bluuebunny/crossref_metadata_2025 huggingface dataset:
2656. Eliciting Preferences for Zoster Vaccination in US Adults Aged 50 Years and Older
Authors: Patterson Brandon J , Meyers Kelley , Stewart Alexandra , Mange Brennan , Hillson Eric M , Cyr Sonya , Poulos Christine
Published: October 2019

Background

In October 2017, the Centers for Disease Control and Prevention (CDC) recommended the adjuvanted Recombinant Zoster Vaccine (RZV) for all adults aged ≥ 50 years, regardless of previous vaccination. Understanding patient preferences for herpes zoster (HZ) vaccination can inform providers, payers, and policymakers about barriers, hesitancies, and utilization of available vaccines.

Methods

A discrete choice experiment survey was completed by 1,454 US adults aged ≥50 years in January 2019, with targeted sampling quotas of African Americans (25%), recent influenza vaccine recipients (50%), and individuals with autoimmune disease or chronic comorbidities (37%), to enable subgroup analyses. HZ vaccine profiles were characterized using seven attributes: vaccine efficacy (VE), duration of protection, location of service, number of doses, injection-site reaction severity, systemic reactions duration, and out-of-pocket (OOP) costs. In a series of choice questions, respondents chose between a pair of hypothetical HZ vaccine profiles, determined by an efficient experimental design, and a no vaccination option. In a second series, respondents stated intentions to complete a 2-dose vaccination series, conditioned on varying levels of side effects experienced with a first dose and expected OOP costs. Differences across subgroups were explored.

Results

Respondents placed the greatest weight on OOP costs and VE when choosing among HZ vaccination options (Figure 1). African American respondents were more sensitive to increases in OOP costs than non-African American respondents (Figure 2). ~75% of respondents indicated they would complete the series of a two-dose HZ vaccine if the cost of completing the series was $8-$13. Second-dose compliance drops about 25% when OOP costs increase to $140–150.

Conclusion

OOP cost had the greatest influence on respondents’ intention to select and complete HZ vaccination. Efforts to remove financial barriers to improve implementation of the CDC recommendations for HZ vaccination should be considered.

GlaxoSmithKline Biologicals SA, GSK study identifiers: 208677/HO-17-18066.

Disclosures

All authors: No reported disclosures.
2660. Infection Complications Following Mismatched Allogeneic Hematopoietic Cell Transplantation
Authors: Ebisu Yosuke , Natori Yoichiro , Jimenez Antonio , Alencar Maritza C , Morris Michele , Komanduri Krishna V , Camargo Jose F
Published: October 2019

Background

The use of haploidentitical or HLA mismatched unrelated donors permits allogeneic hematopoietic cell transplantation (HCT) in individuals with otherwise no donors available. Post-transplantcyclophosphamide(PTCy) is used for prevention graft-vs.-host disease (GVHD) in recipients of mismatched donors. We hypothesized that type and incidence of infectious complications following allogeneic HCT would vary according to the type of transplant.

Methods

We systematically assessed viral kinetics and reactivation rates for cytomegalovirus (CMV) in a prospective cohort of mismatched unrelated donor (MMUD) HCT recipients who had PTCy at our center (April 2017–March 2019). In addition, we evaluated the incidence of invasive aspergillosis (IA), invasive candidiasis (IC), bloodstream infection (BSI), pneumonia, Clostridium difficile (CDI), and community-acquired respiratory virus. Haploidentical donor and anti-thymocyte globulin (ATG) treated MMUD recipients were served as historical control groups.

Results

A total of 81 patients were analyzed in 3 groups (Table 1): PTCy MMUD (group 1; n = 22), ATG MMUD (group 2; n = 40) and haploidentical (group 3; n = 19). Whereas the 1 year incidence of CMV viremia was similar across groups, the rate of clinically significant (requiring preemptive therapy) CMV viremia was lower in group 1, compared with groups 2 and 3 (18 vs 53%; P = 0.02). The 1 year incidence of CDI was 47% in group 3 vs. 18% in groups 1 and 2 (P = 0.01). There was no significant difference in the incidence of IA (5–18%), pneumonia (30–42%), BSI (32–55%) and CARVs (28–53%) between groups. There were no cases of IC in this cohort. 1 year infection attributable mortality was lower in group 1 (figure), compared with groups 2 and 3, (9%, 62% and 39%, respectively; P = 0.005).

Conclusion

Compared with ATG MMUD and haploidentical donor, PTCy MMUD HCT was associated with lower incidence of clinically significant CMV and lower infection attributable mortality. These findings might be related to the contemporary prophylactic strategies used in this patient population. Larger studies are needed.

Disclosures

All authors: No reported disclosures.
2687. Extended Infusions of Piperacillin/Tazobactam vs. Cefepime for Empiric Treatment of Neutropenic Fever
Authors: Norman Sarah , Henshaw Laura , Reeves David , Moore Sarah , Cheatham S Christian
Published: October 2019

Background

In neutropenic patients, a fever may be the only indication of a severe underlying infection. According to the National Comprehensive Cancer Network (NCCN) guidelines, for high-risk patients, monotherapy with an anti-pseudomonal β-lactam agent should be initiated. NCCN states emerging data may support extended or continuous infusions of β-lactam therapies; however, preference is not given for cefepime or piperacillin/tazobactam. The objective of this study was to compare the outcomes of extended infusions of piperacillin/tazobactam vs. cefepime for the empiric treatment of neutropenic fever.

Methods

This retrospective, single-center cohort study included patients ≥18 years with an absolute neutrophil count (ANC) less than 500 cells/mm3, single oral temperature measurement ≥38.3°C or ≥38°C sustained over 1 hour period and admitted to a bone marrow transplant unit. Patients received extended infusion piperacillin/tazobactam or cefepime as initial antibiotic therapy for at least 48 hours between January 1, 2015 and September 1, 2018. The primary outcome was time to defervescence in hours. Secondary outcomes included time to defervescence and no acetaminophen use within 8 hours, defervescence by 72 hours, hospital length of stay, clinical failure, in-hospital mortality, and acute kidney injury.

Results

73 patients were included in this study (36 received piperacillin/tazobactam and 37 received cefepime). The primary outcome of median time to defervescence was 31.8 hours in the piperacillin/tazobactam group and 25 hours in the cefepime group (P = 0.26). Secondary outcomes in the piperacillin/tazobactam group compared with cefepime, respectively included median time to defervescence and no acetaminophen use: 43 vs. 35 hours (P = 0.16), defervescence by 72 hours: 66.7% vs. 91.9% (P = 0.01), median hospital length of stay 28 vs. 22 days (P = 0.04), clinical failure 22.2% vs. 24.3% (P = 0.83), in-hospital mortality 8.3% vs. 2.8% (P = 0.36), rate of acute kidney injury: 50% vs. 24.3% (P = 0.02).

Conclusion

These findings suggest there is no difference in time to defervescence between extended infusions of piperacillin/tazobactam compared with extended infusions of cefepime for the empiric treatment of neutropenic fever.

Disclosures

All authors: No reported disclosures.
162. Identifying Determinants of Therapeutic Switch to Linezolid among Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections
Authors: Nair Rajeshwari , Schweizer Marin L , Perencevich Eli N , Livorsi Daniel J , Goto Michihiko , Alexander Bruce , Beck Brice , Richardson Kelly , Puig-Asensio Mireia
Published: October 2019

Background

In order to target future randomized controlled trials (RCT) of treatment of methicillin-resistant S aureus bloodstream infections (MRSA BSI), it will be important to understand the drivers of antibiotic selection. We aimed to determine factors associated with switching from vancomycin to inpatient linezolid administration during the management of MRSA BSI.

Methods

This retrospective cohort included all patients admitted to Veteran Affairs hospitals from 2007 to 2014 and had received vancomycin for MRSA BSI. Patients were considered to have switched to linezolid from vancomycin if they received at least 2 consecutive days of inpatient treatment and were not on concurrent vancomycin treatment. Cox proportional hazards models were used to identify factors that were associated with switch within 14 days and 30 days. Median with interquartile range (IQR), hazard ratio (HR) and 95% confidence intervals were reported.

Results

Among 7289 patients diagnosed with MRSA BSI during their index admission, 474 (6.5%) switched to linezolid during the admission. The median inpatient duration of vancomycin treatment among all patients was 13 days (IQR: 5–34) and among patients who switched was 16 days (IQR: 6–52). The median inpatient duration of linezolid treatment was 5 days (IQR: 1–13 days). Patients who switched to linezolid were more likely to have a MRSA isolate with MIC >=2 µg/mL (6.8% vs. 4.9%), diagnosis of respiratory tract infection (36.7% vs. 32.9%), or be obese (16.5% vs. 13.6%) than those who continued on vancomycin (P < 0.10). In risk-adjustment models, presence of a respiratory tract infection diagnosis was associated with greater likelihood of being switched to linezolid within 14- and 30-days (HR=1.29, 95% CI 1.01–1.64; HR=1.32, 95% CI 1.06–1.65).

Conclusion

Less than 10% of patients initially treated with vancomycin for MRSA BSI were switched to linezolid in this real-world study. A diagnosis of respiratory tract infection was a major determinant of switching to linezolid. It is important to identify potential subsets of MRSA BSI patients so that future comparative effectiveness RCTs can be targeted to indications with clinical equipoise in real-world practice settings.

Disclosures

All authors: No reported disclosures.
2698. Timing of Standalone Vaccine Administration in Infants Receiving DTaP-Based Combination Vaccines
Authors: Alemayehu Berhanu , Wolfson Lara J , Chen Ya-Ting , Liu Zhiwen , Goveia Michelle , Johnson David , Marshall Gary S
Published: October 2019

Background

The recommended US infant immunization schedule includes doses of DTaP, IPV, Hib and HepB during the first 6 months of life. The majority of infants receive DTaP as one of the two pentavalent combination vaccines (DTaP-IPV/Hib or DTaP-HepB-IPV); standalone HepB or Hib are used to complement these combinations in compliance with the recommendations. Little is known about the timing of standalone vaccine administration in relation to DTaP-based combination vaccines.

Methods

This was a retrospective observational cohort study using the US MarketScan commercial claims and encounters database. Infants included in the study were continuously enrolled in the same insurance plan for ≥13 months after birth, born from 1 July 2010 through 30 June 2016, and had received ≥3 doses of a pentavalent vaccine. Outcomes included the proportion of infants receiving concomitant pentavalent and standalone vaccines, and the deviation in days when these vaccines were not administered on the same date. Birth doses of HepB were not registered in the database but were presumed to have been received; therefore, the first registered HepB claim was considered to be HepB Dose-2, and the second claim was presumed to be HepB Dose-3.

Results

Among infants who received DTaP-IPV/Hib (n = 175,574), 94.8% had claims for ≥3 doses of HepB. Although coverage was high, only 60.7% received HepB Dose-2 on the same day as DTaP-IPV/Hib Dose-1 (around 2 months of age), and only 45.1% received HepB Dose-3 on the same day as DTaP-IPV/Hib Dose-3 (around 6 months of age) (Figure 1). Many infants (46.2%) received HepB Dose-3 after the third dose of DTaP-IPV/Hib. Among infants who received DTaP-HepB-IPV (n = 97,206), 89.9% had claims for the recommended number of Hib doses; most (91% to 98%) of these doses were administered on the same day as doses of DTaP-HepB-IPV (Figure 2).

Conclusion

There was variability in the timing of HepB doses in infants receiving DTaP-IPV/Hib. A newly licensed hexavalent vaccine, DTaP-IPV-Hib-HepB, could synchronize and simplify the HepB administration schedule ensuring that more infants have completed the series by 6 months of age.

Disclosures

All authors: No reported disclosures.
2707. Non 13-Valent Pneumococcal Conjugate Vaccine Serotypes Predominate as Causes of Pneumococcal Otitis Media in Children
Authors: Hulten Kristina G , Barson William J , Lin P Ling , Bradley John S , Peters Timothy R , Tan Tina Q , Romero Jose R , Pannaraj Pia S , Kaplan Sheldon L
Published: October 2019

Background

Pneumococcal acute otitis media (AOM) in children due to vaccine-related serotypes (ST) has declined after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13), although some serotypes, such has 3, 19A and 19F have persisted. Among non-vaccine serotypes, 35B has been shown to contribute substantially to both OM and invasive infections. This study describes the current epidemiology of pneumococcal OM isolates obtained from the U S Pediatric Multicenter Pneumococcal Surveillance Group (USPMPSG).

Methods

From the USPMPSG database, we collected data from patients <18 years of age with pneumococcal OM isolates from 2014 to 2018. Analysis included demographics, immunization status, antimicrobial susceptibility data and serotype. Statistical comparisons included Fisher’s exact and Wilcoxon rank-sum tests.

Results

A total of 494 patients with isolates were identified within the time period from 5 children’s hospitals. Median age was 1.7 years (range 0–17.6) and 299 (60.5%) were male; 176 (35.7%) had an underlying condition. Thirty-two patients had received no dose of either PCV7 or PCV13. Thirty-five serotypes were identified (3 isolates were non-typeable), of which 6 serotypes [35B (16.8%), 3 (9.5%), 15A (7.9%), 15B (7.9%), 23B (7.9%) and 21 (6.1%)] caused more than half of the total OM infections (figure). Ninety (18.2%) isolates were of PCV13 serotypes. Twenty-five of 476 (5.3%) isolates had a penicillin MIC>2 µg/mL. These were of serotypes 11A, 15A/C, 19A/F, 35B and NT; 10/455 (2.2%) isolates had ceftriaxone MIC>1 µg/mL and were of ST 3, 15A, 19A/F and 35B.

Conclusion

Most pneumococcal OM were caused by non-PCV13 serotypes. Serotype 35B remained the most common serotype among pneumococcal isolates recovered from ear drainage or middle ear cultures. The low proportion of penicillin-resistant isolates along with the increasing proportion of AOM cases being due to non-pneumococcal isolates supports the consideration to switch routine antibiotic treatment for AOM to standard dose amoxicillin-clavulanate from high dose amoxicillin in PCV13 immunized children (Pediatr Infect Dis J 2018;37:1255–1257).

Disclosures

All authors: No reported disclosures.
2712. Safety and Immunogenicity of two Doses of ExPEC4V Vaccine Against Extraintestinal Pathogenic Escherichia coli Disease in Healthy Adult Participants
Authors: B Smith William , Abbanat Darren , Spiessens Bart , Go Oscar , Haazen Wouter , de Rosa Tiziano , Fae Kellen , Poolman Jan , Thoelen Stefan , de Palacios Patricia Ibarra
Published: October 2019

Background

The ExPEC4V vaccine contains 4 Escherichia coli O-antigens (O1A, O2, O6A, O25B) conjugated to exotoxin protein A and is being studied for prevention of Invasive Extraintestinal pathogenic E. coli (ExPEC) Disease (IED). This phase-2 double-blind study assessed safety and immunogenicity of ExPEC4V Clinical Trial Material (CTM), manufactured via a redesigned process (optimized O1A strain).

Methods

Participants (≥18 years) in stable health were randomized (3:1) to receive ExPEC4V dose 4:4:4:8 μg PS/serotype or placebo on Day 1 and second vaccination on Day 181 (6 months after first vaccination). Participants will be followed for safety until end of study at Day 360. Reactogenicity and immunogenicity (by ELISA, opsonophagocytic killing [OPA] assays) were evaluated pre-vaccination, and 15 days after first and second vaccinations (Day 195).

Results

Of 100 participants randomized (mean age 56, 48% males) and vaccinated (ExPEC4V, n = 75; placebo, n = 25), 97 completed Day 30. Solicited local AEs were higher for ExPEC4V (38.7%) than placebo (20%); most frequent was pain/tenderness (38.7% vs 20%). Solicited systemic AEs were higher in ExPEC4V (49.3%) than placebo (20%); most frequent was fatigue (32% vs. 12%). No serious or grade 3 solicited local AEs were reported. One participant in ExPEC4V experienced a grade 3 solicited systemic fatigue considered vaccine-related by investigator. ExPEC4V demonstrated immune responses against all serotypes at Day 15. Geometric mean titer effective concentration rank by serotypes was O2 > O1A > O6 > O25B (Figures 1 and 2). At Day 15, ≥ 82% of participants in ExPEC4V and none in placebo had ≥2-fold increase from baseline of ELISA titer for all serotypes. In ExPEC4V, ≥47% had ≥2-fold increase from baseline of OPA titer for all serotypes, while 8% in placebo had ≥2-fold increase only for O6A. Good correlation was observed between ELISA and OPA across serotypes (r ≥ 0.76).

Conclusion

ExPEC4V elicited robust and functional immune responses across all serotypes and was well tolerated with no vaccine safety findings. This study supports the development of future multivalent ExPEC vaccine to prevent IED.

Disclosures

All authors: No reported disclosures.
2735. Improving Uptake of Maternal Immunizations in the Obstetric Care Setting Through an Adaptation of the CDC’s Immunization Quality Improvement Program (AFIX)
Authors: OLeary Sean T , Ellingson Mallory , Spina Christine , Brewer Sarah E , Quick Lori , Chamberlain Allison , Limaye Rupali , Orenstein Walter , Salmon Daniel , Omer Saad
Published: October 2019

Background

Influenza and Tdap vaccines are recommended for pregnant women in every pregnancy. However, vaccine uptake remains suboptimal. Obstetrics practices need quality improvement models to improve their vaccination delivery programs. CDC’s AFIX program has been shown to be effective at increasing vaccination uptake in primary care settings. Our objective was to adapt and evaluate CDC’s AFIX program in the obstetrical setting (AFIIX-OB).

Methods

An average of 40 charts per practice were randomly reviewed pre- and post-intervention. Baseline immunization rates and vaccine administration practices were collected in the Assessment phase. Feedback was provided at meetings conducted by study staff where baseline immunization rates were shared and practices selected quality improvement measures to implement. Practices were required to implement either standing orders for influenza and Tdap vaccines or improve their vaccine documentation. As an Incentive, providers could receive continuing medical education and maintenance of certification part IV credit. After implementing the practice specific measures for 6 months, practice-wide vaccine rates were assessed and a post-intervention meeting was held with providers and staff at each practice to eXchange the results.

Results

AFIX-OB was implemented in 11 obstetric practices: 5 in Georgia and 6 in Colorado. Practices were primarily urban, their patients largely Caucasian and African American and most patients carried private insurance. Baseline practice-level immunization rates ranged from 10% to 82.9% for influenza vaccine and 12.5% to 97.6% for Tdap. 4 practices implemened standing orders, 6 improved their vaccine documentation and 1 did both. After the 6 month follow-up period, all 11 practices saw improvements in their overall Tdap vaccine acceptance (3 with statistically significant increases, P < 0.05) with final rates ranging from 25% to 100%. 9 practices either maintained or improved their influenza vaccination rates (4 with statistically significant increases, P < 0.05) with final rates ranging from 32.5% to 85.0%.

Conclusion

The AFIX-OB model provides a promising intervention to improve maternal immunization uptake that can be administered widely but still be tailored to the needs of individual clinics.

Disclosures

All authors: No reported disclosures.
2741. Seasonal Influenza Vaccine Timing in Children and Adults Hospitalized with Influenza in the United States, FluSurv-NET, 2013–2017
Authors: Haston Julia C , Garg Shikha , Campbell Angela P , Ferdinands Jill , O’Halloran Alissa , Cummings Charisse N , Kirley Pam Daily , Stephens Samantha , Yousey-Hindes Kim , Openo Kyle P , Fawcett Emily , Farley Monica M , Monroe Maya , Kim Sue , McMahon Melissa , Irizarry Lourdes , Dufort Elizabeth , Bennett Nancy M , Billing Laurie M , Thomas Ann , Talbot Keipp , Spencer Melanie , Anderson Evan J
Published: October 2019

Background

Seasonal influenza vaccine may attenuate disease severity among people infected with influenza despite vaccination, but vaccine effectiveness may decrease with increasing time between vaccination and infection. Patient characteristics may play a role in the timing of vaccine receipt.

Methods

We used data from the Influenza Hospitalization Surveillance Network (FluSurv-NET) and included patients ≥ 9 years hospitalized with laboratory-confirmed influenza during October 1–April 30 of influenza seasons 2013–2014 through 2016–2017 who received seasonal influenza vaccine ≥ 14 days prior to admission. Vaccine history was obtained from vaccine registries, medical charts, and patient interviews. We defined “early vaccination” as vaccine receipt before October 15 and “late vaccination” as receipt after (date selected using typical season onset and median vaccination dates). Early and late groups were compared using Chi-square or Fisher exact tests.

Results

Among 21,751 vaccinated patients, 61% received vaccine before October 15, and distribution of vaccination date was similar across seasons (figure). Vaccination occurred earlier with increasing age (45% were vaccinated early among those 9–17 years but 65% in those ≥ 80 years, P < 0.01). White non-Hispanic patients were more likely to receive vaccine early compared with black non-Hispanic and Hispanic patients (63% vs. 55% and 54%; P < 0.01). Those with metabolic disorders, cardiovascular disease, kidney disease, and cancer were vaccinated earlier whereas those with HIV and liver disease were vaccinated later. Vaccine timing also varied by state (P < 0.01) but not by sex.

Conclusion

Among influenza-vaccinated older children and adults hospitalized with influenza, older age, white race, and certain medical conditions were associated with early receipt of influenza vaccination in unadjusted analysis. This may be due to frequent healthcare encounters and targeted public health strategies in high-risk groups. Understanding how timing of vaccine receipt varies among populations can provide insights into variables that must be controlled for in studying possible vaccine effectiveness waning and attenuation of disease among those who are infected despite vaccination.

Disclosures

All authors: No reported disclosures.
2743. Safety of Recombinant Influenza Vaccine Compared with Inactivated Influenza Vaccine in Adults
Authors: Hansen John , Goddard Kristin , Timbol Julius , Zhang Lea , Lewis Ned , Klein Nicola
Published: October 2019

Background

In 2013, a recombinant trivalent influenza vaccine (RIV, Flublok®, Sanofi Pasteur) was licensed for use against influenza virus subtypes A and B contained in the vaccine for persons 18–49 years of age and approved for all adults ≥18 years of age in 2014. The study aim was to evaluate the safety of RIV compared with trivalent standard-dose, inactivated influenza vaccine (IIV3) in Kaiser Permanente Northern California (KPNC).

Methods

This was an observational, retrospective cohort study including all persons ≥18 years vaccinated in KPNC facilities with RIV or IIV3 during the 2015–2016 influenza season as part of routine clinical care. We compared the rates of pre-specified diagnoses of interest (Guillain-Barré Syndrome, pericarditis, pleural effusion, narcolepsy/cataplexy, asthma, acute hypersensitivity reactions and fever) using International Classification of Diseases codes during post-vaccination risk intervals 0–2, 0–13, 0–41, and 0–180 days, as well as all-cause hospitalization rates 0–180 days following vaccination. Comparing cohorts, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression analyses adjusted for age, sex, race/ethnicity, month of vaccination, and concomitant receipt of other vaccinations.

Results

During the study period, 21,976 persons received RIV and 283,683 received IIV3. Comparing RIV with IIV3, there were no statistically significantly elevated outcomes. RIV vaccination was associated with significantly decreased fever in the 0–41 day risk interval (OR 0.38, 95% CI 0.14–0.86) and all-cause hospitalization (OR 0.66, 95% CI 0.61–0.73) in the 0–180 day risk interval. Further analyses found that the lower rates of hospitalization in RIV recipients was mostly, though not fully, related to pregnancy-related hospital events in the IIV3 cohort and to the presence of additional unmeasured confounding. There were no serious adverse events or deaths related to RIV or IIV3.

Conclusion

This study did not identify any safety concerns regarding the use of RIV in adults. Understanding the observed reduction in all-cause hospitalization will need additional studies.

Disclosures

All authors: No reported disclosures.
2771. Seroprotection against Measles, Rubella, Tetanus, and Diphtheria Among Children in Haiti—2017
Authors: Minta Anna A , Andre-Alboth Jocelyne , Childs Lana , Nace Doug , Rey-Benito Gloria , Boncy Jacques , Adrien Paul , François Jeannot , Jn Charles Nadia Phaïmyr , Blot Valery , Vanden Eng Jodi L , Priest Jeffrey W , Rogier Eric , Tohme Rania A
Published: October 2019

Background

Measles, rubella, and maternal and neonatal tetanus have been verified to be eliminated in Haiti, but a diphtheria outbreak has been ongoing since 2014. To evaluate progress toward maintaining vaccine preventable disease (VPD) elimination and control, we conducted the first survey to estimate immunity to these VPDs among children in Haiti.

Methods

We conducted a nationally representative, two-stage cluster survey in 2017, stratifying Haiti into 2 regions: (1) West Region, the highly urban West department that includes one-third of Haiti’s population; (2) Non-West Region (all other departments). We sampled 4,286 households to recruit at least 910 children aged 5–7 years. We obtained vaccination history and dried blood spots from one eligible child per household. Antibody concentrations to VPDs were measured on a multiplex bead assay. We compared seroprotection and vaccination coverage estimates.

Results

Among 1146 enrolled children, tetanus (83%, 95% CI: 80%–86%) and diphtheria (83%, 95% CI: 81%–85%) seroprotection were higher than coverage with ≥3 doses of tetanus and diphtheria containing vaccine (DTP3) (68%, 95% CI: 61%–74%). No participants had antibody concentrations consistent with long-term immunity to tetanus or diphtheria. Measles (87%, 95% CI: 85%–89%) and rubella (84%, 95% CI: 81%–87%) seroprotection were higher than or similar to coverage with at least one dose of measles-rubella (MR) vaccine (84%, 95% CI: 80%–87%) (Figure 1). MR second-dose coverage was 20% (95% CI: 16%–24%). Seroprotection in the West Region was lower than in the non-West region for all VPDs.

Conclusion

Discordance between DTP3 coverage and seroprotection might be due to underestimating vaccination coverage by recall. Lack of long-term protection against tetanus or diphtheria is consistent with declining antibody concentrations by school-age after the primary DTP series, indicating the need for a booster dose. Seroprotection against measles and rubella viruses was lower than levels needed to prevent transmission, particularly in the West region; re-introduction of either virus could lead to an epidemic. Haiti should reach ≥95% DTP3 and two-dose MR coverage and add tetanus and diphtheria vaccine booster doses per global recommendations.

Disclosures

All authors: No reported disclosures.
170. Predictors of Recurrent Infective Endocarditis in Intravenous Drug Users
Authors: Kongpakpaisarn Kullatham , Aslam Sadaf , Tariq Musaab , Mhaskar Rahul , Shin Doosup , Bohra Chandrashekar , Somboonwit Charurut
Published: October 2019

Background

Caring for hospitalized patients with infective endocarditis (IE) can be challenging due to the nature of the disease and its complications, underlying medical and psychiatric problems, socioeconomic status and environmental factors.Some of these patients develop recurrent IE after the first episode treated. On-going intravenous (IV) drug use after hospital discharge is the highest predictive factor for recurrent IE. Besides IV drug use, there are limited data of other contributing factors to recurrent IE. Those factors may be modifiable during the first hospitalization to reduce the incidence of recurrent IE.

Methods

A retrospective cohort study was conducted at a large tertiary acute care medical center in Tampa, Florida. All consecutive patients with IE with history of IV drug use from January, 2011 to December, 2017 were included. Basic demographic information, co-morbidities (diabetes, hypertension, chronic lung and kidney diseases, HIV, Hepatitis B and C status, coronary artery diseases), valves involved, length of stay, complications at their first IE episode such as septic shock and stroke were included. Groups were identified based on the first episode, first recurrence and second or more recurrences of IE.

Results

A total of 106 patients were identified based on the inclusion criteria. The association between the type of valve infection (right side and left side) and IE recurrence was found to be statistically significant. (P = 0.003). Right side valves are prone to have recurrent IE episodes. People with recurrent IE were more likely to have septic shock (P = 0.02) and requiring intensive care unit (ICU) admissions (P < 0.001) during their first episode There was no statistically significant difference between other demographic information and recurrent endocarditis as well as other parameters such as organisms or type of substance used. (Table 1)

Conclusion

Right-sided IE and presence of septic shock during their first episode of IE may be the predictors for recurrent IE. Interventions including closer follow-up, more aggressive septic shock recognition and management, socioeconomic assessment in addition to substance abuse treatments after discharge should be considered to prevent recurrent IE.

Disclosures

All authors: No reported disclosures.
2791. Burden of Respiratory Infections in Trainees Higher Than Healthcare Records Indicate: Results from an Anonymous Survey
Authors: Richard Stephanie , Danaher Patrick , White Brian , Mende Katrin , Burgess Timothy , Coles Christian L
Published: October 2019

Background

Influenza-like illnesses (ILIs) are common in military populations, particularly among trainees, and can impair mission-readiness. To develop effective preventive measures against ILIs, it is vital to understand the ILI burden in the military population and identify potential risk factors for infection.

Methods

Anonymous ILI surveys were administered from January 2017 to March 2019 to military medical trainees living in a congregated setting on Fort Sam Houston (JBSA-FSH), TX. The surveys included questions about sociodemographic characteristics, weight, height, smoking status, activity level, as well as some basic questions about ILI and potential risk factors. Factors associated with ILI were identified using chi-square, t-tests, and multivariate models.

Results

2,381 surveys were returned that included age, sex, and ILI information. Respondents were 16–54 years old, 1,301 (55%) were male, 782 (33%) were Air Force, 817 (34%) were Army, and 763 (32%) were Navy/Marines. 39% of those surveyed (929) reported having experienced an ILI during their training with 40% (370) seeking healthcare for those symptoms. The primary reasons for seeking healthcare included the severity of the illness (59%), concern about spreading the illness (50%), and the accessibility of healthcare (41%). 53% of the respondents reported that ILI had an impact on their performance, among whom 77% stated reduced study time, 66% missing physical training, and 53% missed class. The final multivariate model indicates that men and participants 30+ years old were less likely to report ILI (OR 0.69 (0.58, 0.82); OR 0.65, (0.45, 0.94)) (Figure 1). In addition, participants who reported washing their hands after they coughed or sneezed were less likely to report having had an ILI (OR 0.73 (0.61, 0.89)).

Conclusion

Although 39% of respondents reported having an ILI during their training, only 40% sought healthcare, indicating that ILIs are more common during training than healthcare records indicate. More information is needed regarding how training outcomes vary among those with ILI who seek care, those with ILI who do not seek care and those without ILI during training, to allow a better estimate of the impact of ILI and development of ILI mitigation strategies.

Disclosures

All authors: No reported disclosures.
489. Risk Factors for Mortality in Patients with Elizabethkingia and Clinical Impact of Antimicrobial Susceptibility Patterns
Authors: Seong Hye , Ho Kim Jung , Choi Heun , young Ahn Jin , su Ku Nam , yong Choi Jun , Yeom Joon-Sup , Myung Kim June , Jin Jeong Su
Published: October 2019

Background

Elizabethkingia spp. is a non-fermenting, non-motile, oxidase-positive gram-negative aerobic bacilli that is ubiquitous in the environment, found in freshwater, saltwater and soil. Nowadays, they are emerging as nosocomial pathogens. In this study, we analyzed Elizabethkingia spp infected cases clinically and microbiologically.

Methods

This study was performed to evaluate the risk factors for mortality and to study the impact of microbiologic response on clinical outcomes in patient with Elizabethkingia spp Data on 210 patient of Elizabethkingia pneumonia and bacteremia that have occurred between November 1, 2005, and May 31, 2016, in a teaching hospital (2000 beds) in Seoul, Korea, were analyzed. Furthermore, antimicrobial susceptibility testing of Elizabethkingia from sputum and blood cultures was performed by E test for rifampin, moxifloxacin and vancomycin.

Results

Among 210 patients, there were 157(74.8%) survivor and 53(25.2%) non-survivor. Among these patients, 129 patients (61.4%) were male and the median age was 66.5 years. There were no significant differences in the Charlson comorbidity index between survivor and non-survivor groups (P = 0.413). In the multivariate logistic regression, microbiologic failure (odds ratio [OR], 7.862; 95% confidence interval [CI], 3.448–17.931; pElizabethkingia infection (OR, 1.032; 95% CI, 1.013–1.051; P = 0.001), previous use of immunosuppressants (OR, 3.309; 95% CI, 1.334–8.210; P = 0.010), and Percutaneous cardiopulmonary support system use at the time of Elizabethkingia infection (OR, 7.439; 95% CI,1.180–46.900; P = 0.033) were significantly associated with 28day mortality. Patients with moxifloxacin-resistant and vancomycin-resistant showed higher mortality rate but no statistically significant difference.

Conclusion

The early identification of these clinical factors in patients with Elizabethkingia infection is important to improve prognosis

Disclosures

All authors: No reported disclosures.
1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017
Authors: Sondermeyer Cooksey Gail L , Kamali Amanda , Vugia Duc , Jain Seema
Published: October 2019

Background

Coccidioidomycosis (CM) is caused by inhalation of spores of the soil-dwelling Coccidioides spp. fungus; infection can lead to severe respiratory or disseminated disease. In California, reported cases increased 222% since 2014 (2,316 cases) peaking in 2017 with 7,466 cases (rate 18.1/100,000 population), the highest annual reported cases on record. We reviewed the California hospital CM data to describe trends, demographics, comorbidities, and risk factors for in-hospital death.

Methods

Using 2000–2017 California administrative hospital discharge data, we identified hospitalizations with ≥1 CM-associated International Classification of Diseases, Ninth or Tenth diagnosis code. We calculated incidence rates per 100,000 population, assessed trends by negative binomial regression, and compared patient characteristics for potential risk factors for in-hospital death by calculating age-adjusted odds ratios (aOR) using bivariate logistic regression (significance, P < 0.05).

Results

From 2000 to 2017, 25,372 patients were hospitalized with a CM discharge code in California, and hospitalization rates increased significantly from 2.3 to 5.8/100,000 population (P < 0.01) (Figure 1). Most patients were male (69%), >40 years old (69%), white (40%) or Hispanic (38%), and residents of the higher incidence CM regions in California (52%). Most (83%) were not immunocompromised; only 3% had a human immunodeficiency virus (HIV) diagnosis. A total of 1,951 (8%) patients died in-hospital with more deaths among those with disseminated CM (15%), particularly meningitis (17%), than with pulmonary disease (7%). Frequency of death increased with increasing age (0–19 years [2%], 20–39 years [5%], 40–59 years [7%], 60+ years [13%]). Odds of in-hospital death was highest among patients with HIV (aOR 6.4, 95% CI 5.3–7.7) or chronic kidney disease (aOR 2.6, 95% CI 2.3–2.8) (Figure 2).

Conclusion

CM-associated hospitalization rates have increased in California in the last 18 years, peaking in 2017, with 1 in 12 patients dying in-hospital. Risk factors for death include disseminated CM, older age, HIV infection, and chronic kidney disease. Clinicians should be aware of these risks in caring for patients hospitalized with CM.

Disclosures

All Authors: No reported disclosures.
185. Clinical Characterization of Staphylococcus aureus Bacteremia in Children at an Inner-City Community Hospital
Authors: Oommen Jomi K , Cani Eris , Park Tae E , Manwani Savita , Purswani Murli
Published: October 2019

Background

Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality rates. Data on epidemiology and outcomes of SAB in children is not as well described as in adults. The primary objective of this study was to describe clinical and microbiological cure rates of SAB in hospitalized children. Secondary objectives included time to clinical and microbiological cure, mortality, proportions of methicillin-sensitive and resistant SA (MSSA, MRSA) bacteremia, and antibiotic usage pattern.

Methods

This was an electronic chart abstraction conducted at a community hospital in the South Bronx, NY, of all pediatric cases of SAB (<21 years of age) from January 1, 2010 to March 30, 2017. Demographic, clinical and microbiological data along with risk factors for bacteremia were collected. Clinical cure was defined as resolution of acute symptoms and signs of SAB and microbiological cure was defined as documentation of first negative blood culture after initiation of treatment. Standard definitions were used for hospital-acquired (HA) and community-acquired (CA) isolates of SA.

Results

Of 41 patients, neonates comprised 12%, 1- to 23-month-old infants 56% and 2- to 17-year-olds 31%. Overall, 76% of patients had bacteremia due to MSSA, and 24% MRSA. MRSA was isolated in 37% of HA SAB compared with 14% of CA SAB (P = 0.15). The two highest risk factors identified for SAB were peripherally inserted central catheters lines (PICC, 29%) and skin and soft-tissue infections (22%). SAB in the neonatal period was associated with PICC lines when compared with children outside the neonatal period (80% vs. 22%, P = 0.02). Using available data, clinical and microbiological cure rates were similar at 73%. The median time to clinical cure was 5 days (interquartile range [IQR] 2–10) and to microbiological cure, 2 days (IQR 1–4). A 2-month-old infant died (mortality 2.4%). Initial antibiotic selection was vancomycin (39%), clindamycin (39%), and nafcillin (7%). The proportion of SA resistant to clindamycin was 22%.

Conclusion

Pediatric SAB was uncommon in this community hospital experience over 7 years and is associated with PICC lines in neonates. MSSA was more prevalent than MRSA. Initial antibiotic selection had anti-staphylococcal coverage in 85% of cases, while clindamycin resistance occurred in 22% of SA isolates.

Disclosures

All authors: No reported disclosures.
186. Risk Factors for Extended Spectrum β-Lactamase Bacteremia and External Application of a Clinical Prediction Tool
Authors: Burnell Jacqueline , Fallis Rebecca , Axelrod Peter , Mueller Daniel
Published: October 2019

Background

Extended spectrum β-lactamase (ESBL) bacteria are resistant to many antibiotics, which increases the risk of inadequate early antibiotic therapy. A previous single-center study had created a prediction tool to assist clinicians in identifying patients at risk for ESBL bloodstream infections. The purpose of our research project was to assess validity of this tool while also identifying risk factors for ESBL bacteremia within our own institution, which would allow for assessment of alternative prediction tools.

Methods

We performed a retrospective chart review of adult patients admitted to an urban university hospital who were found to have bacteremia with Escherichia coli, Klebsiella pneumoniae, and/or Klebsiella oxytoca between October 2016 and April 2018. Demographics and comorbidities were assessed, along with other potential risk factors including exposure to antibiotics and hospitalizations within the past 6 months.

Results

A total of 214 instances of bacteremia were identified and 14% were due to ESBL organisms. Risk factors for ESBL bacteremia in our cohort included history of positive culture for ESBL (RR = 5.9) or MRSA (RR = 3.5) and antibiotic usage in the past 6 months (RR = 2.3). Patients with ESBL bacteremia were hospitalized longer (mean 16 days vs. 6 days for non-ESBL), received longer durations of antibiotic therapy (11.7 days vs. 5.3 days), and were exposed to greater numbers of different antibiotics (1.9 vs. 0.7) in the previous 6 months. Multivariate logistic regression showed that history of prior ESBL infection (OR 14.7, CI 1.8–120) and increasing number of different antibiotic classes administered in the prior 6 months (OR 4.3, CI 1.7–11.2) were significant risk factors for ESBL bacteremia. The previously created prediction tool did not sufficiently differentiate higher and lower risk for ESBL bacteremia in our cohort.

Conclusion

Although risk factors were similar, the previously derived stepwise prediction tool did not predict ESBL bacteremia in our external cohort. Point-based prediction modeling might better assess risk across institutions. Additionally, the number of different antibiotics received was associated with risk for ESBL bacteremia and should be investigated further.

Disclosures

All authors: No reported disclosures.
193. Comparison of Survival for MSSA and MRSA Endocarditis
Authors: Kanyo Emese , Shrestha Nabin K , Gordon Steven M
Published: October 2019

Background

Prior studies have yielded conflicting findings regarding outcomes for MRSA vs. MSSA infective endocarditis (IE). Our experience suggests that MSSA IE is not any less severe than MRSA IE. The purpose of this study was to compare survival in MSSA and MRSA IE.

Methods

Episodes of IE caused by Staphylococcus aureus were identified from the Cleveland Clinic Infective Endocarditis Registry. Only the first episode was included for each patient. Acceptance for surgery was considered surgical treatment. Survival from the surgical decision date was compared for MSSA vs. MRSA endocarditis using multivariable Cox proportional hazards regression. Selection of variables for the model was done by stepwise backward elimination from a collection of clinically important baseline variables.

Results

Between January 1, 2008 and January 1, 2010, 76 episodes of IE caused by S. aureus were identified. The mean (SD) patient age was 58 (15) years, 46 (61%) were males, 14 (18%) had a prior history of IE, 33 (43%) had diabetes mellitus, 22 (29%) had end-stage renal disease (ESRD), 27 (36%) had prosthetic valve endocarditis (PVE), 70 (92%) had left side involvement, 27 (36%) had invasive disease, 59 (78%) were referred patients, and 39 (51%) were treated surgically. The mean (SD) time to decision on surgery was 6 (7) days. Of these episodes 40 (53%) had MSSA IE and 36 (47%) had MRSA IE. There was no difference in hazard of death between MSSA and MRSA IE (HR 0.98, 95% C.I. 0.54–1.78, P-value 0.96), after adjusting for age, ESRD, prior history of IE, PVE, invasive disease, calendar year, and surgical treatment, which were the significant explanatory variables in the multivariable analysis. Survivals predicted by the model for a reference patient with MSSA IE and MRSA IE are shown in the figure.

Conclusion

Preliminary findings suggest that survival in MSSA IE may be similar to that in MRSA IE. The study is limited by its small sample size. The study finding will need confirmation with a larger sample.

Disclosures

All authors: No reported disclosures.
195. Descriptive Study of the Use of External Cooling Blankets in Hyperthermia
Authors: Chen Thomas , Malhotra Prashant , Khameraj Aradhana , Vyas Pooja , Ong-Bello Nelda , Rasul Rehana , Schwartz Rebecca , Farber Bruce
Published: October 2019

Background

Fever is a beneficial physiologic response to infection and is protective in gram-negative bacteremia and invasive candidiasis. Cooling blankets (CBs) are used in fevers due to a perception of providing symptomatic relief. However, external cooling of septic patients has been shown to be an independent risk factor for adverse effects. Here, we present a retrospective analysis of CB use in our institution and the associations of infections with CB duration.

Methods

We reviewed electronic medical records of patients aged ≥18 years admitted to a tertiary care hospital between 2015–2017 and in whom a CB was used. Study variables included demographics and clinical characteristics such as infection and fever duration (time of CB start to first defervescence). Correlations between continuous variables were assessed using the Spearman's rank correlation test and differences in the distribution of continuous variables by groups were assessed using Mann–Whitney U and Kruskal–Wallis tests.

Results

This analysis included 548 patients who used a total of 575 CBs during their stay (27 patients used ≥1 CB). The median age was 61.9 years and 56.9% were male. The most frequent comorbidities were immunocompromised state (40.3%), diabetes mellitus (33.6%) and coronary artery disease (32.3%). Pneumonia was the most common infection within 5 days of CB start (31.9%). Only 174 CBs had a documented discontinuation during hospitalization; for the remaining CBs, such documentation was absent. The median CB duration for these patients was 33.8 hrs (IQR: 18.0–80.9) while median fever duration was only 21.8 hours (IQR: 6.6–52.2). CB duration was highly correlated with fever duration (rho=.773, p

Conclusion

Clinician documentation of CB use was poor, only 30.2% recorded a stop time. Documented CB duration exceeded fever duration by more than 1.5 times and led to shivering responses in over 2/3 of patients. These findings suggest that CB use is arbitrary, not in keeping with established protocol or rationale, and its adverse effects may outweigh potential benefits. Their role should be re-evaluated and appropriate institutional protocols formulated.

Disclosures

All authors: No reported disclosures.