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OBJECTIVES We aim to compare the trends of non-communicable diseases (NCDs) and death among people living with HIV (PLWH) and uninfected controls in South Korea. METHODS We identified PLWH from a nationwide database of all Korean citizens enrolled from 1 January 2004 to 31 December 2016. A control cohort was randomly selected for PLWH by frequency matching for age and sex in a 20:1 ratio. To compare NCD trends between the groups, adjusted incidence rate ratios for outcomes across ages, calendar years and times after HIV diagnosis were calculated. RESULTS We included 14 134 PLWH and 282 039 controls in this study; 58.5% of PLWH and 36.4% of the controls were diagnosed with at least one NCD. The incidence rates of cancers, chronic kidney disease, depression, osteoporosis, diabetes and dyslipidaemia were higher in PLWH than in the controls, whereas those of cardiovascular disease, heart failure, ischaemic stroke and hypertension were lower in PLWH. Relative risks (RRs) for NCDs in PLWH were higher than controls in younger age groups. Trends in the RRs of NCDs tended to increase with the calendar year for PLWH vs. controls and either stabilized or decreased with time after HIV diagnosis. The RR of death from PLWH has decreased with the calendar year, but showed a tendency to rise again after 2014 and was significant at the early stage of HIV diagnosis. CONCLUSIONS Although the RR of each NCD in PLWH showed variable trends compared with that in controls, NCDs in PLWH have been increasingly prevalent.

Background: Recently, a new scoring system was developed that uses the red blood cell distribution width (RDW), delta neutrophil index (DNI), and platelet count (PC) to predict mortality in patients with sepsis. We investigated whether a modified simple scoring system based on the RDW, DNI, and mean platelet volume-to-PC (MPV/PC) ratio could predict the mortality of patients with sepsis, and compared it to the previous scoring system. Methods: We conducted a retrospective cohort study of 264 adults who had been treated for sepsis in an emergency department between January 2016 and February 2019. Each patient was rated on a scale of 0 to 3 according to the modified scoring system. Point values were assigned based on RDW > 14.5%, DNI > 5.0%, and MPV/PC ratio >10.1. Results: The 28-day mortality rate was 14.4%. Those who died had higher scores than those who survived (mean: 1.55 ± 0.92 vs 0.93 ± 0.78, P < .001). The area under the curve for the new scoring system was higher than that of the previous scoring system (0.685 vs 0.645). Conclusion: The modified scoring system was a good predictor of the 28-day mortality and was more useful than the previous scoring system for predicting mortality in patients with sepsis.

Background The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis. Materials and methods Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively. Results A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%). The most frequently identified microorganisms were Staphylococcus aureus (51.1%), followed by Streptococci sp. (21.1%), Enterobacteriaceae (8.4%), and coagulase-negative-Staphylococci (CNS; 8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant S. aureus (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections. Conclusion Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered.

Supplementary_data for A Modified Simple Scoring System Using the Red Blood Cell Distribution Width, Delta Neutrophil Index, and Mean Platelet Volume-to-Platelet Count to Predict 28-Day Mortality in Patients With Sepsis by Jun hyoung Kim, Yongseop Lee, Yun Suk Cho, Yu Jin Sohn, Jong Hoon Hyun, Sang Min Ahn, Woon Ji Lee, Hye Seong, Jung Ho Kim, Jin Young Ahn, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Joon-Sup Yeom and Young Goo Song in Journal of Intensive Care Medicine

Background Although it is essential to know the particular causes of antibiotic-resistant infections in the community, there is lack of evidence regarding risk factors for community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteraemia in South Korea. As such, this study aimed to identify risk factors for community-onset ESBL-KP bacteraemia. Methods From May 2016 to April 2017, patients with community-onset KP bloodstream infection (BSI) (n = 408) from six sentinel hospitals participating in the Global Antimicrobial Surveillance System in South Korea were included in this study. Risk factors of ESBL-KP BSI were assessed. Polymerase chain reaction and sequencing to identify genes encoding ESBLs and multi-locus sequence typing were performed. Results Of the 408 patients with community-onset KP BSI, 70 (17%) had ESBL-KP BSI. Admission to a long-term-care hospital within the previous 3 months [odds ratio (OR) 5.7, 95% confidence interval (CI) 2.1–15.6; P = 0.001], previous use of trimethoprim/sulfamethoxazole (TMP/SMT; OR 11.5, 95% CI 2.7–48.6; P = 0.001) or extended-spectrum cephalosporin (OR 2.2, 95% CI 1.2–3.9; P = 0.01), and previous use of a urinary catheter (OR 2.3, 95% CI 1.1–4.5; P = 0.02) were independent risk factors for community-onset ESBL-KP BSI. ESBL-KP isolates most frequently carried the CTX-M-1 group ESBL (74%, n = 52). The most prevalent sequence type (ST) among the ESBL-KP isolates was ST48 (14%, n = 10). Among non-ESBL-KP isolates, ST23 was most prevalent (21%, n = 70). Conclusion Previous admission to a long-term-care hospital, use of a urinary catheter and use of TMP/SMT or extended-spectrum cephalosporin within the previous 3 months were identified as risk factors for community-onset ESBL-KP BSI. Strict antibiotic stewardship and infection control measures are needed for long-term-care hospitals.

Background Antibiotic resistance is a significant threat to public health not only in healthcare setting but also in community because antimicrobial-resistant infections can be transmitted in community. Although it is essential to know whether there are particular reasons that caused antibiotic-resistant infection in community, there is lack of evidence regarding risk factors for community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae bloodstream infection (ESBL-KP BSI) in South Korea. In the present study, we aimed to reveal risk factors for community-onset ESBL-KP BSI. Methods From May 2016 to April 2017, patients with community-onset KP BSI (n = 408) from six sentinel hospitals in South Korea were included. The hospitals are located in different districts throughout South Korea, and had a total of 5,194 beds, ranged from 715 to 1,050 beds per hospital. Admission history and previous usage of antibiotics and medical devices before bacteremia were acquired from National Health Insurance claims data. Risk factors of ESBL-KP BSI were analyzed with a multivariable logistic regression model. PCR and sequencing for the identification of genes encoding ESBLs, and multilocus sequence typing were performed. Results Of 408 patient of community-onset KP BSI, 70 (17%) were ESBL-KP BSI patients. ESBL-KP isolates most frequently carried CTX-M-1-group ESBLs (74%, n = 52), followed by CTX-M-9-group ESBLs (16%, n = 11). Most prevalent sequence type (ST) among ESBL-KP isolates was ST48 (14%, n = 10). Among non-ESBL-KP isolates, ST23 was most prevalent (21%, n = 70). Analyzing with multivariate analysis, recent admission to long-term care hospital within 3 months (OR, 5.7; 95% CI, 2.1–15.6; P = 0.001), previous usage of trimethoprim-sulfamethoxazole (OR, 11.5; 95% CI, 2.7–48.6; P = 0.001), expanded-spectrum cephalosporin (OR, 2.2; 95% CI, 1.2–3.9; P = 0.01), and previous use of urinary catheter (OR, 2.3; 95% CI, 1.1–4.5; P = 0.02) were identified as independent risk factors for community-onset ESBL-KP BSI. Conclusion Recent admission to long-term care hospital, use of urinary catheter, recent usage of antibiotics were identified as risk factors for community-onset ESBL-KP BSI. Strict antibiotic stewardship and infection control measures in long-term care hospital are needed. Disclosures All authors: No reported disclosures.

Background Brain abscess is a fatal neurological infection, despite reduction of mortality rate on account of medical improvement. Therefore, we investigated to identify risk factors for poor clinical outcomes of patients with brain abscess and subdural empyema in Korea. Methods A retrospective analysis was conducted among patients treated for brain abscess or subdural empyema over a period of 11 years between May 2005 and July 2016 in a tertiary hospital, Seoul, South Korea. Based on medical records, we reviewed the clinical findings, therapeutic modalities and prognostic factors of brain abscess or subdural empyema. A multivariate analysis was performed to evaluate the independent risk factors of poor clinical outcomes. Unfavorable clinical outcomes were defined as death or neurologic deficit. Results In total, 121 patients were enrolled in this study. 79 (65.2%) were males and the mean age was 55.3 years. The common symptoms at presentation included a focal neurological deficit (52.8%), a reduced Glasgow coma scale (47%), headache (49.5%) and fever (22.3%). Gram-positive cocci were most frequently isolated as the causative microorganism. The most common location of brain abscess was the frontal lobe (32.5%), followed by parietal (18.7%) and temporal lobe (11.38%) and a subdural empyema (8.26%). 28-day mortality was 2.47% (3/121), and 43.8% (53/121) had long-term disability. In multivariate analysis, reduced GCS, headache at presentation and high blood urea nitrogen were independently associated with unfavorable clinical outcomes. Conclusion In this study, reduced GCS, headache at presentation and high blood urea nitrogen were significant risk factors for unfavorable clinical outcomes in patients with brain abscess and subdural empyema. Disclosures All authors: No reported disclosures.

Background With the emergence of carbapenem-resistant strains of Enterobacteriaceae, non-carbapenem antibiotics are suggested as the alternative treatment of extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae infection. In this study, efficacy of non-carbapenem antibiotics on acute pyelonephritis (APN) with ESBL-producing Enterobacteriaceae was compared with that of carbapenems. Methods The medical records of patients who had diagnosed to have acute pyelonephritis with ESBL-producing Enterobacteriaceae on their urine culture, from January 2011 to December 2018, were reviewed retrospectively. Patients were classified as carbapenem and non-carbapenem group according to the definitive antibiotics they had treated with. Results Total number of patients was 141, including 112 (79.4%) who had received carbapenem, and 29 (20.6%) received non-carbapenem as definitive therapy against to APN with ESBL-producing Enterobacteriaceae. The duration of hospitalization was shorter for non-carbapenem group (median 9.93 days) than for carbapenem group (median 14.39 days) (P < 0.001). The duration of negative conversion of culture was shorter for carbapenem group (median 40.73 hours) than for non-carbapenem group (median 56.79 hours). There was no significant difference in time to febrile period and duration of definitive therapy between two groups. Conclusion Non-carbapenem therapy against APN with ESBL-producing Enterobacteriaceae has no significant difference in clinical outcome compared with carbapenem therapy. Disclosures All authors: No reported disclosures.