The aim of this study was to identify patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with low risk of infective endocarditis (IE) who might not require routine trans-esophageal echocardiography (TEE). We retrospectively evaluated 398 patients presenting with MRSA bacteremia for the presence of the following clinical criteria: intravenous drug abuse (IVDA), long-term catheter, prolonged bacteremia, intra-cardiac device, prosthetic valve, hemodialysis dependency, vertebral/nonvertebral osteomyelitis, cardio-structural abnormality. IE was diagnosed using the modified Duke criteria. Of 398 patients with MRSA bacteremia, 26.4 % of cases were community-acquired, 56.3 % were health-care-associated, and 17.3 % were hospital-acquired. Of the group, 44 patients had definite IE, 119 had possible IE, and 235 had a rejected diagnosis. Out of 398 patients, 231 were evaluated with transthoracic echocardiography (TTE) or TEE. All 44 patients with definite IE fulfilled at least one criterion (sensitivity 100 %). Finally, a receiver operator characteristic (ROC) curve was obtained to evaluate the total risk score of our proposed criteria as a predictor of the presence of IE, and this was compared to the ROC curve of a previously proposed criteria. The area under the ROC curve for our criteria was 0.710, while the area under the ROC curve for the criteria previously proposed was 0.537 (p < 0.001). The p-value for comparing those 2 areas was less than 0.001, indicating statistical significance. Patients with MRSA bacteremia without any of our proposed clinical criteria have very low risk of developing IE and may not require routine TEE.

Following ertapenem therapy, patients reported improvements in quality of life. This treatment appears promising as an adjunct to biologics or as a bridge to surgery in the treatment of severe, refractory hidradenitis suppurativa.

Application of the new 2015 NHSN definition of catheter-associated urinary tract infection (CAUTI) in intensive care units reduced CAUTI rates by ~50%, primarily due to exclusion of candiduria. This significant reduction in CAUTI rates resulting from the changes in the definition must be considered when evaluating effectiveness of CAUTI prevention programs. Infect Control Hosp Epidemiol 2017;38:239-241.

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Background Hidradenitis suppurativa (HS) is a chronic debilitating cutaneous inflammatory condition caused by follicular occlusion/rupture with resultant inflammatory response. No durable control of HS is seen with current management strategies including topical and/or oral antibiotics, immunomodulatory drugs and local surgery. A recent French study using IV ertapenem for ≥4 weeks showed significant control of severe HS in patients (patients) who failed alternate medical strategies. We performed a prospective trial to study the effectiveness of IV ertapenem in severe HS.Methods A prospective pilot clinical study was done at Henry Ford Hospital, Detroit from May 2013 to December 2015. All patients with severe HS (Hurley Stage III) and who failed medical management by Dermatology were referred to Infectious Diseases for daily IV ertapenem through a PICC line. Patients were followed up for at least 6 months after completion of therapy with weekly monitoring. Data including demographics, clinical response/adverse effects to ertapenem and any PICC line-related complications were recorded. Response to the treatment was based on clinical improvement in pain score/drainage and Hurley Staging of HS.ResultsTwenty-three patients with severe HS consented to participate with a median age of 40 years (range 23–78 years) and 56% were female. Median treatment duration was 8 weeks (range 6–12). A 100% response rate was observed within 2 weeks of initiation and near complete resolution of active inflammation/drainage and improvement of pain score was observed in all patients at the end of treatment. Durable response was variable after completion of ertapenem (median 4 weeks; range 2–12); all subjects relapsed with varying degree of severity. In three patients who relapsed back to Hurley Stage III, ertapenem was restarted after 3 months with successful response. Adverse events include diarrhea (four patients), Clostridium difficile infection (one patient), and PICC line-related DVT (three patients). Clinical benefit despite ertapenem non-responsive bacteria in pretreatment culture of cutaneous drainage suggests an unproven immune-modulatory activity. Role of gut/skin microbial alteration needs further study.Conclusion In selected patients with severe HS, IV ertapenem is highly effective in the control of inflammation and can be useful in combination with local surgery.Disclosures All authors: No reported disclosures.