bluuebunny/crossref_metadata_2025 huggingface dataset:
683. Molecular Detection of Enterovirus D68 among Children with Acute Respiratory Tract Infection in Ghana
Authors: Appiah-Kubi Joyce
Published: January 2021

Background

Acute respiratory tract infections of viral origin remain a leading cause of morbidity, mortality and economic loss regardless of age or gender. A small number of acute respiratory tract infection cases caused by enterovirus D68 (EV-D68) have been reported regularly to Centers for Disease Control and Prevention since 1987 by countries in North America, Europe and Asia. However, in 2014 and 2015, the number of reported confirmed EV-D68 infections was much greater than in previous years. The National Influenza Centre (NIC), Ghana carries out surveillance of respiratory infections, focusing on those caused by influenza virus; however, there is inadequate information on other viruses causing respiratory infections in Ghana, including EV-D68.

Objectives

To investigate the association of EV-D68 with Severe Acute Respiratory Infections (SARI) and Influenza-Like Illness (ILI) in Ghana.

Methods

This was a retrospective cross-sectional study which involved archived human respiratory specimens stored at -80ºC at the NIC from 2014 to 2015. Using a random sampling method, oropharyngeal and nasopharyngeal swabs from patients with SARI and ILI that were negative by real-time PCR for human influenza viruses were screened for EV-D68 using real-time reverse transcription-polymerase chain reaction (rRT-PCR).

Results

Enterovirus D68 was detected in 4 (2.2%) out 182 SARI samples tested. EV-D68 was detected in children younger than 5 years (4-100% of positives) and was not detected in children older than 5 years. Enterovirus D68 was detected more frequently in SARI cases (3%) than in ILI cases (1.2%).

Conclusion

This study has shown for the first time the presence of EV-D68 in acute respiratory infection in Ghana. The results confirmed minimal EV-D68 circulation in the Ghanaian population.

Disclosures

All Authors: No reported disclosures
686. Elevations in TNFα and IL-18 are Associated with Increased Risk of Probable Cytomegalovirus Tissue Invasive Disease in Solid Organ Transplant Recipients
Authors: Karaba Andrew H , Figueroa Alexis , Ray Stuart C , Avery Robin K , Avery Robin K , Cox Andrea L
Published: January 2021

Background

Human cytomegalovirus (CMV) continues to cause significant morbidity and mortality in solid organ transplant (SOT) recipients despite prophylaxis. Tissue invasive CMV disease (TI-CMV) can lead to end-organ damage and graft loss. Diagnosing TI-CMV can be challenging as CMV viral load in the blood does not always correlate with episodes of TI-CMV and therefore definitive diagnosis often requires an invasive procedure such as bronchoscopy or colonoscopy. The purpose of this study was to determine if proinflammatory cytokines, including IL-18, are elevated in SOT recipients with probably TI-CMV as a way to identify patients at risk for this severe form of CMV disease.

Methods

The electronic medical record was searched for adult SOT recipients who were tested for CMV via blood qPCR during an 11-month period.Twenty-nine SOT recipients were identified that had episodes of CMV DNAemia without other concomitant infections during this time period. Patients were divided into those that had probable TI-CMV and those with CMV DNAemia alone, by chart review. Inflammatory cytokines (IFNγ, TNFα, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-18, and IL-1RA) were measured in residual plasma from these patients using a commercially available multiplex assay for at least two time points during the study period. Wilcoxon-Rank-Sum, logistic regression, and principal component analysis was performed comparing patients with and without probable TI-CMV.

Results

Patients with probable TI-CMV had significantly higher IL-18, TNFα, and IL-1β than patients with CMV DNAemia alone (p < 0.001, < 0.001, and < 0.05 respectively). When adjusting for transplant type and CMV recipient serostatus, elevations in TNFα (OR 1.43, 95% CI 1.07-1.92) and IL-18 (OR 2.00, 95% CI 1.06-3.75) were associated with increased odds of having probable TI-CMV. In principal component analysis the combination of CMV viral load, IL-18, TNFa, and IL-1β accounted for 80% of the variance in the data.

Conclusion

TNFα and IL-18 in combination with CMV viral load may be useful in predicting likelihood of TI-CMV. This is important in situations where tissue biopsies are not feasible, and adds to our diagnostic capability for TI-CMV in SOT recipients.

Disclosures

Stuart C. Ray, MD, miDiagnostics, Inc. (Board Member, Research Grant or Support) Robin K. Avery, MD, Aicuris (Scientific Research Study Investigator)Astellas (Scientific Research Study Investigator)Chimerix (Scientific Research Study Investigator)Merck (Grant/Research Support, Scientific Research Study Investigator)Oxford Immunotec (Scientific Research Study Investigator)Qiagen (Scientific Research Study Investigator)Takeda/Shire (Scientific Research Study Investigator)
688. Marginal Structure Models to Estimate the Effect of Cytomegalovirus Infection on Hospitalization Among Children Undergoing Allogeneic Hematopoietic Cell Transplantation
Authors: Li Yun , Oganisian Arman , Boge Craig L K , Hayes Molly , Newman Alexander , Fisher Brian T , Fisher Brian T
Published: January 2021

Background

Children receiving an allogeneic hematopoietic cell transplant (HCT) are at risk for cytomegalovirus (CMV) infection in the post-transplant period, necessitating routine surveillance for CMV. Some patients will not have CMV detected while others will have intermittent or persistent CMV detection. Prior analyses assessing the association of CMV infection on hospitalization in the post-transplant period have been limited by methods that did not consider the time-varying nature of the exposure (CMV reactivation) and its confounders or aim to obtain causal effect estimates. We aimed to assess the causal effect of CMV reactivation on hospitalization using a causal modeling approach.

The Effect of CMV Infection on Hospitalization Using Generalized Estimating Equations and Marginal Structural Models

Methods

A cohort of allogeneic HCT patients transplanted at Children’s Hospital of Philadelphia January 2004–April 2017 was assembled and followed for 100 days after transplant. Eligible patients included those under CMV surveillance, defined as having ≥2 CMV whole blood polymerase chain reaction tests in the first month after HCT. All information was abstracted from medical charts. The association of CMV reactivation on the rate of hospitalization was estimated using traditional generalized estimating equations and repeated using a marginal structural model that accounted for time-varying exposure, confounders and non-random drop-out and obtained effects with causal interpretations.

Results

The study cohort included 340 pediatric allogeneic HCT recipients under CMV surveillance testing. 46.5% were female and the median age was 9 (range: 0 to 26). The CMV infection rate was 33.9%, with a median time to CMV detection of 23.5 days (range: 4-100). CMV infection was common in Donor+/Recipient+ (58.9%) and Donor-/Recipient+ (34.6%) patients. A traditional model estimates an additional week of CMV infection was associated with a 22% increase in average weekly hospitalization (Incidence rate ratio: 1.22, 95%: 1.12 -1.34). A marginal structure model estimates an additional week of CMV infection is associated with 3% increase in average weekly hospitalization incidence (Incidence rate ratio: 1.03, 95%: 0.91-1.16).

Conclusion

Our research showed the effect of CMV on hospitalization diminished after properly considering the time-varying nature of the CMV infection status and its confounders.

Disclosures

Brian T. Fisher, DO, MPH, MSCE, Astellas (Advisor or Review Panel member)Merck (Grant/Research Support)Pfizer (Grant/Research Support)
690. Oka-Strain Varicella-Zoster Virus Meningitis in a Healthy Adolescent
Authors: Nadimpalli Sruti S , Gershon Anne
Published: January 2021

Background

Routine vaccination with varicella-zoster (VZV) vaccine has resulted in significant declines in the incidence of VZV cases, hospitalizations, and deaths across pediatric age. This vaccine is safe and effective and adverse events are monitored closely.

Methods

We describe a case of vOka meningoencephalitis in a twelve-year-old vaccinated boy who presented with altered mental status and a vesicular facial rash.

Results

A twelve-year-old healthy, fully-vaccinated boy presented to urgent care clnic with left-sided frontotemporal headache, left-sided eye pain, and photosensitivity. Over several days, a left-sided facial rash progressed to include papular and vesicular lesions over the cheek, as well as over the left side of the chin and at the midline of the lower lip. He was somnolent, sleeping 18- 20 hours a day. The child was evaluated by a pediatric neurologist who noted a left-sided ptosis and left lateral rectus palsy; he was admitted for further workup. Cerebrospinal fluid (CSF) analysis showed WBC of 33 cells/ml3 with 92% lymphocytes; glucose of 44mg/dL (serum glucose 84mg/dL), and protein of 50mg/dL (range: 15-45). Nasopharyngeal multiplex polymerase chain reaction (PCR) (BioFire Diagnostics, Salt Lake City, Utah) was positive for rhinovirus/enterovirus. Testing of facial vesicles for varicella-zoster virus (VZV) and herpes simplex virus (HSV) was negative by DFA and culture, and enteroviral throat and rectal PCRs were negative. However, CSF PCR for VZV was found to be positive. In light of this finding, the viral isolate was sent to Dr. Anne Gershon’s research lab at Columbia University Medical Center for typing and was determined to be vOka. Quantitative and functional immune studies were performed, and were normal. The patient initially received 7 days of intravenous acyclovir, during which time his rash resolved and mental status returned to baseline. He completed a total of 14 days of acyclovir and has had no recurrences.

Conclusion

This case represents only the tenth case of Oka-strain meningitis in an immunocompetent child reported to date, and one of very few cases in immunocompetent adolescents. While rare, vOka meningitis is an entity of which primary care pediatricians and infectious diseases specialists should be aware, even in older children.

Disclosures

All Authors: No reported disclosures
695. Infective endocarditis in people who inject drugs (PWID) at UK Medical Center
Authors: Cari Evelyn Villacorta , Henderson John T , Burgess Donna R , Porterfield J Zachary , Leedy Nicole , Thornton Alice
Published: January 2021

Background

The Intravenous Drug Use (IVDU) epidemic has been developing into a public health crisis in the last twenty years. As a result, the incidence of severe bacterial infections such as infective endocarditis (IE) has been rising dramatically.

Methods

Cross-sectional study, we reviewed records of all admissions to University of Kentucky hospitals with IVDU associated ICD9/10 codes who received an Infectious Diseases consult during 2018 and focused on the cases with a diagnosis of IE. We describe associated epidemiologic, clinical, and microbiological features

Results

We include 391 patients in this cohort, among those 157 patients were for IE. Patients had a median age of 34 years old (range: 20 - 62); 81 (51.5%) were female, and five (6.1%) were pregnant and 153 (97.4%) identified as white. A previous episode of infective endocarditis was reported in 55 (35%) cases. The most common illicit substances used were heroin 68 (43.3%) and methamphetamine 65 (41.45%). Tobacco abuse was reported in 134 (86.4%) cases. Fever reported in 93 (59.8%) cases, shortness of air in 43 (28.0%) cases, and chest pain in 44 (28.6%) cases were the most common symptoms. Hepatitis C antibody was positive in 115/149 (73.2%) and 3/143 (1.9%) were HIV positive. Right-sided IE was more frequent, the tricuspid valve was involved in 94 (59.8%) patients. Gram-positive pathogens were isolated in 139 (88.5%) patients, Staphylococcus aureus was isolated in 102 (64.9%) patients, of which 67 (65.7%) were methicillin resistant. Gram-negative pathogens were isolated in 18 (11.2%) patients. Eighty-eight (56.4%) patients had an addiction medicine consult during their admission, (22.9%) patients left against medical advice and 20 (12.7%) patients needed to be readmitted within 30 days after discharge. Overall mortality was 12.7% and was significantly associated with infection by gram-negative pathogens (RR: 2.5; CI 95% 1.05 – 6.25, p=0.037).

Conclusion

Infectious endocarditis is a frequent complication in PWID which carries a high risk of mortality and often involves the tricuspid valve. The most common pathogen isolated was S. aureus, isolation of gram-negative pathogens was associated with increased mortality.

Disclosures

All Authors: No reported disclosures
703. Do Patients with Drug Use-Associated Infective Endocarditis Receive Differential Care?
Authors: Ceniceros Ashley , Felson Uriel , Fox Aaron
Published: January 2021

Background

Outpatient parenteral antimicrobial therapy (OPAT) is the preferred modality for long term intravenous antibiotics for infections such as infective endocarditis (IE). People with drug use-associated (DUA) infections achieve similar outcomes as those with non-DUA-infections when treated using OPAT. The study objective was to compare OPAT use between cohorts of patients with DUA-IE and non-DUA-IE.

Methods

This retrospective cohort study compared OPAT use for DUA-IE vs. non-DUA-IE in adults hospitalized between 1/1/15 and 9/1/19 at three Bronx, NY hospitals. We used multivariable logistic regression to assess the association between DUA-IE and discharge with OPAT, adjusting for clinically significant covariates that were decided a priori. Additional models excluded patients with unstable housing and those who left against medical advice (AMA).

Figure 1: Flow chart of inclusion and exclusion criteria

Results

The cohort included 457 patients (346 non-DUA-IE, 111 DUA-IE). Compared to those with non-DUA-IE, DUA-IE patients were younger (mean age 54.9 years), more commonly male (65.8%), Hispanic (44.1%), Medicaid insured (40.5%), and undomiciled (9%). In models adjusting for age, sex, race/ethnicity, insurance, year of admission, length of stay, socioeconomic status, Charlson Comorbidity Index, MICU admissions, and infectious disease consults, DUA-IE patients had significantly lower odds of being discharged with OPAT than non-DUA-IE patients (aOR 0.16, 95% CI 0.08, 0.34). Odds of being discharged with OPAT remained lower for DUA-IE patients after excluding unstably housed patients (aOR 0.17, 95% CI 0.09, 0.38) and patients who left AMA (aOR 0.23, 95% CI 0.11, 0.47).

Table 1: Non-DUA-IE and DUA-IE Patient Characteristics

Table 2: Unadjusted and Adjusted Odds Ratios for Discharge with OPAT

Table 3: Odds Ratios for Discharge with OPAT Among Patients Stably Housed and Retained in Care

Conclusion

Patients with DUA-IE were discharged with OPAT significantly less than those with non-DUA-IE, and patients having unstable housing or leaving AMA did not account for these differences. These data do not elucidate whether differential treatment was clinically appropriate, but other studies have demonstrated safety and effectiveness of OPAT in DUA-infections. Understanding whether addressable clinician-related factors, including their attitudes toward people who use drugs, contribute to differential treatment is an important next step in this research.

Disclosures

All Authors: No reported disclosures
709. Multidisciplinary Drug Use Endocarditis Team (DUET): Results From an Academic Center Cohort
Authors: Vyas Darshali A , Marinacci Lucas , Sundt Thoralf , Jassar Arminder , Bearnot Benjamin , Triant Virginia A , Nelson Sandra B , Wakeman Sarah E , Dudzinski David M , Paras Molly L
Published: January 2021

Background

Guidelines recommend multidisciplinary models for the management of infective endocarditis but have failed to incorporate the unique challenges of treating drug-use associated infective endocarditis (DUA-IE). Given the drug use and overdose epidemic with rising cases of DUA-IE, we created a multidisciplinary Drug Use Endocarditis Team (DUET), which convened monthly case conferences among the specialties involved, including Infectious Diseases, Cardiothoracic Surgery, Cardiology and Addiction Medicine. Objective: To conduct a retrospective cohort study of the patients presented at the DUET conferences from August 2018 to February 2020 to (1) assess clinical and demographic characteristics and (2) describe clinical outcomes.

Methods

A retrospective chart review was conducted to analyze 57 patient cases, including descriptive statistical analyses of demographics, clinical characteristics, and outcomes.

Results

Among our DUET cohort, 43.8% represented isolated right-sided endocarditis, and 84% involved native valve. Methicillin-susceptible Staphylococcus aureus was the most common microorganism isolated. ID was consulted in 94.7% of cases and overall 43.9% completed the planned antimicrobial course. The 7 patients who developed relapse/recurrent IE were initially managed medically, and 5 did not complete the initial antimicrobial course. Formal cardiothoracic surgery consultation was obtained in 57.9% and 24.6% were managed operatively. Of the patients managed operatively, 64.3% completed the antimicrobial course. The rate of antibiotic completion was higher among patients managed operatively but did not reach statistical significance (p=0.08). Formal addiction medicine consultation was obtained in 85.9% of cases, with 63.1% discharged on medications for opioid use disorder (MOUD). The rate of MOUD on discharge was not significantly different between patients managed operatively and non-operatively.

Figure 1: Patient Characteristics

Figure 2: Infection Characteristics

Figure 3: Outcome Analyses

Conclusion

ID is nearly universally involved in the care of patients with DUA-IE, but this patient population requires input from numerous sub-specialties. Multidisciplinary care teams provide a promising framework for DUA-IE to enhance and integrate nuanced decision-making.

Disclosures

Sarah E. Wakeman, MD, Celero Systems (Advisor or Review Panel member)Optum Labs (Grant/Research Support)UpToDate (Other Financial or Material Support, Author)
710. Non-invasive Diagnosis of Whipple Endocarditis Using Next-Generation Sequencing for Microbial Cell-free DNA in Plasma
Authors: de Vries Christiaan R , Macintyre Ann , Buggy Brian
Published: January 2021

Background

Tropheryma whipplei is a gram-positive bacillus that causes Whipple’s disease, a protean multisystemic syndrome classically characterized by arthralgias, chronic diarrhea, malabsorption, and weight loss. T. whipplei infection has a wide spectrum of clinical manifestations including pleuropulmonary disease, skin hyperpigmentation and cardiac infection. Endocarditis has been diagnosed in a small number of patients and may represent an atypical presentation of T. whipplei infection. Diagnosis can be challenging and has typically been accomplished with histopathology on resected valvular tissue or GI tract biopsy. Next-generation sequencing (NGS) of microbial cell-free DNA (mcfDNA) in plasma offers a rapid, non-invasive means of diagnosis of this rare cause of culture-negative endocarditis and challenging clinical entity.

Methods

McfDNA analysis was performed in a patient with culture negative endocarditis. McDNA was extracted from plasma and NGS was performed by Karius, Inc. (Redwood City, California). Human sequences were removed and remaining sequences were aligned to a curated database of over 1,400 pathogens. Organisms present above a predefined statistical significance threshold were reported and quantified in DNA molecules per microliter (MPM). Chart review was performed for clinical correlation.

Results

A 64 year-old male with history of valve replacement presented with significant deterioration of the mitral valve. An exhaustive infectious workup including blood cultures was negative. Karius testing detected T. whipplei at 766 MPM within two days of sample receipt. The normal range for T. whipplei is 0 MPM based on a cohort of 684 healthy individuals. Blood PCR for T. whipplei was confirmatory.

Table 1: Clinical Parameters of Case

Conclusion

NGS for mcfDNA in plasma offers a rapid, non-invasive method for identifying T. whipplei and, to our knowledge, the first diagnosis of Whipple disease using NGS of plasma mcfDNA.

Disclosures

Christiaan R. de Vries, MD, PhD, Karius (Consultant, Independent Contractor)Stanford University (Employee) Ann Macintyre, DO, Karius (Employee)
711. Rapid, non-invasive detection and monitoring of Bartonella quintana endocarditis by plasma-based next-generation sequencing of microbial cell-free DNA
Authors: Solanky Dipesh , Ahmed Asim A , Fierer Joshua , Mehta Sanjay
Published: January 2021

Background

There are up to 50,000 new cases of infective endocarditis each year in the United States, of which approximately 20% are culture negative endocarditis (CNE). In-hospital mortality remains high at 20 to 30%. Despite advances in diagnostic testing, determining the timing of surgery and duration of treatment in CNE are significant challenges for clinicians. Plasma next-generation sequencing (NGS) for circulating microbial cell-free DNA (mcfDNA) has shown utility in diagnosing and monitoring the response to treatment in endocarditis.

Methods

Serial blood samples were obtained prior to and after aortic valve replacement in a patient with culture negative endocarditis. Microbial cfDNA was extracted from plasma and NGS was performed by Karius, Inc. (Redwood City, California). Human sequences were removed and remaining sequences were aligned to a curated database of over 1,400 pathogens. Organisms present above a predefined statistical significance threshold were reported and quantified in DNA molecules per microliter (MPM). Chart review was performed for clinical correlation.

Results

A 53-year old man with history of homelessness, well-controlled HIV infection and a bioprosthetic aortic valve presented with symptomatic severe aortic stenosis and elevated inflammatory markers 3 years following valve surgery. Transesophageal echocardiography showed a paravalvular leak. Bartonella quintana was detected by Karius NGS (in parallel Bartonella henselae serologies were positive). After 4 weeks of parenteral antibiotics, repeat Karius testing demonstrated a 94% (16-fold) decrease in the Bartonella quintana mcfDNA signal to 8813 MPM. He underwent surgical valve replacement; twenty-four hours after removal of the infected valve repeat Karius testing showed a rapid decay of the Bartonella quintana mcfDNA signal to 103 MPM. The patient completed 3 months of oral antibiotics post-operatively, ultimately returning to his former performance status.

Conclusion

Plasma-based next-generation sequencing assays for circulating microbial cell-free DNA offer a unique means of pathogen detection, assessment of infection burden and monitoring of response to both medical treatment and surgical debridement/definitive source control in a case of Bartonella quintana endocarditis.

Disclosures

Asim A. Ahmed, MD, Karius (Employee)
712. Risk of Infective Endocarditis after Transcatheter Aortic Valve Replacement in Patients with Bloodstream Infection: A Population-Based Study
Authors: Talha Khawaja M , McHugh Jack , DeSimone Daniel , Baddour Larry M , Baddour Larry M , Sohail M Rizwan , Lahr Brian , Eleid Mackram , Sauver Jennifer St
Published: January 2021

Background

Transcatheter aortic valve replacement (TAVR) was initially approved as an alternative to surgery for patients at high surgical risk. However, it is now being considered for patients with intermediate and low surgical risk. This will result in the expansion of patient pool for TAVR; hence it is of interest to ascertain risk of blood stream infection (BSI) and infective endocarditis (IE) following TAVR. We aim to study the incidence, epidemiology and risk factors associated with IE in patients who underwent TAVR and subsequently developed a BSI.

Methods

A population-based study was conducted in 7 counties in southeastern Minnesota using the expanded Rochester Epidemiology Project (E-REP) for all adult (≥18 years) patients who underwent TAVR from January 1st, 2010 to December 31st, 2018. Transcatheter procedures that included replacement of either the aortic or mitral valve were included. Medical records were screened for development of BSI from time of TAVR until May 15th, 2020. Patients were classified as having BSI only, BSI with IE at outset, or BSI with subsequent development of new IE. ‘Early’ IE was defined as that occurring < 12 months following TAVR, with subsequent cases defined as ‘late’ IE.

Results

A total of 247 patients underwent TAVR during the study period. There were 24 patients with of BSI and 10 (42%) developed IE with an annual incidence of 5 per 1000 persons-years. Median age for patients who developed IE was 85.4 years. Male gender was affected predominantly (70%). Six developed IE at outset of BSI, while four developed IE subsequent to IE. The median time to development of IE was 791 days following TAVR. There was an equal number of early and late IE cases (n=5). The most common pathogen causing IE was viridians group streptococci (n=4) followed by enterococci and coagulase-negative staphylococci with 2 patients each. Mean Charlson comorbidity index was 6.6. Two patients with IE died before resolution of infection (20%).

Conclusion

The incidence of BSI and subsequent IE in patients with TAVR was low in our population. Due to the small number of BSI and IE cases, statistical analysis was not feasible. An analysis of all cases seen at Mayo Clinic is planned since the number of cases would be much higher to investigate potential risk factors associated with BSI and IE.

Disclosures

Larry M. Baddour, MD, Boston Scientific (Consultant) M. Rizwan Sohail, MD, Aziyo Biologics (Consultant)Medtronic Inc (Consultant, Research Grant or Support)
714. Increase in Multidrug-resistant Salmonella Serotype I 4,[5],12:i:- Infections Linked to Pork—United States, 2009–2018
Authors: Plumb Ian D , Brown Allison C , Stokes Erin K , Chen Jessica , Tolar Beth , Sundararaman Preethi , Folster Jason , Carleton Heather , Friedman Cindy R
Published: January 2021

Background

Salmonella enterica I 4,[5],12:i:- is the 5th most common serotype causing clinical Salmonella infections in the United States. A strain with resistance to ampicillin, streptomycin, sulfamethoxazole, and tetracycline (ASSuT) has been linked to swine production in Europe and the United States. We reviewed U.S. surveillance data to describe clinical infections with antibiotic-resistant I 4,[5],12:i:-.

Methods

We reviewed data from CDC’s National Antimicrobial Resistance Monitoring System (NARMS) from 2009–2018 to describe trends. We analyzed whole-genome sequence data in PulseNet, the molecular surveillance network for foodborne illness in the United States, from 2015–2018 to distinguish between strains of I 4,[5],12:i:- using core-genome multilocus sequence typing, and identified antibiotic resistance determinants (ARDs). We reviewed data from the Foodborne Disease Outbreak Surveillance System to identify foods associated with outbreaks during 2009–2018.

Results

From 2009–2013 to 2014–2018, I 4,[5],12:i:- increased as a proportion of nontyphoidal Salmonella isolates in NARMS from 4.3% to 5.0% (P=0.006), while I 4,[5],12:i:- resistant to ASSuT increased from 1.1% to 2.6% (P< 0.001). Of the 3,056 sequenced I 4,[5],12:i:- isolates in PulseNet, 2,105 (69%) were in a clade within 0–108 alleles of each other (ASSuT clade). Within this clade, 77% of isolates had ARDs conferring resistance to ASSuT, compared with 3% outside the clade. Isolates in the clade were also more likely than those outside the clade to have ARDs conferring decreased susceptibility to ciprofloxacin (13.1% vs. 5.2%, P< 0.001) and resistance to ceftriaxone (5.4% vs. 2.3%, P< 0.001). Among I 4,[5],12:i:- outbreaks with a single food source, those related to the ASSuT clade were more often linked to pork (10/15 [67%] vs. 1/5 [20%], P=0.07).

Conclusion

The increase in I 4,[5],12:i:- infections during 2009–2018 was likely driven by a clade of which most members had resistance to ASSuT, and many had decreased susceptibility to antibiotics used for empiric treatment. The association of this strain with outbreaks linked to pork suggests that measures to decrease carriage of Salmonella and selection for this strain in swine could prevent clinical infections with multidrug resistant Salmonella I 4,[5],12:i-.

Disclosures

All Authors: No reported disclosures
715. A 79 year old Female with Bloody Diarrhea and Hypovolemic Shock: Keep the Differential Diagnosis Open
Authors: Inkollu Sindhura , Korem Sindhuja , Dwivedi sukrut , Osman Ramy , Inamdar Arati
Published: January 2021

Background

Schistosomiasis is considered one of the neglected tropical diseases which is rarely seen in USA. We are reporting herein a case of intestinal schistosomiasis presented as bloody diarrhea and hypovolemic shock at Monmouth Medical Center, New Jersey.

Methods: Case Report

A 79 year old female presented with bleeding into her colostomy bag and associated left lower abdominal pain for one day duration. She has a history of colon cancer diagnosed 25years ago, which was treated with chemotherapy and a left hemicolectomy with colostomy formation. On admission, her blood pressure was 78/51 mm Hg. She looked pale and her abdominal examination revealed tenderness in left lower quadrant. Laboratory findings showed hemoglobin of 5.3 g/dl. CT abdomen showed extensive colitis. She was resuscitated and treated with Piperacillin-Tazobactum for 6 days with minimal improvement. Stool for ova and parasites were negative. EGD was unremarkable with no evidence of acute bleeding. Colonoscopy showed severe ulcerative colitis in the distal 30cm of colon. Pathology revealed ischemic and necrotic tissue with numerous calcified schistosoma eggs in the colon (Figure 1). After furthering questioning, the patient mentioned that she travelled to South China 8months prior to presentation. Patient was then treated with Praziquental for one day for possible Schistosomiasis Japonicum, given the regional distribution. The patient showed marked clinical improvement and was discharged home later.

Figure 1: Histopathology image showing calcified schistosoma eggs in colon

Results

Intestinal Schistosomiasis is a parasitic disease which peaks at age 15-20yrs, older patients usually have less parasitic burden. Symptoms include diarrhea, abdominal pain, dyspepsia and malnutrition. Heavily infected patients can have hemorrhagic diarrhea, obstruction and ischemic colitis. Definitive diagnosis requires egg identification. Treatment is relatively safe and effective, especially in the developed countries where the resistance to Praziquantel (PZQ) has not been reported yet.

Conclusion

Even though the worms that cause the disease are not found in USA, this case highlights the importance of recognizing Schistosomiasis especially in New Jersey, due to the high traveling immigrant population, as early recognition and treatment reduces morbidity and mortality.

Disclosures

All Authors: No reported disclosures
716. A Case of Symptomatic Intestinal Spirochetosis
Authors: Chan Zhi En , Shimin Jasmine Chung
Published: January 2021

Background

Intestinal spirochetosis (IS) is a condition caused by Brachyspira aalborgi and Brachyspira Pilosicoli. Its clinical significance has long been a point of contention with some debating that these spirochetes are simply colonic commensals. It is a condition that is more prevalent in developing nations as well as patients with HIV and the homosexual population. The epidemiology and prevalence of IS has not been studied in the local context.

Methods

We reviewed a case of a 37-year-old man who presented with a two month history of persistent lower abdominal pain, hematochezia, and increase in mucous discharge per rectum. He is sexually active with multiple male partners, and was previously treated for gonorrhea, chlamydia, and syphilis. His basic laboratory investigations were unremarkable, Venereal Disease Research Laboratory (VDRL) antibody and human immunodeficiency virus (HIV) screen were both non-reactive. Computed tomography of the abdomen was unremarkable. Endoscopic evaluation revealed multiple discrete ulcers measuring 1-2mm seen only in the rectum. Random biopsies of the cecum, ascending colon, transverse colon and descending colon showed mild acute colitis with IS. There was also mild to moderate acute proctitis in the rectum with spirochetes seen. 16s RNA gene sequencing of the biopsy specimen were confirmatory for Brachyspira aalborgi.

Investigation findings. A: Discrete Ulcers found in rectum, B: Hemotoxylin and Eosin stained specimen showing proctitis, C: False brush Border appearance D: Spirochetes on Warthin Starry stain

Results

The patient received a 10 day course of metronidazole with complete resolution of his symptoms.

Conclusion

This case demonstrates the existence of a treatable condition that can be diagnosed with current available investigations for patients with similar symptoms. Recognising at risk populations can also raise clinical suspicion for this condition. Some studies have found associations between IS with development of colonic polyps and also certain colorectal cancers. Further studies on this treatable condition and its disease burden in the local context should be further explored.

Disclosures

All Authors: No reported disclosures
717. Antibiotic treatment of Shiga toxin-producing Escherichia coli related gastroenteritis and the risk of hemolytic uremic syndrome: a population based matched case-control study in Japan
Authors: Myojin Shota , Pak Kyongsun , Sako Mayumi , Kobayashi Tohru , Takahashi Takuri , Sunagawa Tomimasa , Igarashi Takashi , Miyairi Isao
Published: January 2021

Background

The role of therapeutic intervention, particularly antibiotics, for Shiga toxin-producing Escherichia coli (STEC) related infection is controversial.

Methods

We performed a population based matched case-control study to assess the association between treatment (antibiotics, antidiarrheal agents and probiotics) for STEC related infections and HUS development. We identified all STEC HUS patients as cases and matched five non-HUS patients as controls using the data from the National Epidemiological Surveillance of Infectious Diseases (NESID) between January 1, 2017, and December 31, 2018. Further medical information was obtained by standardized questionnaires answered by physicians who registered each patient. We used multivariate conditional logistic regression model to evaluate the association between exposures (use of antibiotics, use of antidiarrheal agents, days between disease onset and fosfomycin administration [within two or three days]) and the development of HUS, by matched odds ratios (OR) and 95% confidence intervals (CI). Covariates we used were sex, age group, area code, presence of diarrhea and other factors. We also performed subgroup analyses using age (adults and children) as a stratification factor.

Results

7,760 STEC related patients were registered in the NESID. We selected patients who had a record of HUS diagnosis (n=182) and matched controls without HUS (n=910). After collecting standardized paper-based questionnaires, we enrolled 90 HUS patients and 371 non-HUS patients for analysis. In the main analysis, matched OR of fosfomycin was 0.75(0.47-1.20) in all ages, 1.41(0.51-3.88) in adults and 0.58(0.34-1.01) in children. Matched OR of antidiarrheal agents was 2.07(1.07-4.03) in all ages, 1.84(0.32-10.53) in adults, 2.65(1.21-5.82) in children. Matched OR of probiotics was 0.86(0.46-1.61) in all ages, 0.76(0.21-2.71) in adults, 1.00(0.48-2.09) in children. There was no significant association between the timing of fosfomycin use in the first two or five days of illness and HUS development in any age group.

Conclusion

Our results suggest that fosfomycin might decrease the risk of HUS in children younger than 15 years of age with STEC confirmed bacterial gastroenteritis.

Disclosures

All Authors: No reported disclosures
718. Asymptomatic campylobacteriosis as a risk factor for developing acute neurological syndromes in Veracruz, Mexico
Authors: Del Carpio-Orantes Luis , Sánchez-Díaz Jesús Salvador , Peniche Moguel Karla Gabriela , Perfecto-Arroyo Miguel Arnulfo , Solis-Sánchez Ishar , García-Méndez Sergio , Mata-Miranda Maria del Pilar , Pola-Ramírez María del Rosario , Contreras-Sánchez Edna Rosario , Luna-Ceballos Rosa Isela , Contreras-Sánchez Celso Ossiel , Gutiérrez-Moreno Juan Antonio , Moreno-Aldama Nancy Patricia , González-Arce América Alejandrina , Dorantes-Nava Claudia Leticia , Munguia-Sereno Alvaro Efren , Guerrero-Mancinas Zeltzin Olivia , Aparicio-Sánchez Elisa Estefanía , García-Hernández Omar , Segura-Rodríguez Orlando Israel , Escobar-Huerta Alejandro
Published: January 2021

Background

Campylobacter infection is the main cause of diarrheal disease, however it is recognized as a risk factor for developing Guillain Barré syndrome, which has been previously corroborated in our population after analyzing the incidence of the syndrome during arboviral outbreaks of 2016-2018, resulting that 75% of the cases were due to infection by Campylobacter. Furthermore, of these patients, 83% did not present gastrointestinal symptoms, constituting an asymptomatic campylobacteriosis at the intestinal level, and Guillain Barré syndrome could be its primary manifestation. Reason why the need arose to look in this population for cases of asymptomatic campylobacteriosis.

Methods

Analytical, observational and prospective study. 200 healthy and asymptomatic individuals over 18 years of age were selected in the Veracruz Norte branch of the Mexican Institute of Social Security during September to December 2019, who were asked for a stool sample, which was subjected to a study to search for Campylobacter through a chromatographic immunoassay test for the qualitative detection of said bacteria (Certest). Patients who were positive to the Certest test underwent stool culture (Campy-bap) in order to typify the identified Campylobacter species.

Results

In the search for Campilobacter, the Certest was positive in 6 (3.0%); In 5 (83.3%) subjects some variety of Campylobacter could be isolated by stool culture, in 4 (66.7%) Campylobacter Jejuni was isolated and in 1 (16.7%) Campylobacter Coli was isolated. The positive result of Certest was similar between women and men [4 (3.8%) women vs 2 (2.1%) men; p = 0.684)]. However, in relation to the culture, there was the percentage of women in whom the culture was positive for Campilobacter Jejuní was statistically significant [4 (100%) VS 0 (0.0%); p = 0.038].

Positive cases of campylobacter

Positive cases by Certest and Campy-bap

Conclusion

Asymptomatic positive cases of Campilobacter were identified in this study population in 3%, mainly isolating Campilobacter jejuni, which leads to the conclusion that there are cases of asymptomatic Campylobacteriosis that could act as a risk factor for the development of acute neurological syndromes related to the presence of the bacteria

Disclosures

All Authors: No reported disclosures
721. Effect of Gastrointestinal Pathogen Panel (GIP) in Antibiotic Management
Authors: Saling Christopher F , Seville Maria T , Patron Roberto L
Published: January 2021

Background

GIP offers detection via PCR for a wide array of common microbes associated with diarrheal illness. Its rapid turnaround time and high sensitivity has made GIP testing commonplace for the evaluation of diarrhea. The purpose of this study is to determine if GIP influences antibiotic management in patients hospitalized with diarrhea.

Methods

Fifty patients hospitalized at Mayo Clinic Arizona between July and December 2019 who underwent BioFire® FilmArray™ GI PCR Panel testing were randomly selected. Medical records were reviewed to capture gender, age, immunocompromised state, antibiotic use within 30 days, prior hospitalization within 3 months, history of Clostridioides difficile infection, time from admission to testing and GIP results, and to determine if GIP results directly contributed towards antibiotic management. This study was exempt from Institutional Review Board approval.

Results

Twenty-six patients were male and twenty-four were female. The average age was 61.7 years. Thirty-four patients (68%) were immunocompromised. Forty-one GIPs were ordered within 24 hours of admission. Twenty-two patients (44%) had a positive GIP result; five were positive for 2 concurrent organisms. C. difficile was the most commonly detected organism, found in 16/24 (66.7%) positive tests. Eleven patients (68.8%) with C. difficile had a recent hospitalization, antibiotics within 30 days, or a history of C. difficile infection. There were 3 cases of Enteropathogenic Escherichia coli, 2 of Enterotoxigenic Escherichia coli, 2 of adenovirus, 2 of norovirus, 1 of rotavirus, and 1 of Vibrio cholerae. Excluding C. difficile positive patients, GIP testing contributed in changing antibiotic management in 3/50 (6%) patients tested. One patient had antibiotics stopped, one received correct antibiotics, and one received inappropriate antimicrobial therapy.

Conclusion

These results suggest that except in the setting of C. difficile infection, GIP has little utility in guiding antimicrobial management, even in the immunocompromised patient. GIP testing is expensive and it may be more resourceful to screen patients hospitalized with diarrhea for C. difficile alone, especially in those with risk factors for C. difficile infection. Furthermore, GIP testing can lead to antibiotic overuse.

Disclosures

All Authors: No reported disclosures
723. Epidemiology, Risk Factors, and Treatment Considerations for Pyogenic Liver Abscess (PLA) in the Calgary Health Zone (CHZ) Revisited: A Population-Based Study
Authors: Losie Jennifer A , Parkins Michael , Lam John , Gregson Daniel
Published: January 2021

Background

PLA is a significant cause of morbidity and mortality. However, its epidemiology and outcomes have not been recently evaluated in the CHZ. Understanding current trends will help guide management.

Methods

In this population-based study, we evaluated epidemiology, risk factors, and treatment of patients with PLA in the CHZ. CHZ residents aged ≥ 20 years diagnosed with PLA in 2015-2017 were included. Charts were reviewed for demographics and clinical outcomes. Multivariate logistic regression was used to determine factors associated with 30-day mortality. Findings were compared to a previous assessment of PLA in the CHZ from 1999-2003 (Kaplan et al., 2004).

Results

A total of 136 patients with PLA were identified, representing an annual incidence rate of 3.7 cases per 100,000 population. Compared to 1999-2003, incidence of PLA was increased (2.3 per 100,000; p< 0.01) but mortality was similar (1999-2003: 0.22 per 100,000 vs. 2015-2017: 0.26 per 100,000; p=0.6). The most common culprit organisms were Streptococcus anginosus group (40%), Klebsiella species (25%), Escherichia coli (18%), and obligate anaerobes (16%). Pathogen prevalence was similar to the prior cohort. Compared to 1999-2003, antibiotic resistant organisms were more frequent (8% vs 1%, p=0.04). In our cohort, liver aspirations were less frequent (p=0.02) but aspirate culture was more often positive (p< 0.01). The median duration of intravenous antibiotic therapy was longer compared to previous (2015-2017: 23 days (IQR 9-38) vs. 1999-2003: 17 days (IQR 10-29); p=0.001). Similarly, the total duration of antibiotic therapy was longer (2015-2017: 42 days (IQR 25-65) vs. 1999-2003: 31 days (IQR 18-45); p< 0.001). Thirty-day mortality from admission was 7% and did not differ amongst cohorts. Risk factors are shown in Table-1.

Table-1: Risk factors for 30-day mortality in PLA

Conclusion

Incidence of PLA in the CHZ is rising with more antimicrobial resistance. Diagnostic liver aspirations are less frequent. Antibiotic durations are longer with no reduction in mortality. Understanding changing trends is valuable in directing future care. Encouraging liver aspirations to obtain a microbiologic diagnosis, especially with increasing resistance, is crucial. Considering shorter antibiotic durations in light of stable mortality warrants further exploration.

Disclosures

All Authors: No reported disclosures
730. Severity Of Clostridioides difficile Infection Based On Toxin Analysis, Acid Suppressant Medications and Antibiotics
Authors: Krishnan Gayathri , Parikh Richa , Witt Anna N , Bano Kulsum , Bhattacharyya Sudeepa , Kothari Atul
Published: January 2021

Background

Clostridioides difficile (C difficile) infection (CDI) is a major health problem in the United States and despite updated guidelines, the laboratory diagnosis remains vexed. A multistep algorithm is recommended to diagnose CDI that includes antigen, toxin and toxin gene Nucleic Acid Amplification (NAAT) assays. This study was done to assess severity of CDI based on toxin B and NAAT statuses. The other objective was to analyze if antibiotics and PPI/H2B (Proton Pump Inhibitors and H2 blockers) affected severity of CDI.

Methods

Retrospective analysis of all adult patients admitted to a tertiary medical center with diarrhea and a positive C difficile antigen test from 01/2017- 12/2017. From more than 2000 stool samples submitted to the lab, C diff antigen was positive in 265 patients. 191 were diagnosed with CDI based on the 2-step algorithm. Clinical data was available for 168 patients. Severity of CDI was determined based on published guidelines. Fischer’s exact test was used for statistical analysis.

Results

The mean age at diagnosis was 55.96. Toxin B was detected in 34% (57/168) patients and Toxin NAAT positive in 66% (111/168) patients. 57% of CDI was health care onset compared to 43% with community onset. 42% (72/168) were classified as severe out of which 40.2% (29) were toxin B positive, and 59.8% (43) were NAAT positive. There were no significant differences in severity of CDI based on toxin B and NAAT status (50.9% vs 38.4%, p=0.14). 46% of cases from community vs 39.6% from hospitals were classified as severe CDI (p=0.415). 72% of cases had antibiotic use in the last 30 days. Use of antibiotics was significantly associated with severe CDI (82% vs 64%, p=0.015). 62.5% (105) patients had history of PPI/H2B use and severity was not significantly associated with its use (p=0.872).

Conclusion

Our study shows that the presence of toxin did not significantly impact the clinical severity of CDI. The use of antibiotics did not affect the presence of toxin although the total number of CDI cases with previous antibiotic exposure was high. Patients who had recent antibiotic exposure were more likely to have severe clinical presentation. More toxin positive cases were health care onset but the effect was not pronounced. Severity of CDI did not significantly depend on health care onset or on exposure to PPI/H2B.

Disclosures

Atul Kothari, MD, Ansun Biopharma (Consultant)