bluuebunny/crossref_metadata_2025_split huggingface dataset:
2318. Prevalence of Influenza-like Illness in Sheltered Homeless Populations: A Cross-Sectional Study in Seattle, WA
Authors: Rogers Julia H , Brandstetter Elisabeth , Wolf Caitlin , Logue Jennifer , Kim Ashley E , Newman Kira L , Sugg Nancy , Gerard April M , Weis Braia , Fay Noah , Newman Jennifer , Cathey Jeffery , Englund Janet A , Boeckh Michael , Chu Helen Y 
Published: October 2019

Abstract

Background
Individuals experiencing homelessness are at an increased risk of respiratory illness due to high prevalence of underlying chronic conditions, inadequate ventilation and crowding in shelters, and difficulty accessing health services. Few studies have investigated the prevalence and transmission of viral respiratory infections within shelters. We sought to determine the prevalence and risk factors for influenza-like illness (ILI) at two homeless shelters in Seattle, WA.

Methods
Between January and April 2019, we conducted a cross-sectional study of adults experiencing homelessness who identified their primary residence as one of the two shelters in Seattle. Participants voluntarily enrolled if they self-reported at least two symptoms of acute respiratory illness in the past week. Demographic, clinical, and behavioral data were ascertained via questionnaire, and a mid-nasal swab was collected. ILI was defined as fever with cough or sore throat. Chronic lung disease was defined as chronic obstructive pulmonary disease, asthma, and/or chronic bronchitis.

Results
Among the 480 participants enrolled in the study, 204 (42.5%) reported ILI symptoms. Of those enrolled, 144 (30.0%) had chronic lung disease. The prevalence of ILI was higher among individuals with chronic lung disease (53.5% vs. 42.5%, P = 0.001). A total of 422 (87.9%) had health insurance; the prevalence of ILI was lower among those with health insurance (42.4% vs. 57.8%, P = 0.66). 216 (45.0%) of participants received flu vaccine; the prevalence of ILI was similar among those who received the vaccine than those that did not (42.6% vs. 42.4%, P = 1.00). 129 (30.6%) of those with health insurance sought care for their reported symptoms; ILI was more prevalent in those that sought care than those that did not throughout the observation period (33.8% vs. 21.7%, P = 0.002). Of those with ILI that sought care, 46 (54.8%, P = 0.42) received antivirals or antibiotics. Laboratory results for the corresponding mid-nasal swabs are pending.

Conclusion
A large proportion of our study population self-reported ILI and chronic lung disease. Despite high insurance coverage, a low proportion of homeless enrolled sought care for their symptoms or received treatment.

Disclosures
All authors: No reported disclosures.
2323. Clinical Characteristics and Disease Burden of Epstein–Barr Virus and Four β-Herpes Viruses Infections in Children Visiting Emergency Room
Authors: Hattori Fumihiko , Kawamura Yoshiki , Miura Hiroki , Kozawa Kei , Ihira Masaru , Yoshikawa Tetsushi 
Published: October 2019

Abstract

Background
It is well known that most of infants and young children with primary EBV and CMV infection are inapparent, and primary HHV-6B and HHV-7 infection cause exanthema subitum (ES). However, the precise incidence of apparent infection of these viruses remains unclear. Therefore, we sought to elucidate clinical features and disease burdens of these viral infections in febrile children visiting emergency room (ER).

Methods
Between June 2015 and December 2017, febrile children under 5 years old, who visited ER and received hematological examination, were enrolled in this study. Detection of serum viral DNAs using real-time PCR and measurement of antibody titers in acute-phase serum were carried out. Clinical information was collected from the medical records.

Results
In total of the 905 cases, EBV, CMV, HHV-6B and HHV-7 were detected in 18 cases (2%), 12 cases (1.3%), 104 cases (11.5%) and 23 cases (2.5%), respectively. No HHV-6A DNA was detected. Primary infection rates among EBV, CMV, HHV-6B and HHV-7-infected patients accounted for 44%, 25%, 91% and 57%, respectively. Admission rates of the primary-infected patients were 88% of EBV, 68% of CMV, 66% of HHV-6B and 42% of HHV-7, respectively. Five of the 8 cases (62.5%) of primary EBV-infected patients demonstrated typical clinical course of infectious mononucleosis (IM); however, no IM patient was seen in 9 patients with viral reactivation. No IM case was observed in CMV-infected patients, regardless of primary infection or reactivation. Clinical characteristics were compared between patients with primary HHV-6B and HHV-7 infections because of similarity of clinical features. Average age (1.5 vs. 2.8 years old; P < 0.001), duration of fever (4.5 vs. 2.9 days; P < 0.001), the highest body temperature (40.2 vs. 39.6°C; P < 0.001), and the frequency of typical skin rash (ES) (87% vs. 54%; P < 0.001) were statistically different between the two viral infections. The main reason for admission due to primary HHV-6B and HHV-7 infection was complex-type febrile seizure (58.7 vs. 66.7%; P = 0.705).

Conclusion
The clinical features and disease burden of the 5 human herpesviruses infections were elucidated in the febrile children visiting ER.

Disclosures
All authors: No reported disclosures.
2335. Newborn Dried Blood Spot for Retrospective Diagnosis of Congenital Cytomegalovirus (CMV) Infection: It’s Time for Universal Screening!
Authors: Medoro Alexandra K , Shimamura Masako , Malhotra M D S , Findlen Ursula M , Hounam Gina , Hanlon Cory T , Kaptsan Irina , Adunka Oliver , J. Sanchez Pablo 
Published: October 2019

Abstract

Background
The diagnosis of congenital cytomegalovirus (cCMV) infection requires that CMV be detected in a body fluid before 3 weeks of age. After 3 weeks, a diagnosis of cCMV infection is difficult since one cannot differentiate between prenatal, natal, and postnatal CMV acquisition. Infants who refer on the newborn hearing screen often are diagnosed with hearing loss after 3 weeks of age. Our objective was to describe the use of the newborn dried blood spot (DBS) for detection of CMV DNA in infants who are evaluated for sensorineural hearing loss (SNHL).

Methods
Retrospective review of the electronic health records of infants who were referred to the Neonatal Infectious Disease (NEO-ID) Clinic at Nationwide Children’s Hospital, Columbus, OH since 2015 for evaluation of SNHL. Demographic, clinical, laboratory, and radiographic data were reviewed. With maternal informed consent, the newborn DBS was obtained from the Ohio Department of Health for detection of CMV DNA by polymerase chain reaction (PCR) testing as previously described (Boppana et al. JAMA, 2010).

Results
Eighteen infants (gestational age [mean ± SD], 38 ± 4 weeks; birth weight, 3,094 ± 705 g) with SNHL were referred by Otolaryngology for evaluation of possible cCMV infection; 17 (94%) had referred on the newborn hearing screen. The 18 infants were first tested for CMV at 151 ± 124 days of age (mean ±SD; range, 21–521 days), and 3 (17%) had a positive CMV DBS. Fourteen (78%) of the 18 infants had a positive serum CMV IgG antibody while 5 (63%) of 8 infants had CMV DNA detected in urine by PCR. Of the 3 infants with a positive CMV DBS, 2 were tested for CMV DNA PCR in urine and both were positive. Of the 3 infants, 1 had a negative serum CMV IgG antibody test at 174 days of age but the urine CMV PCR test was positive. In comparison, of 54 infants with cCMV infection confirmed by a positive urine CMV PCR in the first 3 weeks of age, 37 (68%) had a positive CMV DBS.

Conclusion
DBS testing for CMV DNA by PCR testing identified a small minority of infants with SNHL and thus confirming congenital infection. However, the overall sensitivity of CMV DBS testing in our cohort was 68%, suggesting that some infants with SNHL due to congenital CMV infection are missed.

Disclosures
All authors: No reported disclosures.
2356. Increased Clinical Specificity with Ultrasensitive Detection of Clostridioides difficile Toxins: Reduction of Overdiagnosis Compared with Nucleic Acid Amplification Tests
Authors: Sandlund Johanna , Estis Joel , Katzenbach Phoebe , Nolan Niamh , Hinson Kirstie , Herres Jennifer , Pero Troy , Peterson Gwyn , Schumaker Jeung-Mi , Stevig Craig , Warren Rhonda , West Tsubasa , Chow Siu-Kei 
Published: October 2019

Abstract

Background
Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections, resulting in significant morbidity, mortality, and economic burden. Diagnosis of CDI relies on the assessment of clinical presentation and laboratory tests. We have evaluated the clinical performance of ultrasensitive Single Molecule Counting technology for detection of C. difficile toxins A and B.

Methods
Stool specimens from 298 patients with suspected CDI were tested with nucleic acid amplification test (NAAT; BD MAX™ Cdiff assay or Xpert® C. difficile assay) and Singulex Clarity® C. difficile toxins A/B assay. Specimens with discordant results were tested with cell cytotoxicity neutralization assay (CCNA), and results were correlated with disease severity and outcome.

Results
There were 64 NAAT-positive and 234 NAAT-negative samples. Of the 32 NAAT+/Clarity− and 4 NAAT-/Clarity+ samples, there were 26 CCNA− and 4 CCNA- samples, respectively. CDI relapse or overall death was more common in NAAT+/toxin+ patients than in NAAT+/toxin− and NAAT−/toxin− patients, and NAAT+/toxin+ patients were 3.7 times more likely to experience relapse or death (Figure 1). The clinical specificity of Clarity and NAAT was 97.4% and 89.0%, respectively, and overdiagnosis was over three times more common in NAAT+/toxin− than in NAAT+/toxin+ patients (Figure 2). Negative percent agreement between NAAT and Clarity was 98.3%, and positive percent agreement increased from 50.0% to effective 84.2% and 94.1% after CCNA testing and clinical assessment.

Conclusion
The Clarity assay was superior to NAATs in diagnosis of CDI, by reducing overdiagnosis and thereby increasing clinical specificity, and presence of toxins was associated with disease severity and outcome.

Disclosures
All authors: No reported disclosures.
130. Clinical Presentation and Molecular Epidemiology Characterization of Invasive GBS Infection in Nara, Japan from 2007 to 2016
Authors: Hirai Nobuyasu , Kasahara Kei , Ogawa Yoshihiko , Suzuki Yuki , Hishiya Naokuni , Nakano Ryuichi , Yano Hisakazu , Yoshikawa Masahide , Mikasa Keiichi 
Published: October 2019

Abstract

Background
Streptococcus agalactiae (GBS), a leading cause of neonatal infections, also occurs as an invasive infection in elderly people. The aim of this study was to evaluate the clinical aspect of invasive infections and the phenotypic and genetic diversity of GBS isolates to develop better antibiotics treatment and curb the increasing rate of antibiotic resistance in Nara, Japan.

Methods
GBS strains sequentially collected from blood and cerebrospinal fluid cultures between 2007 and 2016 were identified and evaluated for capsular types, multilocus sequence typing (MLST), antibiotic susceptibility, resistant gene, and pulsed-field gel electrophoresis (PFGE). Clinical characteristics were retrospectively collected.

Results
A total of 42 GBS isolates (12 from children and 30 from adults) were collected. In adults, common underlying conditions were malignancy and diabetes, and primary bacteremia was the most common source of infection. In children, 6 were early-onset diseases, 4 were late-onset diseases, and 2 were school children. Overall, the mortality rate was 0% in children and 17% in adults. The serotypes and main clonal complex are summarized in Table 1. Minimum inhibitory concentrations of the antibiotics were also determined (Table 2). The serotypes and resistant genes are shown in Table 3. PFGE revealed serotypes V and VI belonging to ST1, and serotype III belonging to ST335 were highly identical.

Conclusion
In clinical aspects, neonates with early-onset diseases experienced certain disorders during the perinatal period. In adults, serotype Ib, which tends to exhibit levofloxacin resistance, was the most common, followed by serotypes V and VI belonging to ST1; however, they were not observed in children. Contrastingly, serotype III belonging to ST335, which tends to exhibit macrolide resistance, was mainly observed in children. Quinolone among adults and macrolide among the younger generation are widely used as oral antibiotics in Japan. A tendency to use antibiotics affects bacterial flora and induces selectivity of specific clones, thereby causing diseases in the local community. Continuous surveillance is warranted in local areas for appropriate antibiotics treatment and prevent increasing antibiotic-resistant isolates.

Disclosures
All authors: No reported disclosures.
131. Duration of Therapy for the Treatment of Gram-Negative Bloodstream Infections
Authors: Shulder Stephanie , O’Connell Matthew , Agedal Kaitlyn J , Conn Kelly M , Pillinger Kelly E 
Published: October 2019

Abstract

Background
While current guidelines suggest a total treatment duration of 7 to 14 days for gram-negative bloodstream infections (GN-BSI), there is mounting evidence to suggest that shorter durations may be sufficient. This study compared the treatment outcomes of patients who received short duration therapy (6–10 days) with those who received long durations (11–15 days).

Methods
This was a retrospective study of adult patients who grew an aerobic gram-negative organism from a blood culture while admitted at Strong Memorial Hospital between May 2016 and May 2018. The primary outcome was a composite of mortality and relapsed GN-BSI with the same organism within 90 days of index culture. Secondary outcomes included clinical resolution at end of therapy (EOT), length of stay (LOS), 30-day readmission rate, Clostridoides difficile infection (CDI), development of recurrent GN-BSI resistant to prior antibiotic therapy, and development of multi-drug-resistant (MDR) GN-BSI within 90 days. Appropriate therapy was defined as an antibiotic with confirmed in vitro susceptibility that was either parenteral or a highly bioavailable oral antibiotic (fluoroquinolones or sulfamethoxazole–trimethoprim).

Results
Of 600 patients screened, 116 were included in the long duration group and 34 patients in the short-duration group. The majority of patients had a urinary source of infection (59.3%). The primary composite outcome occurred in 11.8% of the short duration group compared with 10.3% in the long (P > 0.999). There was no difference in clinical resolution at EOT, LOS, or rates of CDI, MDR GN-BSI, recurrent GN-BSI resistant to prior therapy, or 30-day readmission. Patients in the long duration group were discharged with longer appropriate outpatient courses (8 days vs. 0.5 days, P < 0.001), which remained significant when including lower bioavailability agents (e.g., oral β lactams) (8 days vs. 5 days, P < 0.001).

Conclusion
There was no difference in clinical outcomes between the long and short duration therapy for treatment of GN-BSI. This study may support shorter treatment durations for uncomplicated GN-BSI, but should be interpreted cautiously given the smaller sample size.

Disclosures
All authors: No reported disclosures.
132. Epidemiology, Antimicrobial Resistance and Predictors of Typhoidal and Non-Typhoidal Salmonella Bacteremia in Victoria, Australia
Authors: Griffin David W J , Tramontana Adrian R , Jaksic Sasha , Wong Jenny S J 
Published: October 2019

Abstract

Background
Salmonella species are major contributors to the global burden of foodborne disease. While typhoidal salmonella (TS) is typically associated with travel in high-income settings, non-typhoidal salmonella (NTS) is more commonly associated with locally acquired diarrhoeal disease. We aimed to assess the epidemiology, antimicrobial resistance (AMR) patterns, and clinical markers of Salmonella bloodstream infections (BSI) in Victoria, Australia.

Methods
We conducted a retrospective audit of blood culture results over a 5.5-year period at a large, private pathology provider, in Victoria, Australia. All Salmonella isolates detected in blood between January 2013 and June 2018 were included. Epidemiological, microbiological, AMR and clinical data were extracted from the pathology record and collated for analysis.

Results
Of 27,546 positive blood cultures, 262 were positive for Salmonella spp. (rate 9.51 per 1,000 positive cultures) in 187 episodes. 113 (60%) were NTS (47.8% S. Typhimurium, 9.7% S. Enteritidis), while 74 (40%) were TS (59% S. Typhi, 41% S. Paratyphi). Patients with TS were younger (median age 29 vs. 65, P < 0.0001), more likely to have traveled [OR 125 (95% CI 28.47, 549], but fewer had a positive stool [OR 0.21 (95% CI 0.08–0.58)] than those with NTS. NTS was associated with a higher median CRP (149 vs. 83, P < 0.001) and more frequently associated with an abnormal white cell count (39% vs. 18%, P = 0.003). Quinolone non-susceptibility was stable with time, and occurred more frequently in TS than NTS (71 vs. 23%, P < 0.0001). Non-susceptibility to Azithromycin was also common in TS (42%), and increasing with time (P = 0.02). Non-susceptibility to ≥1 antibiotic occurred in 54 (73%) of TS, while 24 (32%) had non-susceptibility ≥2. Ceftriaxone resistance occurred infrequently in both NTS and TS (2 vs. 0%, P = 0.5).

Conclusion
Salmonella is an uncommon cause of BSI in our setting, with similar proportions of TS and NTS. Typhoidal isolates were more likely to be associated with travel, and antimicrobial resistance. Despite this, ceftriaxone remains a reliable option for first-line therapy for both TS and NTS. Quinolone resistance remains common, while Azithromycin resistance has increased with time in TS.

Disclosures
All authors: No reported disclosures.
2400. Are Multiple Clostridioides difficile Infections in Pediatric Oncology Patients Related to Recurrence of the Same Isolate or Re-infections with Different isolates?
Authors: Barbar Ruba , Hakim Hana , Hayden Randall , Hayden Randall , Garner Cherilyn D , Brazelton de Cardenas Jessica B , Carroll Karen C , Bourdas Dimitrios , Kimberly. Carroll Shawna 
Published: October 2019

Abstract

Background
Pediatric oncology and hematopoietic stem cell transplant patients (POTP) are at increased risk for Clostridioides difficile infection (CDI) and recurrence. It is unknown whether recurrent CDI is related to the same C. difficile strain as the initial CDI. We describe genomic relatedness of C. difficile strains in patients with multiple CDI using whole-genome sequencing (WGS).

Methods
This was a retrospective cohort study of CDI in POTP in 2016. CDI cases were identified by electronic medical record search for positive C. difficile toxin PCR tests. Patients with multiple CDI episodes were identified. CDI episodes were classified as incident, duplicate or recurrent using National Healthcare Safety Network (NHSN) definitions. Retrieved residual stool specimens were cultured anaerobically, toxin-producing C. difficile isolates were determined using a cell culture cytotoxicity assay with neutralization and WGS was performed followed by core genome MLST (cgMLST). Variability of the isolates was summarized by strain type (ST), and a minimum spanning tree was constructed, defining genomically related isolates as those with <7 allele difference.

Results
Eighteen patients had 51 positive C. difficile samples. CDI were classified as incident in 31 (61%) episodes, recurrent in 18 (36%), and duplicate in 2 (3%). Isolates from 47 (92%) samples were sequenced, identifying 14 different strain types (ST) in 41 (87%) isolates. Of the 31 incident CDI, 13 (42%) episodes occurred 8 weeks or more after the initial incident CDI. Among those 13 incident CDI, 7 (54%) had prior CDI due to a related isolate. Of the 18 recurrent CDIs, 10 (55%) were due to an isolate related to the previous incident CDI and 5 (28%) were due to an isolate unrelated to the incident CDI. The relatedness of the remaining 3 recurrent episodes could not be evaluated because no isolate was available for sequence analysis.

Conclusion
CDI classification of incident vs. recurrent infection using NHSN definition might be not applicable in POTP. WGS showed that more than half of CDI episodes classified as incident were actually a recurrence of a previous C. difficile strain. Similarly, some CDI episodes classified as recurrent were actually re-infection with a different stain.

Disclosures
Randall Hayden, MD, Abbott Molecular: Advisory Board; Quidel: Advisory Board; Roche Diagnostics: Advisory Board
2415. Oral Vancomycin for Secondary Prophylaxis of Clostridium difficile Infections among High-risk Patients
Authors: Lew Alison , Rao Krishna , Tribble Alison , Klein Kristin , Ateya Mohammad , Nagel Jerod 
Published: October 2019

Abstract

Background
Clostridium difficile infection (CDI) is associated with high rates of recurrence, and major risk factors for recurrence include prior CDI episode(s) and antibiotic exposure. Prior studies concluded a reduction in CDI recurrence using oral vancomycin for prophylaxis (ppx), but were limited by prescriber bias and inclusion of all hospitalized adult patients with prior CDI and receipt of systemic antibiotics. We sought to determine whether or not oral vancomycin prophylaxis reduced CDI recurrence in high-risk patients.

Methods
This retrospective cohort study included patients > 2 years of age who had at least 2 episodes of CDI within the last year prior to broad-spectrum antibiotic exposure. The ppx cohort included patients who received oral vancomycin for > 50% of the duration of broad-spectrum antibiotic therapy, and the no ppx cohort included patients who received no oral vancomycin while on broad-spectrum antibiotics. Cohorts were compared via a univariate analysis. A Kaplan–Meier analysis was used to evaluate the time-to-event for development of CDI.

Results
Of 108 patients who met inclusion criteria, 88 patients were included in the no ppx cohort and 20 patients in the ppx cohort. The primary outcome of CDI incidence was numerically lower in the ppx cohort [13 (14.8%) vs. 2 (10%), p = 0.733]. Secondary outcomes within 12 weeks of broad-spectrum antibiotic initiation were similar between cohorts. The mean time from broad-spectrum antibiotic initiation to CDI recurrence was longer among the ppx cohort, suggesting a delay in time to CDI recurrence (29 + 25.9 vs. 57.5 + 26.1 days, p = 0.171). This delay led to a lower incidence of hospital acquired (HA) CDI in the ppx cohort [4 (30.8%) vs. 0 (0%), P > 0.99]. The Kaplan–Meier analysis (Figure 1) demonstrated no significant difference in time-to-event of CDI, p = 0.70.

Conclusion
The use of oral vancomycin for secondary ppx of CDI was not shown to have a statistically significant difference in CDI recurrence compared with no ppx in this study. However, this may be due to the low sample size in the ppx cohort and low CDI event rates. The trend toward a delay in CDI recurrence and reduction in HA-CDI with the use of oral vancomycin is hypothesis generating. Further controlled studies are warranted to confirm the role of oral vancomycin for secondary ppx of CDI.

Disclosures
All authors: No reported disclosures.