bluuebunny/crossref_metadata_2025 huggingface dataset:
2749. Disparities in Healthcare Seeking Behaviors in the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) Study
Authors: Schofield Christina , Richard Stephanie , Colombo Rhonda , Collins Limone , Ganesan Anuradha , Geaney Casey , Lalani Tahaniyat , Markelz Ana E , Maves Ryan , Mende Katrin , Seshadri Srihari , Spooner Christina , Utz Gregory , Warkentien Tyler , Coles Christian L , Burgess Timothy
Published: October 2019

Background

Healthcare outcome disparities exist for underrepresented populations, which may be partially due to reduced engagement in clinical research trials. Within the military with free, open access to medical care for members and beneficiaries, some healthcare outcome disparities become less apparent. We sought to assess the impact of the open access to care within the military healthcare system on research engagement among underrepresented populations.

Methods

During the PAIVED study (2018–2019 influenza season) enrollees were randomized to receive an FDA approved influenza vaccine (egg-based, recombinant, or cell-culture derived) followed by weekly surveillance for influenza-like illness (ILI) symptoms throughout the influenza season. At enrollment, participants self-identified gender, race, ethnicity, and level of education.

Results

Overall, the non-recruit study population (n = 852) was 52% male, 18% Hispanic, 15% African American, 70% White, 24% with High School or less, 22% with Associate’s, 24% with Bachelor’s and 30% with Post-Bachelor degree at enrollment. Individuals who reported African American race (OR 2.1, 95% CI (1.4, 3.3)) or Hispanic ethnicity (OR 1.7 (1.1, 2.6)) were more likely to have missed > 15% of the surveys, whereas military retirees (OR 0.5 (0.3, 0.9)) and dependents (OR 0.6 (0.4, 0.95)) were less likely to have missed > 15%. Individuals with African American race (OR 2.2 (1.3, 3.9)) or Hispanic ethnicity (OR 1.9 (1.1, 3.0)) were more likely to have missed the past 3 survey weeks. Retirees (OR 0.4 (0.2, 0.7)), dependents (OR 0.5 (0.3, 0.9)) and those with higher levels of education were less likely to have missed the past 3 weeks. There were no gender differences for these outcomes.

Conclusion

Healthcare outcome disparities may be partially explained by disparities in healthcare research engagement from underrepresented populations. Our cohort provides a unique perspective where access to and affordability of care and reliable income are minimized. Despite this, there remained differences in research engagement by race, ethnicity and education level, but not by gender. Future efforts should inform research design to increase research engagement from underrepresented populations.

Disclosures

All authors: No reported disclosures.
2765. Pediatric Mumps during the 2015–2017 Mumps Resurgence in the United States
Authors: Marlow Mariel , Zhang John , Clemmons Nakia S , Marin Mona , Patel Manisha , Patel Manisha
Published: October 2019

Background

Numerous mumps outbreaks occurred in the United States over the last decade, with outbreaks affecting young adults on college campuses being among the largest and most widely publicized. However, at least half of mumps cases and outbreaks occurred in other age-groups and settings. We describe reported mumps cases among children and adolescents during 2015 through 2017.

Methods

The Centers for Disease Control and Prevention (CDC) analyzed reports of confirmed and probable mumps cases in persons aged ≤18 years (defined here as pediatric mumps) transmitted electronically through the Nationally Notifiable Diseases Surveillance System (NNDSS) by the 52 reporting jurisdictions.

Results

Between January 1, 2015 and December 31, 2017, 49 jurisdictions reported 4,886 pediatric mumps cases (35% of all US reported cases, 13,807); 8 jurisdictions reported >100 cases each, representing 82% of all pediatric cases. Overall, 29 (1%) cases were in infants <1 yr, 406 (8%) were in children aged 1–4 years, 1,408 (29%) in children aged 5–10 years, 1,365 (28%) in adolescents aged 11–14 years, and 1,678 (34%) in adolescents aged 15–18 years. Most (3,548, 73%) cases did not travel outside the state during their exposure period; only 37 (1%) traveled outside the country. Cases in patients aged 1–4 years were more frequently non-outbreak associated (38%) than those in patients <1 years and 5–18 years (24% and 9%, respectively). Among 3,309 (68%) patients with known number of MMR doses received, 81% of those 5–18 years had ≥2 MMR doses, while 67% of those 1–4 years had ≥1 dose. Median time since last MMR dose for patients with 2 doses was 8 years (IQR: 4, 11 years). Four patients had meningitis and 1 had encephalitis; all were ≥10 years old and previously received 2 MMR doses. Of male mumps patients older than 10 years of age (2,113), 46 (2%) reported having orchitis; of these, 33 (72%) had 2 MMR doses. Sixty-four patients were hospitalized and there were no deaths.

Conclusion

About one-third of cases reported during the recent US mumps resurgence were in children and adolescents. The low rate of mumps complications compared with previous studies suggests mumps complications may not be adequately captured in national surveillance or identified by providers. Providers should remain vigilant that mumps can still occur among fully vaccinated pediatric patients, even those recently vaccinated.

Disclosures

All authors: No reported disclosures.
2778. Impact of Reactogenicity on Quality of Life and Physical Functioning in Adults ≥50 Years Receiving Both Doses of the Adjuvanted Recombinant Zoster Vaccine
Authors: Schmader Kenneth E , Levin Myron J , Chen Michael , Matthews Sean , Riley Megan , Woo Wayne , Hervé Caroline , Grupping Katrijn , Schuind Anne , Oostvogels Lidia , Curran Desmond
Published: October 2019

Background

The adjuvanted recombinant zoster vaccine (RZV) is efficacious in preventing herpes zoster in adults ≥ 50 years. The current study investigates whether the vaccinees’ quality of life (QoL) and physical functioning (PF) are impacted by local and systemic reactions due to RZV. In a previous report of this phase III, open-label, multicenter study (NCT02979639), overall PF and QoL were not significantly affected by a first RZV dose. [1] Here we report the results from the same study after a second RZV dose and safety results from dose 1 up to study end.

Methods

Adults aged ≥ 50 years were to receive 2 doses of RZV 2 months apart. Changes in mean Short Form health survey (SF-36) PF score between pre- and post-each RZV dose for 7 days, QoL, reactogenicity and safety were assessed.

Results

401 adults received dose 1 and 391 received dose 2 of RZV. Post-second RZV dose, the reported solicited local symptoms were pain (75.1%), erythema (22.4%) and swelling (13.9%), and the most frequent solicited systemic symptoms were fatigue (46.3%), headache (37.5%) and myalgia (32.9%). Grade 3 solicited symptoms were reported by 7.2% (local) and 11.1% (general) of participants, and 5 (1.2%) participants reported reactogenicity triggering medical attention post-second RZV dose. From first dose up to study end, 14 (3.5%) participants reported 21 serious adverse events, none related to RZV. In days 1–2, post-second RZV dose, a transient, clinically-important decrease in SF-36 PF score (table) was seen in those reporting grade 3 solicited symptoms, which impacted activities such as walking and climbing stairs. Overall, during the 7 days post-second RZV dose, a mean change of −0.4 points was observed from the mean baseline score, indicating the PF was not clinically meaningfully impacted. No overall quality-adjusted-life-year loss was recorded.

Conclusion

Overall, the QoL and PF of adults ≥ 50 years were not affected post-second RZV dose; a transient impact was observed in adults with grade 3 reactogenicity. These results and the observed reactogenicity and safety profile are consistent with first RZV dose results, as well as that of previous studies with the RZV vaccine in adults of similar age.

Funding: GlaxoSmithKline Biologicals SA.

1. Schmader et al., Abstract 2488, IDWeek 2018

Disclosures

All authors: No reported disclosures.
2784. Increased Frontal Lobe Volume and Density in Macaques Exposed to Zika Virus In Utero
Authors: Mohr Emma L , Koenig Michelle , Razo Elaina , Mitzey Ann , Semler Matt , Stewart Laurel , Breitbach Meghan , Newman Christina , Dudley Dawn , Weiler Andrea , Rybarczyk Sierra , Bach Kathryn , Mohns Mariel , Simmons Heather , Mejia Andres , Teixeira Leandro , Schotzko Michele , Nork T Michael , Rasmussen Carol , Katz Alex , Hou Jiancheng , Hartman Amy , Hoeve James Ver , Kim Charlene , Schneider Mary , Ausderau Karla , Kohn Sarah , Aliota Matthew , Salamat M Shahriar , Hayes Jennifer , Schultz-Darken Nancy , Antony Kathleen , Noguchi Kevin , Zeng Xiankun , Ikonomidou Chrysanthy , Prabhakaran Vivek , Capuano III Saverio , Friedrich Thomas , Golos Thaddeus , O’Connor David
Published: October 2019

Background

In utero Zika virus (ZIKV) infection causes birth defects and neurodevelopmental deficits in neonates. We reasoned that a translational macaque model of congenital ZIKV infection could define disease pathophysiology not possible in human clinical studies.

Methods

We inoculated 5 pregnant rhesus macaques with a Puerto Rican isolate of ZIKV (ZIKV-PRVABC59) during the first trimester, monitored infection with plasma viral RNA (vRNA) loads, and evaluated infants for birth defects and neurodevelopmental deficits during their first week of life. Assessments included neurobehavioral assessments, ophthalmic examinations, optical coherence tomography, electroretinography with visual evoked potentials, hearing examinations, brain magnetic resonance imaging (MRI), and tissue histopathological analyses.

Results

All five pregnant dams demonstrated plasma viremia and seroconversion following ZIKV inoculation. One of the five pregnancies resulted in a stillbirth. All liveborn infants had decreased feeding volumes and weight gain compared with control infants. A comprehensive voxel-based morphometric comparison of ZIKV-exposed and control infant brain MRIs identified increased gray matter volume and density in the frontal lobe in the ZIKV-exposed infant group, which corresponds to the pharyngeal motor cortex responsible for coordinating swallowing. Ocular studies identified differences between ZIKV-exposed and control infants in retinal layer thicknesses (inner plexiform, outer nuclear layers, photoreceptor outer segment) and visual evoked potentials (increased amplitude of waveforms). While ZIKV vRNA was detected in the decidua of 2/5 pregnancies, no ZIKV vRNA was identified in infant tissues and none of the infants developed an anti-ZIKV IgM response.

Conclusion

In utero ZIKV exposure resulted in decreased feeding volumes and weight gain, which may be related to the gray matter changes identified in the pharyngeal motor cortex. Changes in retinal layer thicknesses and increased cortical visual pathway waveform amplitude suggest vision may be impaired. These changes occurred despite the lack of evidence of vertical transmission, suggesting that ZIKV exposure without measurable vertical transmission affects fetal brain development.

Disclosures

All authors: No reported disclosures.
2799. Inability to Locally Differentiate Rhinovirus/Enterovirus Results Impacts Infection Control Practices
Authors: Donelan Susan V , Spitzer Silvia , Spitzer Eric
Published: October 2019

Background

Rhinoviruses and Enteroviruses are closely related members of the family picornavirideae; however, they have distinct clinical manifestations. Rhinoviruses cause respiratory infections while Enteroviruses often present as nonspecific febrile illnesses. Enterovirus D68 (EV-D68) is unusual in that although it is classified as an enterovirus it causes respiratory illness. Most of the currently used nucleic acid amplification assays for respiratory viruses do not distinguish between Rhino and Enteroviruses because of their shared homology. Rhino/Enterovirus infections are common in the Summer and Fall. In October of 2018 the NYS DOH issued a health advisory describing increased numbers of EV-D68 infection. Although there is no specific treatment for EV-D68, the advisory recommended contact precautions in addition to the droplet precautions recommended for other respiratory viruses. This recommendation creates logistical difficulties since there are no commercial test-kits that can identify EV-D68. The aim of this study was to determine the incidence of EV-D68 among patients admitted to Stony Brook Hospital that tested positive for Rhino/Enterovirus.

Methods

Nasopharyngeal swabs were tested with the BioFire® FilmArray® Respiratory Panel (RP 2) test. 44 Rhino/Enterovirus positive specimens were sent for further identification to the NYS DOH Virology Lab. Enterovirus was differentiated from Rhinovirus by qRT–PCR. EV-D68 was identified by sequencing.

Results

During one week in October, 10 patients were admitted with positive EV-D68 (5 adults and 5 children). In contrast, all 21 admitted patients who had specimens sent for typing had Rhinovirus.

Conclusion

This study confirmed that there was significant EV-D68 activity among patients who required hospitalization consistent with the NYS DOH advisory in the Fall of 2018. In contrast, in the Winter a drop in the prevalence of Rhino/enterovirus was observed. EV-D68 was not found in any of the samples sent for typing. These data informed our internal decision to cohort all patients this past Winter with positive Rhino/enterovirus results, positively impacting patient cohorting capabilities during a time with increased local influenza activity.

Disclosures

All authors: No reported disclosures.
2800. Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED): Influenza-Like-Illness Rates in Year 1
Authors: Schofield Christina , Richard Stephanie , Colombo Rhonda , Collins Limone , Ganesan Anuradha , Geaney Casey , Lalani Tahaniyat , Markelz Ana E , Maves Ryan , Mende Katrin , Seshadri Srihari , Spooner Christina , Utz Gregory , Warkentien Tyler , Coles Christian L , Burgess Timothy
Published: October 2019

Background

Influenza-like illnesses (ILI) are common in military populations due to close living and working conditions, physical exertion, and exposure to novel viruses. The PAIVED trial aims to compare the effectiveness of 3 FDA approved influenza vaccines in active-duty military, retiree, and dependent populations, and will also provide information about the burden, impact, and severity of ILI.

Methods

Participants were enrolled in the 2018–2019 influenza season at 5 geographically diverse military facilities. Active duty, non-recruit military personnel, retirees, and dependents were randomized to receive influenza vaccine (egg-based, recombinant, or cell-culture derived) and then completed weekly electronic surveys throughout the influenza season. If a participant reported ILI symptoms during surveillance, 2 in-person visits with study personnel were scheduled for confirmed ILI. Nasal swabs and blood samples were collected for diagnostic and immunologic testing.

Results

Among the 852 non-recruit participants enrolled in PAIVED, 25% were active military, 36% retired military, and 39% dependents. Almost half (48%) were female, and 72% were white, 15% African American, 6% Asian, 4% multiple races, and 3% unknown or other race. 788 participants (92%) responded to at least one surveillance questionnaire. Participants reported 407 ILIs (Figure 1), of which 160 met the study case definition. Between 12 and 28% of the participants experienced an ILI during the surveillance period, and 12 people experienced 2 ILIs. Most sites reported a median 2–3 days of fever/feverishness or chills and 3–4 days of reduced activity associated with an ILI episode. No viruses were detected in 58% of nasal swabs, 1 virus in 40%, and 2 viruses in 1% of swabs (Figure 2 for pathogen data).

Conclusion

During the period under study, ILIs were common with 1 in 6 participants experiencing a confirmed ILI, many of which were 6–8 days in duration. ILIs resulted in reduced activity, although few individuals reported missing work or school, a situation that could result in greater likelihood of transmission to others. Planned analyses will provide additional information about the pathogens responsible for these illnesses and help guide effective prevention policies in these populations.

Disclosures

All authors: No reported disclosures.
173. Successful Treatment of Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp) Aortic Valve Endocarditis with Ceftazidime–Avibactam
Authors: Alegro Jason V , Argentine Sarah , Russell Lisa
Published: October 2019

Background

The emergence of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) presents significant clinical challenges with our limited antibiotic armamentarium. Infective endocarditis caused by CR-Kp is rare, with few cases reported in the literature. The use of the novel β-lactam/β-lactamase inhibitor combination ceftazidime–avibactam (CAZ-AVI) in this setting has only been described in one 2018 case in Italy. Guidance in how these novel antibiotics should be used becomes more prudent as the prevalence of complicated CR-Kp infections increases.

Methods

A 51-year-old male with a past medical history of a gunshot wound to the neck, type 2 diabetes, and osteomyelitis status post right below-the-knee and left toe amputations presented to the emergency department with altered mental status and right upper extremity weakness. The patient’s hospital course was complicated by hemorrhagic stroke, left above-the-knee amputation, and intraoperative cardiac arrest. Subsequently, blood cultures on hospital days 41 and 43 grew CR-Kp and a transthoracic echocardiogram (TTE) showed moderate to severe aortic regurgitation.

Results

Antimicrobial therapy was changed from imipenem-cilastatin and colistin to CAZ-AVI and amikacin. The organism was found to be susceptible to CAZ-AVI and amikacin, intermediate to colistin, and resistant to all carbapenems. A transesophageal echocardiogram (TEE) confirmed the presence of a small mobile vegetation on the aortic valve with perforation and severe regurgitation. CAZ-AVI and amikacin were continued for two weeks, and then switched to CAZ-AVI and ertapenem for an additional four weeks. Follow-up blood cultures on and after day 44 were negative for CR-Kp. A TTE performed after therapy completion no longer demonstrated aortic regurgitation; however, the valves were poorly visualized. The patient then suffered anoxic brain injury after a second cardiac arrest, thought to be unrelated to endocarditis. The patient’s family then decided on hospice care and the patient expired.

Conclusion

We report the successful treatment of CR-Kp endocarditis with CAZ-AVI and amikacin for two weeks followed by CAZ-AVI and ertapenem for four weeks. This regimen can be a viable option for patients that present with this rare multidrug-resistant infection.

Disclosures

All authors: No reported disclosures.
2804. Systematic Review of the Role of Prenatal Ultrasound and Amniocentesis in the Diagnosis and Evaluation of Congenital Zika Syndrome
Authors: Viens Laura , Fleck-Derderian Shannon , Baez-Santiago Madelyn , Oduyebo Titilope , Broussard Cheryl , Khan Sumaiya , Meaney-Delman Dana
Published: October 2019

Background

To inform recommendations for optimal screening for fetal outcomes of Zika virus infection during pregnancy, we examined the relationship between prenatal diagnostics (ultrasound examination and amniotic fluid Zika virus testing) and postnatal congenital Zika syndrome (CZS) abnormalities.

Methods

Systematic searches were performed in 27 medical and public health databases from inception to March 21, 2018 for articles with the keywords “Zika,” “prenatal,” “ultrasound,” and “amniocentesis.” A total of 2,281 unique records were identified. Two reviewers independently assessed titles, abstracts, and full texts for content and relevance. Together, the 61 included articles describe 307 mother–fetus/infant dyads; 291 were included in the systematic review of prenatal ultrasound and Zika virus, and 38 were included in the systematic review of amniocentesis and Zika virus.

Results

There were 155 fetuses with CZS findings on prenatal ultrasound examination (53.3%); among them, postnatal CZS abnormalities were reported for 114 (73.5%). High proportions of microcephaly (72.4%), cerebral atrophy (85.7%), and ventriculomegaly (80.6%) were confirmed at pregnancy completion. In addition, 20.6% of the 136 fetuses without any CZS findings on prenatal ultrasound had CZS abnormalities identified at pregnancy completion. Structural CZS abnormalities were identified in approximately equal proportions after pregnancy completion in dyads with and without Zika virus RNA detected in one or more amniotic fluid specimen (53.8% and 58.3%). In 6 pregnancies, Zika virus RNA was detected in amniotic fluid, but no Zika virus RNA was detected in a subsequent amniocentesis specimen.

Conclusion

Prenatal ultrasound can detect structural findings associated with Zika; prenatal detection may vary with factors such as timing of infection, timing of ultrasound, technical expertise, and severity of abnormalities. Detection of Zika virus RNA in amniotic fluid did not predict the risk for CZS abnormalities in this review, and clearance of Zika virus RNA from amniotic fluid appears possible after maternal infection. The decision to perform diagnostic testing for Zika remains a shared decision between patients and clinicians, and more data are needed to define clinical predictors that will inform these decisions.

Disclosures

All authors: No reported disclosures.
300. Drug Use Characteristics and Hepatitis C Antibody Prevalence in Southern Illinois
Authors: Defever Kali , Patrick Sarah L , Layden Jennifer E , Fletcher Scott , Van Ham Brent , Jenkins Wiley D , Pho Mai T
Published: October 2019

Background

Hepatitis C virus (HCV) infection rates have increased among younger, rural persons nationally. We report on a preliminary sample of a study examining HCV acquisition risk factors among rural persons who inject drugs (PWID) or person who use opioids (PWUO) non-medically.

Methods

We used respondent-driven sampling (RDS) to recruit PWID/PWUO in southern, rural Illinois as part of a larger study on infectious disease rates among social networks of PWID and illicit opioid users. Participants were surveyed regarding drug and sexual risk behavior, healthcare access, stigma, and social networks, and underwent rapid screening for HCV (OraQuickÒ HCV Rapid Antibody Test) and other infections. Using R software, we generated descriptive statistics to characterize HCV prevalence.

Results

Between July 2018 and April 2019,135 current PWID/PWUO were recruited, screened, and surveyed (58.5% male; 82.2% white; mean age 40.1 years). HCV rapid tests detected antibodies (HCV+) among 53 of 112 screened (47.3%). HCV+ participants were more likely to be white (96.2% vs. 83.1%, P = 0.006) than HCV antibody negative (HCV-) participants and showed a bimodal age distribution with peaks in the 25–30 and 45–50 age ranges. Reported injection drug use and heroin use in the past 30 days was significantly more common among HCV+ participants (96.2% vs. 72.9%, P = 0.001, and 12.9 vs. 7.9 days, P = 0.024) While HCV+ participants less frequently used methamphetamine compared with HCV -participants, the use of that drug was still high in both groups (11.9 vs. 18.4 days of use in the past 30 days, P = 0.01). HCV+ participants reported fewer social network members than HCV- participants (2.2 vs. 3.0, P = 0.048).

Conclusion

In this analysis of a preliminary sample, HCV exposure was high; with those positive for HCV antibody showing a bimodal age distribution, high frequency of multiple drug use, and smaller social network size compared with HCV negative counterparts. Upon RDS-based enrollment completion and pending analysis we will further examine HIV RNA status as well as the specific associations between network size and other risk factors that may inform disease screening and treatment interventions.

Disclosures

All authors: No reported disclosures.
301. Risk of Virologic Failure with Antiretroviral Switches in HIV/HCV Co-infections
Authors: Mosquera Diana M , Wilder Julius , Ellis Alicia , Naggie Susanna
Published: October 2019

Background

Direct-acting antivirals (DAA) and antiretroviral (ARV) medications pose treatment challenges in HIV/HCV co-infection. Management of contraindicated combinations varies across practices. ARV switches may increase the risk of HIV virologic and treatment failure, and has been reported to increase the risk of DAA treatment failure. This analysis assesses how switches in ARV regimen impacts treatment outcomes in HIV/HCV co-infection.

Methods

This retrospective cohort study includes patients 18 years and older with stable HIV/HCV co-infection (HIV RNA<50 for ≥6 months) who received DAA HCV therapy. Data were obtained using the Centers for AIDS Research Network of Integrated Clinical Systems. The “ARV switch” cohort is defined as patients undergoing a switch in ARV regimen within 6 months prior to DAA treatment. The “no ARV switch” cohort was defined as patients without a change in ARV during the same time period. The primary outcome is HIV treatment failure which is a composite endpoint including HIV virologic failure (defined as confirmed loss of HIV viral suppression), discontinuation/change of ARV regimen, progression to AIDS, or death. We compared baseline characteristics, the proportion of patients free of HIV treatment failure, free of HIV virologic failure, and that achieved sustained viral response (SVR) at 12 and 24 weeks after DAA treatment among ARV switch and no ARV switch groups.

Results

Of the 256 patients, 63/256 (25%) underwent an ARV switch (Table 1). At baseline, the most common regimen in the ARV switch group was protease inhibitor (PI)-based while for the no ARV switch group, it was an integrase strand transfer inhibitor (INSTI)-based regimen. HIV/HCV transmission risk factors, HCV genotype, and AST/ALT were similar among the two groups (Table 1). The proportion with HIV treatment and virologic failure, and the proportion achieving SVR12/24 were similar among the ARV switch and no ARV switch groups.

Conclusion

HIV treatment and virologic failure, and SVR12/24 were not different among patients who did or did not undergo a switch in their ARV regimen prior to DAA treatment. This suggests that switches in the ARV regimen for DAA treatment of HCV do not negatively impact HIV or HCV outcomes among patients with HIV/HCV Coinfection.

Disclosures

All authors: No reported disclosures.
180. Klebsiella pneumoniae and K. oxytoca Bacteremia: Differences in Host, Source, and Antibiotic Susceptibility
Authors: Youssef Dima , Hooshmand Babak , Riederer Kathleen M , Johnson Leonard B , Khatib Riad
Published: October 2019

Background

Klebsiella species (KS) bloodstream infection (BSI) is often caused by K. pneumoniae (KP). K. oxytoca (KO) is emerging and implicated in antibiotic-associated right-sided colitis. We compared the clinical and microbiological characteristics of KP and KO.

Methods

We reviewed blood culture (BC) results (January 1, 2010–December 31, 2017), selected patients with KS in ≥1 BC, reviewed their medical records, abstracted patient demographics, source of bacteremia, antibiotics susceptibility, and outcome. Each patient was counted once. We compared KP and KO cases. All differences were assessed by the chi-square test and regression analysis, using SPSS.

Results

We encountered KS in 975/14,256 (6.8%) positive BC, representing 611 BSI including 537 KP-BSI (484 patients) and 55 KO-BSI cases (54 patients); each patient was counted once. Mean age and prevalence of diabetes and most comorbidities were similar but KO was less frequent in African Americans (40.7% vs. KP [61.3%]; P = 0.005) and in patients with neurological debility (Stroke, paraplegia, multiple sclerosis; 11.1% vs. KP [24.8%]; P = 0.03). KO BSI was more frequent in IVC BSI and was absent in pneumonia-associated BSI (table). Antibiotic resistance was rare among KO isolates except for cefazolin-intermediate susceptibility (42.6% vs. 1.7%; P < 0.001). CREs were limited to KP. Logistic regression analysis confirmed KO link to IVC (OR = 3.57; 95% CI: 1.89, 6.76; P < 0.001) and Caucasian race (OR = 2.46; CI: 1.37, 4.42; P = 0.003). Mortality rate was comparable (28.1% [KP] vs. 35.2% [KO]; P = 0.3).

Source and antibiotic susceptibility (%) in K. pneumoniae and K. oxytoca bacteremia

Conclusion

KO and KP BSI differ in the type of host and source, suggesting different colonization dynamics. KO remains antibiotic-susceptible but might be cefazolin less susceptible. Prospective studies are needed to confirm differential cephalosporin susceptibility and delineate host–pathogen interactions.

Disclosures

All authors: No reported disclosures.
182. Appropriateness of Treatment Duration for S. aureus Bacteremia (SAB)
Authors: Griebe Kristin , Kenney Rachel , Davis Susan L
Published: October 2019

Background

An algorithm-based guide to optimal treatment duration in staphylococcus bacteremia demonstrated a non-inferior rate of clinical success compared with standard of care. The purpose of this descriptive study was to assess appropriateness of staphylococcus bacteremia duration of therapy according to the SAB treatment algorithm.

Methods

IRB approved, retrospective cohort describing antibiotic use in S. aureus bacteremia across a health system from January to March 2019. Patients were included if they had at least one blood culture with S. aureus. Exclusion criteria included transfer from outside hospital, concurrent osteomyelitis diagnosis, and death within 72 hours of positive culture. The primary outcome was the appropriate duration of antibiotics for uncomplicated SAB. Secondary outcomes included clinical failure, antibiotic adverse effects, 90-day mortality, and hospital length of stay.

Results

A total of 59 patients were included. The median age was 66 years old and 22 patients (37.3%) were female. Diagnosis: uncomplicated SAB 28 (47.5%) and complicated SAB 31 (52.5%); MRSA 32 (%) and MSSA 27 (%). Infectious Diseases Consultation 56 (94.9%). 4 patients died before treatment duration was determined. Breakdown of treatment durations and clinical failures are listed in Tables 1. Appropriate duration occurred in 9 (32.1%) of patients with SAB. Overall, 14 patients experiences antibiotic adverse effects, 11 which occurred in antibiotic use for ≥4 weeks, 4 occurred in patients with uncomplicated SAB treated for ≥4 weeks. Breakdown of adverse effects: acute kidney injury 9, myositis 1, rash 1, nausea/vomiting 1, anaphylaxis 1, hypersensitivity pneumonitis 1.

Conclusion

Excess treatment duration for uncomplicated SAB was common (16%), in this study, inconsistent with best practice recommendations. 79% of adverse effects occurred in patients who received a ≥4 week course. The results of this study suggest more efforts are needed to implement contemporary evidence-based treatment duration algorithms for uncomplicated SAB to minimize unnecessary antibiotic harm.

Disclosures

All authors: No reported disclosures.
197. Infective Endocarditis Over a Five-Year Period in an Academic Teaching Center: The Validity of ICD Codes vs. Manual Chart Review
Authors: Haden Michael , Mahdee Sobhanie Mohammad , Hebert Courtney , Castillejo Becerra Clara , Turner Abigail N
Published: October 2019

Background

Opioid dependence and overdose are at epidemic levels in the United States. Ohio has the third highest rate of opioid-related overdose deaths. Infectious complications of intravenous drug use (IDU) include increased acquisition of hepatitis C, HIV and infective endocarditis. In this study, we aimed to characterize cases of infective endocarditis admitted to our healthcare system over a five-year period. We additionally sought to determine the validity of using ICD codes to identify infective endocarditis cases and IDU.

Methods

Patients with ICD-9 or 10 discharge diagnosis codes for infective endocarditis were identified from our institution’s electronic health record. ICD codes pertaining to substance abuse were used to classify patients according to IDU status. Readmissions during the same episode of infective endocarditis were excluded. We compared chart review to ICD code for the identification of infective endocarditis and IDU in a random sample of 296 of 1590 cases.

Results

Of 296 charts reviewed, 133 (44.9%) were excluded because they did not meet criteria for definite infective endocarditis by modified Duke’s criteria or because the episode was a readmission. A total of 163 (55.1%) cases met inclusion criteria, all of whom were seen in consultation by the inpatient Infectious Disease service. Of these, 52 (31.9%) had ICD 9 or 10 codes linked to substance abuse. Following manual chart review, we established that in fact 86 of these 163 cases (52.8%) had evidence of substance abuse.

Conclusion

Misclassification due to use of ICD codes is a well-established challenge to epidemiological research. However, the extent of misclassification in this analysis was greater than expected. If prior research on IDU and infective endocarditis has relied on medical record data alone without verification through manual chart review, the observed epidemiological trends may not be accurate.

Disclosures

All authors: No reported disclosures.
216. Association Between Days to Initiate Appropriate Therapy and Hospital Length of Stay Among Adult Hospitalized Patients With Gram-negative Bloodstream Infections (GN-BSI)
Authors: Lodise Thomas , Kanakamedala Hemanth , Hsu Wei-Chun , Cai Bin
Published: October 2019

Background

The deleterious outcomes associated with delay receipt of appropriate therapy are well documented. However, scant data exists on the consequences of each day delay of appropriate therapy and subsequent outcomes among adult hospitalized patients with GN-BSIs.

Methods

Study design: a retrospective cohort analysis. Study population: consecutive adult, hospitalized patients with a GN-BSI (11 most prevalent pathogens) in 1 of 181 institutions contributing microbiology data to the Premier Healthcare Database (October 2010–Sep 2015). Exclusion criteria: age < 18 years; diagnosis of pregnancy or cystic fibrosis, died or discharged within 2 days of index GN-BSI culture, lack of sufficient antibiotic susceptibility or treatment data to determine appropriateness. Day of initiating appropriate therapy was defined as the first day when the patient received an antibiotic with in vitro activity against the GN-BSI post index culture. Results were summarized by Kaplan–Meier estimates, and Cox Proportional-Hazards (CPH) analyses modeling discharge to home were conducted. Time to initiate appropriate therapy (0, 1–2 days, 3–4 days, ≥5 days) was included in the CPH model as an ordinal variable.

Results

A total of 40,549 patients met selection criteria. Mean (SD) age was 67.5 (16.1) years and 54% were female. E. coli and K. pneumoniae were the most common GN-BSI (58.0% and 18.3%, respectively). Approximately 30% of patients were in the ICU at index GN-BSI and in-hospital mortality was 6.8%. The mean (SD) time to receive appropriate therapy post index GN-BSI culture was 0.6 (2.7) days, and 69.7%, 22.5%, 5.7% and 2.1% received appropriate therapy in 0, 1–2, 3–4, and ≥5 days of index GN-BSI, respectively. The mean/median LOS post index GN-BSI by 0, 1–2, 3–4, and ≥5 days delays in appropriate treatment were 8.3/6, 9.8/7, 11.5/8, and 19.2/11 days respectively. Kaplan–Meier plots are shown in Figure 1. In the CPH model, each interval delay in appropriate therapy was associated with a 21% decrease in the likelihood of being discharged home for patients with GB-BSIs.

Conclusion

Hospital length of stay was found to increase when appropriate therapy was delayed. These findings highlight the critical need for early appropriate therapy among patients with GN-BSIs.

Disclosures

All authors: No reported disclosures.
228. Early Recurrent Postoperative Bloodstream infections in Living-Donor Liver Transplant Recipients
Authors: Kim Si-Ho , Mun Seokjun , Lee Hyunjoo , Nam Eliel , Huh Kyungmin , Young Cho Sun , Kang Cheol-In , Ryeon Chung Doo , Ran Peck Kyong
Published: October 2019

Background

Bloodstream infections (BSIs) represent a poor prognosis in living-donor liver transplant recipients (LDLT-Rs). Some patients develop recurrent BSIs. We evaluated the impacts of ER-BSIs on outcomes in LDLT-Rs.

Methods

All LDLT-Rs with follow-up data between January 2008 and December 2016 were included. Early BSIs (E-BSIs) defined as BSI events within 2 months after LDLT. ER-BSI was defined as new-onset BSI within 2 months due to another pathogen ≥48-hour interval, or relapse of BSI by the same pathogen ≥1-week interval with negative cultures in between. Logistic regression model was used to analyze risk factors for 1-year mortality. An associated factor of E-BSI and ER-BSI were also evaluated.

Results

Among 727 LDLT-Rs, 108 patients had 149 events with 170 isolated pathogens of E-BSI. Twenty-eight patients (25.9%, 28/108) experienced ER-BSI. Enterococcus (37.6%) was the most common pathogen. Intra-abdominal infection was the most common focus in the first episode of E-BSI and even significantly more common in ≥ second (59.3% vs. 82.9%, P = 0.007). Intra-abdominal and/or biliary complications were risk factors for both E-BSI and ER-BSI. Whereas high MELD score, longer cold ischemic time and longer recipient operative time were associated with E-BSI, longer post-transplant intensive care unit stay and longer donor operative time was associated with ER-BSI. 1-year survival rates of patients with or without single event of E-BSI were 81.3% and 92.4%, respectively. Patients having ER-BSI showed significantly low 1-year survival rates of 28.6% (Figure 1). ER-BSI was the most relevant risk factor for 1-year mortality (adjusted OR = 8.26; 95% CI = 4.30–15.88).

Conclusion

LDLT-Rs with ER-BSI showed very low survival rates accompanying with intra-abdominal and/or biliary complications. Clinicians should aware to prevent recurrence of BSI focusing on intra-abdominal complications in order to improve clinical outcomes of LDLT-R.

Disclosures

All authors: No reported disclosures.
229. Molecular Typing by RAPD, Characterization and Antibiotic Resistance Profile of ESBL Producing and Non-ESBL Producing Klebsiella Species Isolated From Diarrheal Stool and Environmental Samples
Authors: Giri Shobha , Acharya Poojashree , Shetty Veena , Shetty Avinash K
Published: October 2019

Background

Extended-spectrum β-lactamase is a major public health problem in hospitals and community that mediate resistance to Penicillin, Cephalosporins, and Monobactams. Data regarding the detection of TEM, CTX-M, and SHV genes by molecular techniques and typing by RAPD in ESBL producing bacteria can be useful in epidemiology and risk factors associated with infections.

Methods

Total of 140 samples were collected. Well water (n = 50), Fish effluents (n = 40), and Diarrheal stool samples (n = 80). Antibiotic susceptibility test was done using the Kirby–Bauer disc diffusion method. Phenotypic detection of ESBL enzyme was done by Double disk diffusion test. PCR analysis was carried out for β-lactamase genes TEM, SHV, and CTX-M. Molecular Typing was done by RAPD.

Results

38 (57.57%) Klebsiella spp. isolated from Fish Effluents,11 (57.89%) from Well water and 15 (18.98%) from Diarrheal stool samples. ESBL producers were 4 (26.66%) from stool and 12 (31.57%) from fish effluents. Stool isolates showed high resistance to Ampicillin (86.7%), Cefuroxime (83.3%), Cefepime (76.7%), and Ceftazidime (70%). Fish effluents were more resistant to Cefeperazone sulbactum (95.9%), Ampicillin (81.6%) while well water isolates showed high resistance to Ampicillin (94.7%) and Erythromycin (73.7%). Molecular identification showed the presence of more than 2 genes among the isolates. Prevalence of gene bla- TEM was highest, followed by bla-CTX-M and bla-SHV. Genetic relatedness are expressed as percentage similarity and presented as dendogram.

Conclusion

The study shows high prevalence of ESBL among Klebsiella isolates mainly rom Fish effluents and diarrheal stool samples. It shows 24% ESBL positive rate. Antibiotic-resistant bacteria from fish effluents highlights the associated human health risk when they enter food chain and become passive carriers. Practice of routine ESBL testing with conventional antibiotic susceptibility testing would be useful for combatting multi drug resistance.Present study shows high prevalence of TEM gene among Klebsiella species. RAPD-PCR will help in descriminating isolates and reflecting the genotypes circulating in the settings either hospital or in community.

Disclosures

All authors: No reported disclosures.
230. Molecular Typing of Streptococcus pyogenes Isolates Collected at Mongolian Hospital (Ulaanbaatar, Mongolia)
Authors: Thapaliya Dipendra , Mackey Samantha , Kadariya Jhalka , Davaadash Bulgan , Smith Tara
Published: October 2019

Background

Streptococcus pyogenes is a significant cause of morbidity and mortality worldwide causing an estimated 1.8 million cases and 517,000 deaths each year. S. pyogenes infections disproportionately affect low-income countries where routine surveillance is not available. The objective of this study was to investigate the molecular epidemiology and antibiotic resistance of clinically relevant S. pyogenes isolates in Ulaanbaatar, Mongolia, to better understand the burden in this under-served population.

Methods

Clinical S. pyogenes isolates (n = 41) collected at the Bacteriological Reference Laboratory, National Center for Communicable Diseases, Ulaanbaatar, Mongolia, were cultured and characterized using PCR techniques. The emm gene was sequenced and emm type was assigned as per Centers for Disease Control and Prevention (CDC) methods and guideline. Multi-locus sequence typing (MLST) was carried out on selected isolates (n = 15). Antibiotic susceptibility testing (AST) was done via the Vitek-2 system as per manufacturer’s instructions.

Results

We observed 18 distinct emm types among the 41 S. pyogenes isolates. stG6792.0 was the most common emm type, accounting for more than one-third of the isolates (15/41) followed by emm2.0 (ST55) (5/41) and emm 82.0 (ST314) (2/41). A total of seven sequence types (STs) were detected among 15 tested isolates. The most common ST type was ST55 accounting for one-third of the isolates (5/15). Most of the isolates were susceptible to all tested drugs.

Conclusion

The findings of this study provided some insights regarding the molecular characteristics of S. pyogenes in Mongolia that will be crucial for future surveillance studies. Five isolates of this study had similar emm types (emm74.0, emm66.0, stG480.0, emm83.1, emm89.0) compared with a previous surveillance study. emm89.0 (ST101) was a major epidemiological isolate in the United States between 2000 and 2004. emm89.0 was also implicated with a recent single-clone outbreak in China. This information suggests the possibility of a shifting epidemiological trend of S. pyogenes on the global stage. The information about antibiotic susceptibility patterns and molecular types can help to devise better treatment strategies for S. pyogenes infections, and potentially inform vaccine development.

Disclosures

All authors: No reported disclosures.
233. The Epidemiology, Genomics, and Evolution of Staphylococcus aureus in Northeast Ohio
Authors: Watkins Richard R , Thapaliya Dipendra , Savri Rami , Smith Tara
Published: October 2019

Background

Infections due to S. aureus result in significant morbidity, mortality, and healthcare expense. We sought to identify the strains of S. aureus causing infections in hospitalized patients in Northeast Ohio and determine whether they are reflective of the S. aureus strains present in the surrounding environment.

Methods

The study was approved by the Institutional Review Board at Cleveland Clinic Akron General. Clinical S. aureus isolates (n = 300) were cultured and PCR was used to amplify the staphylococcus protein A (spa), Panton–Valentine Leukocidin (PVL), and mecA genes. The clinical spa types were compared with ones from our data base of S. aureus strains previously collected and sequenced from the community and environment in Northeast Ohio.

Results

A total of 51 spa types were detected from 129 S. aureus clinical isolates (discriminatory index, 0.876; 95% confidence interval [CI], 0.827–0.925; Table 1). The most common spa types were t008 (42/129, 32.6%), t002 (16/129, 12.4%), and t334 (6/129, 4.7%). In comparison, the most frequently detected spa types from the environmental samples were t189 (40/257, 15.6%), t002 (16/257, 6.2%), and t008 (11/257, 4.3%). Among the S. aureus isolates (n = 146), 45 were PVL-positive (30.8%) and 94 (66.7%) carried mecA. Of the 42 t008 (ST8/USA300; a common community-associated strain) isolates, 35 (83.3%) were methicillin-resistant S. aureus (MRSA) (based on the presence of the mecA gene) and 25 (59.5%) were PVL-positive. Thirteen of the sixteen (81.2%) t002 (ST5/USA100; a common hospital-associated strain) were MRSA and only one (6.2%) was PVL-positive.

Conclusion

There is considerable overlap of S. aureus strains present in clinical samples with those found in the environment. This finding should draw attention to the need for more effective prevention strategies to reduce the risk of transmission of S. aureus, including MRSA, in the environment to humans.

Disclosures

All authors: No reported disclosures.
237. Adenovirus Types in Children with Acute Respiratory Illnesses in Nashville Over Two Respiratory Seasons
Authors: Probst Varvara , Speaker Andrew , Stewart Laura S , Guevara Claudia , Gerber Susan I , Rha Brian , Lively Joana , Lu Xiaoyan , Halasa Natasha B
Published: October 2019

Background

Human adenovirus (HAdV) types 1–7, 11, 14, 16, and 21 within species B, C, and E are commonly associated with acute respiratory illnesses (ARI) in children. We sought to compare demographics, clinical characteristics, and outcomes of HAdV types with children who presented with fever and/or respiratory symptoms.

Methods

Children < 18 years with fever and/or ARI seen at Vanderbilt Children’s Hospital inpatient and emergency department settings from December of 2016 to October of 2018 were enrolled. Interviews and chart abstraction were conducted. Mid-turbinate nose and throat swab specimens were collected and tested by real-time RT-PCR for common respiratory viruses including HAdV. HAdV molecular typing was performed by type-specific real-time PCR assays for types 1–7, 11, 14, 16, and 21 targeting the hexon gene using published methods.

Results

Of 5111 ARI cases, 206 (4%) were HAdV-positive with a median age of 16 months (IQR 9–30); 57% male, 47% White, 40% Black, 33% Hispanic, 20% admitted, and 24% of hospitalized required oxygen support. Of the 206, 186 (90%) were able to be typed with more than one types detected in 13 (7%) cases. Distribution of HAdV types among single detections (n = 173) is shown in Figure 1; HAdV-1 and HAdV-2 were most common. Children with HAdV-2 were younger (median age 12 months vs. 15 months (HAdV-1) and 59 months (all other types), P < 0.001), and those with HAdV-1 were less likely to be male (44% vs. 65% for both HAdV-2 and other types, P = 0.029). Figure 2 displays HAdV detections over time, with winter and early spring peaks. Co-detection with other respiratory viruses occurred in 47% of cases; the most common among typable HAdV were rhinovirus/enterovirus in 30/186 (16%) and RSV in 19/186 (10%). Distribution among HAdV types is shown in Figure 3.

Conclusion

HAdV-1 and HAdV-2 were more prevalent than other HAdV types over two respiratory seasons in the Nashville area with peak cases in December-March. Children with HAdV-1 and HAdV-2 had some demographic differences. Further studies with a larger sample size for HAdV typing are needed in the pediatric population to determine whether additional clinically-relevant differences between HAdV types exist.

Disclosures

All authors: No reported disclosures.