Ceftaroline is a novel broad-spectrum cephalosporin that has activity against gram-negative and gram-positive bacteria including methicillin-resistant Staphylococcus aureus. It was approved by the Food and Drug Administration for the treatment of community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections in October 2010. We report 2 cases of S aureus vertebral osteomyelitis treated effectively with ceftaroline.

5058 Background: The presence of elevated nucleated red blood cells (NRBC) in the peripheral blood smear points towards the presence of myelodysplastic syndrome (MDS) or myelophthisis. The intent of our study was to assess the prognostic implication of the presence of increased NRBC in patients with MDS. Methods: Retrospective single institution chart review over a period of 10 years from 2000 to 2010. Our study population comprised 288 diagnosed cases of MDS whose diagnoses were made by bone marrow (BM) examination. Results: 174 patients were male (60.4%) and 114 were female (39.6%). Average age at diagnosis of MDS was 71.92 years. 204 patients were Caucasian (70.8%), 69 patients were African-American (23.9%), 1 patient was Hispanic, 2 patients were Asian, and race was not documented in 12 patients. 117 patients had intermediate-1 IPSS (40.6%), 79 had low IPSS (27.4%), 54 patients had intermediate-2 IPSS (18.7%), 26 patients had high IPSS (9.0%), and 12 patients had unknown IPSS. 131 patients (45.5%) had undetectable NRBC in their peripheral smear prior to their initial diagnostic BM examination. 13 out of these 131 patients (9.92%) progressed to acute myeloid leukemia (AML). 157 patients (54.5%) had one or more NRBC in their peripheral smear prior to their diagnostic BM examination. 27 out of these 157 patients (17.19%) progressed to AML. Survival in days was available in 59 patients. 19 out of 59 patients had undetectable NRBC in their peripheral smear prior to their initial diagnostic BM examination with an average survival of 1,256.2 days. Only one patient in this group underwent allogeneic matched unrelated peripheral stem cell transplantation (PSCT) with a survival of 2,532 days. 40 out of 59 patients had one or more NRBC in their peripheral smear prior to their diagnostic BM examination with an average survival of 850.4 days. Only 3 patients in this group underwent allogeneic matched PSCT (2 related and 1 unrelated) with an average survival of 924.3 days. Conclusions: The presence of nucleated red blood cells in the peripheral blood smear of patients with MDS seems to be a marker of more aggressive disease, higher rates of progression to AML and portends worse survival. To our knowledge this is the first study documenting the prognostic implication of NRBC in the peripheral circulation of patients with MDS. Disclosures: No relevant conflicts of interest to declare.

1925 Introduction: Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic premalignant clonal plasma cell proliferative disorder. It occurs in over 3 percent of the general population over the age of 50. MGUS can progress to multiple myeloma (MM) or related cancers at a rate of about 1.0 to 1.5 percent per year. There are no findings at diagnosis of MGUS that reliably distinguish patients who will remain stable from those who will progress to a malignant disease. Size and type of serum monoclonal protein, as well as serum free light chain ratio have been suggested in some studies as independent risk factors for disease progression. In this study, we tried to analyze the relationship between Mean Corpuscular Volume (MCV) and the risk of progression of MGUS into a malignant lymphoproliferative condition. Methods: A total of 1744 patients, from a single institution, with a first diagnosis of MGUS from April 18th, 1995 till June 24th, 2010 were included in this study. Patients analyzed were divided into two groups. Group 1 consisted of 345 patients with an elevated MCV (>100fL/red cell) and group 2 consisted of 1399 patients with a normal MCV (between 80fL/red cell and 100fL/red cell). Patients with short follow up (<3 months), low B12/folate levels, hypothyroidism, liver disease or a serum monoclonal protein >1.5g/dL were excluded. The Chi-square test was used to compare the proportion of patients who progressed in group 1 relative to group 2. Results: After a median follow up of 51 and 58 months for the high MCV and normal MCV respectively, there were 78 progressions (22.6%) versus 267 non-progressions (77.4%) among the high MCV patients (Group1) and 110 progressions (7.9%) versus 1289 non-progressions (92.1%) among the normal MCV patients (Group 2). The difference in progression between the two groups was statistically significant (Chi-square test p-value < 0.001). The odds ratio for the progression comparison of the high versus normal MCV groups was 3.4 with a 95% confidence interval of 2.5 to 4.7. Conclusion: In our single institution, retrospective study, there seems to be a higher incidence of malignant transformation in the subset of patients with MGUS having an elevated MCV. MCV is a cost effective method that might help identify, at presentation, patients with benign monoclonal gammopathies requiring stricter monitoring. Disclosures: No relevant conflicts of interest to declare.

Purpose To compare the foot external rotation above-knee (FERAK) brace and the Denis Browne boot (DBB) brace in terms of relapse prevention and parents' compliance after successful correction with Ponseti casting. Methods A single-centre, randomized controlled study was conducted between 2016 and 2020. A total of 60 feet in 38 patients with idiopathic clubfoot initially corrected with the Ponseti method were included. They were randomized into two equal groups: the FERAK group and the DBB group. The primary outcome was the efficacy in maintaining correction measured by the Pirani score. The secondary outcomes were parents' compliance and complications (e.g., relapses, skin complications). ResultsThe follow-up period was 24 months for each patient. The mean final Pirani score was 0.42 ± 0.76 in the FERAK group and 0.57 ± 0.82 in the DBB group. This difference was statistically insignificant (p-value = 0.411). Regarding parents' compliance in the FERAK group, 86.7% of parents had good and intermediate compliance while 13.3% had bad compliance. In the DBB group, 66.7% had good and intermediate compliance while 33.3% had bad compliance. This difference was also statistically insignificant (p-value = 0.118). Conclusion Both braces achieved good comparable outcomes after Ponseti casting. However, the FERAK brace yielded slightly better parents' compliance with a less recurrence rate.

4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.