bluuebunny/crossref_metadata_2025 huggingface dataset:
689. Streptococcus suis Endocarditis: Echocardiographic Features and Clinical Outcomes
Authors: Trirattanapa Kornkanok , Kaewpoowat Quanhathai , Kanjanavanit Rungsrit
Published: December 2021

Background

Streptococcus suis (S. suis) is a zoonotic pathogen that transmits to the human with direct contact of pig or raw pork ingestion. This infection has been described in Asia, especially Thailand, Vietnam, and China. S. suis could cause wide range of infection, including endocarditis. This study aimed to describe the clinical features, echocardiogram findings, and outcomes of S. suis endocarditis.

Methods

A single center, ten-year (January 2009 to December 2018), retrospective cohort was conducted among patients who were diagnosed with S.suis endocarditis in 1,200-bed hospital in Northern, Thailand.

Results

Forty-three patients of S.suis endocarditis were identified during the study period. Of those, 28 (65%) patients had positive blood culture and 15 (35%) was diagnosed by 16SRNA bacterial identification from heart valve tissue. Majority (81%) were male with median age of 35. There were 62 affected valves in 43 patients. Twenty patients (48%) had vegetation larger than 10 mm in diameter and 35 (81.4%) patients had moderately severe or severe valvular regurgitation. Valvular perforation was described in 23 patients (53%). Perivalvular complications were founded in 15 patients (35%). Systemic embolism occurred in 17 (40%) patients. Cardiac operation was undertaken in 35 (81%) patients. There were 2 in-hospital deaths (5%) and 6 patients (14%) had disabilities. Moderately severe/severe regurgitation, systemic embolism, and no cardiac operation were significantly associated with disability or death from univariate analysis. By logistic regression analysis, systemic embolism was the only risk factor for disability or death (OR = 12.6, 95% CI 1.3-123.5, p = 0.029).

Presenting signs/symptoms, prediction score and laboratory data on admission

Conclusion

S. suis endocarditis had high rate of valvular damage with complications and resulting systemic embolism. Surgery is required in majority of the patients. Embolism was associated with disability or death.

Disclosures

All Authors: No reported disclosures
690. High Mortality and Over-representation of Young Women Amongst People Who Inject Drugs Admitted with Infective Endocarditis in Saskatchewan, Canada from 2013-2018
Authors: Gupta Anmol , Kassir Sandy , Nguyen Savio , Konrad Stephanie , Skinner Stuart
Published: December 2021

Background

The province of Saskatchewan has had the highest rates of HIV and Hepatitis C in Canada for over 10 years, the majority of which is related to People who inject drugs (PWID) and with higher proportion of young women. However, the most severe complications of injection drug use (IDU) are infective endocarditis (IE) and its associated sequelae. While high rates of IE have been noted, no data exists to show the burden of infective endocarditis and its clinical outcomes. Thus, we looked to determine the mortality and impact of IE amongst PWID and also establish the epidemiology while comparing to non-PWID IE.

Methods

This is a retrospective chart review of consecutive adult patients (age > 18) admitted for IE, as defined by Duke’s IE Criteria, at tertiary care hospitals in Regina, the capital city of Saskatchewan, between January 1, 2013 and December 31, 2018. PWID were identified through chart documentation of self-reported IV drug use. Outcomes included 1-year mortality, surgical intervention and referral to addiction services.

Results

Of the total 227 patients in our cohort, 130 (57.3%) were female, and the 1-year mortality was 39.2%. PWID related IE comprised 132 (58.1%) of the cohort. In comparison to non-PWID related IE, PWID were younger (median age 38.0, compared to 68.0 for non-PWID), more likely to be female (RR 2.06; 95% CI [1.44-3.04]; p< 0.001), to suffer right-sided disease (RR 9.14; 95% CI [4.74-15.14]; p< 0.001) and less likely to receive surgical management (RR 0.30; 95% CI [0.27-0.77]; p< 0.001). Surgical management was associated with lower mortality (RR 0.40; 95% CI [0.11-0.65]; p< 0.001). Addiction support and treatment also was protective (RR 0.89; 95% CI [0.34-1.21]; p=0.051).

Conclusion

This cohort study of IE episodes shows for the first time the devastating impact of IDU in Saskatchewan and identifies PWID as having a 39% mortality at 1 year, which coupled with their younger age translates into an enormous years of life lost. Additionally, the over-representation of young women amongst PWID IE is consistent with the higher percentage of young women with HIV and HCV infections, and identifies them as a group that is particularly vulnerable to complications of IDU. Targeted programs for PWID, particularly towards young women at risk are urgently needed.

Disclosures

All Authors: No reported disclosures
692. Coccidioides sp. Infective Endocarditis: A Review of the Literature
Authors: Kasule Sabirah N , Apolinario Michael , Saling Christopher , Blair Janis E , Speiser Lisa , Vikram Holenarasipur R
Published: December 2021

Background

Despite the endemic nature of Coccidioides sp. to the American Southwest, the incidence Coccidioides sp. infective endocarditis (CIE) is rare. Following successful treatment of a patient with CIE at our institution, we reviewed the literature to identify trends in disease presentation, patient characteristics, and outcomes.

Methods

We reviewed all cases of CIE reported since 1938. Details including patient demographics, underlying immunodeficiency, time to diagnosis, treatment, and outcome were collected for analysis of diagnostic challenges and survival.

Results

Including ours, we identified 11 published cases of CIE. The majority (7) occurred in men. 5 patients were of either African American or Hispanic descent. Of the 10 patients with reported ages, the median age was 35.5 years (range 3 weeks – 61 years). 5 patients had a previous diagnosis of coccidioidomycosis and only 3 had an immunocompromising condition. These comprised pregnancy, heart transplant, and juvenile inflammatory arthritis. Three cases had multi-valvular involvement, but the majority affected the mitral (5) and the aortic (4) valves. Only 2 of the 11 cases involved a prosthetic valve. Of the 8 cases with reported blood cultures, only 2 were positive. Ten of the 11 cases had extra-cardiac disease. Complement fixation (CF) titers were heterogenous with a median of 1:32 and a range of 1:1 to 1:2048. There was no obvious correlation between a patient’s CF titer and their survival. Average time to diagnosis was 3.5 months (range 2.5 – 36 months). Diagnosis was made post-mortem in 4 of the 11 cases. 6 patients (54%) did not survive. Notably, 2 of the fatal cases preceded the discovery of amphotericin B (1969) and 4 occurred prior to the discovery of fluconazole (1990). Of the five patients that survived, four required surgical intervention in addition to azole therapy.

Conclusion

CIE is a diagnostic and therapeutic challenge. The diagnosis itself is rare, culture incubation times are long, and the symptoms are often non-specific thus delaying definitive therapy. The introduction of azole therapy appears to have had significant impact on rates of survival. Despite this, successful management of CIE still requires concurrent surgical intervention with aggressive, indefinite anti-fungal therapy.

Disclosures

All Authors: No reported disclosures
694. Prediction Tool for Infective Endocarditis in Beta-hemolytic Streptococcal Bacteremia
Authors: Hasegawa Ryo , Matsuo Takahiro , Takahashi Osamu , Mori Nobuyoshi
Published: December 2021

Background

Although beta-hemolytic streptococci (BHS) is a rare causative pathogen of infective endocarditis (IE), IE is a serious condition and it is important to predict IE in BHS bacteremia (BHS-IE). The purpose of this study was to develop a predictive score for BHS-IE.

Methods

We conducted a retrospective study comparing the clinical features of BHS-IE and BHS-non infective endocarditis (BHS-nIE) in adult patients with BHS bacteremia at a 520-bed tertiary hospital in Tokyo, Japan from 2004 to 2020. IE was diagnosed according to modified Duke's criteria, and both “Definite” and “Possible” were included. Univariate and multivariable analyses were conducted using logistic regression.

Results

Among 250 patients with BHS bacteremia, 47 (19%) were diagnosed with BHS-IE. The median (IQR) patient age was 71 (59, 84) years and 121 (68%) were male. The proportions of A, B, C/G groups were 14%, 38.4%, and 47.6%, respectively. Five predictors, either independently associated with BHS-IE or clinically relevant, were used to develop the prediction score: C-reactive protein ≥ 10 mg/dl (2 points); Group B Streptococci (1 point); Auscultation of heart murmur (1 point); Platelet count < 150 /µl (1 point); and Hypotension (systolic blood pressure < 90 mmHg or on vasopressor) (1 point). In a receiver operating characteristic analysis, the area under the curve was 0.74 (95% confidence interval [CI]: 0.66 - 0.82). The cut-point was 2. A score ≥2 had a sensitivity of 87% (95%CI: 0.743 - 0.952), a specificity of 37% (95%CI: 0.308 - 0.445), a positive predictive value of 24%, and a negative predictive value of 93%, respectively.

Conclusion

We developed the score to help clinicians rule out IE in BHS bacteremia. Further research is warranted for validation.

Disclosures

All Authors: No reported disclosures
695. Antipseudomonal Versus Narrow-spectrum Agents for the Treatment of Community-onset Intra-abdominal Infections
Authors: Worden Lacy , Dumkow Lisa E , Dumkow Lisa E , VanLangan Kali , Beuschel Thomas , Jameson Andrew
Published: December 2021

Background

Antipseudomonal antibiotic regiments are often used to treat community-acquired intra-abdominal infections (CA-IAI) despite common causative pathogens being susceptible to more narrow-spectrum agents. The purpose of this study was to compare post-infection complications in adult patients treated for CA-IAI with antipseudomonal or narrow-spectrum regimens

Methods

This retrospective cohort study included patients ≥18 years admitted for CA-IAI treated with antibiotics between January 1, 2013, and December 31, 2019. Patients who had bacteremia or peritonitis were excluded. The primary objective of this study was to compare post-infection complications within 90 days between patients treated empirically with antipseudomonal versus narrow-spectrum regimens. Post-infection complication was defined as post-operative infection, recurrence of diverticulitis, or mortality. Secondary objectives were to compare infection and treatment characteristics along with patient outcomes. Sub-group analyses were planned to compare outcomes of patients with low-risk and high-risk CA-IAI and patients who required surgical intervention versus who were medically managed

Results

A total of 350 patients were included: Antipseudomonal, n=204; Narrow-spectrum, n=146. There were no differences in 90-day post-infection complications between groups (Antipseudomonal 15.1% vs Narrow-spectrum 11.3%, p=0.296). Additionally, no differences were observed in hospital LOS, 90-day readmission, C. difficile, or mortality. Patients treated with Antipseudomonal regimens received longer durations of therapy (median 11 days [IQR 8-14] vs 9 days [IQR 5-12], p< 0.001). No differences were observed in 90-day post-infection complications for patient with low-risk (Antipseudomonal 15% vs Narrow-spectrum 9.6%, p=0.154) or high-risk CA-IAI (Antipseudomonal 15.8% vs Narrow-spectrum 22.2%, p=0.588), or those who were surgically (Antipseudomonal 8.5% vs Narrow-spectrum 9.2%, p=0.877) or medically managed (Antipseudomonal 17.5% vs Narrow-spectrum 13.1%, p=0.463).

Conclusion

Post-infection complication rates were similar among patients treated with antipseudomonal and narrow-spectrum antibiotics. Antipseudomonal therapy is likely unnecessary for most patients with CA-IAI

Disclosures

Lisa E. Dumkow, PharmD, BCIDP, Nothing to disclose
696. Optimal Duration of Prophylactic Antibiotics in Patients with Cirrhosis and Upper Gastrointestinal Bleeding
Authors: Davis Kristin C , Reulbach Lindsay , Schrank John , Ewing Alex , Johnson Emily
Published: December 2021

Background

Spontaneous bacterial peritonitis (SBP) is a serious complication of variceal hemorrhage. Guidelines recommend a maximum of seven days of antibiotics after variceal hemorrhage to prevent SBP and reduce rates of rebleeding and mortality. However, studies supporting these guidelines used varied durations of therapy including those with less than seven days. The objective of this study was to determine if less than seven days of antibiotic prophylaxis was noninferior to seven or more days in patients with cirrhosis and variceal hemorrhage.

Methods

This was a single-center, retrospective cohort conducted from August 2019 to August 2020 including adult patients who received treatment for variceal hemorrhage and antibiotics for prevention of SBP during hospitalization. Patients were excluded if they were diagnosed with non-variceal hemorrhage, received treatment with antibiotics within 72 hours prior to the variceal hemorrhage, or expired or transitioned to end of life care within 48 hours of hospital admission. The primary outcome was in-hospital mortality. Secondary outcomes included SBP within the first 30 days after variceal hemorrhage, 30-day mortality, 30-day readmission rate, incidence of rebleeding at seven and 30 days, incidence of Clostridioides difficile infection, and intensive care unit and hospital length of stay.

Results

64 patients were included with 45 patients in the less than seven days group and 19 patients in the seven or more days of antibiotic prophylaxis group. In each group, patients were primarily male with a median age of approximately 60 years. There was no difference in the primary outcome of in-hospital mortality between the less than seven days group as compared to the seven or more days group (22.2% vs 0%, p=1). No difference was identified between the less than seven days group as compared to the seven or more days group for any of the secondary outcomes.

Conclusion

This study identified no difference in patient-centered outcomes when comparing less than seven days of prophylactic antibiotics to seven or more days in patients with variceal hemorrhage. Less than seven days of prophylactic antibiotics may be a reasonable duration for prevention of SBP.

Disclosures

All Authors: No reported disclosures
697. Outcomes of Tigecycline Use for Clostridioides difficile Infection: A Case Series of 28 Patients
Authors: Phillips Emma C , Warren Cirle A , Madden Gregory
Published: December 2021

Background

Clostridioides difficile infection remains a highly morbid or lethal condition in an unacceptably large proportion of patients. To date, there are limited and conflicting data to support the use of tigecycline for C. difficile infection and the optimal stratification approach, timing (i.e., initial vs. salvage therapy), and duration are unclear.

Methods

We describe in detail a retrospective cohort of 28 C. difficile inpatients treated with tigecycline at UVA Medical Center. We stratify each patient by the Infectious Diseases Society of America’s guidelines on severity of infection and detail the timing and duration of tigecycline therapy in each case. We further characterize the effect of tigecycline on 90-day mortality and recurrence.

Results

9/28 (32.1%) patients were treated with tigecycline for fulminant (presence of hypotension, shock, ileus, or megacolon), and 12/28 (42.9%) for severe (white blood cell count over 15x109/L or creatinine over 1.5mg/dL) C. difficile infection. Tigecycline was used in all cases in combination with oral vancomycin +/- metronidazole. The average duration of therapy was 7.6 days, with tigecycline as initial therapy (use within the first 72 hours of the start of directed antimicrobial therapy) in 7/28 (25%) cases. 90-day mortality occurred in 10/26 (35.7%) patients (two did not reach 90-day follow-up), all 10 of which were in-hospital mortalities and 5/10 (50%) occurred in patients with fulminant infection. 7 of the 16 (43.8%) surviving patients that reached 90-day follow-up had recurrent C. difficile infection.

Conclusion

Patients selected for treatment with tigecycline for C. difficile infection suffered a high rate of in-hospital mortality, especially among the significant proportion with fulminant disease. The rate of recurrent infection was substantial, contrary to some reports of reduced recurrence with tigecycline from the literature. The outcomes of tigecycline (as adjunct or monotherapy) for treatment of severe/fulminant and refractory infection versus standard treatments warrant further retrospective analysis and the benefit of tigecycline in these settings remains to be proven in well-controlled clinical trials.

Disclosures

All Authors: No reported disclosures
699. Case-Case Comparison of Exposures among Fluoroquinolone-Resistant and Pan-Susceptible Campylobacter Cases, Tennessee, 2016-2018
Authors: Hanna Samir , Garman Katie , Dunn John R
Published: December 2021

Background

Campylobacter causes an estimated 1.5 million infections each year in the United States. Of those, approximately 448,400 infections are caused by antimicrobial resistant strains, including strains resistant to fluoroquinolones (e.g., nalidixic acid and ciprofloxacin), which are commonly used to treat campylobacteriosis. Campylobacter infection is commonly attributed to consuming poultry products. We compared exposure data between fluoroquinolone-resistant and pan-susceptible Campylobacter cases reported in 2016-2018 to assess attribution.

Methods

Broth microdilution was performed on Campylobacter isolates at CDC to determine the minimum inhibitory concentration for nine antimicrobial drugs. Whole genome sequencing (WGS) was performed at the Tennessee (TN) State Public Health Laboratory and the sequence data were analyzed at CDC to determine the genetic resistance determinants. Exposure data was collected through routine case interviews. Exposures among cases with fluoroquinolone-resistant infection and cases with no resistance to antimicrobials were compared.

Results

A total of 606 Campylobacter isolates from TN were submitted to CDC NARMS. Of those, 123 (20%) isolates were resistant to fluoroquinolones and 304 (50%) isolates were pan-susceptible. The gyr A (86) resistance gene was detected in 46/54 (85%) of resistant isolates. Exposure data were available for 59 (48%) fluoroquinolone-resistant cases and 186 (61%) pan-susceptible cases. Consumption of chicken (OR 2.1, p-value 0.03) and handling raw seafood (OR 3.1, p-value 0.03) were significantly associated with fluoroquinolone-resistance. More fluoroquinolone-resistant cases reported international travel compared to pan-susceptible cases (15% versus 4%) with OR 4.6, and p-value 0.004.

Conclusion

Fluoroquinolone-resistant Campylobacter infections were acquired domestically and internationally. Exposure to chicken products and handling raw seafood were reported more often among fluoroquinolone-resistant cases. Whole genome sequencing of Campylobacter isolates provides predicted resistance data. Coupling predicted resistance data with exposure data facilitates better understanding of source attribution of different strains.

Disclosures

All Authors: No reported disclosures
700. Risk Factors and Molecular Epidemiology of Acute and Chronic Norovirus Infection at a Large Tertiary Care Cancer Center
Authors: Kondapi Divya S , Ramani Sasirekha , Olvera Adilene , Atmar Robert L , Estes Mary , Okhuysen Pablo C
Published: December 2021

Background

Norovirus (NoV) is the leading cause of viral diarrhea in patients with cancer. In this study, we describe risk factors associated with acute and chronic NoV infection in this patient population.

Methods

We identified 132 patients with NoV diarrhea (using stool RT PCR) between 2016-2020 at University of Texas MD Anderson Cancer Center (MDACC). Patient data, including demographics, clinical characteristics, NoV treatments, and complications were retrospectively extracted from charts. Stool samples were analyzed for NoV genogroups and genotypes. We compared characteristics and outcomes of patients with acute diarrhea (< 14day; AD) versus chronic diarrhea ( >14day or recurrences within 12 weeks; CD) and analyzed the data using Pearson Chi square or Fisher’s exact for categorical variables and Wilcoxon rank-sum test for continuous variables.

Results

Of 132 patients identified, 124 had an underlying cancer (39 solid tumor, 85 hematological malignancies, Table 1). On univariate analysis, CD patients were more likely to have a hematological malignancy (p=0.002), be a hematopoietic stem cell recipient (p= 0.013), have a history of gastrointestinal graft versus host disease (p= 0.011), or have received immunosuppressants or steroids in the 90 days before diarrhea onset (p=0.001, Table 2). CD patients had significantly lower white blood cell counts (p=0.038), absolute neutrophil counts (p=0.049), IgG levels (p= 0.001), and serum albumin levels (p=0.002) at the time of NoV diagnosis (Table 3). Patients with CD more often received symptomatic or NoV targeting treatment, including anti-diarrheal (p=0.005), nitazoxanide (p< 0.001), intravenous immune globulin (p=0.017), and oral IgG (p=0.042). CD patients more often had diarrheal recurrence in the first 4 weeks (p=0.001) or the second month (p< 0.001) after initial diagnosis and needed enteral or parenteral nutrition (p=0.004). We genotyped NoV in 67 patients (Figure 1), resulting in identification of the following genogroups: GI (n=9, 13%), GII.4 (n=23, 34%), and other types of GII (n=35, 52%). Genotype diversity was higher in patients with CD than AD (Figure 1).

Conclusion

In patients with cancer, CD from NoV is associated with severe immunosuppression, is refractory to therapy and can be caused by a variety of NoV genotypes/genogroups.

Disclosures

Robert L. Atmar, MD, Takeda Vaccines, Inc. (Grant/Research Support) Mary Estes, PhD, Takeda Vaccines (Consultant, Grant/Research Support) Pablo C. Okhuysen, MD, FACP, FIDSA, Deinove Pharmaceuticals (Grant/Research Support)Ferring Pharmaceuticals (Consultant)Melinta Therapeutics (Grant/Research Support)Merck & Co. (Grant/Research Support)Napo Pharmaceuticals (Consultant, Scientific Research Study Investigator, Research Grant or Support)Singulex (Consultant)Summit Therapeutics (Grant/Research Support)
701. An Open-label Phase 2a Study of Ibezapolstat, a Unique Gram-positive Selective Spectrum (GPSS) Antibiotic, for Patients with Clostridioides difficile Infection
Authors: Garey Kevin W , Begum Khurshida , Hu Chenlin , Wang Weiqun , Lancaster Chris , Gonzales-Luna Anne J , Loveall Caroline , Jahangir Alam M , Silverman Michael
Published: December 2021

Background

Ibezapolstat, a DNA polymerase IIIC inhibitor, currently in Phase 2 clinical development for treatment of C. difficile infection (CDI). Its unique mechanism of action targets low G+C content Gram-positive bacteria primarily Firmicutes including C. difficile. Phase I healthy volunteer results demonstrated a favorable microbiome profile suggestive of an anti-recurrence effect. The purpose of this study was to report clinical outcomes, pharmacokinetics, and microbiome changes from this Phase 2a clinical study and to continue to test for anti-recurrence microbiome properties.

Methods

Ibezapolstat 450 mg was given twice daily for 10 days to patients with mild-moderate CDI defined as diarrhea plus a positive C. difficile toxin test. Test of cure was evaluated at day 12 and sustained clinical cure at day 38. Stool samples were evaluated for C. difficile cultures and microbiome changes.

Results

Ten subjects (female: 50%) aged 50 ±15 years were enrolled. All ten subjects experienced a clinical cure by the test of cure visit at day 12 and all 10 subjects experienced a sustained clinical cure at the day 38 visit. Ibezapolstat was well tolerated with 1 adverse event (nausea) probably related to drug. Ibezapolstat systemic exposure was minimal with no plasma level reaching 1 ug/mL any time during therapy. Ibezapolstat colonic concentrations averaged 400 ug/g stool at day 3 and greater than 1,000 ug/g by day 10 of dosing. Six of the seven available baseline stool samples grew toxigenic C. difficile of various ribotypes including RT078-226 and RT014-020 (Ibezapolstat MIC range: 0.25-1 ug/mL). Follow-up cultures were no growth starting from day 3 stool cultures. Microbiome changes included overgrowth of Actinobacteria and/or Firmicute phylum species while on therapy.

Conclusion

Favorable clinical efficacy and safety results were observed in ibezapolstat patients with CDI including 100% clinical cure and sustained clinical cure. These results begin to validate our approach to ibezapolstat development in that the favorable microbiome effects seen in healthy Phase 1 volunteers may be predictive of beneficial patient outcomes, including low rates of recurrence. These results support the continued clinical development of ibezapolstat.

Disclosures

Kevin W. Garey, Pharm.D., M.S., FASHP, Summit Therapeutics (Research Grant or Support) Michael Silverman, MD, Acurx Pharmaceuticals (Consultant)
703. Peritoneal Coccidioidomycosis in a Pediatric Patient: An Extremely Rare Presentation and Literature Review
Authors: Braz Barbara Ximenes , Soobhanath Chantal , Thompson Amelia B
Published: December 2021

Background

Chronic peritonitis is an unusual manifestation of coccidiomycosis (CM) that is challenging to diagnose and manage due to its propensity for relapse. It is even more unusual to diagnose peritoneal CM in the pediatric population, with only two other cases reported in the literature.

Methods

We present the case of a previously healthy 5-year-old Filipino female in Florida who was diagnosed with peritoneal CM. After months of unintentional weight loss and worsening abdominal distention, she presented to medical care. Imaging revealed significant abdominal ascites and nodularities throughout the peritoneum. The peritoneal fluid demonstrated a lymphocytic pleocytosis and infectious workup was benign. CA125 levels were elevated, but peritoneal adenosine deaminase was within normal limits. A biopsy of the affected tissue revealed diffuse granulomas surrounding spherules that were positive on GMS and PAS staining, concerning for CM. Exposure history revealed that she was raised in California and moved to Florida one year prior to presentation. Complement fixation titers were significantly elevated at ≥ 1:512 and immunodiffusion titers were positive. A Coccidioides PCR was sent from the tissue to the Mayo clinic and was positive, and fungal cultures from the tissue grew C. immitis/posadasii. Immunologic workup was reassuring. She was started on oral Fluconazole with rapid resolution of her symptoms.

Results

Involvement of the peritoneum in CM is extremely rare. Abdominal distention due to ascites is the most common presentation, and the peritoneal fluid is typically exudative. Imaging may reveal peritoneal deposits which can mimic other infections and malignancy. Diagnosis can be based on histopathological demonstration of fungal structures, cultures, antibody testing, antigen detection and/or PCR. Treatment guidelines suggest azole therapy for nonmeningeal disseminated CM with at least 6–12 months of treatment for extrapulmonary coccidioidal soft tissue infection.

Conclusion

Peritoneal CM is an extremely uncommon condition and it is even more rare in the pediatric population, but should be considered in those in the appropriate clinical settings, particularly if they have history to suggest exposure to regions where this fungus is endemic.

Disclosures

All Authors: No reported disclosures
704. Contemporary Salmonella spp. Infections in Houston, TX (2019 and 2020) and Emergence of Cephalosporin Resistance
Authors: tabarani christy , Flores Anthony R , Flores Anthony R , Arias Cesar A , Wanger Audrey
Published: December 2021

Background

Salmonella spp. Infections are a significant cause of morbidity in children in the United States. Contemporary clinical and microbiological characteristics of pediatric Salmonella infections in urban cities are not well described.

Methods

We used a retrospective chart review of records (0-18 years of age) from a network of hospitals (n=11) in Houston, TX. Only patients with Salmonella spp. isolated from clinical samples in 2019 and 2020 were included. Demographic, clinical, and microbiological data were extracted from the medical record.

Results

A total of 35 pediatric cases of Salmonella spp infection were identified over the two-year period. Median age was 1.6 years with over one-third (13/35, 37.1%) under one year (Table 1). Nearly half (15/35, 42.9%) of patients required hospitalization with a median length of stay of 2 days. From cases with available clinical data (n=31), most common symptoms were fever (22/31, 71%) and bloody diarrhea (21/31, 67.7%) (Table 2). Bacteremia was detected in 17.1% (6/35) of cases (Table 3). Exposure history was elicited in 29% (9/31) of cases with foreign travel being most common risk factor (Table 2). All speciated isolates were Salmonella enterica with the majority (24/29, 82.8%) subspecies enterica. Of 24 samples with serotype information, the most common was infantis (Table 3). A single isolate was resistant to all antibiotics tested except meropenem (Table 3) and was recovered from a patient after travel to Pakistan. Nearly half of patients (15/31, 48.4%) received definitive therapy with a third generation cephalosporin antibiotic. Complications were rare and included septic arthritis/osteomyelitis (n=1), UTI (n=3), coagulopathy (n=1), and hepatitis (n=1).

Conclusion

Salmonella spp. Infections were common in the Houston metropolitan area over the 2-year period and occurred primarily in young children. Foreign travel seems to be a major risk factor for acquisition of this infection in children. For the first time, the identification of a multi-drug resistant Salmonella isolate suggests that this phenotype is likely to increase and highlights the importance of ongoing surveillance.

Disclosures

Anthony R. Flores, MD, MPH, PhD, Nothing to disclose Cesar A. Arias, M.D., MSc, Ph.D., FIDSA, Entasis Therapeutics (Grant/Research Support)MeMed Diagnostics (Grant/Research Support)Merk (Grant/Research Support)
705. Community Acquired Gastrointestinal Infections among Transplant Recipients
Authors: Al-Obaidi Mohanad , Zangeneh Tirdad T
Published: December 2021

Background

Community-acquired gastrointestinal (cGI) infections carry a significant risk of mortality and morbidity. Transplant patients are at increased risk of infectious complications. We aimed to study the risks and outcomes of cGI infections in this population.

Methods

After the institutional review board’s approval, a multi-center retrospective study was conducted. Data was collected from inpatient admission for patients with a history of hematopoietic stem transplantation or solid organ transplantation. Data regarding patient demographics, gastrointestinal polymerase chain reaction (GIPCR), clinical presentation, medications, discharge, and length of stay were collected. Chi-square test was performed to compare categorical data, and student’s t-test and Wilcoxon test were used to compare parametric and non-parametric variables accordingly.

Results

From 10/01/2017 to 07/14/2020, there were 445 encounters with GIPCR tests ordered. 48% were female, 53% were non-Hispanic White, and the mean age was 58 (SD ±14.6). Of the 445 encounters, 66 had a positive test. 40/66 had kidney transplants. The most common detected organisms were Norovirus (36%), Enteropathogenic E. coli (26%), Campylobacter species (9%), and Enteroaggregative E. coli (9%). The most common symptoms were abdominal pain and diarrhea, with 26% reported an exposure or a recent travel. There was no difference in the mortality rates between positive and negative GIPCR (3% versus 2.4%, p=0.7), during the study period. There was a significant difference in the mean length of stay between positive GIPCR with 7.5 (SD ±10.5) days versus 12.4 (SD ±18.3) days in negative GI PCR, p=0.036.

Conclusion

The majority of GIPCR tests were negative. Patients with positive GIPCR had shorter length of stay compared to negative GIPCR transplant recipients. There was no difference in mortality between positive and negative GIPCR among transplant patients. Future studies are required to evaluate the impact of cGI infections on transplant patients.

Disclosures

All Authors: No reported disclosures
707. Hospital-Onset Clostridioides difficile Infection Rates During COVID-19 Pandemic in the ICU Patients
Authors: Gavrielatou Evdokia , Temperikidis prodromos , Tsimaras Michalis , magira eleni
Published: December 2021

Background

Due to COVID-19 gastrointestinal microbiome alterations, COVID-19 can be complicated by Clostridioides difficile infection (CDI). This retrospective cohort study aimed to evaluate the prevalence of Clostridium difficile infection in patients with COVID-19pneumonia

Methods

A retrospective cohort study was conducted on PCR Covid-19 positive patients admitted in the ICU from September,2020 to 30th April 2021. All patients in the cohort study were on mechanical ventilation, or at some point during their ICU admission required mechanical ventilation. Hospital-onset (HO-CDI), defined as a positive C. difficile test over 3 days after admission.

Results

Overall, during the study period, a total of 240 PCR Covid-19 patients were admitted to the ICU; of these, 11 (4.5%) were COVID-19 CDI positive. Nine were males (81%). The mean hospital stay for these COVID-19 patients was 12 days (range 1–59 days). HO-CDI median day of identification was 12 days. All patients received ≥2 antibiotics and dexamethasone at admission. Compared to historical controls, COVID-19 patients did not have a higher overall CDI positive rate. However, mortality among COVID-19 HO-CDI patients was increased 7/11 (63%).

Conclusion

Whether COVID-19 itself increases an individual’s risk for CDI remains unclear. Multiple contributing factors drive CDI incidence, severity, and recurrence. Although protective measures such as gowns and gloves during COVID-19 increased, CDI cases in the hospital setting should continue to emphasize the importance of antimicrobial stewardship.

Disclosures

All Authors: No reported disclosures
708. Evaluation of Fungal Culture versus Bacterial Culture for the Identification of Various Mold Species
Authors: Su Erin , She Rosemary
Published: December 2021

Background

Invasive mold infections are challenging to diagnose and in part relies on fungal cultures. A large proportion of mold isolates are recovered on routine bacterial cultures in our medical center, thus we sought to define the utility of bacterial versus fungal cultures for isolation of mold from clinical specimens.

Methods

Routine bacterial and fungal culture results from wound, tissue, body fluid, and respiratory specimens from Jan 2019-Dec 2020 from Keck Medical Center of USC (Los Angeles, CA) were retrospectively reviewed. Cases were excluded if specimens were collected specifically for dermatophyte recovery or for blood culture. Cultures in which mold, including dimorphic fungi, were isolated were included in the evaluation.

Results

Mold was isolated from 612 specimens from 408 patients, with recovery from 329 bacterial and 450 fungal cultures. Among the 329 bacterial cultures, fungal cultures were not requested in 119 (36.2%) while the remaining 210 had concurrent fungal cultures which recovered mold in 167 cases (79.5%). Of 450 fungal cultures recovering mold, a corresponding bacterial culture was performed in 445, isolating mold in 181 (38.8%) of these cases. Two or more molds were found in 28 fungal cultures and in 5 bacterial cultures. Of positive specimens with both fungal and bacterial cultures performed (n=488), mold was isolated in fungal cultures in 446 (91.4%) and in bacterial cultures in 209 (42.9%) (Table).

Yield of molds in 488 specimens with concomitant bacterial and fungal cultures

Conclusion

Although a significant number of molds are recovered in routine bacterial cultures, over half would be missed without concomitant fungal cultures. Conversely, recovery of clinically relevant mold species was optimal when both bacterial and fungal cultures were requested on a specimen. This may be related to increased specimen sampling and incubation conditions allowing for broader organism recovery.

Disclosures

All Authors: No reported disclosures
709. Risk Factors for Candida auris Candidemia: Results from a Multicenter Case-Control Study
Authors: Simon Samuel , Li Rosanna , Andrade Justin A , Tharian Biju , Silver Michael , Cox Diana Villanueva , Gonzalez Daniel , Mayer Ariel M , Fu Lung H , Truong James , Figueroa Nilka , Ghitan Monica , Chapnick Edward , Lin Yu Shia
Published: December 2021

Background

The emergence of Candida auris as a global pathogen has been described as a serious global threat by the CDC. It has caused outbreaks in healthcare settings as it is transmissible between patients. The risk factors for candidemia caused by C. auris may be different than candidemia caused by other Candida spp.

Methods

We performed a multicenter, retrospective case-control study at three hospitals in Brooklyn, New York between 2016 and 2020. Patients with at least one positive blood culture for Candida spp who were started empirically on an antifungal within 24 hours of blood culture positivity were included in the study. Subsequent cases in the same patient were excluded unless separated by at least 90 days from the initial case. Similar variables such as antibiotics and antifungals within the same drug class were compressed into one variable. Variables with a p-value ≤ 0.05 on univariate analysis were entered into a multivariable analysis with a p-value ≤ 0.05 considered to be statistically significant.

Results

84 cases of C. auris candidemia and 105 cases of candidemia caused by other Candida spp were included in the analysis. The most common species of other Candida spp was C. glabrata (N=33, 31.7%) followed by C. albicans (N=32, 30.4%). In the multivariable model, the strongest risk factor for C. auris candidemia was prior infection or colonization with C. auris (aOR 17.5; 95% CI, 1.60-192.93; P = 0.019) followed by prior infection or colonization with multidrug-resistant bacteria (aOR 6.97; 95% CI 1.49-32.74, P = 0.014). A history of peripheral vascular disease (PVD) (aOR 7.78; 95% CI 1.34-45.34, P = 0.023), cerebrovascular disease (CVA) (aOR 4.24; 95% CI 1.18-15.20, P = 0.027) and hemiplegia (aOR 6.43; 95% CI 1.19-34.85, P = 0.031) were also statistically significant. These risk factors remained significant analyzing only patients without any history of C. auris.

Conclusion

These data suggest that in hospitalized patients with candidemia, a history of colonization or infection with C. auris, prior infection or colonization with multidrug-resistant bacteria, as well as a history of PVD, CVA, and hemiplegia are associated with C. auris candidemia.

Disclosures

Samuel Simon, PharmD, Accelerate Diagnostics (Employee)
710. Comparison of Initial CXR to CT in Patients (pts) with Hematologic Malignancy (HEM) and Documented Symptomatic Pulmonary Mucormycosis (PM)
Authors: Franklin Alexander , Axell-House Dierdre B , Spallone Amy , Tarrand Jeffery , Kontoyiannis Dimitrios P
Published: December 2021

Background

There is a spectrum of pulmonary disease burden in pts with HEM and PM. There have not been any data comparing the sensitivity and findings of initial Chest X-Ray (CXR) and chest CT in these pts.

Methods

We compared the findings of the initial CXR and CT in all pts with proven or probable PM via EORTC/MSG criteria. We included only pts who had pulmonary symptoms and who had both CXR and CT within 5 days of each other and within seven days of symptom onset or date of culture at MD Anderson Cancer Center from April 2000 and April 2020. We collected data regarding demographics, status of HEM, clinical presentation, frequency and findings of BAL and imaging findings, mold-active prophylaxis and treatment regimens, and mortality. CXR findings were classified as normal or abnormal, and if abnormal sub-classified as mass-like/consolidative, nodular, cavitary or heterogenous/non-specific. CT findings were classified in a similar manner.

Results

We Identified such 39 pts with PM who had both CXR and CT within 5 d. All pts had positive CT. Five pts (13%) had a negative CXR. The majority of pts 28 (72%) were neutropenic (neutrophil count < 500). The most common CXR findings were consolidation or mass-like lesions (56%), followed by patchy, heterogenous or non-specific findings (33%) and nodules (13%). Only 3% had cavitary lesions. Similarly, consolidation or mass-like lesions were the most common finding on CT (69%), followed by nodular lesions with or without ground glass halos (56%). Cavitary lesions and/or reverse halo sign (RHS) were common (31%) on CT. Patients with normal CXR vs those with abnormal CXR were comparable in all clinical parameters we collected. The median survival from time of symptoms onset for all pts was 45 days. There was a trend for lower 42 day mortality in pts with normal CXR (20% vs 47%, P=.253).

Conclusion

A negative CXR does not preclude PM, especially in neutropenic pts. A CT is recommended for better sensitivity and although there was concordance in CXR with CT findings in some chest abnormalities (mass, consolidation), CT more commonly revealed nodules and signs highly suggestive of PM such as RHS. Although small numbers precluded a robust comparison, it is possible that HEM pts with PM and negative initial CXR have better prognosis, perhaps reflecting a lower burden of pulmonary involvement

Disclosures

Dimitrios P. Kontoyiannis, MD, Astellas (Consultant)Cidara Therapeutics (Advisor or Review Panel member)Gilead Sciences (Consultant, Grant/Research Support, Other Financial or Material Support, Honoraria)
712. Neurocysticercosis at a Large Academic Center in the USA
Authors: Ramanathan Maya , Cordova Leopoldo , Bertran-Lopez Jovanna , Lichtenberger Paola , Lichtenberger Paola
Published: December 2021

Background

Neurocysticercosis (NCC) is a parasitic infection that results from the ingestion of eggs from the adult tapeworm Taenia solium that develops when cysticercoids migrate into the central nervous system. In addition, this infection has been found to affect over 50 million individuals worldwide. In the United States, NCC mainly affects immigrants from Latin America, where the disease is endemic with seroprevalence rates ranging from 5% to 11%. Most data regarding NCC in the United States comes from hospital reports from California and Texas. We are undertaking this study to determine the differences seen in a higher Latin American and Haitian population compared to a previously seen predominantly Mexican population. In this retrospective review, we characterized the population diagnosed with NCC at one large tertiary medical center in South Florida, University of Miami Hospital.

Methods

This retrospective chart review included adult patients from January 2009 to December 2019 with the admission or discharge diagnosis of neurocysticercosis (ICD 10 Code B 69.0 Neurocysticercosis and CPT code 86682 Cysticercosis). We extracted data on demographics, clinical symptoms, recurrence, treatment, resolution and follow up.

Results

Forty-seven patients were analyzed to completion. Most of the cases were seen in Hispanics 72.3 % and from Central America 40.4%. The most common symptom was headache 53.2% followed by seizures 42.6%. Normal physical exam was noted in 93.6% of the cases. Most of the cases have 1-10 lesions (98%), located in the brain parenchyma (75%). Serum serology, CSF antibody or stool studies were not obtained in around 90% of the cases. Treatment was indicated in 70.2% of cases and recurrence was low at 17.0%. Refer to Tables 1-5 for full results.

Figure 1. Demographics and Clinical Symptoms

Figure 2. History and Imaging

Figure 3. Laboratory Evidence and Follow up

Conclusion

NCC is a neglected tropical disease which is preventable. Our study noted that the majority of the affected population were immigrants that had been in the US for more than 10 years and came from central America and the Caribbean. With appropriate treatment, most of the symptoms and CNS lesions resolved, with a low mortality. Public health efforts to identify and treat the tapeworm carrier could be improved to allow for public health follow-up of cases. Although not yet considered endemic in Florida, we hope to bring awareness in this state.

Disclosures

All Authors: No reported disclosures
714. Invasive Fungal Infection Caused by Curvularia Species in a Patient with Intranasal Drug Use: A Case Report
Authors: Kulla Bakri , Pham Jason , Johnson McKenna
Published: December 2021

Background

Invasive fungal infections (IFIs) are uncommon infections that account for approximately 27.2/100,000 cases per year in the United States. One form of IFI is chronic invasive fungal sinusitis (CIFS). If untreated, invasion into neighboring structures may cause altered mental status, seizures, strokes, proptosis, and intracranial complications.

Case Report

An afebrile 43-year-old female with a history of polysubstance abuse presented to the ED due to altered mental status, left sided facial droop, right sided hemiparesis, and slurred speech. The patient was somnolent but arousable to stimuli and appeared acutely ill. The patient’s mother reported a history of cocaine abuse, which was confirmed on urine toxicology. A CT head and neck with contrast revealed subacute basal ganglia lacunar infarcts and a left sphenoid opacity with scattered hyperintensities and erosive changes [Figure 2]. One month prior, she had been diagnosed with a left superior pole kidney mass and a left-sided enlarged periaortic lymph node containing multiple noncaseating granulomas and GMS stains positive for fungal hyphae [Figure 1].

The patient underwent nasal endoscopy with tissue biopsy. Tissue showed necrotizing invasive fungal sinusitis with granuloma formation and foreign-body giant cell reaction. Fungal speciation of the tissue culture showed Curvularia species was placed on IV voriconazole. While the infection stabilized, her neurologic deficits did not significantly improve. She was discharged to inpatient rehabilitation.

Figure 1. Coronal and axial view of left upper pole kidney mass with perinephric fat stranding.

Figure 2. MRI brain CTA Head and Neck with contrast in axial plane showing multifocal infarcts likely represent complications of fungal basilar meningitis secondary to the left sphenoid sinus disease. Imaging also shows irregular erosive change at the anterior aspect of the sella turcica, through the planum sphenoidale, and bony defect of the sphenoid sinus.

Methods

Results

Conclusion

Intranasal use of cocaine causes vasoconstriction to elicit sinonasal tissue ischemia. With extended use, chronic mucosal inflammation can occur that can result in sinonasal osteocartilaginous necrosis and potential for infection. CIFS is infrequently diagnosed and its indolent nature with progression over weeks or months can make diagnosis and treatment difficult. The most frequent fungal species identified are the Aspergillus species, but Curvularia species have been found as well. CT and MRI scanning can be suggestive, but are not sufficiently specific or sensitive. The main forms of interventional modalities include surgical debridement and antifungal therapy to maximize survival

Disclosures

All Authors: No reported disclosures