IMPORTANCE Limited data suggest that screening for asymptomatic bacteriuria (ASB) prior to nonurologic procedures is not useful. However, high-quality evidence to support consensus recommendations and influence clinical practice is lacking. OBJECTIVE To characterize the association between detection and treatment of preoperative ASB and postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study involved patients, predominantly male veterans, who underwent surgical procedures in 109 US facilities within the US Department of Veterans Affairs health care system from October 1, 2008, to September 30, 2013. Participants included patients (n = 68 265) who had cardiac, orthopedic, or vascular surgical procedures. Each received a planned clinician review of complete medical records for antimicrobial prophylaxis as well as 30-day surgical-site infection (SSI) and urinary tract infection (UTI) outcomes, and each had a preoperative urine culture result available within the 30 days prior to the procedure. Data analysis was performed from December 2016 to August 2018. MAIN OUTCOME AND MEASURES The primary outcome was the association between preoperative ASB and postoperative SSI. The secondary outcomes included postoperative UTI and the association between antimicrobial therapy for ASB and postoperative infectious outcomes. RESULTS In total, 68 265 patients (65 664 [96.2%] were men and 2601 [3.8%] were women, with a mean [SD] age of 64.6 [9.2] years) were identified, and 17 611 (25.8%) were eligible for inclusion in the primary analysis. Preoperative urine cultures were performed in 17 749 (26.0%) patients, and the results were positive in 755 (4.3%), of which 617 (81.7%) were classified as ASB. With adjustments for age, American Society of Anesthesiologists class, smoking status, race/ethnicity, sex, and diabetes status, patients with or without ASB had similar odds of SSI (2.4% vs 1.6%; adjusted odds ratio [aOR], 1.58; 95% CI, 0.93-2.70; P = .08). Receipt of antimicrobial therapy with activity against the ASB organism was not associated with a reduced SSI risk (aOR, 1.01; 95% CI, 0.28-3.65; P = .99). Urinary tract infection occurred in 14 (3.3%) of 423 patients with ASB and 196 (1.5%) of 12 913 patients without ASB (aOR, 1.42; 95% CI, 0.80-2.49; P = .22). Treatment or prophylaxis for the ASB organism similarly was not associated with reduced odds of postoperative UTI (aOR 0.68; 95% CI, 0.20-2.30; P = .54). The ASB organisms matched a postoperative wound culture in 2 cases, both Staphylococcus aureus. CONCLUSIONS AND RELEVANCE The findings of this study suggest that receipt of antimicrobial therapy with activity against ASB organisms identified in preoperative urine cultures was not associated with reductions in the risk for postoperative infections, including UTI and SSI; such findings suggest there is evidence for discontinuing the practice of screening and treatment for preoperative ASB.

Peritoneal carcinomatosis (PC) is generally considered a lethal disease, with a poor prognosis. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a new approach for peritoneal surface disease. This study investigated the early experience with this combined modality treatment at a single institute. From January 2007 to March 2010, 24 patients were treated After aggressive CS, with HIPEC (cisplatin 25 mg/m2/L and mitomycin C 3.3 mg/m2/L was administered for 90-minutes at 40.5° C). These data suggest that aggressive CRS with HIPEC for the treatment of PC may result in low mortality and acceptable morbidity. Rigorous patient selection, appropriate and prudent operative procedures were associated with encouraging results in our experience.

BackgroundOver 300,000 people in the United States are infected with Trypanosoma cruzi, the parasite that causes Chagas disease. Less than 1% of those people have received antitrypanosomal therapy. We report findings of an ongoing project to address Chagas disease in East Boston, including the epidemiology and cascade of care for this disease.MethodsProviders at the East Boston Neighborhood Health Center were offered continuing medical education sessions on Chagas disease by the Strong Hearts project. One-time screening for Chagas disease is recommended for all patients <50 years old who had lived in Mexico, South or Central America for ≥6 months at the provider’s discretion. Screening is performed by a commercial laboratory using the Hemagen ELISA; confirmatory testing is performed at CDC. Patients with confirmed positive serology are referred to the Center for Infectious Diseases (ID) at Boston Medical Center for evaluation and treatment. We compared the prevalence of Chagas disease by age, sex and national origin. We then used a conditional numerator and fixed denominator to construct the cascade of care, with the stages defined as referred to ID care, evaluation in ID, initiation of treatment and completion of antitrypanosomal therapy. We used chi-squared tests to compare proportions.ResultsFrom March 21, 2017 to April 17, 2019, 5,125 patients were screened. 50 (0.97%) were confirmed to have T. cruzi infection, among them 3 pregnant women. There were no differences in the prevalence of T. cruzi infection by sex (M = 22/1870 [1.18%], F = 28/3305 [0.85%], P = 0.245) but prevalence increased from 0/190 (0%) in those <20 years old to 11/1083 (1.02%) in 40–49 year olds (P = 0.001). The 3 infants of infected mothers were screened. The cascade of care for Strong Hearts is displayed in Figure 1.ConclusionChagas disease prevalence in at-risk communities in Boston is substantial. 20% of patients with T. cruzi infection identified in this program have completed treatment to date. Most infected patients were referred for evaluation, but substantial drop-off occurred at each of the next 3 steps of the cascade. Confronting barriers at each of these steps is a crucial component of efforts to address this neglected disease. Disclosures All authors: No reported disclosures.

Background This study reports on the results of a screening program for Chagas disease in East Boston. Methods Based at the East Boston Neighborhood Health Center, the Strong Hearts Program offers continuing medical education sessions on Chagas disease to providers in Adult Medicine, Pediatrics, Family Medicine and Obstetrics. Providers are encouraged to offer one-time screening for Chagas disease for all patients who lived in Mexico, South or Central America for ≥6 months, at their discretion. A commercial lab performs the initial screening test using the Hemagen ELISA while confirmatory testing is performed at the US CDC. For each patient, completion of screening requires a multi-step process consisting of splitting the serum sample to save a frozen aliquot for send out to CDC if the ELISA is positive/indeterminate, monitoring screening results to send the saved aliquot to the CDC if indicated, filling out the CDC requisition, shipping the serum aliquot, and monitoring the result returning from the CDC. Patients diagnosed with confirmed Chagas disease are referred to Boston Medical Center for further evaluation and treatment if indicated. Results From 3/21/2017 – 5/18/2020, 8,142 patients were screened. 423 (5.2%) patients had an initial positive test, 7,669 (94.2%) initially tested negative and 50 were indeterminate (0.6%). Among those with a positive screening result, 76 were confirmed to have T. cruzi infection for an overall prevalence of 0.93% in this population. 293 (69.3%) patients with positive screening tests had a negative (discordant) confirmatory test, 18 (4.3%) had an indeterminate test, and 36 (8.5%) had results that were unavailable or pending as of this analysis. None of the indeterminate screening tests were positive upon confirmation. Conclusion Prevalence of infection with T. cruzi was nearly 1% among patients in East Boston who had lived in Latin America. Diagnosis of Chagas was challenging due to a large number of false positive screening tests. The resource burden imposed by current screening options is itself a barrier to addressing Chagas disease. Given the significant prevalence of Chagas disease in the US, increased access to tests (i.e., two-step screening conducted through commercial laboratories) and screening assays with improved specificity are needed. Disclosures All Authors: No reported disclosures