bluuebunny/crossref_metadata_2025 huggingface dataset:
2557. Knowledge, Attitude, and Practices on Vaccination and Occupational Health Among Healthcare Workers in a Teaching Hospital in Mexico City
Authors: Lopez-Enriquez Claudia , Martinez-Hernandez Lucia , Donis-hernandez Jose-Juan , Virgen-Cuevas Margarita
Published: October 2019

Background

Vaccination is one of the most effective ways to prevent the transmission of certain bacterial and viral diseases and it has reduced the associated morbidity and mortality. WHO estimates that all over the world 59 million healthcare workers (HCWs) are exposed every day to multiple occupational hazards.

Methods

Cross-sectional survey of a sample of HCWs from a hospital in Mexico was conducted through an anonymous, self-administered questionnaire between October 2015 and May 2016.

Results

Of 930 HCWs 76% completed the questionnaire. Among responders 64% declared knowing the required vaccines. Specialties associated with greater knowledge in vaccines were: Internal medicine (70%) (P = 0.04) and Pediatrics (63%) (P = 0.003); however, only 31% and 34% respectively were vaccinated against influenza. The mean number of years since influenza vaccination was 1.5 ± 1.8 and only 30% workers reported having been vaccinated in the period 2015–2016; 61.2% referred at least one dose against hepatitis B with a mean of 4.4 ± 4.4 years since the application, 15% reported knowing their immune status for hepatits B. In total 65% have been vaccinated against Tdap/td with an average of 3.7 ± 3.9 years from application. The reasons for not getting vaccinated included: Not having access to vaccines in 34%, cost in 8%, fear of adverse events 8%, belief of not require to be vaccinated in 5%. A total of 82.5% HCWs have worked while been sick. Reasons: Sense of duty in 57%, perception of poor performance in 21%, not disappointing colleagues in 13% and not letting down patients in 8%. Better compliance in vaccination coverage was observed among laboratory personnel: OR 2.0 (95% CI 1.0–4.7; P = 0.04) and nursing staff: OR 1.5 (95% CI 1.0–2.3; P = 0.01). There was no difference in compliance by medical specialty (P = 0.5). In total 17% HCWS reported having some occupational accident in the last 10 ± 5 years. Working in the emergency room: OR 1.6 (IC95% 1.0–2.4, P = 0.01); Unit of Intensive Care OR: 1.5 (IC 95% 10–2.3; P = 0.3) and operating room OR: 1.5 (IC95% 09–2.5; P = 0.05) were risk factors for occupational accidents.

Conclusion

HCWs vaccination coverage and knowledge were poor. Considering the important role of HCWs in preventing diseases, it should be mandatory that all HCWs receive proper advice concerning vaccination at their work place.

Disclosures

All authors: No reported disclosures.
2559. A Novel Approach to Interprofessional Education to Expand HIV Workforce Pipeline
Authors: Leedy Nicole , Porterfield J Zachary , Romanelli Frank , Stover Crystal , Thornton Alice
Published: October 2019

Background

Effective care for persons living with HIV (PLWH) requires a coordinated, multi-disciplinary approach that includes social workers, physicians, advanced practice providers, pharmacists, social workers and community outreach workers. Unfortunately, these individuals often work and train independently of one another without a full sense of the responsibilities and contributions of others. Too often, this results in fragmented or ineffective care.

Methods

In response to the need to improve exposure to both HIV and coordinated interdisciplinary care, the Kentucky AIDS Education and Training Center at the University of Kentucky developed the HIV Interprofessional Education (IPE) Program in 2016. This dynamic IPE links students in multiple professional training programs (including pharmacy, medical, social work, and physician assistant students) to a year-long curriculum designed to acquire advanced skill sets for the treatment of HIV/AIDS. This curriculum includes inpatient and outpatient shadowing opportunities with multiple departments, didactic seminars, flexible mentored learning, and a collaborative capstone project designed to impact the local HIV community.

Results

We report on the development of this program as well as a comprehensive assessment of the quantitative and qualitative experiences of our trainees. Participants reported significant improvements in their understanding of not only the complexities of the continuum of care for PLWH but also on how to improve care by enhancing collaboration between disciplines. They also reported development of critical and generalizable skills including taking a social history, addressing co-morbid mental health and substance abuse issues, cultural competency, screening and prevention strategies for HIV.

Conclusion

As we strive to provide comprehensive and effective care for PLWH aimed at achieving the goals of universal test and treat and retention in care, we must find way to improve crosstalk and understanding of the interdisciplinary nature of modern medical care. Ideally, this begins during training. We present our experience in the development of a novel and highly effective program which has spanned multiple departments and has substantially impacted the approach to HIV care in our trainees.

Disclosures

All authors: No reported disclosures.
2561. Doxycycline Saves Lives! Educating Healthcare Providers on Tickborne Rickettsial Diseases in the United States Using an Online Toolkit
Authors: Binder Alison M , Armstrong Paige
Published: October 2019

Background

Tickborne rickettsial diseases (TBRDs), including Rocky Mountain spotted fever (RMSF), are major causes of illness in the United States. Doxycycline is the first-line treatment for patients of all ages; delay in treatment is the single most important predictor of fatal outcome. Recent assessments have identified a lack of knowledge in recognition and treatment of RMSF among providers. CDC developed an online toolkit to address the need for increased awareness in the medical and public health communities.

Methods

In August 2018, CDC released the Rocky Mountain Spotted Fever (and other tickborne diseases) Toolkit for Healthcare Providers, an online platform including: (1) Narrated video discussing RMSF clinical presentation, diagnosis, and treatment, (2) Physician pocket card, (3) Clinical timeline with images to aid diagnosis, and (4) Tickborne Diseases of the United States Manual. Participants receive free continuing education (CE) by scoring ≥75% on a posttest and providing an evaluation. We summarized post-test scores and evaluations to assess impact on participant knowledge and satisfaction with the format.

Results

As of April 30, 2019, there have been 14,103 visits to the toolkit website. In total, 247 participants registered for CE and completed the posttest; 245 (99%) passed. The majority of participants self-reported as nurses (121, 49%), followed by other professionals (32, 13%) and physicians (31, 13%). All posttest questions except one indicated correct responses were selected by ≥80%. In all, 245 provided a course evaluation; 94% agreed the content and materials addressed a gap in their knowledge, and 84% agreed the knowledge gained from the activity could be applied to practice. Nearly all (96%) agreed the delivery methods used was appropriate and aided in learning the content. Suggested improvements included integration of case-based scenarios, Spanish-language materials, and more information on epidemiology and information on TBRDs in vulnerable populations.

Conclusion

Participation in this online toolkit led to improved knowledge and confidence among providers regarding timely diagnosis and treatment of TBRDs, highlighting the utility of online education in addressing gaps in provider awareness of TBRDs in the United States.

Disclosures

All authors: No reported disclosures.
2574. Temporal Changes in the Vaginal Microbiome During Treatment for Bacterial Vaginosis: Is Lactobacillus Iners an Important Player?
Authors: Shay Elizabeth O , Goje Oluwatosin , Padmanabhan Roshan , Eng Charis
Published: October 2019

Background

Bacterial vaginosis (BV) is the most common vaginal condition affecting women of reproductive age and yet it remains poorly understood. Recurrent BV causes significant emotional and psychological distress and can prove difficult to resolve with currently available treatments. We aimed to investigate the microbiome of recurrent BV patients at various time points in relation to oral Metronidazole treatment.

Methods

Women aged 18–40 years, with recurrent BV, were prospectively enrolled. Vaginal samples (lavage) were collected at baseline (D0), at 7–10 days (D7) and 30–40 days (D30) after initiation of oral metronidazole treatment (500 mg BID, 7 days). DNA was extracted, amplified using primers targeting the V3-V4 region of the 16 srRNA, and then sequenced and processed through a hybrid Qiime MICCA bioinformatics pipeline.

Results

Seventeen recurrent BV patients were enrolled. Alpha diversity decreased (P = 0.0049) after the first week of treatment with oral metronidazole, but increased (P = 0.0062) to near baseline by D30. Lactobacillus iners, was the dominant Lactobacillus, with transient increase in this species corresponding with metronidazole treatment. There was also a decrease in Gardnerella vaginalis that re-normalized to baseline at 30 days. Of the 10 recurrent BV patients with data for all three time points, 4 relapsed by D30. Β diversity differed significantly between patients that relapsed and those that did not (p = 0.044). Alpha diversity did not differ between the groups (p = 0.07).

Conclusion

The dominant Lactobacillus pretreatment in this cohort was L.iners. Oral metronidazole was associated with a decrease in alpha diversity, decrease in G. vaginalis and increase in L. iners. Although L. iners increased after metronidazole treatment, this increase was not sustained by D30. Treatment with metronidazole, only temporarily altered the microbiome. Further studies are needed to clarify the role of L. iners in recurrent BV.

Disclosures

All authors: No reported disclosures.
2589. Two Cases of Congenital Babesiosis
Authors: Hachey Kevin , Lewis Deirdre , Rodriguez Julieta L , Richardson Matthew W , Johnston Alicia M
Published: October 2019

Background

Babesiosis is caused by Babesia microti and often transmitted via Ixodes scapularis. To the best of our knowledge, only 9 cases of vertical transmission have been reported. The spectrum of clinical presentation and optimal therapy for this population remains unknown.

Methods

Case 1 is a 4 week old female admitted with fever and irritability for 2 days. She was pancytopenic, with Hgb of 9.2 g/dL, Plt of 57 K/mm3, and absolute neutrophil count (ANC) of 500/mm3. Thin smear revealed 2.5% parasitemia. Mother was diagnosed with acute Lyme disease in the seventh month of pregnancy. Maternal serologies were positive for B. microti (IgM 1:100 and IgG >1:320). The infant received 1 PRBC transfusion and was treated with 10 days of atovoquone and azithromycin. Case 2 is a 5 week old female twin A admitted with 2 days of pallor, fatigue and poor feeding. Initial Hgb was 3.4 Gm/dL. Peripheral blood smear revealed many intraerythrocytic parasites consistent with B. microti. Thin smear obtained 24 hours after initiation of therapy showed 2% parasitemia. During hospitalization, the patient developed neutropenia with ANC nadir of 800/mm3. The patient required 4 PRBC transfusions and was treated with azithromycin and atovoquone for 10 days. The mother had an acute, self-limited febrile illness at 23 weeks gestation. At infant’s presentation, maternal serologies revealed negative B. microti IgM and positive IgG (1:160). Placental tissue from both twins was positive for B. microti DNA by PCR. Twin B was asymptomatic, had negative B. microti blood PCR, a negative B. microti IgM, positive IgG of 1:30 felt to represent transplacental maternal antibody, and did not require treatment.

Results

Both infants were successfully treated without relapse.

Conclusion

Congenital babesiosis is rare and may cause profound hematologic disturbances. We report 2 cases exhibiting neutropenia in addition to anemia and thrombocytopenia, supporting recent assertions by Wormser et al. that this is a common finding. In addition, Case 2 presented with a severe hemolytic anemia significantly worse than previously reported. Finally, we demonstrated successful treatment in neonates without exchange transfusion, even with severe anemia.

Disclosures

All authors: No reported disclosures.
2600. Mannose-Binding Lectin Polymorphisms are Important Modulating Factors in Community- and Hospital-Acquired Pneumonia Caused by Legionella spp.
Authors: Kavaliauskas Povilas , Prakapaite Ruta , Saab Frederic , Petraitiene Ruta , Jarraud Sophie , Semoskaite Rasa , Baneviciene Rasa , Planciuniene Rita , Walsh Thomas J , Petraitis Vidmantas
Published: October 2019

Background

Community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) are the leading causes of death from infection in developed countries. Mannose-binding lectin (MBL) is a C-type serum lectin that plays a central role in the innate pulmonary host defenses against respiratory pathogens. We hypothesized that MBL polymorphisms may increase the risk of developing Legionella pneumonia. Therefore, the aim of this study was to evaluate the role of MBL polymorphisms in susceptibility to CAP and HAP caused by Legionella spp.

Methods

A total of 96 BAL and blood samples collected for routine microbiological analysis from Lithuanian patients presenting with CAP and HAP, were used for this study. MBL polymorphisms in the 54 codon (54 G/G, 54 G/A, and 54 A/A) were detected by BanIRFLP. Legionella spp. were detected by nested PCR.

Results

Polymorphisms in the 54 codon of MBL were determined in 96 patients. Among 96 patients with CAP and HAP, the most commonly observed 54 codon MBL variant was 54 G/G (69.8%, n = 67), followed by 54 G/A (21.9%, n = 21), and 54 A/A (8.3%, n = 8). By using nested PCR, Legionella pneumonia was detected among 15.6% (n = 15) of patients diagnosed with CAP and HAP. Legionella spp. were detected among 7 patients with MBL 54 codon G/G variant (10.4%), while 3 patients with MBL 54 G/A (14.3%), and 5 patients with MBL 54 codon A/A variant (62.5%). During this study Legionella spp. were detected more frequently (P < 0.05) among patients with the A/A variant of the 54 codon vs. those with other variants of MBL 54 codon. There were no significant differences found among those with Legionella infection and G/A (14.3%) or G/G (10.4%) variants of MBL gene 54 codon.

Conclusion

MBL gene 54 codon variant A/A polymorphisms may play an important role in increased susceptibility to lower respiratory infectionscaused by Legionella spp.

Disclosures

All authors: No reported disclosures.
2602. Genetic Basis of Staphylococcus aureus Virulence
Authors: Adams Edward W , Ward Doyle V , Barton Bruce A , Ellison Richard T , Olaitan Oladapo
Published: October 2019

Background

Although multiple different virulence factors have been identified for Staphylococcus aureus, there is limited information on genetic variation present between different strains of S. aureus in the clinical setting. To better define whether differing virulence factors could contribute to differing clinical manifestations of S. aureus infections we undertook a comparison of the frequency of virulence and antibiotic resistance genes present in S. aureus isolates from different clinical sites.

Methods

Whole-genome sequencing was performed on a convenience sample of S. aureus isolates from clinical or surveillance cultures obtained at an academic medical center over a 27-month period. Genomic assemblies were generated and annotated to define protein-coding regions. The prevalence of 28 genes previously defined as being associated with S. aureus virulence or antimicrobial resistance, including MSCRAMM genes, was then analyzed in relation to nine specific culture sources including only a single isolate from each culture source per patient using a likelihood ratio χ 2 analysis.

Results

There were 1286 S. aureus isolates with draft assemblies and annotations, and there was a statistically significant (P < 0.01) difference in gene frequencies between culture sources for 18 genes that included 13 of 19 virulence factors, 4 of 7 antibiotic resistance genes and 1 of 2 MSCRAMM genes. The most notable variation was seen for the presence of the sec, sep, entB, lukS, lufK, fosB, mecA, and ermA genes (all with P < 0.0001). There were also significant variations in overall gene frequency patterns between isolates from wound, blood, and respiratory isolates (P < 0.0001), as well as significant differences in the frequency of cna and hlY genes between surveillance and clinical isolates (P < 0.0001).

Conclusion

This study demonstrates a difference in the prevalence of virulence and antibiotic resistance genes in S. aureus isolates based on the culture source. As the culture location can be considered a surrogate for different types of infections (such as bacteremia, pneumonia, urinary tract infections) these differences in gene frequency may contribute to variation in the clinical manifestations of infections by differing S. aureus strains.

Disclosures

All authors: No reported disclosures.
2614. Demographic and Clinical Characteristics by Antiviral Prescription in Influenza-Positive Children who Presented to Seven US Emergency Departments
Authors: Hamdan Lubna , Probst Varvara , Rahman Herdi Kurnia , Stewart Laura S , Dantuluri Keerti , Howard Leigh M , Speaker Andrew , Szilagyi Peter G , Ogokeh Constance E , Weinberg Geoffrey A , Klein Eileen J , Sahni Leila C , Englund Janet A , Williams John V , Rha Brian , Boom Julie A , Michaels Marian G , Selvarangan Rangaraj , Harrison Christopher J , Lively Joana Y , McNeal Monica , Campbell Angela P , Halasa Natasha B
Published: October 2019

Background

Antiviral (AV) therapy is recommended for children < 2 years, hospitalized, or with underlying conditions (UC) and suspected influenza (flu). We sought to compare demographic and clinical characteristics by AV prescription in flu-positive children who presented to the emergency department (ED) and determine the percentage of AV prescription in these high-risk children.

Methods

Children < 18 years who presented with respiratory symptoms and/or fever at seven New Vaccine Surveillance Network sites were enrolled. We conducted interviews, obtained mid-turbinate nasal and/or throat swabs for molecular flu testing (results unknown to providers), and reviewed medical charts for AV prescription after presenting to the ED. These are preliminary data.

Results

From December 2016 to June 2018, 9,524 subjects were enrolled and tested for flu; 1,260 (13%) were flu-positive by research testing; 54% were male, median age was 41 months, and 23% were prescribed an AV. The frequency of AV prescription differed by study site (Figure 1). Among research-tested flu-positive patients, AV were prescribed to 25% of children < 2 years, 31% of children with UC, and 51% admitted to the hospital from the ED (Table 1). Of the 388 (31%) clinically-tested flu-positive patients, 52%, 66%, and 77% of the same high-risk groups were prescribed an AV, respectively.

Conclusion

AV prescriptions varied by study site and differences by race, ethnicity, and clinical presentation were noted. Clinical testing was associated with higher use of AV treatment in appropriate target patients. Efforts are needed to understand AV use patterns and improve prescription rates in recommended patients.

Disclosures

All authors: No reported disclosures.
2617. Increased Nasopharyngeal Pneumococcal Density During Asymptomatic Respiratory Virus Infection Is Associated with Subsequent Development of Acute Respiratory Illness
Authors: Howard Leigh M , Zhu Yuwei , Griffin Marie , Edwards Kathryn , Williams John V , Gil Ana , Vidal Jorge E , Klugman Keith , Lanata Claudio , Grijalva Carlos G
Published: October 2019

Background

Increased density of nasopharyngeal (NP) pneumococcal colonization has been associated with invasive pneumococcal disease in children. However, factors that lead to increased pneumococcal density are poorly understood. We sought to determine whether viral detection during asymptomatic periods in young children was associated with increased NP pneumococcal density and the subsequent development of acute respiratory illness (ARI).

Methods

Using NP samples obtained during asymptomatic periods from children less than 3 years of age in the rural Peruvian Andes, we determined NP pneumococcal colonization density by quantitative polymerase chain reaction (qPCR) and identified respiratory viruses by RT–PCR. We examined the association between viral detection and pneumococcal density adjusting for relevant covariates using a multivariable quantile mixed effects regression model. We also assessed the association of pneumococcal density during asymptomatic periods in these children on the time to the next ARI using survival analysis.

Results

During asymptomatic periods, the presence of NP pneumococcal colonization was more common when respiratory viruses were detected. In addition, in the multivariable model, log10-transformed pneumococcal densities were significantly higher during asymptomatic periods when viruses were detected [median 4.52 (4.14, 5.01) P < 0.001], specifically human rhinovirus (HRV) [median 4.58 (4.27, 5.12), P < 0.001] and adenovirus (AdV) [median 4.21 (3.79, 4.91), P = 0.014], compared with when no virus was detected [median 3.16 (2.92, 3.73), Figure 1]. Increased pneumococcal density was also significantly associated with a higher rate of subsequent ARI (p = 0.008, Figure 2).

Conclusion

Among young children, detection of respiratory viruses during asymptomatic periods was associated with increased pneumococcal colonization density, which, in turn, was associated with higher rate of subsequent ARI.

Disclosures

All authors: No reported disclosures.
2635. Outbreak of Enterovirus D68 Among Children in Japan and Simultaneous Circulation of Clade B3 in Europe
Authors: Ikuse Tatsuki , Aizawa Yuta , Yamanaka Takayuki , Habuka Rie , Watanabe Kanako , Otsuka Taketo , Saitoh Akihiko
Published: October 2019

Background

Enterovirus D68 (EV-D68) is a re-emerging, high-morbidity pathogen that causes severe respiratory infection and acute flaccid myelitis in children. EV-D68 is phylogenetically divided into 4 major groups—clade A through D—and each clade has subclades defined by genetic variant. Outbreaks of all strains have been reported in more than 10 countries. However, no study has compared the viral genomic characteristics of EV-D68 in contemporaneous outbreaks in different countries.

Methods

An outbreak of EV-D68 in children younger than 15 years occurred in Niigata, Japan, from October through November 2018. The patients were admitted to hospital with respiratory distress and wheezing episodes. RNA extracted from nasopharyngeal samples was tested by EV-D68-specific PCR. Clade was determined by semi-nested PCR analysis of the VP1 region, and the phylogenetic tree of the VP1 sequence was constructed. To clarify viral genomic characteristics, we compared the clade to those of outbreaks occurring during 2014–2018 in other countries.

Results

EV-D68 testing of 47 patients yielded positive results for 22 (47%) (median age 4.6 years; IQR, 2.9–6.7), and 15 (69%) had a past medical history of allergic disease. No patient developed acute flaccid myelitis. The VP1 sequences from all isolates belonged to clade B3, the same clade detected during the 2015 outbreak in Japan (figure). Interestingly, EV-D68 outbreaks were reported in France and Italy (clades D1/B3 and D1, respectively) during this period. Although the EV-D68 clades responsible for outbreaks in 2014 differed by region, clade B3 is now the dominant clade and has caused concurrent EV-D68 outbreaks in children since 2015 (table).

Conclusion

In 2018, an EV-D68 clade B3 outbreak occurred among children in Niigata, Japan. This clade is now dominant and periodically circulates around the world. Because EV-D68 can cause simultaneous outbreaks worldwide and is associated with high morbidity, detailed real-time epidemiological surveillance of EV-D68 is warranted.

Disclosures

All authors: No reported disclosures.
2636. Distinguishing Pertussis from Viral Mimickers: Development and Validation of a Clinical Prediction Score
Authors: Al-Barwani Lamya , Al-Busaidi Muna , Alhinai Zaid , Al-Shibli Naema
Published: October 2019

Background

Pertussis is often confused with respiratory viral infections, leading to misdiagnosis and overuse of antibiotics. Distinguishing the two entities more accurately can help optimize care.

Methods

We reviewed the charts of children under 18 years of age who presented to Sultan Qaboos University Hospital in Muscat, Oman and were tested for Bordetella pertussis by PCR between 2013 and 2018 (discovery cohort). Clinical and laboratory data were collected from the electronic patient record and analyzed. Backward conditional logistic regression was used to identify independent predictors of laboratory-confirmed pertussis cases. The Muscat Pertussis Index (MPI) score was developed based on the logistic regression model. The MPI score was retrospectively validated on a separate cohort of pediatric patients who presented to the Royal Hospital- Oman’s largest pediatric center- between 2017 and 2018, and were similarly tested for pertussis (validation cohort). Ethical approval of the study was obtained formally for both sites.

Results

354 patients were enrolled in the discovery cohort. 196 (55%) were male, and the median age was 10 weeks (IQR, 6–16). 57 (16%) patients tested positive for B. pertussis by PCR, while 266 (75%) tested positive for respiratory viruses. 32 (9%) patients had both pertussis and a viral co-infection and 63 (18%) were negative for both. 255 (72%) patients received macrolide antibiotics. Younger age, fewer vaccine doses, contact with a sick adult, longer symptom duration, paroxysmal cough, cyanosis, post-tussive emesis, apnea, lymphocytosis and thrombocytosis were significantly associated with pertussis (Table 1). After logistic regression, independent predictors of pertussis were longer symptom duration, lymphocytosis, paroxysmal cough, lack of fever, cyanosis and age under 8 weeks. This formed the basis for creating the MPI score (Table 2). The MPI score was validated on a cohort of 122 patients. Higher MPI scores correlated significantly with confirmed pertussis cases (area under the receiver operating characteristics curve = 0.899, P < 0.001, Figure 1 and Table 3).

Conclusion

The majority of suspected pertussis cases were actually due to viral mimickers. The MPI score can predict likely cases of pertussis before laboratory confirmation. Future validation in more diverse settings would help expand its applicability.

Disclosures

All authors: No reported disclosures.
157. Hospital-Onset Staphylococcus aureus Bacteremia Is Associated with More Than Twice the Mortality Compared with Community-Onset: Evaluation of 58 Hospitals
Authors: Daragjati Florian , Sebastian Danielle , Sturm Lisa K , Saake Karl , Sharma Mamta , Fakih Mohamad G
Published: October 2019

Background

Staphylococcus aureus is a common pathogen that is implicated with both community and healthcare-associated infections. S. aureus infections lead to sepsis and bacteremia, and are associated with considerable morbidity and mortality despite available antimicrobial therapy.

Methods

Utilizing a clinical decision support system, patients with the presence of at least 1 positive blood culture for S. aureus were identified from April 2018 to March 2019, in 58 hospitals from a single health system. Patients were then matched in the outcomes measures database to obtain the following outcome measures: mortality, complications rate, length-of-stay (LOS), and cost. The S. aureus bacteremia (SAB) outcome measures were compared between community-onset (CO), and hospital-onset (HO).

Results

There were 2,700 SAB cases within the system identified during that time period. Baseline characteristics were similar between patients with CO-SAB and HO-SAB. CO-SAB accounted for 89.4% (2,413/2,700) of the overall cases, while 10.6% (287/2,700) of the cases were HO-SAB. For overall SAB, the observed mortality rate was 11.9% (321/2,700), complications rate was 35%, observed LOS was 11.97 days, and mean observed cost per admission was $29,114. There is a statistically significant higher observed absolute mortality rate (14.8%, 95% CI 9.61, 19.93), complications rate (53.3%), LOS (11.06 days), and cost per admission ($33,285) for HO-SAB, compared with CO-SAB.

Conclusion

HO-SAB is associated with more than twice the mortality, complication rate, LOS, and cost compared with CO-SAB. Structured efforts to reduce the risk for HO SAB and optimizing management of SAB are essential to improve patient outcomes.

Disclosures

All authors: No reported disclosures.
2647. Influenza Treatment Rates in UK Primary Care Settings: Real-World Data Analysis of the CPRD, 2003–2018
Authors: Chawla Devika , Dayal Parul , Kuhlbusch Klaus , Moawad Dalia , Wallick Chris , Keebler Daniel
Published: October 2019

Background

Influenza remains a significant public health burden, resulting in serious morbidity and mortality globally. The National Institute for Health and Care Excellence (NICE) recommends treatment with antivirals for a broad range of high-risk influenza cases; however, anecdotal reports suggest treatment rates in the United Kingdom remain low. Real-world evidence on influenza treatment patterns in this region is limited. We therefore sought to investigate the proportion of influenza cases presenting to UK primary care facilities that receive antiviral treatment.

Methods

Data were obtained from the Clinical Practice Research Datalink (CPRD), a database of medical records from 674 primary care facilities in the UK. Cases were eligible for study inclusion if a diagnosis code for influenza or influenza-like illness (ILI) occurred between 1 January 2003 and 31 December 2018, and the medical record had sufficient data quality. Treatment was defined as prescription of an antiviral (oseltamivir, zanamivir, peramivir, or amantadine) within ±10 days of diagnosis. We examined (1) treatment rates, overall and by study year to understand time trends, (2) distribution of antiviral types prescribed, and (3) patient characteristics across treatment status.

Results

Of the 116,923 cases of influenza that met study inclusion criteria, 10,923 (9.3%) were treated with an antiviral. Treatment rates varied by study year, ranging from <1.0% in 2004 to 24.0% in 2009. The most recent study year (2018) had a treatment rate of 11.2%. Oseltamivir was the most frequent antiviral prescribed, followed by zanamivir. Treated cases of influenza were younger and more likely to be female compared with untreated cases.

Conclusion

We evaluated real-world estimates of influenza treatment rates over a 16-year period in UK primary care settings, where anecdotal reports suggested low treatment rates. Consistent with these reports, we observed low treatment rates, likely due in part to inclusion criteria and clinical guidelines specifying treatment only for high-risk cases. Subsequent analyses will investigate treatment patterns and patient characteristics in high-risk vs. low-risk cases to provide additional context for observed treatment rates.

Disclosures

All authors: No reported disclosures.
2649. Measles-Containing Vaccination Resulted in a Balanced Cytokine Profile Without Evidence of Immunosuppression in Healthy 12-Month-Old Children
Authors: Gans Hayley , Wang Weiqi , Rosenberg-Hasson Yael , Zerbo Ousseny , Modaressi Sharareh , Goddard Kristin , Lewis Ned , Bok Karin , Klein Nicola
Published: October 2019

Background

Measles virus infection results in immune activation, viral clearance and lifelong immunity. In addition, there is an immunosuppressive state defined by type 2 skewing of CD4+ T‐cell cytokine production and induction of regulatory T cells with reduced dendritic cell (DC) activation in the recovery phase. Studies following measles immunization show conflicting immune profiles. To more robustly interrogate and define specific functional cytokine profiles, this study evaluated cytokine profiles in 12-month old infants before and after primary MMR vaccination.

Methods

Cytokine profiles using luminex assay (62-plex; eBioscience) were measured in 65 infants before and 42 days after MMR vaccination administered at 12 months of age as part of a randomized clinical trial. Mean cytokine percentages of children with increased or decreased concentrations of each cytokine in the post sample compared with the levels in the pre sample were evaluated using Student’s t-test. Cytokines were arranged into dominant CD4+ T-cell type, Th1, Th2, and T regulatory (Treg) and those produced by DC.

Results

No dominant cytokine pattern emerged following measles immunization, with a balanced profile. The mean percentage of children with increased and decreased concentrations (pg/mL) of signature CD 4+ T-cell Th1 (tumor necrosis factor alpha [TNFa], interferon gamma [IFNg]), Th2 (Interleukin [IL] IL5, IL4, IL13), Treg (IL10, transforming growth factor-β TCFb) and DC (IL12P40 and IL12P70) cytokines were equivalent when measured at 42 days after MMR vaccine compared with levels before vaccine (Table 1) (P ≥ 0.05 for all comparisons).

Conclusion

In contrast to data demonstrating an immune suppression profile following measles disease, measles-containing vaccine did not suppress Th1 CD4+ T-cell and DC cytokines or promote Th2 and Treg CD4+ T-cell cytokines measured 42 days after vaccination. The cytokine profile represents one of balance and homeostasis. This study supports the data that show measles vaccine does not cause immunosuppression in healthy infants.

Disclosures

All authors: No reported disclosures.
2652. Cytomegalovirus Meningoencephalitis: A Comparison to Other Viral CNS Infections
Authors: Pankow Stephanie , Masayuki Nigo , Hasbun Rodrigo
Published: October 2019

Background

Cytomegalovirus (CMV) is a rare cause of meningoencephalitis (ME) with clinical data limited to case reports.

Methods

Retrospective observational study of all viral central nervous system (CNS) infections identified in 17 hospitals in the Greater Houston area from 2000 to 2017. CMV, herpes simplex virus (HSV), varicella zoster virus (VZV), and enterovirus were all identified by a positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) and all arboviruses were identified by serology.

Results

A total of 361 patients with viral CNS infections were identified: CMV (n = 33), enterovirus (n = 147), herpes simplex virus (n = 83), varicella zoster virus (n = 28), and arbovirus (n = 70). CMV ME occurred more frequently in immunosuppressed patients [e.g., Acquired Immune Deficiency Syndrome (AIDS)], had more hypoglycorrhachia (59%), and had worse clinical outcomes (61%) as compared with those with HSV, enterovirus, VZV and arboviruses. Furthermore, CMV ME had more altered mental status than enterovirus and HSV and had lower CSF pleocytosis compared with HSV. Additionally, CMV ME had higher CSF protein levels than enteroviral infections and had less CSF lymphocytosis than HSV and VZV.

Conclusion

CMV meningoencephalitis is seen more frequently in immunosuppressed patients (e.g., AIDS), is associated with more hypoglycorrhachia and have worse clinical outcomes compared with other viral CNS pathogens.

Disclosures

All authors: No reported disclosures.
2666. De-escalation of Broad-Spectrum Antibiotics in Hematopoietic Stem Cell Transplant Patients During Initial Episode of Febrile Neutropenia
Authors: Rearigh Lindsey , Stohs Erica J , Freifeld Alison , Zimmer Andrea
Published: October 2019

Background

Febrile neutropenia (FN) is a common and serious complication in patients undergoing hematopoietic stem cell transplant (HSCT). Typically, broad-spectrum antibiotics (BSA) are promptly initiated with controversy on timing of de-escalation. ECIL 2013 guidelines suggest de-escalation after 72 hours if the patient is infection free and afebrile for at least 48 hours. Conversely, the 2011 IDSA recommends continuing BSA in patients who defervesce until absolute neutrophil count (ANC) recovery. In 2014, our center’s practice changed to early de-escalation and we sought to compare outcomes between the two practices.

Methods

We retrospectively analyzed patients who underwent a HSCT in 2013 and 2017 with an episode of FN and negative infectious work up. The standard care group (SCG) were continued on BSA until ANC recovery. The early de-escalation group (EDG) de-escalated to fluoroquinolone prophylaxis at least 24 hours prior to ANC recovery after the patient was fever free for 48 hours. The primary end-point was duration of BSA. Secondary endpoints included 30-day mortality, re-hospitalization and length of stay (LOS) from FN. Median values were compared with the Mann–Whitney test.

Results

Among 229 HSCT patients, 155 (68%) developed FN post-transplant and of those 97 (63%) were without infection (13 EDG and 84 SCG). Initial FN duration of BSA was less in the EDG (3.09 days vs. 4.69 days, P = 0.069). Total antibiotic free days to 30 day follow-up were similar (EDG 24.08 vs SCG 25.19, P = 0.81). Duration of neutropenia was less in the SCG with 7.99 days compared with 11.69 days in the EDG (P = 0.007), but duration of initial fever was less in the EDG (2.55 days vs. 3.33 days, P = 0.023). 30 day mortality was 0% in both groups. Rates of re-hospitalization within 30 days were approximately the same (7.1% vs. 7.6%). LOS from FN was not significantly different with 6.68 days in SCG and 7.75 days in EDG (P = 0.140). More new bacterial infections were identified within 30 days of FN in the SCG than the EDG (10.7% vs. 7.6%).

Conclusion

Early BSA de-escalation resulted in no significant difference in LOS from FN and fewer days of BSA with 30-day mortality and re-hospitalization rates similar. This data suggest de-escalating BSA prior to ANC recovery is likely safe and leads to less BSA exposure, but more multi-center data are needed.

Disclosures

All authors: No reported disclosures.
2681. Outcomes Related to Respiratory Viral Infections in Cancer Patients on PD-1 Inhibitors
Authors: Khawaja Fareed , Batista Marjorie V , Chaftari Patrick , Tayar Jean , Chemaly Roy F , Chemaly Roy F
Published: October 2019

Background

The PD-1 inhibitors or check point inhibitors (CPI) are commonly used for the treatment of many solid tumors (ST) and hematological malignancies (HM). By blocking PD-1 in fatigued T cells, an increase in viral clearance may be noted as evidenced in cases of JC virus. Our objective was to assess the outcomes related to cancer patients with microbiologically documented acute respiratory viral infections while on CPI.

Methods

All patients who were infected with either influenza, respiratory syncytial virus (RSV), parainfluenza virus (PIV), and human metapneumovirus (HMPV) from 9/2016 to 6/2018 with prior or concurrent CPI therapy were included in this study. Demographics and clinical data were collected retrospectively. Comparisons were done between patients with concurrent (group 1) or prior (group 2) CPI therapy.

Results

A total of 92 cancer patients were identified and of those, 50 patients (54%) were on concurrent CPI therapy at the time of infection. Most patients had ST, mainly non-small cell lung cancer, and most were predominantly infected with Influenza (Figures 1 and 2). Side effects-related to CPI therapy and steroid use prior to infection were uncommon (13%). When compared with group 2, patients in group 1 had a trend toward less lower respiratory tract infections (24% vs. 40%, P = 0.11), decreased median length of stay (3 vs. 8 days, P = 0.1125) and lower 30-day mortality (4% vs. 12%, P = 0.2396).

Conclusion

Our data demonstrated trends toward improved outcomes in patients with respiratory viral infections on concurrent CPI therapy. Whether improved outcomes are related to enhanced immune responses to these viral infections need to be determined in a larger prospective observational cohort of patients.

Disclosures

Roy F. Chemaly, MD, MPH, FACP, FIDSA, Chimerix: Advisory Board, Research Grant; Clinigen: Advisory Board; Merck: Advisory Board, Consultant, Grant/Research Support, Research Grant, Speaker’s Bureau; Oxford immunotec: Consultant, Grant/Research Support; Shire: Research Grant, Speaker’s Bureau; Viracor: Grant/Research Support.
161. Evaluating the Predictive Value of Blood Culture Bottle Reporting for Coagulase Negative Staphylococci-Positive Cultures: Assessing Contamination vs. True Bacteremia
Authors: Bailey Pamela , Doern Christopher
Published: October 2019

Background

Coagulase-negative staphylococci (CoNS) are common blood culture (BCx) contaminants, but can also be causes of true blood stream infection (BSI). As a result, the clinical interpretation of CoNS positive BCx poses a significant challenge for providers and drives unnecessary antibiotic use, extended lengths of stay, and increased hospital costs. Despite these challenges, little is known about whether the number of positive BCx bottles within a set can be used to predict contamination vs. true BSI.

Methods

This study was conducted in an 865-bed tertiary care academic medical center in Richmond, VA. A retrospective chart review of CoNS-positive BCx from October to December 2018 was performed. Data collection included patient demographics, number of positive bottles within a set (i.e., were 1 or 2 bottles positive), care setting, antibiotic use, clinical judgement of contamination, and additional workup following the positive BCx result. Polymicrobic BCx were excluded.

Results

50 patients (mean age 58.2 years, 60% male) with CoNS-positive BCx were included in this study. Forty (80%) of the cultures had only 1 of 2 BCx bottles positive within a set. 10 (20%) were positive from both bottles in the set. All patients were drawn in the Emergency Department and 90% were subsequently admitted to the hospital. Upon chart review, 47 (94%) and 3 (6%) of cultures were considered to be contaminants and real BSI, respectively. Of those judged to be contaminants, 10 (20%) were positive in both bottles within a set, and thus falsely suggested true BSI. Of the 3 judged to be true BSI, 2 (66%) were positive in 1 out of 2 bottles, and thus falsely suggested contamination.

42 (84%) patients had repeat BCx drawn following the initial positive culture, and 26 (52%) were continued on IV antibiotics. Forty (80%) of the cultures were judged contaminants by the primary medical service, and 77% stopped antibiotics (20/26) when CoNS was identified.

Conclusion

These data show that reporting the number of bottles which are positive within a set provides misleading information and should not be used to determine whether a culture result represents contamination or true BSI.

Disclosures

All authors: No reported disclosures.
2702. Infants Vaccinated with a Fully-Liquid DTaP-IPV-Hib-HepB Vaccine Are Protected During the High-Risk Period for Haemophilus Influenzae Type B Disease
Authors: Wilck Marissa B , Xu Jin , Stek Jon E , Lee Andrew W
Published: October 2019

Background

DTaP-IPV-Hib-HepB is a fully-liquid, combination vaccine (Vaxelis™) approved for vaccination in infants and toddlers against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and Haemophilus influenzae type b (Hib). Safety and immunogenicity were evaluated in 4 Phase III, randomized, active-comparator controlled clinical trials (Protocols 005 and 006 in the US [Control: PENTACEL™] and Protocols 007 and 008 in the EU [Control: INFANRIX™ hexa]). The vaccine, studied in >6,800 children, has an acceptable safety profile generally similar to that of control vaccines (Xu, PIDJ, 2019; 38:439–43). DTaP-IPV-Hib-HepB includes polyribosylribitol phosphate (PRP) conjugated to outer membrane protein complex of Neisseria meningitidis (OMPC) that elicits a rapid response to Hib.

Methods

Data from these studies provide a summary of the anti-PRP responses of DTaP-IPV-Hib-HepB compared with Control.

Results

After the infant series, the percentage of participants who achieved short-term and long-term protective antibody thresholds for PRP (i.e., anti-PRP titer ≥0.15 μg/mL and ≥1.0 μg/mL, respectively) were higher in DTaP-IPV-Hib-HepB recipients compared with Control. A high level of protective responses (96.6% ≥0.15 μg/mL and 72.9% ≥1.0 μg/mL) were seen after the second dose in the 008 study of the 2 infant series followed by toddler dose hexavalent vaccination schedule (2 + 1). Across all 4 studies, anti-PRP titers were higher in DTaP-IPV-Hib-HepB recipients (91.4% ≥0.15 μg/mL and 46.8% ≥1.0 μg/mL) when compared with Control (63.4% ≥0.15 μg/mL and 17.1% ≥1.0 μg/mL) at the pre-Toddler dose (i.e., prior to the administration of the Toddler dose in the second year of life, between 11–15 months of age). One month after the toddler dose, high levels of anti-PRP titers were achieved in both DTaP-IPV-Hib-HepB recipients (99.8% ≥0.15 μg/mL and 96.6% ≥1.0 μg/mL) and Control (99.5% ≥0.15 μg/mL and 94.9% ≥1.0 μg/mL).

Conclusion

These results support that DTaP-IPV-Hib-HepB induces an early Hib response in the first 6 months of life that is sustained until the booster dose is administered in the second year of life. Thus, a high percentage of infants vaccinated with DTaP-IPV-Hib-HepB are protected during the high-risk period for Hib disease.

Disclosures

All authors: No reported disclosures.
2721. US States’ Policies for Meningococcal Vaccination vs. Disease Epidemiology
Authors: Srivastava Amit , Alderfer Justine
Published: October 2019

Background

Serogroup B (MenB) is the leading cause of invasive meningococcal disease (IMD) cases in the United States, including 69% of cases among 16- to 23-year-olds. College students have 3.5 times greater MenB risk vs noncollege individuals, and MenB caused all college IMD outbreaks between 2011 and 2019. For healthy adolescents, the Advisory Committee on Immunization Practices (ACIP) recommends routine MenACWY vaccination at 11 and 16 years and MenB vaccination based on individual clinical decision-making, preferably at 16‒18 years (Figure 1A, B). Given the recent shift in disease epidemiology, we investigated whether current state policies also shifted to help protect adolescents against all 5 meningococcal serogroups.

Methods

We researched requirements for meningococcal vaccination using state public health websites and national stakeholder materials (e.g., Immunization Action Coalition and their state chapters). Data as of November 2018 were compiled by vaccine type, age, and school/college requirements.

Results

Forty-five states and Washington DC require either meningococcal vaccination and/or vaccine education for school attendance (grades 6–12) and for college attendance. Thirty-one states require a MenACWY primary dose (at 11 years), of which 16 states also require the booster dose at 16 years (Table 1, Figure 1C). One state requires MenB vaccination at 16–18 years. Of the 8 states that experienced college MenB outbreaks between 2013 and February 2019, all require vaccination or education for MenACWY but not MenB (Table 2). These differences in state requirements may underlie the reported adolescent vaccination coverage rates for MenACWY (85% for ≥ 1 dose, 44% for ≥ 2 doses) and MenB (14.5% for ≥ 1 dose of multidose series) vaccines, and additional reasons may be the efficiency of school-based vaccination programs, strength of the 11-year immunization platform, the more recent availability of MenB vs MenACWY vaccines, and disparate ACIP recommendations for these vaccines.

Conclusion

State vaccination requirements have helped catalyze MenACWY vaccine impact. Tailoring new requirements to the current epidemiology can help quell MenB disease and ensure that US adolescents are fully protected against meningococcal disease.

Funding: Pfizer

Disclosures

All authors: No reported disclosures.