bluuebunny/crossref_metadata_2025_split huggingface dataset:
2797. Rates of Respiratory Syncytial Virus (RSV) Infection among Hospitalized Adults by Congestive Heart Failure Status—United States, 2015–2017
Authors: Kujawski Stephanie A , Langley Gayle , Langley Gayle , Anderson Evan J , Thomas Ann , Bennett Nancy M , Lynfield Ruth , Monroe Maya , Pradhan Eva , Reingold Art , Talbot Keipp , Gerber Susan I , Kim Lindsay 
Published: October 2019

Abstract

Background
Respiratory syncytial virus (RSV) can cause severe disease in older adults and adults with cardiopulmonary conditions, such as congestive heart failure (CHF). RSV vaccines in development may target adults based on age or medical conditions. We assessed rates of RSV infection in hospitalized adults by CHF status using RSV surveillance conducted through the Centers for Disease Control and Prevention’s Emerging Infections Program, a population-based platform in the United States

Methods
RSV surveillance was performed during two seasons (2015–2017) from October 1–April 30 at seven US sites covering an annual catchment population up to 13.7 million adults. Adults (≥ 18 years) admitted to a hospital from the catchment area and with laboratory-confirmed RSV infections identified by clinician-directed testing were included. Demographic data and any history of CHF were abstracted from medical charts. For adults ≥ 65 years, county-level CHF prevalence was obtained from 2015 Centers for Medicare and Medicaid Services (CMS) data. To estimate county-level CHF prevalence for adults < 65 years, we used 2015–2016 National Health and Nutrition Examination Survey and CMS data. We calculated crude incidence rates (and 95% exact Poisson confidence intervals) of RSV by CHF status and age group (< 65 years vs. ≥ 65 years) using RSV cases (numerator) and catchment area county-level population estimates from the US Census (denominator).

Results
During 2015–2017, a total of 2,211 hospitalized RSV cases were identified; 2,055 (92.9%) had CHF status documented. The majority were ≥ 65 years (n = 1236, 60.1%) and 26.8% (n = 550) had CHF. The crude rate of RSV was 62.7 (95% CI: 57.5–68.2) per 100,000 population in adults with CHF compared with 6.1 (95% CI: 5.7–6.4) per 100,000 population in adults without CHF (rate ratio: 10.3, 95% CI: 9.3–11.3). In both age groups, those with CHF had higher rates of RSV than those without CHF. Rates were highest in adults ≥ 65 years with CHF (73.4 per 100,000 population, 95% CI: 66.4–80.9).

Conclusion
Using population-based surveillance, we found that adults with CHF had RSV hospitalization rates 10 times higher than those without CHF. Identifying high-risk populations for RSV infection are critical to inform clinical practice and future RSV vaccine policy.

Disclosures
All authors: No reported disclosures.
183. Candidaemia in Children and Importance of Central Venous Catheter Removal
Authors: Arikan Kamile , Arıkan-Akdaglı Sevtap , Kara Ates 
Published: October 2019

Abstract

Background
Candida is the most common cause of invasive fungal infection in healthcare settings and is associated with significant increases in healthcare resource utilization and attributable mortality.

Methods
This study was conducted in a pediatric tertiary care hospital from Turkey. We conducted a retrospective analysis in children ≤18 years with blood culture-proven candidaemia identified between December 2013 and November 2017. Sociodemographic variables,underlying condition, mortality, additional risk factors, origin of specimens were all recorded.

Results
A total of 236 episodes of candidaemia were identified over the study period. The median age of the patients was 600 days (4-6482). 106 specimens (44.9%) were cultured from patients under 1 year of age and 15 of 106 specimens were cultured from neonates. The most frequently isolated Candida spp. were C. albicans (42.%), followed by C. parapsilosis (30.5%), C. glabrata (7.6%), C. tropicalis (6.4%), C. krusei (2.5%), C. lusitaine (2.5%), C. dubliniensis (2.1%), C. kefir (0.8%), and C. pelliculosa (0.4%). In 11 of the 236 episodes (4.5%), two Candida spp were cultured at the same time.The most common coinfection was C. albicans and C. parapsilosis. 112 of the 236 episodes (47.5%) was due to central venous catheter-related blood stream infection. 47.5% of these patients were receiving total parenteral nutrition at the time of candidemia. Concomitant coagulase negatif staphylococcus bacteremia was present in 50 of 236 candidemia episodes (21.2%). Of 236 isolates, 74 (31.4%) was cultured from peripheral blood culture only, 95 (40.3%) from central venous catheter only, 67 (28.4%) from both peripheral and central catheter blood culture.Trombocytopenia was noted in 117 episodes (49.6%) and neutropenia in 45 episodes (19.1 Of the 112 central venous catheter-related candidemia, 35 (31.3%) resulted in death within 30 days from the onset of candidaemia (Figure 1). In 49 (45.%) episodes of central venous catheter-related candidemia, catheter was not removed and 40% of these episodes resulted as death.Catheter removal, thrombocytopenia, total parenteral nutrion were found to be associated with increased mortality in children under 1 year of age (P < 0.001).

Conclusion
Clinicians must be aware of candidemia in children due to high risk of mortality.

Disclosures
All authors: No reported disclosures.
213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections
Authors: Marks Laura , Schwarz Evan , Liss David , Satish Munigala , Warren David K , Stephen Liang , Durkin Michael 
Published: October 2019

Abstract

Background
Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions.

Methods
We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves.

Results
In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates.

Conclusion
Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates.

Disclosures
All authors: No reported disclosures.
219. Is the modified quick SOFA scale superior to quick SOFA in patients with diagnosed septic shock?
Authors: Akyol Deniz , Uyan Önal Ayşe , Önal Uğur , Akdağ Damla , Bulut Avşar Cansu , Uysal Serhat , Guliyeva Günel , Başkol Dilşah , Demir Melike , Mermer Sinan , Chousein Memetali Seichan , Şanlıdağ Gamze , Mert Merve , Sipahi Hilal , Ulusoy Sercan , Reşat Sipahi Oğuz 
Published: October 2019

Abstract

Background
In this study it was aimed to compare the effects of qSOFA (Quick Sequential Organ Failure Assessment) score with modified qSOFA score (PLoS One. 2018 Sep 26;13(9):e0204608) for predicting one month survival in patients with diagnosed septic shock (SS) in a tertiary-care educational university hospital in a developing country.

Methods
Modified qSOFA was created by adding age factor (>50 years=1 point) to patients with qSOFA scale 1 or 2 or 3 who had SS (sepsis+hypotension+adrenergic agent) and consulted by Infectious Diseases consultants between December 2013-December 2018. Arterial lactate level of >2 mmol/L criterion was added as an including criteria for SS according to 3rd International Sepsis and Septic Shock Consensus Statement after 23rd February 2016. Statistical analysis was performed via Chi-square test and a p-value <0.05 was considered significant.

Results
The number of patients with qSOFA score of 1 or 2 or 3 from 527 patients are in Table1 [some of the cases were diagnosed as septic shock according to elder definition (without lactate criterion) and there was a subgroup with qSOFA score 1]. Among the >50-year aged group, the 30-day survival rate was lower in patients with qSOFA3 vs. qSOFA 2 vs. qSOFA 1 (Table1, 3x2 Chi Square test, P = 0.0057). Among the <50 years group, the qSOFA one month survival rate was lower in patients with qSOFA 3 vs. qSOFA 2 vs. qSOFA 1 (Table, 3x2 Chi Square Test, P = 0.0052). According to modified qSOFA, there was a significant difference for one month survival among SS cases with scores of 1, 2, 3 and 4 (12/21 57% vs. Fifty/126 40% vs. 78/269 29% vs. 22/111 20%, 4x2 Chi-square test, P = 0.0003). On the other hand, there was no significant difference in terms of one month survival when we performed subgroup analysis in qSOFA score 1, 2, or 3 subgroups, as ≤50 years vs. >50 years (table, Chi-square test, 12/21 vs. 39/97 P = 0.224, 11/29 vs. 75/244 P = 0.526, 3/25 vs. 22/111 P = 0.572).

Conclusion
In terms of survival at one month, there was a significant difference between qSOFA score 1, 2, 3 and 4 subgroups. In patients with qSOFA score of 1 or 2 or 3, being under 50 years did not have a significant effect on one-month survival. Modified qSOFA may be beneficial to foresee the probable mortality but these findings need to be validated in larger cohorts

Disclosures
All authors: No reported disclosures.
244. Development, Qualification, and Clinical Validation of an Immunodiagnostic assay for the Detection of 11 Additional S. pneumoniae Serotype-Specific Polysaccharides in Human Urine
Authors: Vincent. Kalina Warren , Souza Victor , Wu Kangjian , Giardina Peter , McKeen Andrew , Jiang Qin , Tan Charles , Ren Yanhua , Belanger Kelly , McElhiney Sue , Unnithan Manu , Cheng Huiming , Giordano-Schmidt Donna , Gessner Bradford D , Jansen Kathrin U , Pride Michael W 
Published: October 2019

Abstract

Background
Identifying Streptococcus pneumoniae (Sp) serotypes by urinary antigen detection assay (UAD) is the most sensitive and specific way to evaluate the changing epidemiology of non-bacteremic community-acquired pneumonia (CAP) and efficacy of pneumococcal vaccines. We first described an UAD to detect the Sp serotypes 1,-3,-4,-5,-6A,-6B,-7F,-9V,-14,-18C,-19A,-19F,-23F covered by the 13-valent Sp conjugate vaccine PCV13. To assess the pneumococcal disease burden of additional serotypes, a UAD-2 assay was developed to diagnose 11 additional Sp serotypes (-2,-8,-9N,-10A,-11A,-12F,-15B,-17F,-20,-22F,-33F).

Methods
UAD-2 specificity was achieved by capturing highly purified pneumococcal polysaccharides with serotype-specific monoclonal antibodies using Luminex technology. Assay qualification assessed accuracy, precision, and sample linearity. Serotype positivity was based on cutoffs determined by non-parametric statistical evaluation of urine samples from individuals without pneumococcal disease. Clinical sensitivity and specificity of the positivity cutoffs were assessed in a clinical validation.

Results
The UAD-2 was shown to be specific and reproducible. Clinical validation using urine samples from invasive disease patients demonstrated assay sensitivity and specificity of 92.2% and 95.9%, respectively compared with a gold standard of isolating and typing (by Quellung) Sp bacteria from patient samples. Analysis of 11,087 CAP patients showed a UAD-2 and UAD-1 serotype prevalence of 4.33% and 4.60%, respectively (bacteremic and non-bacteremic CAP combined).

Conclusion
The qualified/clinically validated UAD-2 method has applicability in understanding the epidemiology of nonbacteremic Sp CAP as well as assessing vaccine efficacy of future pneumococcal conjugate vaccines.

Disclosures
All authors: No reported disclosures.
247. Evaluation of the T2Candida Panel as an Antifungal Stewardship Tool in Transplant and Non-Transplant Patients at a Tertiary Care Center
Authors: Sarfraz. Chaudhry Zohra , Vahia Amit T , Kathuria Priya , Doyon-Reale Nicole , Mayur Ramesh , Abreu Lanfranco Odaliz , Del Busto Ramon , Alangaden George J 
Published: October 2019

Abstract

Background
Invasive candidiasis (IC) has a mortality of >30% and likelihood of death increases 50% each day antifungal therapy (AF) is delayed. In patients with suspected IC early empiric AF improves outcomes but has the potential for overuse. Blood cultures (BC) detect ~50% of candidemia with a turn-around-time (TAT) of 2–5 days. T2Candida Panel (T2) an FDA-approved molecular diagnostic test, detects 5 Candida species directly in blood with specificity 99.4%, sensitivity 91.1%, and TAT of 3–5 hours. Our institutional guidelines permit the use of empiric AF in patients with suspected IC (Figure 1). We evaluated the utility of T2 as an AF stewardship tool to support these guidelines.

Methods
We reviewed patients that had T2 done January 2016 to May 2016 at Henry Ford Hospital, a 900-acute care bed teaching hospital in Detroit, MI. Patients with negative T2 [T2(−)] and negative concurrent BC [BC (−)] were evaluated. The primary endpoint was discontinuation (d/c) of AF after a T2 (−) result. Secondary endpoints were candidemia after d/c of AF and all-cause 30-day mortality. Comparative analyses were performed of transplant (txp) vs. non-transplant (non-txp) patients. Univariate analysis was done to determine the association of risk factors and outcomes. Multivariate regression using forward selection was used to model mortality risk. Time to d/c of AF were modeled using Kaplan–Meier estimators.

Results
500 consecutive patients with T2 (−) and BC (−) results were identified. Patients on AF for prophylaxis or treatment of fungal infection were excluded. 472 patients (93 txp patients) were included in the analyses. Characteristics of the txp and non-txp patients are in Table 1. Median TAT in hours (hr) of T2 was 6 (±2) vs. 123 (±25) for final BC (−) result. 264/472 (56%) patients were initiated on empiric AF. In patients with T2 (−) result, AF were d/c within 7 days in 97%; time to d/c of AF was 72 hr in 50% txp patients and 48 hr in 50% of non-txp patients respectively (Figure 2). No episodes of candidemia were diagnosed after d/c of AF. All-cause mortality was lower in txp patients (14%) vs. non-txp patients (34%) (P = 0.0002). Likelihood of mortality did not increase after d/c of AF (OR1.3, 95% CI 0.913–2.064).

Conclusion
T2 promotes d/c of empiric AF in txp and non-txp patients with suspected IC without a negative impact on clinical outcomes.

Disclosures
All authors: No reported disclosures.
280. Monitoring Serum Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) in Correlation with (1–3)-β-d-Glucan Levels in Vascular Pythiosis: A Preliminary Study
Authors: Torvorapanit Pattama , Reinprayoon Rongpong , Reinprayoon Navaporn , Manothummetha Kasama , Ratanawongphaibul Kitiya , Chindamporn Ariya , Permpalung Nitipong 
Published: October 2019

Abstract

Background
Vascular pythiosis, caused by Pythium insidiosum, is a life-threatening disease despite aggressive treatment. Our recent study showed that serum β-d-glucan (BG) trends can be used to monitor disease activity after treatment initiation. A significant decline in BG by 0.5 month indicated complete resection without residual disease. However, BG assay is cost probihitive and available only at King Chulalongkorn Memorial Hospital in Thailand. This study was conducted to preliminarily evaluate erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as monitoring tools.

Methods
A prospective study included proven vascular pythiosis patients receiving treatment with combination therapy from November 2018 to January 2019. Clinical information, BG, ESR, and CRP were collected at 0, 0.5, 1.5, and 3 months post diagnosis. Spearman’s correlation coefficient and analysis of response profiles were used.

Results
Six patients were enrolled. All had thalassemia. Four developed disease at popliteal artery, 1 at common iliac artery, and 1 at brachial artery. All underwent amputation with negative surgical margins achievement. All received itraconazole, azithromycin, and P. insidiosum immunotherapy. One received terbinafine and one received doxycycline additionally. All had positive BG > 500 pg/mL at diagnosis. After treatment initiation, means of ESR were significantly decreased at 0.5 months (P = 0.02). Means of CRP were not significantly changed until 1 month (P = 0.02) (Figure 1a and b). Correlation coefficients between BG and ESR vs. BG and CRP were 0.74 and 0.65, respectively. All survived without relapse at 3 months.

Conclusion
ESR and CRP are potentially valuable markers to monitor vascular pythiosis in resource-limited countries. However, ESR levels and trends seem to be correlated with BG better than CRP. Further studies are needed to enroll more patients, especially patients with incomplete resection or non-surgical candidates.

Disclosures
All authors: No reported disclosures.
302. HCV Care in Federally Qualified Health Centers During the Opioid Epidemic: A Retrospective Cohort Study
Authors: Assoumou Sabrina A , Wang Jianing , Nolen Shayla , Eftekhari Yazdi Golnaz , Mayer Kenneth H , Puro Jon , Salomon Joshua A , Linas Benjamin P 
Published: October 2019

Abstract

Background
Federally qualified health centers (FQHCs) serve diverse communities in the United States (US) and could function as important venues to manage hepatitis C virus (HCV) infections. Little is known on HCV outcomes in underserved communities as most of the current data are derived from clinical trials, commercially insured patients, or small health center samples. We aimed to determine the proportion of HCV testing, factors associated with treatment initiation, and real-world treatment outcomes in a large, national diverse sample of US FQHCs during the opioid epidemic.

Methods
We created a retrospective cohort of adults seen at 341 participating FQHCs in 19 US states. Inclusion criteria were: (1) clinical visit between January 01, 2012 and June 30, 2017; (2) ≥18 years of age. Outcomes included HCV testing proportion, stratified by diagnosis of opioid use disorder (OUD); treatment initiation rates; and sustained virologic response (SVR), defined as undetectable HCV RNA 3 months after treatment completion. We identified factors associated with testing, treatment initiation, and SVR using logistic regression.

Results
Of the 1,508,525 patients meeting inclusion criteria, 88,384 (5.9%) were tested for HCV, and 8,694 (9.8%) of individuals tested had reactive results. Of the 6,357 with HCV RNA testing, 4,092 (64.4%) had detectable RNA. Twelve percent of individuals with chronic HCV and evaluable data initiated treatment. Of those, 86% reached SVR. Having commercial insurance (aOR, 2.10, 95% CI, 1.45–3.02), older age (aOR, 1.07, 95% CI, 1.06–1.09) and being Hispanic/Latino (aOR, 1.35, 95% CI, 1.33–1.38) or Asian/Pacific Islander (aOR, 1.84, 95% CI, 1.79–1.90) were independently associated with higher odds of treatment initiation after multivariable adjustment. Only 8% of individuals with chronic HCV were tested for HIV, and 15% of individuals with identified OUD were tested for HCV.

Conclusion
During the opioid epidemic, fewer than 20% of individuals with identified OUD were tested for HCV at evaluated FQHCs. In addition, approximately 10% of patients initiated treatment and SVR was lower than expected. Expansion of HCV management into community clinics must consider measures to monitor and evaluate treatment effectiveness, and to improve outcomes if cure rates are low.

Disclosures
All authors: No reported disclosures.
317. Utility of a Hepatitis C Screening Best Practice Advisory in University-based Primary Care Practices
Authors: Donaghey Faith , Tuan Jessica , Agaraj Irini , Wakefield Dorothy , Chirch Lisa 
Published: October 2019

Abstract

Background
Hepatitis C virus infection (HCV) is a significant health concern in the United States, impacting an estimated 3 million people. Adults born between 1945 and 1965 (“baby boomers”) are 5 times more likely to have HCV infection compared with the general population. In 2012, the CDC recommended screening of adults born between 1945 and 1965. In April 2018 UConn Health transitioned from utilizing the Next Gen EHR system to Epic. At Epic launch, an HCV-screening Best Practice Advisory (BPA) was implemented, along with 13 other outpatient-based BPAs. This allowed for comparison of HCV screening rates before and after Epic launch.

Methods
Data were collected via retrospective chart review on adults born between 1945–1965 presenting to UConn primary care (PC) clinics one year prior to and 9 months post Epic launch. The BPA was set to fire for patients in the birth cohort who did not have an HCV antibody result or a history of hepatitis C in the medical record. Proportions were compared using chi-squared tests and Fisher’s Exact test.

Results
The HCV screening rate among PC providers 1-year pre-BPA was approximately 7.7%. Analysis of data nine months after BPA implementation demonstrated HCV screening rates were unchanged at 7.6%. Table 1 describes initial care cascade findings. During the post-launch monitoring period, a 0.2% [270/105,431] response rate was noted (as measured by follow-up actions taken from all BPAs, Table 2). During the same period, a significantly higher response rate to the HCV-screening BPA was noted (1.2% [287/24,532], P < 0.01) (Figure 1).

Conclusion
The aim of this study was to improve HCV case identification and to understand the utility of a BPA in this setting. Within the first nine months, the use of an HCV-screening BPA (Figure 2) in PC clinics did not increase screening rates in adults born between 1945 -1965. Alert fatigue may contribute to low screening rates post BPA, as evidenced by the low response rates across all BPAs introduced. Our long-term goal is to gather additional data to assess the efficacy of the HCV BPA and its effects on the HCV care cascade. Modifications to BPA functionality may be indicated.

Disclosures
All authors: No reported disclosures.