bluuebunny/crossref_metadata_2025 huggingface dataset:
984. Maternal and Infant Factors Influencing Influenza Vaccination Among Young Children Born in Colorado From 2008 to 2016
Authors: Alishahi Musheng , De Crescenzo Lauren , Rao Suchitra
Published: November 2018

Background

Factors influencing influenza vaccination in the first 2 years of life are important to identify and target strategies to increase vaccination rates, since this group is at high risk of morbidity from influenza. The objectives of our study were to determine maternal and neonatal factors associated with influenza vaccination in the first 2 years of life.

Methods

We conducted a retrospective cohort study using linked data from the Colorado Birth Registry Database and the Colorado Immunization Information System of live births between 2008 and 2016. Our population was limited to singleton, first births with first varicella vaccination documented in the immunization registry. Our primary outcome was receipt of at least one influenza vaccination in children ≤2 years. Exploratory variables included maternal (number of prenatal visits, urban vs. rural residence) and infant factors (term birth, admission to neonatal intensive care [NICU] at birth). Multivariable logistic regression was used to assess the association between these factors and influenza vaccination.

Results

Among 126,763 births in the cohort, 50.2% were vaccinated against influenza by 2 years of age. Mothers of unvaccinated children were older (27 vs. 26 years), married (67.8% vs. 66.8%), and more likely to have at least some college education (25.4% vs. 24.1%). A higher proportion of infants admitted to the NICU or who received oxygen were unvaccinated compared with vaccinated (8.5% vs. 8.0% and 2.5 vs. 2.1, respectively), P < 0.001 for all. There were no differences between urban vs. rural residence. In adjusted/stratified analyses, an increase in pre-natal visits was associated with a decrease in early influenza vaccination (IR = 0.992, 95% CI 0.986– 0.998, P = 0.0084 for Hispanic mothers and IR = 0.984, 95% CI 0.973–0.996, P = 0.0069 for non-Hispanic mothers). After adjusting for maternal age, preterm birth, and oxygen at birth, children admitted to the NICU were less likely to be vaccinated (IR = 0.915, 95% CI 0.873–0.959) against influenza by 2 years.

Conclusion

There were statistically significant differences in maternal and neonatal factors between unvaccinated and vaccinated children with influenza in the first 2 years of life, but the differences were too small to be clinically significant. Ongoing studies are needed to devise strategies to target early influenza vaccination.

Disclosures

S. Rao, GSK: Investigator, Research grant.
987. Repeated Exposure to an Adjuvanted Quadrivalent Subunit Influenza Virus Vaccine (aQIV): A Randomized, Observer Blind, Multicenter Study
Authors: Daly Wendy , Ramsey Keith , Forsten Aino , Heijnen Esther , Leav Brett , Oberye Janine , Zhang Bin , Pacciarini Filippo , Vesikari Timo
Published: November 2018

Background

The safety, immunogenicity, and efficacy associated with administration of of aQIV in children 6 months through 5 years of age was investigated.1 Although enhanced immunogenicity in children was demonstrated for MF59-adjuvanted influenza vaccines after first administration, the impact of repeated vaccination on immunogenicity and safety has not been evaluated.

Methods

A total of 607 subjects who participated in parent study, now aged 12 months through 6 years, were enrolled the subsequent year and received a single dose of study vaccine. Enrolled subjects received the same type of influenza vaccine administered in the parent study (aQIV or nonadjuvanted comparator). Blood samples were taken for immunogenicity assessment prior to the second year vaccination, and 21 and 180 days after vaccination.

Results

At baseline, approximately 12 months after vaccination in the parent study, subjects in the aQIV group had significantly greater geometric mean titer (GMT) values against all four homologous strains compared with subjects in the nonadjuvanted vaccine group. After year 2 vaccination, CBER criteria for seroconversion and hemagglutination inhibition (HI) titer ≥1:40 were met for the aQIV group for all four homologous strains tested at Day 22. At both Day 22 and Day 181, subjects who received aQIV had significantly greater GMT values for HI against all four homologous strains compared with those who received nonadjuvanted vaccine. Increased immune response of aQIV vs. nonadjuvanted vaccine was also observed for the selected heterologous strains tested at baseline, Day 22 and Day 181. In terms of safety, transient and generally mild to moderate reactogenicity was more commonly observed in the aQIV group vs. the nonadjuvanted group, but overall safety profiles were similar and comparable to the parent study.

Conclusion

This first-year revaccination study in young children confirms enhanced immunogenicity and similar safety profile after repeat aQIV vaccination compared with repeat nonadjuvanted influenza vaccination.

Reference

1.Vesikari T et al. Lancet Respir Med 2018;6:345–356.

Disclosures

K. Ramsey, Seqirus: Investigator, Research support. Novartis: Investigator, Research support. E. Heijnen, Seqirus: Employee and Shareholder, Global Employee Share Plan and Salary. B. Leav, Seqirus: Employee and Shareholder, Salary. J. Oberye, Seqirus: Employee and Shareholder, Global Employee Share Plan and Salary. B. Zhang, Seqirus: Employee and Shareholder, Company stock and Salary. T. Vesikari, Seqirus: Consultant, Consulting fee.
989. Clinical Effectiveness of High-Dose Trivalent vs. Quadrivalent Influenza Vaccination Among Veterans Health Administration Patients
Authors: Young-Xu Yinong , Russo Ellyn , Neupane Nabin , Lewis Melissa , Halchenko Yuliya
Published: November 2018

Background

Despite the widespread availability of several injectable inactivated influenza vaccines (IIV), including the trivalent standard-dose (IIV3-SD) and high-dose (IIV3-HD), and the quadrivalent (IIV4), the US Advisory Committee on Immunization Practices does not currently recommend one over another. The objective of this study was to assess the relative vaccine effectiveness (rVE) of IIV3-HD and IIV4 vs. IIV3-SD.

Methods

rVE was estimated from a retrospective cohort study of Veterans aged 65 years and older who received an IIV during the 2014–2015 influenza season. Veterans Health Administration (VHA) electronic medical records were linked with Centers for Medicare and Medicate Services administrative claims to capture the study outcomes of hospitalizations and baseline characteristics. The inverse probability of treatment weight (IPTW) method was used to adjust for potential confounding due to unmeasured factors associated with IIV3-SD, IIV3-HD, or IIV4 vaccination. The probability was estimated based on patient sociodemographic characteristics, comorbidities, pre-influenza season hospitalizations, prior season influenza vaccination, and use of immunosuppressive medication.

Results

Our study population included 782,346 VHA patients vaccinated during the 2014–2015 season. Of these, 10,543 (1%) received IIV4, while 59,536 (8%) received IIV3-HD and 712,267 (91%) received IIV3-SD. 11,626 (1.5%) were female and 588,324 (76%) were non-Hispanic white. Compared with those that received IIV3-SD vaccine, the IPTW-adjusted rVE for IIV3-HD was 7% (95% CI, 9%–21%) against all-cause, 15% (95% CI, 10%–17%) against cardiorespiratory associated, and 13% (95% CI, 8%–17%) against influenza/pneumonia-associated hospitalization. For those that received IIV4, the IPTW-adjusted rVE was 4% (95% CI, 1%–4%), 1% (95% CI, −2%–5%), and 0% (95% CI, −9%–8%), respectively.

Conclusion

IIV3-HD is more effective than, and IIV4 is as effective as, IIV3-SD vaccination in preventing influenza/pneumonia-associated, cardiorespiratory, and all-cause hospitalizations. Additional studies that employ methods to control for unmeasured confounding are warranted as the use of IIV4 expands.

Disclosures

All authors: No reported disclosures.
997. Protection of Unvaccinated Individuals by Influenza Vaccine Coverage of Household Contacts
Authors: Malosh Ryan E , Evans Richard , Martin Emily T , Petrie Joshua G , Monto Arnold S
Published: November 2018

Background

The evidence that influenza vaccination programs provide some protection to unvaccinated members of a community (i.e., indirect effects) is lacking. We sought to determine the indirect effects of influenza vaccine in prospective cohort study of households with children.

Methods

We used longitudinal data over six influenza seasons from the Household Influenza Vaccine Evaluation (HIVE) study. We categorized households each season based on the proportion of members who received a seasonal influenza vaccination: unvaccinated (0%), low coverage (1–50%), moderate coverage (50–99%), and fully vaccinated (100%). We used mixed-effect Poisson regression models adjusted for age group and sex with random effects to account for household clustering and repeated measures. We estimated the association between the proportion of vaccinated household members and the incidence of influenza virus infection in the entire cohort. We then estimated the indirect effects of influenza vaccination by comparing unvaccinated members of households with low levels of vaccination to unvaccinated members of households with higher levels of vaccination.

Results

During 7,286 person-seasons of follow-up, we detected 578 cases (8 per 100/season) of influenza virus infection. The seasonal incidence rate was highest in completely unvaccinated households (10 per 100/seasons) and lower at all other levels of vaccine coverage (Figure 1). Individuals in fully vaccinated households had a 29% lower seasonal incidence rate of influenza infection compare to those in unvaccinated households (IRR 0.72, 95% CI 0.56–0.93). The estimated indirect VE comparing unvaccinated individuals in completely unvaccinated households to those in households with moderate vaccine coverage was 40 % (95% CI −4 to 65).

Conclusion

We demonstrate that vaccination of close contacts can reduce incidence of influenza in unvaccinated members of a community. Despite insufficient evidence, guidance from public health authorities currently suggests that vaccination protects close contacts. Our findings quantifying the protective effects of seasonal influenza vaccination of household contacts in unvaccinated individuals can provide clearer evidence for global vaccine recommendations.

Disclosures

All authors: No reported disclosures.
1006. Demographic, Clinical, Microbiological Characteristics and Outcome of Patients Admitted to the Emek Medical Center with Blood Stream Infection Acquired in LTCF: A 5-Year Surveillance
Authors: Almog Moty , Yanovskay Anna , Edelstein Hana , Colodner Raul , Schwartz Naama , Chazan Bibiana
Published: November 2018

Background

Residents from long-term care facilities (LTCF) hospitalized with an acute infectious disease are challenging in terms of diagnosis and treatment, considering atypical clinical presentation are high rate of resistant bacteria,.

This study aimed to Characterize patients with LTCF acquired bacteremia (LTCF-B), epidemiology of blood cultures (BC) and potential risk for mortality.

Methods

A retrospective study of LTCF residents hospitalized with LTCF-B. Demographic, clinical and laboratory data were collected and analyzed using SPSS 22 and SAS.

Results

One hundred seventy-seven LTCF residents hospitalized in internal wards were included, mean age 81.6 years, mostly completely dependent, 54.8% were males. Most frequent diagnoses was urinary tract infection (UTI), second by respiratory tract infections. Half were hospitalized during prior 6 months, one-third had a permanent indwelling urinary catheter. On admission, 70% had WBC blood count >10,000 cells/mL. The following pathogens were isolated from BC: Gram-negative enterobacteriaceae (70%): E. coli were 40% and Gram-positive cocci (21%): S. aureus 5.08% (55.5% of them MRSA). Extended-spectrum-β-lactamase (ESBL) producing enterobacteriaceae were in 47.1% BC, clearly document increase during the years, 26% (2010)–63% (2014). Absolute majority of enterobacteriaceae were sensitive to carbapenems and amikacin, half were resistant to gentamycin, second- and third-generation cephalosporins and quinolones. Inappropriate empiric antimicrobial therapy was given to 46.8% of patients with ESBL-producing enterobacteriaceae (P < 0.001). Mortality rates were 21.5% in-hospital and 46.3% day-90 post discharge. Variables associated with mortality: initial diagnosis of skin and soft-tissue infections (SSTI) (OR = 14.44), inappropriate empiric antibiotic (OR = 5.038), high level of urea (OR = 1.017), and nasogastric tube (OR = 4.966). UTI (OR = 0.316) was a protective factor.

Conclusion

Diagnosis of SSTI, high urea levels, nasogastric tube, and inappropriate empiric antibiotic were associated with in-hospital mortality. The notable increased rate of ESBL-producing enterobacteriaceae should alert physicians to be aware of local microbial resistance profile, especially among LTCFs patients.

Disclosures

All authors: No reported disclosures.
1007. Etiology of Sepsis; A Systematic Review of Emergency Department Sepsis
Authors: Husebye Ashley , Baxter Caitlin , Wesenberg Elizabeth , Hansen Glen
Published: November 2018

Background

Sepsis is a systemic response to an infection involving one or multiple organ failures frequently caused by bacteremia. Over a million cases of sepsis are reported in the United States annually with an estimated 25% mortality. Early recognition, diagnosis, and treatment of sepsis in the Emergency Department (ED) improves patient outcomes. Increased awareness of sepsis has fostered novel opportunities to improve diagnostics. EDs are increasingly targeted as areas of primary care for suspected septic patients. Understanding the etiology of ED sepsis supports empiric approaches and opportunities for targeted diagnostics. However, a systematic analysis of etiology of ED sepsis, spanning multiple years, is lacking.

Methods

A retrospective analysis conducted over 60 months at Hennepin County Medical Center, an inner-city level one trauma center with over 100,000 ED visits annually were examined. Positive blood cultures drawn in the ED were included in data analysis. Charts were reviewed for patient demographics and whether the culture was treated; infections that were not treated were considered contaminants, and relevant susceptibility patterns.

Results

A total of 8,013 blood cultures were drawn in the ED over an initial 12-month period. Of these, 8.4% (n = 674) were culture positive resulting in 731 microorganisms. Of these, 314 were treated as infections with the remaining considered contaminants. Overall contamination rate was 2.9%. Of clinically relevant positive blood cultures, 19.4% were Escherichia coli, 18.5% were Staphylococcus aureus, 27.1% were strep species (group A strep 5.4%, group B strep 4.8%, strep pneumonia 5.1%), 7.0% were Enterococcus faecalis, and 6.4% Klebsiella pneumonia. Among these species, they accounted for 78.4% of pertinent positive cultures. Gram-negative bacteremias accounted for 41% of infections compared with 59% for Gram-positive organisms.

Conclusion

A comprehensive understanding of the etiology of ED sepsis facilitates appropriate empiric antimicrobial prescribing for patients who present with sepsis in the ED. Data collected to date identifies five key bacterial species associated with over 78% of confirmed ED sepsis.

Disclosures

All authors: No reported disclosures.
1010. Effectiveness of Oral Antibiotics for Definitive Therapy of Gram-Positive Bloodstream Infections
Authors: Roshdy Danya , Quinn Nick , Sebaaly Jamie , Templin Megan , Weinrib David
Published: November 2018

Background

Transition from intravenous (IV) to oral (PO) antibiotics is common practice in patients with Gram-positive bloodstream infections (GP-BSI); however, clinical data evaluating IV to PO switch options are lacking. The objective of this study was to examine effectiveness of PO antibiotics for definitive treatment GP-BSI, with a focus on bioavailability (BA).

Methods

This was a single-center, retrospective cohort study of adult inpatients admitted to an 874-bed academic medical center in Charlotte, NC between September 1, 2014 and August 31, 2017. Patients with a GP-BSI who received appropriate antibiotic therapy with at least one third of their total course administered PO were included. Patients with GP-BSI caused by staphylococcal species were excluded. The primary endpoint was clinical failure in patients receiving high (≥90%) vs. low (<90%) BA agents. Secondary endpoints included clinical failure stratified by antibiotic group, bactericidal vs. bacteriostatic agents, and organism. Chi-square and Fisher’s exact tests were used to examine clinical failure.

Results

One hundred three patients were included, 26 in the high BA group, and 77 in the low BA group. The median age was 58, 51% were women, 74.8% of patients had streptococcal bacteremia (26.2% S. pneumoniae), with pulmonary being the most common source (30.1%). There were no major differences in baseline demographic and clinical characteristics between groups. The median treatment duration with IV antibiotics was 4 and 5 days in the high and low BA groups, respectively (P = 0.12). There was no statistically significant difference in clinical failure in the high vs. low BA groups (19% vs. 23%, P = 0.66, respectively). Clinical failure stratified by antibiotic group, bacteriostatic vs. bactericidal agent (OR 1.43, CI 0.26–7.90), and organism also did not yield statistically significant differences.

Conclusion

These data demonstrate similar rates of clinical failure among patients definitively treated with high or low BA agents for GP-BSI. High BA agents such as fluoroquinolones may not be needed for all patients with GP-BSI, where more targeted β-lactam therapies may be appropriate. Additional prospective studies with larger sample sizes are needed to further validate these conclusions.

Disclosures

All authors: No reported disclosures.
1013. If Blood Cultures Were Not Done Before Starting Antibiotics, Is It of Any Value to Obtain Them Later?
Authors: Rand Kenneth , Beal Stacy , Allen Brandon , Payton Thomas , Lipori Gloria , Rivera Kimberly
Published: November 2018

Background

Obtaining blood cultures before starting antibiotics is one of the pillars of the Surviving Sepsis Campaign (SSC), and delay in obtaining blood cultures (BC) after starting antibiotics is associated with increased mortality (Levy M 2015, Pruinelli L 2018), but we were unable to find data on the relationship between such a delay and a reduction in percentage of positive cultures.

Methods

All adult patients (>18) admitted from the UFHealth Shands Emergency Department (ED) between August 2012 and December 2016 were included in the study (N = 30,743), excluding hospital-hospital transfers. BC were done with BacTec aerobic, anaerobic, and pediatric resin bottles, incubated for 5 days. We calculated the hourly rate of positive BC obtained before and after the start of IV antibiotics by subtracting the time stamp in the electronic medical record (Epic) between the first BC collection time and the start of the first IV antibiotic dose. We considered S. aureus, all Gram-negative rods, β-hemolytic Streptococci and Enterococci as significant pathogens and coagulase negative Staphylococci, S. viridans, Propionibacterium sp., Micrococcus sp. and Bacillus sp. as contaminants hospital ransfers.

Results

The percentage of BC with significant growth was unchanged during the first hour after starting IV antibiotics, but declined significantly in the period 1–12 hours after IV antibiotics were started. The overall positivity rate before starting IV antibiotics was 1,646/20,867 (7.9%) of patients and declined to 112/3,490 (3.2%), P < 0.0001, in the 1–12 hour period afterwards, but did not decline to 0. Septic patients averaged 1,143/4,923 (23.2%) positive and declined to 65/728 (8.9%), P < 0.0001, while nonseptic patients averaged 503/15,944 (3.15%) positive before antibiotics and declined to 47/2,762 (1.7%) P < 0.0001, 1–12 hours after. It should be pointed out that these are group averages from different patient groups at each hourly time, rather than individual patients with blood cultures drawn serially.

Conclusion

We conclude that IV antibiotics dramatically reduce the likelihood of getting a positive blood culture, but not during the first hour of administration; however, the residual positivity rate remains high enough that blood cultures are still clinically worthwhile.

Disclosures

All authors: No reported disclosures.
1015. Enhanced Detection of Bloodstream Pathogens From Positive Blood Culture Specimens With an Improved Multiplex PCR Molecular Diagnostic System
Authors: Green Jeremy , Carter Caitlin , Chandler Craig , Clark Angela , Thatcher Stephanie
Published: November 2018

Background

Timely bloodstream infection (BSI) pathogen identification requires robust sample purification and testing methods that can accommodate the wide variety of blood culture media used for growing positive blood culture (PBC) specimens. Sensitive molecular methods are needed for identification of all organisms present in PBD, especially polymicrobial cultures which can be difficult to identify with standard methods. Multiple types of BD and BioMérieux blood culture media commonly used in hospital laboratories were used to evaluate the performance of a prototype BioFire® FilmArray® Blood Culture Identification 2 (BCID2) Panel with PBCs.

Methods

Fungi (seven) and bacteria (19) were independently seeded in blood samples, inoculated into as many as eight different types of blood culture bottles, and incubated on the recommended instrument. Time to positivity (TTP) was recorded for all PBCs. Subsets of PBCs were enumerated and tested on the BioFire BCID2 Panel and BioFire® FilmArray® Blood Culture Identification (BCID) panel. Polymicrobial testing was performed by seeding fast and slow growing organisms into the same bottles.

Results

Over 750 PBCs were enumerated; ~500 PBCs were tested on the BioFire BCID2, and over 200 were also tested on the BioFire BCID. 100% of seeded PBCs tested on the BioFire Panels resulted in correct pathogen identification. Across all bottle types, fungi grew to levels ranging from 8E+05 to 5E+07 CFU/mL, Gram-positive bacteria titers ranged from 7E+06 to 2E+09, and Gram-negative bacteria titers ranged from 9E+07 to 3E+09. Polymicrobial PBCs (30) had reduced titers of slow growing organisms when seeded with fast growing organisms but were detected by both BioFire BCID Panels at a rate of 99%.

Conclusion

This study demonstrates that a prototype BioFire BCID2 Panel, and the BioFire BCID Panel, robustly detect and identify (100%) BSI pathogens over a multitude of common blood culture media and systems. Results confirm PBC (single and polymicrobial) titers are above the levels of sensitivity for both BioFire panels. An expanded menu of targets (organism and resistance) and faster run time with the BioFire BCID2 Panel will offer a flexible and comprehensive aid in the diagnosis of BSIs. The BioFire® BCID2 Panel has not yet been evaluated by the FDA or other regulatory agencies for in vitro diagnostic use.

Disclosures

J. Green, BioFire Diagnostics, LLC: Employee, Salary. C. Carter, BioFire Diagnostics, LLC: Employee, Salary. C. Chandler, BioFire Diagnostics, LLC: Employee, Salary. A. Clark, BioFire Diagnostics, LLC: Employee, Salary. S. Thatcher, BioFire Diagnostics, LLC: Employee, Salary.
1017. Impact of Enterococcal Bloodstream Infection on Mortality in Patients With Acute Myelogenous Leukemia
Authors: Messina Julia , Miller Marion Hemmersbach , Sung Anthony , Alexander Barbara D , Chao Nelson
Published: November 2018

Background

Though enterococcal bloodstream infection (EBSI) is common in patients with acute myelogenous leukemia (AML), its impact on mortality requires further elucidation. Our objectives were to: (1) determine attributable mortality to EBSI and (2) compare overall, 1-year, relapse-related mortality (RRM), and treatment-related mortality (TRM) between AML patients with and without EBSI.

Methods

This was a retrospective cohort receiving intensive chemotherapy for AML from 2010 to 2015. EBSI was defined by _1 positive blood culture for E. faecium or faecalis and fever, hypotension, or chills. Attributable mortality to EBSI was defined by failure to achieve BSI Clearance (_1 negative culture _24 hr after last positive culture and defervescence) by the date of death. Student’s t-test was used to compare continuous variables, and C2 test was used for categorical variables. Kaplan–Meier was used for survival analyses (unadjusted), and P-values were computed by log-rank.

Results

Three hundred eight patients were identified during the study period: 80 with EBSI and 228 without EBSI. 5/80 patients died with EBSI (6%) although 4/5 patients had concurrent infections at the time of death (Clostridium difficile colitis, candidemia, proven invasive aspergillosis, and probable invasive fungal disease, respectively). There were no significant differences between overall and 1-year mortality (Table 1). In the survival analyses, EBSI did not significantly impact overall survival, 1-year mortality, RRM, and TRM (Figure 1). However, patients with vancomycin-resistant EBSI (VRE) trended toward increased overall mortality.

Conclusion

Attributable mortality to EBSI is uncommon (6%) in AML. Additionally, EBSI does not significantly impact mortality in this vulnerable patient population that already has very high rates of RRM and TRM. However, as EBSI inflicted 26% of patients over the course of this study period, further investigation is needed to elucidate the morbidity suffered from this common infection and identify potentially modifiable risk factors.

Table 1.

Disclosures

A. Sung, Merck: Grant Investigator, Grant recipient. Enterome: Grant Investigator, Grant recipient.
1018. Prevalence of Bacteremia/Fungemia and Pneumonia in Remission Induction Chemotherapy for Adult Acute Myeloid Leukemia From 1987 to 2005: Japan Adult Leukemia Study Group (JALSG)
Authors: Kato Hideaki , Fujita Hiroyuki , Akiyama Nobu , Kimura Shun-Ichi , Hiramoto Nobuhiro , Hosono Naoko , Takahashi Tsutomu , Shigeno Kazuyuki , Minamiguchi Hitoshi , Miyatake Junichi , Handa Hiroshi , Kanda Yoshinobu , Yoshida Minoru , Miyawaki Shuichi , Ohtake Shigeki , Naoe Tomoki , Kiyoi Hitoshi , Matsumura Itaru , Miyazaki Yasushi
Published: November 2018

Background

Remission induction (RI) chemotherapy for acute myeloid leukemia (AML) is one of the most intensive chemotherapy available. Antibiotic prophylaxis and prompt treatment for infectious complications during RI chemotherapy play a major role in supportive care.

Methods

We retrospectively analyzed the infectious complications associated with RI chemotherapy listed in the Japan Adult Leukemia Study Group AML201 protocol, a nationwide study of de novo AMLs, conducted between 2001 and 2005 in Japan. Of the 1,057 cases initially included in the AML201 study, 980 cases with data on infectious complications during RI chemotherapy were analyzed. The incidences of infectious complications and the causative pathogens were compared with previous studies [(period A) 1987–1991, 577 cases; (B) 1992–1995, 669 cases; (C) 1995–1997, 531 cases; (D) 1997–2001, 808 cases; (E) 2001–2005, 980 cases].

Results

In study period E, the causative pathogens of bacteremia/fungemia were Staphylococcus epidermidis (20.9%), S. aureus (11.6%), Streptococcus sp. (14.0%), and other Gram-positive bacteria (18.6%); P. aeruginosa (12.8%) and other Gram-negative bacteria (10.5%); and fungi (9.3%). Pathogens causing pulmonary infections were Aspergillus sp.(15.8%), P. aeruginosa (7.9%), and other Gram-negative bacteria (6.9%) and Gram-positive bacteria (3.0%). Pulmonary aspergillosis was diagnosed mainly using serological test. The prevalence of bacteremia/fungemia was reported in 11.8%, 9.4%, 8.7%, 9.2%, and 8.3% of cases and pulmonary infections were reported in 24.6%, 16.9%, 13.9%, 12.9%, and 10.3% of cases in the study periods A, B, C, D, and E, respectively. The incidence of Gram-negative bacteremia was significantly lower in period E compared with the periods A, B, and C (2.0% vs. 4.9%, 3.7%, and 3.4%, respectively).

Conclusion

The prevalence of Gram-positive bacteremia and pulmonary aspergillosis was higher in period E than in the periods A–D. This trend was possibly due to the wide use of fluoroquinolone prophylaxis in neutropenic patients and high performance of the serological test for aspergillosis. Sufficient monitoring for Gram-positive bacterial infection and mold infection is therefore essential during RI chemotherapy for AML.

Disclosures

All authors: No reported disclosures.
1019. Treatment Outcomes for Enterococcus faecium Bacteremia in Solid-Organ Transplant Patients: Implications for Daptomycin
Authors: Mercuro Nicholas J , Kenney Rachel M , Alangaden George , Davis Susan L
Published: November 2018

Background

Optimal antimicrobial therapy for Enterococcus faecium (EFM) bacteremia in the solid-organ transplant (SOT) population is not well defined. Antimicrobial resistance, immunosuppression, and high mortality associated with EFM infections all pose serious threats. The purpose of this study was to describe the pharmacotherapy and outcomes of EFM bacteremia in SOT patients.

Methods

This was a single-center retrospective cohort of SOT patients with EFM bloodstream infection from 2013 to 2018. Susceptibility of ampicillin (AMP), vancomycin (VAN), linezolid (LZD), and daptomycin (DAP) against EFM were reported as MIC90 when available. The primary outcome, 30-day all-cause mortality, was assessed in bivariate analysis to identify potential risk factors. Secondary outcomes included inpatient mortality and development of DAP nonsusceptibility (DNS).

Results

Forty-four unique cases representing 40 patients were included in the analysis. The median age was 62.5 years and liver (65.9%), intestine (20.5%), and kidney (11.4%) were the most common organs transplanted. The MIC90 of VAN, DAP, and LZD of initial isolates collected were >32 mg/L, 4 mg/L, and 2 mg/L, respectively; all were AMP resistant. The median durations of hospitalization and intensive care stay were 29 days and 17.5 days, respectively. Most patients had indwelling central lines (81.8%) at the time of bacteremia; intra-abdominal abscesses/fluid collections were present in 45.5% of patients and 9.1% had endocarditis. The most common definitive antimicrobial regimens were DAP plus β-lactam (45.5%), DAP monotherapy (18.2%), and LZD 600 mg Q12H (25.0%). The mean initial and definitive DAP doses were 8.1 ± 1.6 and 8.9 ± 1.7 mg/kg actual body weight, respectively. Among subjects that received DAP, 21.9% developed DNS. Inpatient mortality was 39.5% and 30-day mortality was 27.3%. Mortality at 30-days was greater in patients with high-grade bacteremia (40.7 vs. 5.9%, P = 0.01) and receipt of DAP <10 mg/kg as the first active antibiotic (42.9 vs. 13.0%, P = 0.03).

Conclusion

Inadequate DAP dosing for EFM bacteremia may be associated with mortality in the SOT population. Larger, matched analyses are necessary to determine the impact of optimized pharmacodynamics.

Disclosures

S. L. Davis, Achaogen: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. Nabriva: Scientific Advisor, Consulting fee. Zavante: Scientific Advisor, Consulting fee.
1020. Injection Drug Use-Associated Staphylococcus aureus Bacteremia in a Large Urban Hospital in Atlanta, Georgia
Authors: Serota David P , Kelley Colleen , Jacob Jesse T , Ray Susan M , Schechter Marcos C , Kempker Russell
Published: November 2018

Background

Infectious complications of injection drug use (IDU) have increased with the expanding opioid epidemic in the southeast. We assessed the incidence, clinical presentation, and treatment outcomes of IDU-associated Staphylococcus aureus (SA) bacteremia (SAB).

Methods

We created a retrospective cohort of all adults with community acquired (CA) SAB over 5 years presenting to Grady Memorial Hospital, a 1,000-bed urban county hospital in Atlanta, GA. Charts were reviewed by infectious diseases physicians to obtain clinical and laboratory characteristics, including substance use disorder (SUD), and determine if SAB was IDU-associated. The study period was divided into three periods (P1 = March 2012–January 2014, P2 = January 2014–December 2015, P3 = December 2015–November 2017) to evaluate changes in the incidence of IDU-SAB over time using Poisson regression.

Results

Among 321 patients with a first episode of CA-SAB, 24 (7%) were IDU-SAB. The number of IDU-SAB cases in each period increased (P1 = 4, P2 = 7, and P3 = 13 [P = 0.07 for trend]). The median age of IDU-SAB patients was 38 (IQR 31–57), 11 (46%) were black, and 15 (63%) had chronic hepatitis C virus infection. Heroin was the most common injected drug (92%) followed by cocaine (25%); multiple drugs were injected in 29%. All but two patients (92%) had a complication of SAB, most commonly endocarditis (50%) and septic pulmonary emboli (38%). The median hospitalization was 23 days (IQR 19.5–37.5) and 5 patients (12%) left the hospital against medical advice (AMA). Readmission for persistent or recurrent SA infection during the study period was common (42%), and three (13%) died ≤6 months from initial presentation, including two with prior discharge AMA. Half of the discharge summaries did not mention SUD as a hospital problem. Outpatient SUD treatment was recommended to eight (33%) patients and a recommendation of abstinence was the intervention for 12 (50%).

Conclusion

Increasing IDU-SAB was observed over 5 years in our urban Atlanta hospital, primarily due to heroin use. Most cases were associated with complications of SAB with a long length of stay and frequent readmission, but few patients received treatment or harm reduction interventions for their SUD. These data will raise awareness and direct resources to expanding evidence-based opioid use disorder treatment for patients with infectious complications of IDU.

Disclosures

All authors: No reported disclosures.
1022. Rising Rates of Injection Drug Use Associated Infective Endocarditis in Virginia With Missed Opportunities for Injection Drug Use Disorder Treatment Referral: A Retrospective Cohort Study
Authors: Gray Megan , Rogawski Elizabeth , Scheld Michael W , Dillingham Rebecca
Published: November 2018

Background

Injection drug use disorder (IDD) is a growing public health threat in Virginia, although there is limited knowledge of related morbidity. The purpose of this study was to describe the temporal, geographic, and clinical trends and characteristics of infective endocarditis associated with IDD (IDD-IE) and to identify opportunities for better-quality care of people with IDD.

Methods

We reviewed charts for all admissions coded for both IE and drug use disorders at the University of Virginia Medical Center (UVA) from January 2000 to July 2016. A random sample of 30 admissions coded for IE per year were reviewed to evaluate temporal trends in the proportion of IDD associated IE cases.

Results

There were a total of 76 patients with IDD-IE during the study period, with a 7-fold increase in cases of IDD-IE from the early 2000s to 2016. The proportion of IE that was IDD-associated increased by nearly 10% each year (prevalence ratio of IDD per year: 1.09, 95% CI: 1.05–1.14). Patients with IDDIE had longer hospital stays [median days (interquartile range); IDD-IE, 17 (10–29); non-IDD-IE, 10 (6–18); P = 0.001] with almost twice the cost of admission as those without IDD [median (interquartile range); IDD-IE, $47,899 ($24,578–78,144); non-IDD-IE, $26,460 ($10,220–60,059); P = 0.001]. In 52% of cases, there was no documentation of any discussion regarding addiction treatment.

Conclusion

IDD-IE cases are increasing in Virginia leading to higher morbidity and healthcare costs. IDD-IE may provide an opportunity for the delivery of IDD treatment, counseling, and harm reduction strategies.

Disclosures

All authors: No reported disclosures.
1024. First Episode Infective Endocarditis in Persons Who Inject Drugs (PWIDs); A Retrospective Cohort Study
Authors: Rodger Laura , GlockerLauf Dresden , Shojaei Esfandiar , Sherazi Adeel , Hallam Brian , Ball Laura , Koivu Sharon , Gupta Kaveri , Hosseini-Moghaddam Seyed , Silverman Michael
Published: November 2018

Background

Persons who inject drugs (PWID) represent a distinct demographic of patients with infective endocarditis (IE). Many centers do not perform valvular surgery on these patients due to concerns about poor outcomes.

Methods

Retrospective cohort study comparing PWID patients to non-PWID patients presenting between February 2007 and March 2016 in London, Ontario, among adult (>18) inpatients with first episode IE.

Results

In 370 first episode IE cases, 53.9% occurred in PWIDs. PWID patients were younger (35.4 SD 10.0 vs. 59.4 SD 14.9) (P < 0.001), more likely to have right-sided infection [125/202 (62%), vs. 16/168 (9.5%) (P < 0.001)], and more often due to S. aureus (156/202 (77.3%) vs. 54/168 (32.1%), P < 0.001). Myocardial and aortic root abscesses were less common in PWIDs [17/202 (8.4%) vs. 50/168 (30%) (P < 0.01)]. There was no difference in the frequency of noncardiac complications. In total, 36.5% of patients were treated surgically with PWID patients less likely to undergo surgery [39/202 (19.3%) vs. 98/168 (58%) P < 0.001]. Cox regression analysis identified the protective effect of cardiac surgery with regards to survival in all patients, with a hazard ratio of 0.49 (95% CI 0.31–0.76, P < 0.001), as well as among PWIDs (HR 0.39, 95% CI 0.17–0.87, P = 0.02). Among all patients, lower survival was associated with older age (HR 1.03, 95% CI 1.00–1.05, P < 0.001), injection drug use (HR 2.72, 95% CI 1.52–4.88, P < 0.001), left-sided infection (HR 3.48, 95% CI 2.01–6.03, P < 0.001), and bilateral infection (HR 3.19, 95% CI 1.45–7.01, P = 0.004). The lower survival of left-sided infection (HR 4.01, 95% CI 1.97–8.18, P < 0.001) or bilateral infection (HR 6.94, 95% CI 2.39–20.2,P < 0.001) was re-demonstrated in PWIDs.

Conclusion

This study identifies important clinical differences between PWIDs and nondrug users with respect to valve involvement, causative organism, complications, and management strategies. Our results highlight the important role of surgical treatment in a carefully selected PWID patient population.

Disclosures

All authors: No reported disclosures.
1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series
Authors: Pettigrew Adam , Jariwala Ripal , Zeitler Kristen , Montero Jose , Gompf Sandra , Toney John
Published: November 2018

Background

While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined.

Methods

We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned.

Results

Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia.

Conclusion

CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB.

Disclosures

All authors: No reported disclosures.
1038. Edwardsiella tarda Bacteremia: Epidemiology, Clinical Features, and Outcomes
Authors: Kamiyama Shinya , Kuriyama Akira , Hashimoto Toru
Published: November 2018

Background

Edwardsiella tarda is primarily associated with gastrointestinal disease, but an increasing number of cases with extraintestinal disease have been reported. Additionally, E. tarda bacteremia (ETB) may be associated with high mortality; however, little is known about its clinical epidemiology.

Methods

We collected all clinical information of ETB patients identified between January 2005 and December 2016 from their electronic medical records. We described the epidemiology, clinical features, and 30- and 90-day mortality of these patients.

Results

A total of 182,668 sets of blood cultures were obtained during the study period, of which 40 sets (0.02%) taken from 26 patients were E. tarda positive. Twenty-six patients (13 men and 13 women) with a median age of 75 years were diagnosed with ETB. Clinical diagnoses by infection site included cholangitis (n = 9), liver abscess (n = 6), enterocolitis (n = 4), cholecystitis (n = 3), and spontaneous bacterial peritonitis, mycotic aneurysm, necrotizing fasciitis, empyema, osteomyelitis, and secondary peritonitis (n = 1 each). The overall 30-day and 90-day mortality rates of ETB in our cohort was 11.5% (3/26) and 26.9% (7/26), respectively. There was no seasonal variation in the incidence of E. tarda infection. All E. tarda strains isolated from blood cultures were susceptible to all tested antibiotics. Additionally, hepatobiliary infection was more frequently seen in ETB compared with non-bacteremic E. tarda infections.

Conclusion

This study is the largest case series on ETB to date. We found that ETB is a rare entity that is not associated with high mortality. Hepatobiliary infection is the most common clinical manifestation.

Disclosures

All authors: No reported disclosures.
1046. Clinical and Microbiological Characteristics of Patients With Septicemia Caused by IMP-1-Producing Enterobacteriaceae in a Tertiary Hospital in Japan
Authors: Mori Nobuaki , Kagawa Narito , Aoki Kotaro , Ishii Yoshikazu , Tateda Kazuhiro , Aoki Yasuko
Published: November 2018

Background

Carbapenemase-producing Enterobacteriaceae (CPE) infection has become a great threat to public health worldwide. Although KPC and OXA-48 infections have mostly described, IMP-1 producing Enterobacteriaceae (IMP1-E) are not well studied. We investigated the clinical and microbiological characteristics of septicemia due to the IMP1-E.

Methods

This observational study of inpatients who developed IMP-1E septicemia was conducted in a Japanese tertiary hospital from April 2013 to March 2017. IMP1-E was defined as a decreased susceptibility to meropenem (minimum inhibitory concentration, ≥2 mg/L), as well as a positive sodium mercaptoacetic acid test, and polymerase chain reaction for blaIMP genes. Clinical data were collected from medical charts. Antimicrobial susceptibilitly was determined by the MicroScan Walkway. We performed total genomic analysis, plasmid analysis, and multilocus sequence typing (MLST) using whole genome sequencing data.

Results

In total, six patients were identified (median age: 55 years). All had severe underlying disease on admission, and five were admitted to the intensive care unit. The sources of IMP1-E septicemia were as follows: two catheter-related BSI, one pyelonephritis, one cholangitis, one bacterial peritonitis, and one unknown focus. Four isolates were Enterobacter cloacae and two were Klebsiella pneumoniae. All patients had a previous history of antibiotic treatment and long-term hospitalization. All patients were treated with either levofloxacin (LVFX) only or LVFX and aminoglycoside (AG). Follow-up blood culture was negative for all patients. All-cause 30-day mortality rate was 50%. Although no isolates were resistant to LVFX and AG, they harbored aac(6’)-Ⅱc, sul1, and tet(B) genes.Two isolates harbored the qnrB6 gene. There was a high probability that blaIMP-1 was carried by IncHI2 plasmids. MLST sequence type of E. cloacae isolates comprised three ST78, and one ST997; K. pneumonia isolates comprised ST134, and ST252.

Conclusion

This study showed that IMP1-E septicemia was isolated in patients with severe disease and long-term hospitalization. Selection of antibiotics therapy based on antimicrobial susceptibility induced microbiological cure, but clinical response was dependent on the underlying diseases.

Disclosures

All authors: No reported disclosures.
1060. Risk Factors for Recurrent Staphylococcus aureus Bacteremia
Authors: Choi Seong-Ho , Ruffin Felicia , Park Lawrence , Sharma-Kuinkel Batu K , Souli Maria , Warren Bobby , Hansen Brenda , Medie Felix Mba , Fowler Vance G
Published: November 2018

Background

Recurrent Staphylococcus aureus bacteremia (Re-SAB) occurs in 2–17% of patients with SAB within 3–12 months after resolution of the first episode. The risk factors for Re-SAB are incompletely understood.

Methods

Re-SAB was defined as a second episode of SAB after the resolution of the first episode occurring at least 14 days from the date of the last positive blood culture of the first episode. Using the SAB Group Prospective Cohort Study (SABG-PCS) data between January 2008 and May 2015, patients with Re-SAB were selected and compared with those without it. Pulsed-field gel electrophoresis (PFGE) was done for the clinical isolates from the Re-SAB group, and spa typing was for those from both groups. Baseline sera from patients with Re-SAB and age/race/gender matched (1:1) control subjects with SAB but without Recurrence underwent Luminex multiplex cytokine array.

Results

Seventy patients experienced Re-SAB (9.3%) and 686 SAB patients did not. In the Re-SAB group, 156 episodes of SAB were observed. Median time to Re-SAB was 147.5d (IQR, 76–358). Among 65 PFGE-analyzed pairs of isolates from the first and the subsequent episodes, the time to Re-SAB of <300 days was more commonly found in the PFGE-identical pairs than in the PFGE-different pairs (75.6% vs. 33.8%, P = 0.001). In the comparison of clinical factors between 56 Re-SAB patients with available data and 686 without Re-SAB, African American race, dialysis dependence, the presence of foreign body, persistent bacteremia, metastatic abscess formation, and methicillin-resistant S. aureus (MRSA) were more frequently observed in patients with Re-SAB. In a multivariate analysis to identify risk factors for Re-SAB, African American race, dialysis dependence, metastatic abscess formation, and MRSA were independent risk factors. The distribution of spa types between the two group was presented in Figure 1.

Conclusion

Re-SAB involves a combination of multiple factors of host, microbe, and treatment. Further laboratory investigation for any determinants in host and microbe is required.

Disclosures

V. G. Fowler Jr., Merck, Cerexa/Actavis, Pfizer, Advanced Liquid Logis, NIH, MedImmune, Basilea, Karius, Contrafect, Regneron, Genentech, Affinergy, Locus, Medical Surface, Inc., Achaogen, Astellas, Arsanis, Bayer, Cubist, Debiopharm, Durata, Grifols, Medicines Co, Novartis: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research grant and Research support.