814. Successful Treatment of Cutibacterium acnes (CA) Prosthetic Device Infection (PDI) with Oral Linezolid and Rifampin (LR)

Abstract Background CA PDI is increasingly recognized. CA is felt to create a slime layer that makes infection more likely and treatment more difficult in this setting. Traditional management has included prosthetic device explantation (PDE), prolonged antibiotic treatment, and delayed reimplantation. Recent interest in the use of oral treatment regimens and single stage procedures with long duration antibiotic therapy led us to treat a series of patients with oral treatment and retained prosthesis after debridement. We report those results. Methods Sequential patients with CA PDI treated with oral therapy were identified. All patients underwent debridement of the tissue, exchange of components and/or reimplantation of the prosthetic device. Only patients with exchanges were included. PDE was excluded. MIC testing for CA isolates was obtained when possible. Initial treatment was recorded at time of surgery. LR was the treatment of choice unless toxicity developed. A minimum of a 3-month follow-up post treatment was required to be included. 6 and 12 month follow up were obtained for all patients but 1 at this time. Results 10 patients were treated (Table 1). Shoulder joint infections were most common. All patients were treated with LR. All completed a minimum of 42 days of treatment (Table 2). The medication was well tolerated. The most common adverse events were nausea. 9/10 patients with 12 month follow up had no evidence of relapse. 1/10 had no relapse at 3 months. Typical for CA infection laboratory markers for infection were not markedly elevated. Notably thrombocytopenia did not occur (Table 3). Table 1. Distribution of Prosthetic Device Infections Table 2. Duration of Treatment Table 3. Selected Laboratory Results Conclusion We demonstrated the ability to successfully treat 10/10 patients with CA PDI without explantation using prolonged oral treatment with LR after debridement. This combination should be considered a treatment option and explored further as a low cost, well tolerated, high value treatment approach to this difficult infection. Disclosures Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker’s Bureau)Merck (Grant/Research Support, Speaker’s Bureau) Kathleen H. Seneca, MSN, Abbvie (Research Grant or Support)Alkermes (Research Grant or Support)Gilead (Speaker’s Bureau)

Background. Staphylococcus aureus surgical site infection (SSI) is common and devastating clinically. Pre-operative decolonization is associated with reduced incidence, but has been variably adopted due to barriers implementing high-efficacy prevention bundles, including unintentional non-compliance applying intra-nasal mupirocin by patients at home. Three Veterans Affairs (VA) facilities attempted to implement an alternate evidence-based SSI prevention program that included intranasal povidone-iodine used in the pre-operative setting to reduce challenging patient-burden steps and to overcome other mupirocin barriers. Our objective was to identify strategies used for successful implementation of intranasal povidone-iodine.
Methods. We conducted pre-and post-implementation semi-structured interviews and site visits at three VA hospitals. Participants included surgery and clinic staff (e.g., nurses, physicians, care managers), infection control staff, and administrative leadership. Interviews were audio recorded and transcribed. Our interdisciplinary team performed a deductive and inductive consensus-based analysis.
Results. Implementation of this SSI prevention process was successful when nurse champions drove the implementation. Qualitative interviews indicate that nurses used a variety of strategies and messages variant on their audience. Nurse-driven facilitators included: key leadership buy-in and strategic decisions about timing and setting of implementation (i.e., start implementation in units with likely early adopters then when project is working well circle back to the early detractors). The primary implementation barrier identified was lack of a champion. One site stated that in the absence of a champion, a mandate or top-down approach may be needed for implementation at their facility.
Conclusion. Nurse champions facilitated successful SSI prevention process implementation. Nurses used strategies and approaches dependent on their knowledge and understanding of the stakeholders and setting to obtain buy-in. Future implementation of new clinical practices should consider utilizing nurse champions to promote uptake.

Session: P-44. HAI: Surgical Site Infections
Background. CA PDI is increasingly recognized. CA is felt to create a slime layer that makes infection more likely and treatment more difficult in this setting. Traditional management has included prosthetic device explantation (PDE), prolonged antibiotic treatment, and delayed reimplantation. Recent interest in the use of oral treatment regimens and single stage procedures with long duration antibiotic therapy led us to treat a series of patients with oral treatment and retained prosthesis after debridement. We report those results.
Methods. Sequential patients with CA PDI treated with oral therapy were identified. All patients underwent debridement of the tissue, exchange of components and/or reimplantation of the prosthetic device. Only patients with exchanges were included. PDE was excluded. MIC testing for CA isolates was obtained when possible. Initial treatment was recorded at time of surgery. LR was the treatment of choice unless toxicity developed. A minimum of a 3-month follow-up post treatment was required to be included. 6 and 12 month follow up were obtained for all patients but 1 at this time.
Results. 10 patients were treated (Table 1). Shoulder joint infections were most common. All patients were treated with LR. All completed a minimum of 42 days of treatment (Table 2). The medication was well tolerated. The most common adverse events were nausea. 9/10 patients with 12 month follow up had no evidence of relapse. 1/10 had no relapse at 3 months. Typical for CA infection laboratory markers for infection were not markedly elevated. Notably thrombocytopenia did not occur (Table 3).