bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.
250. Comparison of T2Candida Assay with Blood Culture, Candida Sepsis Score and Serum β-d-glucan in Diagnosis of Candidemia
Authors: Nizami Sobia , Zacharioudakis Ioannis , Aguero-Rosenfeld Maria E , Neumann Henry J 
Published: October 2019

Abstract

Background
Although blood cultures are the clinical diagnostic standard for candidemia, their delay in results and low sensitivity has lead to increasing the use of alternate tests and diagnostic algorithms. The T2Candida magnetic resonance assay (T2C) results in a few hours, but concomitant cultures are also needed. We compared results from the T2C with β-d-glucan (BDG), blood cultures (BCx) and the Candida Sepsis Score (CSc) in diagnosis and management of candidemia.

Methods
This retrospective observational study included patients from July 2017 to December 2018 who had a T2C as well as BCx. Positive (+) and negative (–) results of BCx and BDG within 24 hours (24 h) of T2C were recorded, with clinical data to determine CSc at the time of T2C (recent surgery, severe sepsis, parenteral nutrition, multifocal candida colonization).

Results
There were 648 T2Cs done over the study period. Only the first +T2C for patients with multiple T2Cs on admission was included. There were 41 patients with +T2, in which 31 had a 24hBCx. Two patients were of pediatric age. There were 7 neutropenic, 1 post-transplant, and 27 intensive care (ICU) patients. Reasons for ordering T2C included sepsis and persistent fevers. In 18 (44%) patients, antifungals were given prior to the T2C. Eight among 31 24hBCx were positive for concordant Candida spp. (26%). Six of these 8 patients were on antifungal therapy when T2C was sent. Seventeen patients had a 24hBDG, with 7 positive (41%). Overall mean CSc in 27 ICU patients with +T2C was 2.2 ± 0.8, and 40% of adult non-neutropenic ICU patients had a CSc of 3 or above. A central line was present in 26 patients, and was removed in 16 after +T2. In 213 patients with −T2C who had 24hBCx, only 1 BCx was positive, from a PICC line in a 2-year-old patient. Seven of the 41 patients with +T2C were treated for deep-seated candidiasis with 6 weeks antifungal therapy or longer; others received 1 to 4 weeks. Thirteen patients died while on antifungal therapy.

Conclusion
T2Candida was used for diagnosis and management of candidemia in patients who had concomitant blood culture positive in 26%, β-d-glucan positive in 41%, and ICU Candida sepsis score 3 or above in 40% patients. It did not miss candidemia in adults, compared with blood culture within 24 hours. Positive T2Candida helped expedite source control e.g line removal.

Disclosures
All authors: No reported disclosures.
267. Fungal Culture Diagnostic Stewardship: An Avenue for Antimicrobial Stewardship in the Immunocompromised Host
Authors: Gurram Pooja , Vashistha Kirtivardhan , O’Horo John C , Shah Aditya 
Published: October 2019

Abstract

Background
Bronchoalveolar lavage (BAL) is a widely used procedure in the diagnosis of pneumonia in critically ill and immunocompromised hosts. Fungal smears and cultures are commonly performed on these samples. We evaluated the yield of various fungi, including but not limited to Candida species, Aspergillus species, Penicillium species, isolated from BAL specimens at our institution to determine the yield of this test and its impact on decision making.

Methods
We identified adult immunocompromised patients who underwent “Bronchoscopy with Immunocompromised Host Protocol (ICH),” which consists of an exhaustive list of diagnostic tests for various pathogenic organisms, over a one year period from January 1, 2017 to December 31, 2017. We reviewed if positive fungal cultures led to a change in management and if this was appropriate.

Results
582 patients underwent bronchoscopy with ICH protocol. There were 285/582 (48.9%) positive fungal cultures of which 177 (62%) grew Candida species. The most common species was Candida albicans (142/177, 80%). 53(18%) were Aspergillus species of which Aspergillus fumigatus was the most common (26/53). 16/285 (5.6%) patients underwent intervention based on the results, 14(87.5%) of which were appropriate. 176/177 (99.4%) patients with Candida species in BAL cultures were not treated.10/53 (18. 8%) patients with Aspergillus species in BAL cultures were treated of which 80% were appropriate interventions based on proven/probable invasive fungal infections criteria as were rest of the 6/16 patients with other fungal organisms (Table 4). Patients with Aspergillus species in BAL cultures are 8 times more likely to have an intervention (OR: 8. 7, P = < 0. 0001) while patients with Candida species in BAL cultures are not likely to be intervened upon (OR: 0. 26, P = 0. 0098) (Table 3).

Conclusion
Although Candida species is commonly isolated in BAL cultures its clinical significance is minimal in the absence of disseminated disease even in immunosuppressed hosts. Evaluating the way that Candida cultures are communicated for respiratory specimens, along with diagnostic stewardship may be a route for antimicrobial stewardship. Consulting ID service early on is essential in assessing the significance of fungal culture data thereby resulting in appropriate changes in management.

Disclosures
All authors: No reported disclosures.
271. Fungal Diagnostic Studies in Histoplasmosis
Authors: Krishnan Gayathri , Power Margaret , Bariola J Ryan , Dare Ryan K 
Published: October 2019

Abstract

Background
Histoplasmosis (histo) is a common cause of invasive fungal infection in endemic regions and accurate diagnosis is difficult without direct tissue culture or pathology. Indirect fungal antigen testing for various fungal pathogens is typically performed to assist with diagnostic workup though cross-reaction can lead to difficulty interpreting results. We aimed to evaluate the prevalence of positive antigen testing for non-Histoplasma fungal pathogens in patients with proven invasive histo.

Methods
We performed a retrospective review of adult patients with proven invasive histo from 2010–2018 at our institution. For inclusion purposes, histo was confirmed by either fungal culture and/or cytology. Patient demographics, clinical characteristics and results of fungal antigen testing for Histoplasma, Blastomyces, Aspergillus, Cryptococcus and β-d-glucan were evaluated. Two different urine Histoplasma antigen assays were used during the study period.

Results
57 (31%) of 182 patients diagnosed with histo during the study period had culture or cytology evidence of disease and were included in all further analysis. Thirty-two (56%) of these patients were male, 35 (61.4%) were Caucasian and the mean age was 50.1 years. HIV (20; 35%) and being on immunosuppressive medications (21, 37%) were common in this population. The majority of cases were classified as disseminated histo (40, 70%) followed by acute pulmonary (10; 18%) and chronic pulmonary (7, 12%) disease. Results of fungal antigen testing are documented in the table. Chi-squared analysis was performed.

Conclusion
There is a frequent cross reaction of non-Histoplasma fungal tests in patients with histo. In our review, there was a high rate of cross reaction with Blastomyces antigen, which can be confusing in regions where both pathogens coexist. Elevation of β-d-glucan was high in these patients. Urine Histoplasma antigen sensitivity was higher with MiraVista testing for disseminated disease in our review. While noninvasive fungal tests are helpful in diagnosis of these infrequent infections, clinicians must still maintain knowledge of the clinical differences between these fungal pathogens and be aware of the limitations of these tests. A prospective study is needed to better define differences between individual Histoplasma tests.

Disclosures
All authors: No reported disclosures.
272. Invasive Pulmonary Aspergillosis: Comparative Analysis in cancer patients with Underlying Hematologic Malignancy vs. Solid Tumor
Authors: Wilson Dib Rita , Khalil Melissa , Fares Johny , Dandachi Dima , Hachem Ray Y , Jiang Ying , Hajjar Chaftari Anne-Marie , Raad Issam I 
Published: October 2019

Abstract

Background
Over the years, the profile of patients with invasive pulmonary aspergillosis (IPA) has extended beyond the commonly associated population with hematologic malignancy (HM) and is now comprising patients with solid tumors and patients with lung diseases. We therefore aimed to compare the clinical characteristics, diagnostic approach and therapeutic outcome of IPA in cancer patients with hematologic malignancies vs. solid tumor (ST).

Methods
We conducted a retrospective study evaluating consecutive cases of proven and probable IPA from March 2004 to December 2016 in a tertiary cancer center. We included patients >18 years with an underlying ST, HM, or Hematopoietic Cell Transplantation (HCT) within 1 year of IPA diagnosis.

Results
A total of 311 patients were analyzed: 225 had HM including HCT and 86 ST. Patients with ST were more likely to have had COPD (33% vs. 8%, P > 0.01) or other underlying pulmonary diseases when compared with HM patients (76% vs. 43%, P < 0.01). Radiation therapy prior to the infection was also notably higher in the ST group than the HM group (48% vs. 14%, P < 0.01). Patients with HM were more likely to have received steroid (38% vs. 15%, P = 0.0001) and have concurrent neutropenia 37% vs. 2%, P < 0.0001). A. fumigatus was most commonly recovered in patients with ST than in patients with HM (66% vs. 38%, P < 0.01). Monotherapy and voriconazole-based primary antifungal therapy were more often prescribed in patients with ST than in patients with HM (87% vs. 56%, P < 0.0001 and 77% vs. 53%, P = 0.0002 respectively). Complete or partial successful response to therapy was recorded in 66% of patients with ST compared with 40% in the HM group (P = 0.0001). IPA attributable mortality within 12 weeks was significantly higher in the HM than in the ST group (30% vs. 18%, P = 0.04).

Conclusion
Monotherapy with voriconazole were more often prescribed in patients with ST than in patients with HM. Patients with ST had a better response to antifungal therapy and a lower IPA attributable mortality within 12 weeks compared with those with HM.

Disclosures
All authors: No reported disclosures.