritavancin was assessed against clinically relevant Gram-positive pathogens causing infections in cancer patients in European and US hospitals.Methods: A total of 1357 Gram-positive cocci (GPC) were included. Isolates were predominantly from bloodstream infections (54.6%). The most frequently isolated GPC were Staphylococcus aureus (43.6%), CoNS (14.4%) and Enterococcus spp. (22.0%).Results: Oritavancin (99.8% susceptible) showed modal MIC, MIC50 and MIC90 results of 0.015, 0.015-0.03 and 0.06 mg/L, respectively, when tested against S. aureus, regardless of methicillin susceptibility or geographical region. CoNS isolates from the USA demonstrated an MIC90 of oritavancin (MIC90, 0.12 mg/L) that was slightly higher than that for isolates from European countries (MIC90 0.06 mg/L). Oritavancin inhibited all Enterococcus faecalis and Enterococcus faecium, including VRE, at ≤ 0.25 mg/L. Oritavancin exhibited MIC50 results of 0.03 and 0.008-0.015 mg/L when tested against isolates of β-haemolytic streptococci and viridans group streptococci, respectively, regardless of geographical region.Conclusions: Oritavancin had potent activity in vitro against this contemporary collection of European and US GPC isolates from cancer patients. [ABSTRACT FROM AUTHOR]

Objectives: The in vitro activity of oritavancin was assessed against clinically relevant Gram-positive pathogens causing infections in cancer patients in European and US hospitals. Methods: A total of 1357 Gram-positive cocci (GPC) were included. Isolates were predominantly from bloodstream infections (54.6%). The most frequently isolated GPC were Staphylococcus aureus (43.6%), CoNS (14.4%) and Enterococcus spp. (22.0%). Results: Oritavancin (99.8% susceptible) showed modal MIC, MIC50 and MIC90 results of 0.015, 0.015-0.03 and 0.06 mg/L, respectively, when tested against S. aureus, regardless of methicillin susceptibility or geographical region. CoNS isolates from the USA demonstrated an MIC90 of oritavancin (MIC90, 0.12 mg/L) that was slightly higher than that for isolates from European countries (MIC90 0.06 mg/L). Oritavancin inhibited all Enterococcus faecalis and Enterococcus faecium, including VRE, at ≤0.25 mg/L. Oritavancin exhibited MIC50 results of 0.03 and 0.008-0.015 mg/L when tested against isolates of β-haemolytic streptococci and viridans group streptococci, respectively, regardless of geographical region. Conclusions: Oritavancin had potent activity in vitro against this contemporary collection of European and US GPC isolates from cancer patients. [ABSTRACT FROM AUTHOR]

Background: The clinical features of bacteria endocarditis became atypical when consolidated with other conditions such as tuberculosis (TB). Especially, the symptoms of bacteria endocarditis (BE) which were hidden behind the TB fever often lead to misdiagnosis and missed diagnosis.Case Presentation: A 56-year-old male with thoracic vertebra bone TB history presented with low-grade fever, shortness of breath and cardiac souffle. After conventional antibiotic therapy and strengthen anti-tuberculosis treatment condition did not be improved. Further inspection, there were bacteria endocarditis with the vegetation across the mitral valve. But the other valves were not involved. He was treated with intravenous penicillin for 4 weeks in all including during surgery, and following with oral antibiotic for another 2 weeks. The patient improved clinically eventually.Conclusion: It is the first reported case of isolated thoracic vertebra tuberculosis with valve endocarditis caused by streptococcus viridans and was successfully managed by combination therapy of internal medicine and surgery. It was suggested in tuberculosis patients, the possibility of bacterial endocarditis should be considered when came into fever and unexplained cardiac soufflé (in tuberculosis patients). [ABSTRACT FROM AUTHOR]

Background: Breakthrough viridans streptococcal bacteremia (VSB) in patients with hematological malignancy receiving levofloxacin prophylaxis is a major blood stream infection (BSI) occurring during febrile neutropenia. However, clinical data focused on VSB in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients are lacking.Methods: The medical records of allo-HSCT recipients who received oral levofloxacin prophylaxis between January 2011 and August 2013 at Toranomon Hospital were reviewed to evaluate breakthrough VSB. Stored viridans streptococcal (VGS) species were identified by using sodA gene sequencing, and were assessed for drug susceptibility.Results: Among the 184 allo-HSCT recipients on levofloxacin prophylaxis, 28 (15.2 %) experienced breakthrough VSB. All of the 28 recipients with VSB were treated with a cefepime-based or piperacillin/tazobactam-based regimen. The susceptibility rates of the VGS strains for levofloxacin, cefepime, piperacillin/tazobactam, meropenem, and vancomycin were 0 %, 95 %, 100 %, 100 %, and 100 %, respectively. Both the MIC50 (minimum inhibitory concentration) and the MIC90 of ceftazidim (0.5 μg/mL and 2 μg/mL, respectively) were higher than the MIC90 of all the other anti-pseudomonal beta-lactams (APBLs). Only 1 VGS strain had a penicillin MIC ≥ 2 μg/mL by the Etest (3.6 %). There were no cases with acute respiratory distress syndrome (ARDS) that was associated with VSB, although the rate of viridans group streptococcal shock syndrome was high (26 %). The crude 30-day mortality rate in the VSB group (10.7 %) did not differ significantly from that in the BSI without VSB group (9.3 %) or non-BSI group (7.0 %) (P = 0.77). Also, VSB was not a risk factor for all-cause mortality up to 60 days following allo-HSCT (P = 0.43).Conclusions: APBL with increased anti-VGS activity (APBL-VA) monotherapy would typically be optimal for treating the VGS strains in this setting. Indication of adding an empiric anti-gram-positive agent to APBL-VA for treating VSB should depend on local factors, such as the susceptibility results. In addition, breakthrough VSB is probably not a major cause of death in allo-HSCT settings, where beta-lactam non-susceptible VGS and the ARDS are rare. [ABSTRACT FROM AUTHOR]

Acute suppurative thyroiditis (AST) is a rare clinical condition. Streptococcus anginosus has a propensity of producing empyema in the head and neck. Here, we reported two cases of AST caused by S. anginosus. A 44-year-old man presented with anterior neck tender swelling and odynophagia for 12 days. He had thyrotoxicosis. He was initially diagnosed as thyroid cancer due to the misleading computed tomography report. Fine needle aspiration (FNA) yielded pus and neutrophils. S. anginosus was isolated from pus. After aspiration of abscess and treatment with sensitive antibiotics, he recovered uneventfully with 3 weeks treatment. He was euthyroid 3 months later. The other case is a 40-year-old women complained of fever and left neck swelling for 20 days. Magnetic resonance imaging showed left neck inflammatory changes. FNA revealed pus and inflammatory cells infiltration. She had moderately decreased level of thyroid-stimulating hormone (TSH). Blood cultures were positive for S. anginosus. After penicillin treatment, TSH level returned to normal range, and the nodule gradually resolved. She recovered uneventfully after 5 weeks treatment. S. anginosus has a previously unappreciated clinical niche in AST. Once AST is clinically concerned, FNA procedure should be performed as early as possible. [ABSTRACT FROM AUTHOR]

Background The microbiology of pathogens causing orbital cellulitis in children is evolving over time, with studies from around 10 years ago describing MRSA as responsible for anywhere from 0 to 13% of cases of orbital cellulitis. However, the prevalence of community-acquired MRSA infections has declined over the past decade. A current understanding of the bacteria most commonly found to be responsible for orbital cellulitis would be important to inform the empiric antibiotic regimens for cases of orbital cellulitis in which no microbiologic data are available. Methods This is a single-center retrospective cohort study of children ≤18 years hospitalized with orbital cellulitis at Children's National Medical Center between January 1, 2017 and July 31, 2018. We excluded children with immunocompromising conditions, cystic fibrosis, underlying craniofacial abnormality, or recent craniofacial or otolaryngologic surgery. Baseline clinical characteristics, microbiologic data, clinical outcomes, and antibiotic treatment data were abstracted through structured chart review and summarized with descriptive statistics. Results We identified 68 children that met inclusion criteria, with an average age of 8.2 years; 66.2% were male, 48.5% were African American, and 14.7% were Hispanic. Most (67.6%) had no underlying medical problems, 14.7% had asthma, and 22.1% had allergic rhinitis. The median duration of symptoms prior to presentation was 4 days. An abscess or phlegmon was identified in 41 of the 68 (60.3%). Three patients (4.4%) developed intracranial complications. About one-quarter (27.9%) of all patients in the cohort underwent surgical drainage. The most commonly identified pathogens were viridans group streptococci (7/19, 36.8%), followed by Staphylococcus aureus (4/19, 21.1%). Anti-MRSA therapy was provided empirically in almost all (95.6%) of patients. Conclusion One-quarter of all patients hospitalized for orbital cellulitis underwent surgical drainage, and viridans group streptococci and S. aureus were the most commonly isolated pathogens. While MRSA was isolated in only one patient (5.2%), almost all received empiric anti-MRSA therapy. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background In this prospective nation-wide survey of bloodstream isolates associated with first episode of FN in high-risk cancer patients from 14 US cancer centers (December 2016 and June 2018), viridans group Streptococci (VGS) were the most common Gram-positive isolate. We sought to clinically and microbiologically characterize VGS bloodstream infections (BSI). Methods Among 343 patients,we compared 90 with VGS vs 253 with non-VGS BSI. Minimum inhibitory concentrations for blood culture isolates were determined by broth dilution for selected agents at our reference microbiology laboratory (UNMC). Clinical data were electronically captured in RedCap, including local site isolate identification and confirmatory reference lab identification via MALDI. Categorical and continuous variables were assessed via chi-square and Mann–Whitney U tests, respectively. Results Ninety-two VGS isolates were identified among 90 FN patients, representing 27% of all BSI isolates. S. mitis or oralis comprised 64 (70%) of VGS. There were no differences between age, sex, and primary diagnosis (50% with AML) among the 2 groups; 1/3 were HSCT recipients. Fluoroquinolone prophylaxis was used in 64 (71%) vs. 139 (55%), P < 0.01, in VGS vs non-VGS groups. Critical illness composite (new need for pressor(s), mechanical ventilation or death within 30 days) was 6 (7%) vs. 44 (17%), P = 0.01, in the VGS vs non-VGS groups. Figure 1 displays an overview of antibiotic susceptibilities for 79 testable isolates. VGS susceptibilities to levofloxacin, penicillin, and ceftriaxone were 39%, 47%, and 94%, respectively. Conclusion VGS are common pathogens in FN patients. Prior fluoroquinolone prophylaxis use may be a risk factor. VGS BSI was not associated with increased critical illness compared with non-VGS. Finally, assuming ceftriaxone susceptibility confers that of cefepime, >90% of VGS are susceptible to empiric FN cefepime regimens. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

The most common causal organism in septic bursitis and pyomyositis is Staphylococcus aureus. Primary subacromial and subdeltoid abscess caused by viridans Streptococcus infection has never been reported and, to our knowledge, nor has diffuse pyomyositis of the rotator cuff associated with subacromial abscess. We describe the clinical presentation, radiological investigations and strategies for the management of a 56-year-old female who presented with purulent subacromial/subdeltoid bursitis and abscess formation in the rotator cuff muscles as a result of viridans Streptococcus infection. Because of its deep anatomic location, primary subacromial/subdeltoid septic bursitis and pyomyositis of rotator cuff muscles are rarely reported. The immunocompromise caused by diabetes mellitus presented a risk factor for the unusual infection observed in this patient. Magnetic resonance imaging aided the diagnosis. Treatment consisted of surgical debridement and drainage, with antibiotic administration, which resolved the infection without sequelae. [ABSTRACT FROM AUTHOR]

A strain of viridans Streptococcus from the pharynx of a 6-year-old healthy girl was found to be inhibitory to Neisseria meningitidis, employing both an agar overlay technique and a cross streaking technique. The results showed that the viridans Streptococcus was also able to inhibit the growth of Pseudomonas aeruginosa, Salmonella typhi, Acinetobacter calcoaceticus and Neisseria lactamica, but was unable to inhibit the growth of Shigella sp. and E. coli. These results suggest that viridans streptococci from the normal pharyngeal microflora may play an important role in regulation of the ecology of the pharynx and upper airways. [ABSTRACT FROM AUTHOR]

Background Patients with suspected urinary tract infection (UTI) are often prescribed an empiric antibiotic treatment due to delays in obtaining results of urine cultures. The BacterioScan System measures the turbidity of incubating urine specimens to provide a qualitative determination of bacteriuria at a density of >5 × 104 colony-forming units (CFU)/mL within approximately 3 hours. We examined the utility of the BacterioScan assay in predicting bacteriuria and assessed the potential impact of this test to reduce the number of urine cultures processed. Methods Urine samples received for culture in the microbiology laboratory of the Cleveland VA Medical Center were collected daily between September 2018 and December 2018. For each specimen, we performed a bacterioscan diagnostic test and compared it with the result of the traditional culture and urinalysis if available. Urinary cultures were categorized into 4 groups as defined in Figure 1. We compared the sensitivity and specificity of the bacterioscan vs. urinalysis (leukocyte esterase and/or pyuria) results. Results 120 urine samples were tested. As shown in Table 1, the BacterioScan had better sensitivity and specificity than the urinalysis for detection of positive urine cultures. The use of the BacterioScan to rule out UTI could have accurately spared 69 of 120 (57.5%) samples from traditional culture and prevented 26 of 120 (21.6%) from possible misinterpretation as infection due to reporting of growth. BacterioScan resulted in 4 of 31 (12.9%) false negatives, but all occurred when positive cultures were due to viridans streptococci or uropathogens in numbers below 100,000 CFU.ml. Conclusion The BacterioScan system is a rapid diagnostic test that provides early information on urine culture results that could help to avoid overuse of empirical antimicrobials in patients with suspected UTI and decrease the workload of the Microbiology Laboratory. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Durable mechanical circulatory support device (MCSD) use continues to grow. MCSD deep-seated infections are a serious complication. Removal of the infected hardware is not always possible. Methods Single institution retrospective review of all culture-proven deep MCSD infection (pump and/or driveline) from 2009–2019. Patients were managed with intravenous (IV) and oral (PO) antibiotics; definitive surgical interventions included incision and drainage (I&D), device replacement, and heart transplant; and temporizing surgical measures were chronic chest tube (CCT) drainage for pump pocket and mediastinum and antibiotic impregnated bead implantation for driveline infection. Outcomes were analyzed. Results Total of 29 patients identified, 23 (79%) were male. Median age at device implantation was 44 years (20–68). MCSD were 18 (62%) destination therapy and 11 (38%) bridge to transplant. MCSD included 1 Heartmate I, 17 Heartmate II, 1 Heartmate III, 4 Heartware HVAD, and 6 Syncardia TAH. The median time to infection of 258 days (43–1551), affecting pump in 8 (28%), pump + driveline in 13 (44%), and driveline in 8 (28%). Microorganisms were S. aureus in 17 (60%, MRSA 11 and MSSA 6); coag-negative staphylococci in 3 (10%); Viridans streptococci in 1; Serratia marcescens in 3; P. aeruginosa in 2; Klebsiella oxytoca in 1; Mycobacterium abscessus in 1 and C. albicans in 1. Antibiotics are given to 28 patients, 23 (80%) with initial IV for a median of 6 weeks (1–14) and 5 (17%) with initial PO, for a median of 7 weeks (2–20). Nineteen patients (83%) on IV received PO antibiotics after. 17 patients (61%) remained on chronic suppression antibiotics (13 PO, 2 IV, 2 PO and IV). Twenty-six (90%) patients had I&D, 6 (21%) had device replacement and 11 (38%) had transplant. Of 21 patients with pump infection 16 (76%) had CCT drainage of pump pocket site or mediastinum for a median of 116 days (range 10–887 days). Of 21 patients with driveline infections, 6 (29%) had antibiotic impregnated bead implants. Overall survival at 90 days was 28/29 (95%) and 24/29 (83%) at 1 year. Infection-related mortality in Table 1. Conclusion Deep MCSD infection remains a challenging clinical problem. CCT drainage (for pump) and antibiotic-impregnated bead implant (for driveline) may be temporizing options for patients unable to undergo timely device replacement or heart transplant. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Distinguishing blood culture (BC) results between common contaminants (CC) and truly pathogenic organisms can be challenging, especially among pediatric patients, but is important for effective clinical care. However, no recent studies have analyzed the true positivity of common BC contaminants in pediatric patients using linked laboratory data from a large national sample of United States hospitals. Methods We conducted a retrospective cohort study among patients ages < 19 using the Premier Healthcare Database (2009–2016), limiting to hospitals reporting ≥ 4 years of BC data and encounters with one of the five most frequent CC among laboratory-confirmed BC. True positivity was defined for each CC as a second positive BC within 48 hours among all BCs. A multivariable logistic regression model including all variables significant in univariate analyses was created comparing encounters: (1) with and without a second BC; and (2) second BC positive vs. negative, with corresponding adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported. Results A total of 5056 isolates corresponding to 4915 encounters with a CC were included in this analysis; 3075 (61%) isolates had a second BC within 48 hours. Adjusted odds of a second BC were higher for encounters from urban (aOR: 1.73, 95% CI: 1.31, 2.29) and ≥ 500 bed hospitals (aOR 1.40, 95% CI: 1.20,1.63). True positivity was 20.2% for coagulase-negative staphylococci (CoNS), 5.9% for Bacillus spp. 5.2% for Viridans group streptococci, 5.0% for Diphtheroids spp. and 3.1% for Micrococcus spp. True positivity for CoNS was higher among neonates but all other organisms were higher for non-neonates (figure). Adjusted odds of true positivity were higher for encounters with chronic conditions (OR 1.44, 95% CI: 1.13, 1.82), a central line in place (OR: 1.65, 95% CI: 1.30, 2.10), per length of stay day (OR: 1.01 (1.01, 1.01), and with an intensive care unit admission (OR: 1.39, 95% CI: 1.08, 1.77). Conclusion True positivity varied substantially by organism, and in most cases was higher among non-neonates. Regional variations for conducting a second BC within 48 hours were found, and more seriously ill patient encounters were more likely to have a common contaminant be pathogenic. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]