bluuebunny/crossref_metadata_2025_split huggingface dataset:
2183. Survival Impact and Clinical Predictors of Anaerobic Bloodstream Infection
Authors: Hsieh Ronan , Yo Chia-Hung , Liu Cheng-Heng , Galvis Alvaro , Hsieh Yueh-Cheng , Huang Huai-Hsuan , Hsu Tzu-Chun , Lee Chien-Chang 
Published: October 2019

Abstract

Background
Few controlled studies are available for the outcome and risk factor analysis of anaerobic bloodstream infection (BSI). We conducted a cohort study to identify the clinical predictors and survival impact of anaerobic BSI as compared with aerobic BSI.

Methods
Consecutive emergency department patients in a tertiary medical center with laboratory confirmed BSI between 2015 and 2016 were prospectively enrolled. We compared demographics, comorbidity, and sources of infection between anaerobic and aerobic BSI. We then constructed a multivariable logistic regression model to identify independent risk factors for anaerobic BSI. The survival impact of anaerobic BSI was evaluated by propensity score-matched analysis.

Results
We identified 1,166 episodes of BSIs during the 2-year study period, of which 61 (5.2%) were anaerobic BSI. Clinical variables predicted anaerobic BSI with moderate discrimination (optimism corrected C statistic = 0.75). Significant predictors included metastatic cancer (OR 6.03, 95% CI 2.78–13.09), intra-abdomen infection (OR 3.92, 95% CI 1.47–10.45), liver abscess (OR 2.65, 95% CI 1.26–5.62), skin and soft-tissue infection (OR 2.40, 95% CI 1.13–5.08) as the positive predictors. Urinary tract infection (OR 0.15, 95% CI 0.04–0.62), diabetes mellitus (OR 0.38, 95% CI 0.18–0.78), or thrombocytopenia (OR 0.33, 95% CI 0.18–0.60) were identified as the negative predictors of anaerobic BSI. Anaerobic BSI were not associated with worse prognosis in either adjusted (HR 1.08, 95% CI 0.68–1.72) or PS-matched analysis (HR 1.50, 95% CI 0.61–3.67).

Conclusion
Anaerobic BSI accounted for a significant proportion (approximately 1 in 20) of community-onset BSI. Clinical predictors identified in this study may help guide the prescription of empiric anti-anaerobe antibiotics. The apparent adverse outcome associated with anaerobic BSI may be explained by the underline comorbidity, high-risk infection site, and inadequate initial antibiotics.

Disclosures
All authors: No reported disclosures.
2201. Cost of Antimicrobial Use Against Upper Respiratory Infection in Japan
Authors: Tsuzuki Shinya , Kimura Yuki , Ishikane Masahiro , Kusama Yoshiki , Ohmagari Norio 
Published: October 2019

Abstract

Background
Antibiotics are often inappropriately prescribed for treating upper respiratory infection (URI) patients in ambulatory care settings. In Japan, a previous study estimated physicians prescribed antibiotics in about 30% of URI cases. However, trends of prescription behavior and additional costs of inappropriate antibiotic use in URI cases are still not clear in Japan. The present study’s main objective was to clarify the amount of additional cost owing to inappropriate antibiotic prescription for URI, and the recent trend.

Methods
We conducted a retrospective observational survey using longitudinal claims data spanning 2013–2016, obtained from the Japan Medical Data Center Co., Ltd. (JMDC) Claims Database, which contains anonymous claim data on 5.1 million (for 2013–2016) corporate employees covered by the employees’ health insurance plan (Social insurance), and their family members <65 years old. Six physicians specialized in infectious disease assessed the appropriateness of antibiotic prescription based on the ICD-10 code in the database. The total additional cost of antibiotic prescription for URI at the national level was estimated by weighting corresponds to the age-structured population data, from the healthcare payer perspective. Costs of treatment for adverse events and of antimicrobial resistance caused by inappropriate antibiotic prescription were not taken into consideration.

Results
The total annual cost of antibiotic prescription for URI was estimated at US$423.6 (95% confidence interval: 416.8–430.5) million in 2013, $340.9 (335.7–346.2) million in 2014, $349.9 (344.5–355.3) million in 2015, and $297.1 (292.4–301.9) million in 2016.

Conclusion
Although a decreasing trend was observed, the annual cost of antibiotic prescription for URI potentially imposes a substantial economic burden in Japan.

Disclosures
All authors: No reported disclosures.
2204. Microbiology of Pneumonia Due to Co-Infection in the ICU: Impact of Host Immune Status
Authors: Zelus Casey , Blaha Michael , Marcelin Jasmine R , Marcelin Jasmine R , Cawcutt Kelly , Cawcutt Kelly , Kalil Andre C , Samson Kaeli 
Published: October 2019

Abstract

Background
Pneumonia epidemiology is increasingly showing the presence of co-infection due to the utilization of emerging diagnostic testing modalities such as multiplex polymerase chain reaction (PCR) panels. However, the prevalence and clinical significance of co-infection with respect to host immune status remain unclear.

Methods
A single-center retrospective analysis of mechanically ventilated adult patients treated in critical care units from January to October 2018 was performed on those with positive microbiological analysis of a bronchoalveolar lavage (BAL) sample. Host immune status and microbiological analyses were obtained including PCR and culture testing. Categorical variables and co-infection or immunocompetent status were assessed using Chi-Square, Fisher exact tests, or t-tests. REDCap was utilized for data abstraction and SAS software version 9.4 was used to perform all analysis.

Results
Of the 139 BAL samples that met inclusion criteria, 107 and 32 were obtained from immunocompetent and immunocompromised hosts, respectively. There was no statistical difference found between the frequency of co-infection detected by BAL culture with respect to host immune status. Immunocompetent patients had a higher proportion of positive bacterial cultures compared with immunocompromised (76.7% vs. 43.8% respectively, P = 0.0004). There was no significant difference seen with frequency of fungal or acid fast bacilli cultures between the two groups. Analysis of the microbiologic data obtained (figures) revealed different pathogens according to host immune status.

Conclusion
Pneumonia due to co-infection in critically ill, mechanically ventilated immunocompromised hosts occurs at a similar frequency regardless of host immune status, however different microbiological patterns emerge. Interestingly, patients who were not immunocompromised had a higher proportion of positive bacterial cultures compared with those who were immunocompromised. Comparative analysis of the other pathogen types may also reveal differences in detection rates if sample size is increased. Clinically, this may help guide efficient use of microbiological testing among patients based on immune status.

Disclosures
All authors: No reported disclosures.
2205. Clinical Burden of Pneumococcal Disease in US Adults Aged 65 Years and Above with Chronic or Immunocompromising Conditions
Authors: Deb Arijita , Johnson Kelly D , Ou Wanmei 
Published: October 2019

Abstract

Background
The presence of chronic and immunocompromising conditions is associated with a disproportionately high risk of developing pneumococcal disease at older ages. The objective of this study was to quantify the risk of all-cause pneumonia (ACP) and invasive pneumococcal disease (IPD) in older US adults aged 65 years and older with underlying medical conditions.

Methods
A retrospective observational study was conducted using the Humana claims database. The study cohorts were identified at January 1 of each calendar year of observation from 2012 to 2017 and comprised adults aged 65 years and older with continuous enrollment for at least one year before and at least one year after January 1 of each year. For each yearly cohort, medical conditions were identified during the one year before each calendar year and episodes of ACP and IPD were identified during the corresponding 1-year follow-up period from January 1 to December 31. Individuals were stratified into 3 groups: those without any medical conditions of interests (healthy), those with chronic conditions (at-risk) and those with immunocompromising conditions (high-risk). Rate of ACP or IPD was expressed as the number of cases per 100,000 person-years and the rate ratio (RR) was expressed as the rate of pneumococcal disease of patients with medical conditions divided by the rate of pneumococcal disease in healthy adults.

Results
Of the 10,766,827 adults included in the study, 75% of adults had an underlying medical condition linked to an increased risk of pneumococcal disease. In adults with at-risk conditions, rates of ACP and IPD were 3.1 and 3.6 times the rate in healthy adults, respectively. In adults with high-risk conditions, rates of ACP and IPD were 4.1 and 5 times the rate in healthy adults, respectively. Rate of pneumococcal disease increased substantially with the addition of medical conditions: RR for ACP and IPD increased from 2.1 and 2.2, respectively, in adults with one at-risk conditions to 4.8 and 6.2, respectively, among adults with 2 or more at-risk conditions.

Conclusion
Despite recommendations of universal pneumococcal vaccination in older adults aged 65 years and above in the United States, the burden of pneumococcal disease remains high, particularly among those with chronic and immunocompromising conditions.

Disclosures
All authors: No reported disclosures.
2210. Nasopharyngeal Detection of Streptococcus pneumoniae and Clinical Disease Severity in Children with Community-Acquired Pneumonia (CAP)
Authors: Wook Yun Ki , Juergensen Alexis , Wallihan Rebecca , Desai Ankita P , Alter Sherman J , Ambroggio Lilliam , El-Assal Osama , Marzec Sarah , Florin Todd A , Florin Todd A , Keaton Meghan , Shah Samir S , Leber Amy , Mejias Asuncion , Ramilo Octavio , Ramilo Octavio 
Published: October 2019

Abstract

Background
Streptococcus pneumoniae is the most common pyogenic bacteria associated with CAP in children, but the proportion of cases might be underestimated because of the low sensitivity of current standard diagnostic methods. Nasopharyngeal (NP) carriage of pneumococcus commonly precedes the development of pneumococcal pneumonia, and facilitates pneumococcus interactions with other respiratory pathogens and the host immune response. This study investigated the relationship between pneumococcal carriage and the severity of CAP in children.

Methods
We conducted a prospective, multicenter, observational study for CAP among previously healthy children aged 2 months through 18 years in six children’s hospitals in Ohio. Blood, pleural fluid, and NP swabs were collected for pathogen detection by culture and/or polymerase chain reaction (PCR). S. pneumoniae was quantified in NP swabs by real-time PCR. Patient management followed the standard of care in each study site.

Results
Among 441 children with radiologically confirmed CAP, 156 (35.4%) had no bacterial or viral pathogens identified as etiologic agents. NP pneumococcal carriage rate in this group was 34.6%. Children with CAP and pneumococcal carriage (53/156) were younger (5.9 vs. 9.6 years, P < 0.001) than those with no carriage (103/156). Median neutrophil counts and median procalcitonin concentrations were significantly higher in the pneumococcal carriage group (12,030 vs. 8,370 cells/mm3 and 1.0 vs. 0.5 mg/dl, respectively; P < 0.05 for both) than in the non-carriage group. Children with documented pneumococcal carriage received respiratory support more frequently (50.0% vs. 28.2%, p = 0.012) and had a longer duration of hospitalization (3.5 ± 3.8 vs. 2.1 ± 2.0 days, P = 0.026) than those without pneumococcal carriage. Age was not associated with any of the variables used to assess clinical disease severity.

Conclusion
Pneumococcal carriage was associated with higher inflammatory markers and greater clinical disease severity in children with CAP in whom no pathogens were identified by standard diagnostics. This suggests that NP carriage of pneumococcus in children with CAP may modulate the host immune response and possibly influence clinical disease severity.

Disclosures
Octavio Ramilo, MD, Bill & Melinda Gates Foundation: Research Grant; Janssen: Research Grant; Merck: Advisory Board; NIH: Research Grant; Ohio Children’s Hospital Association (OCHA): Research Grant; Pfizer: Advisory Board, Consultant, Lectures; Sanofi/Medimmune: Advisory Board.
114. Chorioretinal Lesions in Persons Who Inject Drugs and Are Hospitalized with Bloodstream and Related Infections
Authors: Greven Margaret A , Weinstein Jessica , Tsamis Kathy , Ayres Philippe F , Barnes Erin W , Peacock James E 
Published: October 2019

Abstract

Background
Eye infection is one of the many potential sites of infection in persons who inject drugs (PWID). The purpose of this study was to determine the prevalence of chorioretinal (CR) lesions, identify causative organisms, and correlate symptoms with ophthalmic involvement in PWID hospitalized with bloodstream infection (BSI) and/or related metastatic foci of infection (MFI).

Methods
Actively using PWID 18 years or older admitted to Wake Forest Baptist Med Ctr with documented BSI or MFI related to injection drug use (IDU) were prospectively enrolled after providing informed consent. All patients, whether or not they had eye symptoms, received a dilated retinal examination as soon as feasible after admission. Ocular symptoms, visual acuity, and ocular examination findings were recorded and fundus photos were obtained as indicated. Patients could be re-enrolled if re-admitted with a different infection.

Results
Fifty-three PWID with 55 episodes of disseminated infection related to IDU underwent ophthalmic exams at a median of 7 days post-admission. Mean age was 33.4 years and 51% were female. Twenty (38%) patients had HCV viremia but none had active HIV infection. Heroin was the injection drug of choice in 55% of patients. Of the 55 episodes of systemic infection, 33 were classified as infective endocarditis (IE), 6 were BSI only, 10 were BSI with MFI, and 5 were MFI without active BSI. Nine (17%) patients had CR involvement on examination but only 33% (3/9) were symptomatic. Of those with ocular involvement, 1 had fungal endophthalmitis due to Candida albicans. Single or multifocal subretinal infiltrates were found in 5/9 patients (MSSA 2, MRSA 2, H. parainfluenzae 1), 2/9 had cotton wool spots (S. mitis 1, MRSA 1), and 7/9 had intraretinal or white-centered hemorrhages (MSSA 3, MRSA 2, S. mitis 1, H. parainfluenzae 1). Of the 9 patients with CR lesions, 7 had IE. Interestingly, 3.8% (3/53) had old multifocal CR scars, possibly related to prior disseminated infection.

Conclusion
PWID admitted with BSI or MFI may have ophthalmic involvement even in the absence of ocular symptoms, especially in the setting of IE. Further study is needed to characterize the epidemiology of these infections, to identify risk factors for ocular involvement, and to optimize diagnosis and management.

Disclosures
All authors: No reported disclosures.
2213. Etiology of Community-Acquired Pneumonia (CAP) in Hospitalized Native American Adults
Authors: Hammitt Laura , Driscoll Amanda , Weatherholtz Robert , Reid Raymond , Colelay Janene , Grant Lindsay , VanDeRiet Daniel , Alexander-Parrish Ronika , Pride Michael W , McLaughlin John M , Gessner Bradford D , Isturiz Raul E , Santosham Mathuram , O’Brien Katherine 
Published: October 2019

Abstract

Background
Native Americans experience a high burden of community-acquired pneumonia (CAP). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was introduced for adults ≥65yrs in 2014. Data on CAP etiology can guide prevention and treatment.

Methods
We enrolled adults hospitalized with CAP and age-group-matched non-hospitalized controls on Navajo and White Mountain Apache tribal lands. Nasopharyngeal/oropharyngeal (NP/OP) swabs from cases and controls were tested by multiplex PCR for respiratory pathogens. Urine from cases and controls was tested for pneumococcus (Sp) by conventional (BinaxNOW) and serotype-specific urine antigen detection (UAD) for 24 serotypes (PCV13 types plus 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20, 22F, 33F). Blood culture and chest radiographs (CXRs) were obtained from cases at the provider’s discretion. Radiographic pneumonia was determined by clinical interpretation of CXRs.

Results
From March 2016 to March 2018, we enrolled 580 CAP cases with CXR confirmation and 411 controls. Positive blood culture was identified in 42/483 (9%), of which 29 (69%) were Sp. Sp was detected in 164/572 (29%) cases (table). Of 125 cases with serotype information available, serotypes 3 (n = 35; 28%) 8 (n = 19; 15%) and 20 (n = 15; 12%) were the most common. Among 53 Sp cases aged ≥65 years, 26 (49%) were PCV13-type. Compared with blood culture, UAD was 100% sensitive and 100% concordant (n = 24). Viruses were detected by NP/OP PCR in 43% of CAP cases and 18% of controls. Influenza A, parainfluenza type 3, rhinovirus, and RSV were statistically significantly associated with case status. Among 263 cases in whom all diagnostic tests were collected, 63% had a pathogen detected: bacteria alone in 19%, viruses alone in 23%, and both bacterial and viral infection in 22%. Bacterial causes outnumbered viral causes when adjusting for virus detection in the control population.

Conclusion
Pneumococci were the most common etiology identified among Native American adults with CAP. UAD improved detection of pneumococcal CAP. Respiratory viruses also contributed substantially to CAP burden. Broader prevention strategies, including new vaccines, are required to prevent viral pneumonia and pneumococcal pneumonia caused by serotypes not contained in currently-available vaccines.

Disclosures
All authors: No reported disclosures.
2215. Diarrheal Illness as a Risk Factor for Subsequent Respiratory Infection Among Women and Infants in Nepal
Authors: Newman Kira L , Gustafson Kathryn , Englund Janet A , Khatry Subarna , LeClerq Stephen , Tielsch James , Katz Joanne , Chu Helen Y 
Published: October 2019

Abstract

Background
Globally, diarrheal and respiratory infections are responsible for nearly one-quarter of deaths in children under 5 years old. Historically these diseases have been studied separately; recent evidence suggests that preceding diarrheal disease may be a risk factor for subsequent respiratory illness. We sought to identify whether diarrhea was associated with subsequent respiratory illness in adult women and infants in Nepal.

Methods
We used data from a community-based, prospective randomized trial of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011 to 2014. Diarrhea episodes were defined as at least three self-reported watery bowel movements per day for one or more days. Respiratory illness episodes were defined as the presence of fever with an additional respiratory symptom. Diarrhea and respiratory illness episodes were identified through longitudinal household-based weekly symptom surveillance. A case-crossover design was used to determine whether risk of respiratory infection was increased in the 30 days following a diarrhea episode compared with the 30 days prior.

Results
Of 3,693 women in the study and their 3,646 infants, 525 (14.2%) women experienced one or more episodes of diarrhea during pregnancy, 226 (9.4%) women experienced one or more episodes of diarrhea after pregnancy, and 342 (9.4%) infants had one or more episodes of diarrhea. The incidence of respiratory episodes during the exposure and control periods was approximately 2–5% in adults and 8–10% in infants. Preceding diarrhea was not significantly associated with respiratory infection in adult women or infants. There was a slight trend toward greater incidence of diarrhea during the exposure period among infants (Figure 1), but it was not statistically significant. These results held after a sensitivity analysis limiting follow-up time to 15 days before and after diarrhea episode.

Conclusion
In this study of pregnant and postpartum women and their infants in Nepal, diarrheal illness was not a significant risk factor for subsequent respiratory illness.

Disclosures
All authors: No reported disclosures.
2221. Chlamydia pneumoniae (Cpn) Induces IFN-γ Responses in Peripheral Blood Mononuclear Cells (PBMC) from Pediatric and Adult Asthma Patients: Effects of Age and Inhaled Corticosteroid Use
Authors: Szigeti Aviva , Hammerschlag Margaret , Weaver Diana , Smith-Norowitz Tamar , Kohlhoff Stephan 
Published: October 2019

Abstract

Background
Chlamydia pneumoniae (Cpn) is unique in its ability to cause chronic infections, potentially triggering asthma exacerbations as well as subsequent asthma development. Th1-mediated immunity and IFN-γ are critical for clearing chlamydial infections. Persistent or recent Cpn infection may be identified in vitro by detecting T-helper cytokine IFN-γ produced by peripheral blood mononuclear cells (PBMC) stimulated by Cpn. Inhaled corticosteroids (ICS) may have an inhibitory effect on IFN-γ. Prior studies have shown increased Th2 responses upon in vitro Cpn stimulation with increased age. Our aim was to determine whether age and inhaled corticosteroid (ICS) use affect Cpn-induced PBMC produced IFN-γ levels.

Methods
Pediatric and adult subjects with (n = 23) and without (n = 10) asthma were enrolled. PBMC obtained from all subjects were stimulated with Cpn (MOI = 0.1 x48h) in vitro. IFN-γ levels in culture supernatants were determined by ELISA and reported as pg/mL. Nasopharyngeal (NP) swabs were tested for Cpn using Real-Time PCR. Statistical analysis for continuous variables was performed using the Mann–Whitney U test.

Results
None of the subjects were positive for Cpn by PCR on NP swab. Levels of IFN-γ produced by PBMC stimulated by Cpn were similar between asthmatic vs. control subjects (41.7 vs. 68.8, respectively; P = 0.72) and between pediatric and adult subjects with asthma (IFN-γ 54 vs. 20.1 respectively, P = 0.95). Pediatric subjects with asthma who received ICS had lower IFN-γ levels than those who did not (median IFN-γ 25.5 vs. 209; P = 0.003).

Conclusion
Our finding of lower IFN-γ levels among asthma patients on ICS compared with those not on ICS suggests that ICS use may dampen the systemic inflammatory response. While we did not find a statistically significant difference between pediatric and adult age groups in this pilot study, there was a trend to higher Cpn-induced IFN-γ levels among younger pediatric subjects. Future prospective studies should further define predictors of diminished IFN-γ responses in patients with asthma.

Disclosures
All authors: No reported disclosures.