bluuebunny/crossref_metadata_2025_split huggingface dataset:
2766. Identification and Description of Mumps Cases in a Non-Outbreak Setting and Evaluation of the Effectiveness of Mumps Containing Vaccines Over Time
Authors: Zerbo Ousseny , Glanternik Julia , Modaressi Sharareh , Goddard Kristin , Ross Pat , Lewis Ned , Klein Nicola 
Published: October 2019

Abstract

Background
Despite high coverage for 2 doses of MMR/MMRV vaccine, the United States and other countries have seen increases in outbreaks of mumps, mainly on college campuses and other close communities, which has been attributed to waning immunity to mumps. The objective of this study was to identify mumps cases within Kaiser Permanente Northern California, a large healthcare organization, and to assess waning of vaccine immunity against mumps in a non-outbreak setting.

Methods
Potential cases were identified by international classification of disease (ICD) 9 code 072, ICD 10 code B26 or by laboratory orders for mumps. We conducted medical chart reviews to confirm diagnoses, timing relative to vaccination and clinical characteristics. We selected cases and controls among KPNC born after 1988 who were members for ≥9 months before diagnosis or anchor date and who received their second dose at ages 4 to 6 years, matching cases with controls on geographical area. To assess for risk of mumps in relation to time since a second MMR/MMRV dose, we compared cases and controls using multivariable logistic regression adjusted for age, sex and calendar time of mumps diagnosis.

Results
Among 397 potential cases identified, chart review confirmed 178 (44.8%) as mumps. About half (87/178) were confirmed by both positive laboratory test and clinical diagnosis, with the remainder by clinical diagnosis alone. Median age at diagnosis for the 187 cases was 30 years (range 1 year–91 years). Most cases had parotitis (93%) and there were 7 cases of orchitis. The 34 cases with complete vaccination information were matched to 539,301 controls. The mean time since the second vaccine dose was shorter for cases compared with controls (6.5 years vs. 9.0 years, P = 0.008). After adjustment, there was no significantly increased risk of mumps associated with time since second MMR/MMRV dose (adjusted odds ratio = 1.08, 95% CI 0.57–2.05).

Conclusion
In the setting of a large healthcare organization, our results do not provide evidence of waning immunity following 2 doses of MMR/MMRV; however, identifying and confirming mumps cases were challenging and analyses were limited by small number of cases. Large future studies will be needed to confirm whether risk of mumps increases over time in non-outbreak settings.

Disclosures
All authors: No reported disclosures.
2775. Safety and Immunogenicity of a Seasonal Influenza Vaccine and Ad26.RSV.preF Vaccine With and Without Co-Administration: A Randomized, Double-Blind, Placebo-Controlled Phase 2a Study in Adults Aged ≥ 60 Years
Authors: Comeaux Christy , Bastian Arangassery Rosemary , Paepe Els De , Omoruyi Edmund , Haazen Wouter , Schuitemaker Hanneke , Strout Cynthia , Callendret Benoit , Sadoff Jerald 
Published: October 2019

Abstract

Background
Influenza and RSV can cause respiratory tract infections leading to severe illness, hospitalization and mortality in at-risk populations, particularly the elderly. The seasonality of influenza and RSV present the potential to co-administer vaccines. This study aimed to demonstrate the non-inferiority of co-administration of the experimental RSV vaccine Ad26.RSV.preF with an influenza vaccine (Fluarix) vs. Fluarix alone in terms of immunogenicity against influenza.

Methods
This was a single-center, randomized, double-blind, placebo-controlled Phase 2a study (NCT03339713) in healthy adults ≥60 years old. Volunteers were randomized 1:1 to receive Fluarix + 1 × 1011 vp Ad26.RSV.preF on Day 1 and placebo on Day 29 (Group 1), or Fluarix + placebo on Day 1 and 1 × 1011 vp Ad26.RSV.preF on Day 29 (Group 2). Blood samples were taken prior to each vaccination and at Day 57. The primary endpoints were geometric mean titers (GMTs) of hemagglutination inhibition (HI) antibody titers against Fluarix strains (A/Michigan, A/Hong Kong, B/Brisbane and B/Phuket) and the safety and tolerability of Ad26.RSV.preF administered with or without Fluarix. A key secondary endpoint was neutralizing antibody titers to RSV A2.

Results
Volunteers (N = 180) were included in Group 1 (n = 90) or Group 2 (n = 90). Most volunteers were white (89%) and female (63%), with a median age of 65 years. Both groups exhibited an increase from baseline in HI antibody response on Day 29. The 95% one-sided upper confidence limit of all GMT ratios were below the non-inferiority margin of 2. The frequency of solicited adverse events (AE) after Ad26.RSV.preF vaccination was similar with and without influenza co-administration. Solicited AEs were mainly of Grade 1 and 2 and of transient duration. Most unsolicited AEs were considered unrelated to the study vaccination and were Grade 1 or 2. There were no serious AEs related to the study vaccine and there were no discontinuations due to AEs. RSV neutralizing antibody titers 29 days post- Ad26.RSV.preF immunization were similar in both groups (1404, Group 1; 1690, Group 2).

Conclusion
Co-administration of Ad26.RSV.preF with Fluarix was non-inferior to Fluarix alone in terms of immunogenicity against influenza and had an acceptable tolerability profile.

Disclosures
All authors: No reported disclosures.
2792. Association of Body Mass Index with Rates of Hospitalization in Patients with Respiratory Viral Infections—Puerto Rico, 2012–2018
Authors: Tobolowsky Farrell A , Zambrano Laura , Sharp Tyler , Beckham John David , Alvarado Luisa , Paz-Bailey Gabriela 
Published: October 2019

Abstract

Background
Obesity is a serious public health problem in Puerto Rico, where 31% of the population is obese. Multiple studies have suggested that adults with influenza who are underweight, overweight, or obese have increased risk of hospitalization compared with those of normal weight. We sought to determine whether risk of hospitalization among patients infected with influenza or other respiratory viruses differs by BMI among patients in Puerto Rico.

Methods
We analyzed data from patients enrolled in the Sentinel Enhanced Dengue Surveillance System (SEDSS), a prospective study of patients with acute febrile illness (AFI), from May 2012 to September 2018. We evaluated those older than 24 months, who had height, weight, and clinical disposition recorded, and tested positive by RT–PCR for infection with influenza A (n = 1253), influenza B (n = 844), adenovirus (n = 435), respiratory syncytial virus (n = 289), parainfluenza virus (n = 361), metapneumovirus (n = 247), or coronavirus (n = 15). BMI categories were determined using standard cutoffs in adults and BMI-for-age percentiles for children and adolescents. Risk of hospitalization by BMI category was calculated using multivariate Poisson regression.

Results
Among the 3,388 patients included, 675 (20%) were overweight, 926 (27%) were obese, 405 (12%) were underweight, and 1382 (41%) were normal weight. Median age was 13.4 (range: 2–100 years), and 50% were male. Risk of hospitalization was not significantly different in children and adult patients infected with a respiratory virus who were overweight relative to those that had normal BMI; however, once hospitalized, obese individuals of any age had a mean length of hospital stay 1.7 days longer than normal weight persons (95% CI: 0.27–3.17 days). Among adult patients, underweight patients were nearly 3 times more likely to be hospitalized compared with normal weight patients (relative risk 2.8, 95% CI: 1.4–5.9). Underweight children were not at increased risk of hospitalization.

Conclusion
Among patients infected with a respiratory virus, risk of hospitalization was higher among underweight adult patients, and obese patients had a longer mean length of stay once hospitalized. Body mass index should be considered when evaluating risk and managing these patients.

Disclosures
All authors: No reported disclosures.
2793. Influenza and Bacterial Pneumonia Coinfection: Rates and Outcomes
Authors: Bartley Patricia , Deshpande Abhishek , Yu Pei-Chun , Haessler Sarah , Zilberberg Marya , Imrey Peter , Klompas Michael , Rothberg Michael 
Published: October 2019

Abstract

Background
Limited evidence suggests that influenza leads not only to bacterial colonization and greater risk of bacterial pneumonia, but to poor outcomes and increased mortality. We compared bacterial culture results between patients positive (FLU+) and negative (FLU-) for influenza in the setting of community-acquired pneumonia (CAP). Among FLU+ patients we compared bacterial etiology, characteristics, treatment and outcomes between patients with and without bacterial coinfection.

Methods
We included adults admitted with pneumonia 2010–2015 to 179 US hospitals participating in the Premier database. Pneumonia was identified using an ICD-9-CM algorithm. Among patients tested for FLU, we limited the microbiology results to the first 14 hospital days. We assessed inpatient mortality, ICU admission, use of vasopressors, mechanical ventilation (MV), cost, and LOS using mixed multiple logistic regression and gamma generalized linear mixed models.

Results
Among 166,273 patients hospitalized with CAP, 38,665 (23.3%) were tested for influenza and 4,313 (11.15%) were positive. In FLU+ patients the most common bacterial co-infection was Staphylococcus aureus (37.6%) followed by Streptococcus pneumoniae (25.9%) and Pseudomonas aeruginosa (10.9%), varying based on the day of coinfection (days 1–3 vs. days 4–14) (Figure 1). In FLU- patients, S. pneumoniae (30.5%) and S. aureus (30.3%) were similarly common, followed by P. aeruginosa (10.0%). FLU+ patients with bacterial co-infection were younger (66.3 vs. 69.1 years), with more comorbidities (3.2 vs. 2.7) than influenza patients with no bacterial co-infection (all comparisons P < 0.001). Bacterial co-infection was also associated with increased odds of in-hospital mortality (OR 1.86, 95% CI,1.31–2.65), ICU admission (OR 3.46, 2.44–4.9), use of vasopressors (OR 3.74, 2.61–5.36), and MV (OR 3.51, 2.49–5.36), increased cost (risk-adjusted ratio of geometric means, 1.6, (1.47–1.73) and LOS (risk-adjusted ratio of geometric means 1.42, (1.33–1.52).

Conclusion
In a large US inpatient sample hospitalized for CAP, 11% of patients with influenza had or acquired a bacterial co-infection. Bacterial co-infection was associated with significantly worse outcomes and higher cost.

Disclosures
All authors: No reported disclosures.
491. Working Together: A Tale of Carbapenemase-Producing Organism Investigations in Three New York City Nursing Homes
Authors: Ostrowsky Belinda , Snavely Emily , Kogut Sarah , Giardina Rosalie , Adams Eleanor , Nazarian Elizabeth , Musser Kimberlee A , Jean-Denis Ronald , Greenko Jane , Lutterloh Emily 
Published: October 2019

Abstract

Background
New York State Department of Health (NYSDOH) and Wadsworth Center (WC) participate in the Centers for Disease Control and Prevention’s Antibiotic Resistance Laboratory Network (AR Lab Network), including identification and characterization of specific bla genes in carbapenemase-producing organisms (CPO). Three investigations from November 2018–March 2019 illustrate the findings and challenges investigating CPO in a blaKPC endemic setting.

Methods
NYSDOH WC testing includes organism identification, drug susceptibility testing, detection of carbapenemase production, detection of carbapenemase genes, and whole-genome sequencing (WGS). NYSDOH epidemiologic (epi) investigations of novel resistance mechanisms review demographic and exposure data, conduct contact tracing with targeted rectal screening to identify colonized persons, and assess infection control (IC) and public health (PH) practices and provide recommendations.

Results
NYSDOH identified three nursing home residents infected with CPO with novel carbapenemase genes (Figure 1) with no travel history but multiple co-morbidities, including mechanical ventilation: blaOXA-48Klebsiella pneumoniae (KP) (Facility A), blaNDM KP (Facility B and C). Epi investigations identified CPO in 48 of 106 residents screened for rectal colonization; most isolates had genes other than the index gene. Facility A and Facility B each had no additional residents colonized with CPO with the index gene after screening; 14 and 10 residents, respectively from Facility A and B, had CPO with endemic blaKPC gene. WGS analysis identified 2 clusters of blaKPC KP within Facility A and no clusters of CPO were detected in Facility B. IC/PH recommendations were made after diagnosis at all 3 facilities; serial IC/PH assessments/recommendations and screening were needed to interrupt transmission at Facility C, where 24 residents were colonized with CPO, including 7 residents with CPO with the index gene (blaNDM), and a subset of the blaNDM isolates were related to the index case by both epi and WGS analysis.

Conclusion
Epi investigation and WGS were complementary to detect transmission, identify clusters within an endemic setting, and inform PH response and IC measures for these emerging CPO in NY Healthcare Facilities.

Disclosures
All authors: No reported disclosures.
178. Evaluation of Oral Antibiotic Stepdown Therapy for the Management of Gram-Negative Rod Bacteremia in a Tertiary Care Medical Center
Authors: Savage Heather , Stewart Kyana , Dermady Miranda , Foy Jessica , Bohan Jefferson , King Travis , Mohammed Alaa 
Published: October 2019

Abstract

Background
Treatment strategies surrounding bacteremia are constantly changing as new data emerges. Transition from intravenous (IV) to oral (PO) antibiotics in patients with Gram-negative rod bloodstream infections (GNR BSI) remains controversial. The objective of this study was to characterize clinical outcomes in patients who received early (≤72 hours) vs. late (>72 hours) stepdown therapy (ES vs. LS, respectively) for GNR BSIs.

Methods
A single-center, retrospective cohort study was conducted including adults with GNR BSIs admitted to a 610-bed tertiary care academic medical center between January 1, 2016 and December 31, 2017 who were transitioned from IV to PO antibiotics. Patients with severe renal impairment, inadequate source control, prolonged antibiotic course, HIV/AIDS, and pregnancy were excluded. The primary endpoint was clinical failure and secondary endpoints were 30- and 90-day all-cause mortality, duration of bacteremia, and adverse events.

Results
164 patients (ES = 61; NS = 103) were included. Population median age was 63 years, 56% were male, and 19% were immunocompromised. Genitourinary source was most common (48.7%), while the most common organism isolated was Escherichia coli (52.4%). Most infections were community-acquired (70.1%) and the most common step-down therapy choice was ciprofloxacin in 75% of patients. There were no major differences in baseline demographic and clinical characteristics between groups except for the greater presence of central venous catheters (16.4% vs. 35.9%; P = 0.006) in the LS group. Overall clinical failure was 9.8% vs. 13.6% between the ES and LS groups, respectively. The LS group had a higher rate of clinical failure defined by escalation from PO to IV antibiotics (1.6% vs. 10.7%; P = 0.03). Patients who failed therapy tended to be immunocompromised and/or have an intra-abdominal source of infection. Secondary endpoints did not differ between groups.

Conclusion
Higher clinical failure rates in the LS group indicate that these patients may have underlying clinical characteristics not amenable to stepdown therapy. Choice of step-down therapy was not driven by the source of infection or patient acuity. Further analysis and studies are needed to determine optimal time and population for stepdown.

Disclosures
All authors: No reported disclosures.
190. Clinical Presentation of Streptococcus gallolyticus Infections
Authors: Kannangara Don , Pandya Dhyanesh 
Published: October 2019

Abstract

Background
There are multiple publications on the association of Streptococcus gallolyticus (SG) with malignancies of the colon. SG has been also found in association with hepatocellular carcinoma, biliary tract infections, meningitis, endocarditis, urinary and other infections. In a preliminary analysis of SG and other streptococcal infections, we find that any of the GI flora may gain access to the bloodstream when there is a breach of the mucosa due to inflammation or malignant invasion. In our study, the majority of SG infections were polymicrobial and lower urinary tract infections were the most common presentation. Only 2 out of 45 had gastrointestinal malignancies both with polymicrobial blood culture results.

Methods
We evaluated 45 cases of SG seen in our health network hospitals for the past 15 months. The charts of all SG isolates were reviewed for age, sex, clinical presentation, laboratory data and susceptibilities.

Results
There were 34 female and 11 male patients.The majority were elderly with only 5 patients below age 50, Thirty patients presented with urinary infections, 28 lower and 2 upper tract. All except 4 urinary infections were in females. Sixteen urinary infections were polymicrobial and 14 monomicrobial. Two upper tract urinary infections were monomicrobial.There were 8 bloodstream infections, 4 polymicrobial and 4 monomicrobial. Three gall bladder infections were polymicrobial and one monomicrobial. Two liver abscesses yielded polymicrobial flora. Only 4 patients had cancer 1. Metastatic pancreatic cancer 2. Carcinoma of the ampulla of Vater 3. Advanced prostate cancer 4. Anal cancer. Only 1 and 2 had positive blood cultures, both polymicrobial.The other 2 had polymicrobial lower tract urinary infections. One patient had aortic prosthetic valve endocarditis. All SG isolates tested were susceptible to penicillin, ceftriaxone and vancomycin.

Conclusion
The most common presentation was urinary. There was a higher number of females due to a large number of urinary infections.The majority of infections were polymicrobial including all 4 cancer patients. Two bacteremias were associated with gastrointestinal malignancies but none with the colon. SG isolates were susceptible to penicillin, ceftriaxone and vancomycin.

Disclosures
All authors: No reported disclosures.
212. Outcomes of Adults with Uncomplicated Staphylococcus aureus Bacteremia Receiving Short-Course Vs. Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort
Authors: Thorlacius-Ussing Louise , Nissen Jette , Rasmussen Jon J , Skov Robert , Arpi Magnus , Schonheyder Henrik , Frimodt-Møller Niels , Dahl Knudsen Jenny , Ostergaard Christian , Benfield Thomas 
Published: October 2019

Abstract

Background
The recommended duration of antibiotic treatment for uncomplicated Staphylococcus aureus bloodstream infections is 14 days. We compared the outcomes of patients receiving short-course (6–10 days) vs. prolonged-course (11–16 days) antibiotic therapy for S. aureus bacteremia (SAB).

Methods
30-day outcome of patients with penicillin (PSSAB, n = 202)) or methicillin-susceptible SAB (MSSAB, n = 203) treated with in vitro active therapy in the range of 6–16 days was analyzed using pooled data from two previously published, observational studies. Individuals were matched 1:1 by nearest neighbor propensity score matching without replacement. Regression analysis was performed to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment. Eligible individuals had to have >1 day of follow-up after discontinuation of antimicrobials. Individuals with a diagnosis of endocarditis, bone infection, meningitis or pneumonia were excluded.

Results
There were 107 well-balanced matched pairs; 58 in the PSSAB and 39 in the MSSAB cohort. For PSSAB, the median duration of therapy was 8 (interquartile range [IQR], 7–10) in the short-course group and 12 days (IQR, 10–13) in the prolonged-course group. For the MSSAB cohort, these numbers were 9 days (IQR, 7–10) and 14 days (IQR, 13–16 days), respectively. No difference in mortality between short-course and prolonged-course treatment was observed (adjusted hazard ratio [aHR], 0.74; 95% confidence interval [CI], .23–2.41) and 1.14; 95% CI, 0.31–4.20), respectively for PSSAB and MSSAB.

Conclusion
Short courses of antibiotic therapy yielded similar clinical outcomes as prolonged courses of antibiotic therapy for S. aureus bacteremia. The findings warrant a randomized clinical trial to study the safety and efficacy of shortened antimicrobial therapy for the treatment of uncomplicated SAB.

Disclosures
All authors: No reported disclosures.
214. Comparison of Clinical and Laboratory Findings of Human Monocytic Ehrlichiosis (HME) and Human Granulocytic Anaplasmosis (HGA) in Long Island, New York.
Authors: Azab Nancy , Smith Kalie , Spitzer Eric , Weinbaum Fredric I , Marcos Luis 
Published: October 2019

Abstract

Background
Suffolk County reports to the Department of Health the highest absolute number of cases of tick-borne diseases (TBD) for NY State. While Lyme disease and Babesiosis are the most common TBD in this county with more than 600 and 100 cases reported every year, respectively; two other TBD, HME (due to Ehrlichia chaffeensis) and HGA (due to Anaplasma phagocytophilum) are also commonly reported in this county (63 and 37 every year, respectively). There is limited data directly comparing both diseases on acute presentation; the aim of this study was to compare the clinical features, laboratory findings and complications of HME and HGA in the epicenter of TBD in NY State.

Methods
A retrospective study was designed to collect cases with the diagnosis of HME and HGA by using ICD9 or ICD10 codes from 2013 to 2018 at Stony Brook Medicine. Inclusion criteria were patients 18 years or older who had a positive PCR in blood for E. chaffeensis or A. phagocytophilum. Demographics, clinical features, laboratory results, and complications were extracted from patient charts. We used the chi-square test to compare the proportion of symptoms and a two-tailed unpaired student T-test to compare laboratory values.

Results
A total of 40 cases of HME (mean age 67 ± 13) and 27 with HGA (mean age 63 ± 12) met inclusion criteria. Only approximately 50% of cases had a documented history of tick exposure. Clinical presentations were similar in terms of frequency of fever, headache, arthralgia, and myalgia. In contrast, hypotension, confusion, and rash were more common in HME although only the latter was significantly more common. HME patients had significantly greater degrees of leukopenia and thrombocytopenia and elevated AST levels. The majority of patients with HME and HGA were hospitalized >1 day for management of their acute illness (HME, 30/40 and HGA 17/27). Several patients with HME had gastrointestinal (GI) complications including 3 with acute acalculous cholecystitis, 1 with duodenitis, and 1 with acute colitis; 1 patient with HGA had perforated diverticulitis.

Conclusion
Patients with acute HME tend to be more ill than those with acute HGA; however, a substantial proportion of both groups require hospitalization. GI complications were more commonly seen in HME (12.5%) than HGA (3.7%) which deserves further investigation.

Disclosures
All authors: No reported disclosures.