bluuebunny/crossref_metadata_2025_split huggingface dataset:
2265. Clinical Outcomes with Single vs. Combination Antibiotic Therapy in the Treatment of Burkholderia cepacia complex Bacteremia and Pneumonia
Authors: George G Taylor A , Stevenson Kurt , Balada-Llasat Joan-Miquel , Coe Kelci E 
Published: October 2019

Abstract

Background
Burkholderia cepacia complex (Burkholderia cenocepacia and Burkholderia multivorans) (BCC) are uncommon, yet serious often drug-resistant pathogens of immunocompromised patients, especially in lung transplants; pre-operative infection/colonization is seen as a contraindication to transplant. Optimal treatment for these difficult infections is not known. We examined impact of single vs. combination therapy on patient outcomes.

Methods
All cases of BCC positive pulmonary or blood cultures at The Ohio State University Wexner Medical Center between January 1, 2012 and June 30, 2018 were analyzed. No cystic fibrosis patients were included. All combinations thereof were evaluated. The primary outcomes were 30 all-cause mortality and 30-day infection-related mortality. Secondary outcomes included sterilization of cultures, isolation of a non-susceptible isolate within 30 days of therapy, hospital and intensive care unit (ICU) length of stay, and adverse drug effects (ADE) of therapy including: hyperkalemia, acute kidney injury (AKI), transaminitis, and QTc prolongation.

Results
There were 90 unique patients who grew BCC (22 patients with 92 positive blood cultures; 54 patients with 87 positive pulmonary cultures). Four patients had mixed pulmonary and blood cultures. Ten patients died prior to having treatment for their cultures and were not evaluated. Overall, there were 85 evaluable infection events. Overall 30-day all-cause mortality was 20/85 (23.5%); mortality in blood culture monotherapy 3/14 (21.4%); combination therapy 3/18 (16.7%) (P = 1.00). Mortality in pulmonary culture monotherapy was 6/32 (18.75%); combination 10/30 (33.3%) (P = 0.19). Among blood cultures monotherapy was associated with 8 ADE while combination therapy was 11 (P = 0.82). In pulmonary patients, monotherapy had 16 ADE while combination had 23 (P = 0.03).

Conclusion
Overall mortality trends improved with combination therapy in blood culture patients and with monotherapy patients in pulmonary cultures. These findings are influenced by the limited number of patients available, and the medical co-morbidities of these patients. In lung patients there were significantly fewer ADE associated with monotherapy as opposed to combination therapy.

Disclosures
All authors: No reported disclosures.
2266. Management of Ertapenem-Resistant, Meropenem-Susceptible Enterobacteriaceae
Authors: Srinivas Pavithra , Wu Janet , Neuner Elizabeth A , Pallotta Andrea , Richter Sandra S , Tsigrelis Constantine 
Published: October 2019

Abstract

Background
Carbapenemases are the most frequent mechanism of carbapenem resistance in Enterobacteriaceae. However, alternative mechanisms such as loss of porin channels or up-regulation of efflux pumps can cause intermediate- to high-level resistance to ertapenem (ERTA) and possibly reduced susceptibilities to meropenem (MERO) leading to discordant phenotypic profiles. Clinical implications of discordant carbapenem susceptibilities and optimal therapy options are yet unknown. We sought to describe our experience with carbapenem-discordant Enterobacteriaceae (CDE).

Methods
Descriptive study of hospitalized adult patients with a CDE positive culture from December 1/16 - December 1/18. Discordance was defined as Enterobacteriaceae with an ERTA-resistant and MERO-susceptible phenotype. Primary objective was to describe antibiotic use patterns for CDE infections. Secondary outcomes included infectious diseases (ID) involvement and clinical outcomes. Clinical failure was defined as a composite of in-hospital mortality, switch of definitive therapy due to clinical worsening, re-hospitalization within 30 days for re-infection, or failure to achieve blood culture clearance for ≥7 days.

Results
A total of 55 patients with CDE were identified. Most common organisms were Enterobacter cloacae complex (72%) and Klebsiella pneumoniae (9%). Of 21 isolates tested, 1 (4.8%) was positive for a carbapenemase. Mean age of patients was 61 ± 16 years, 51% were admitted to a medicine service, and 18% were immunocompromised. ID was involved in 82% of CDE cases. Most common sites were urine (33%), wound/tissue (27%), and respiratory (18%). 43/55 (78%) patients were treated – 17/43 (40%) with MERO, 14/43 (33%) with fluoroquinolones. Ceftazidime/avibactam and tigecycline were used in 4 (9%) patients each. Combination therapy was used in 8 (19%) patients, most commonly with MERO or tigecycline. Clinical failure occurred in 21/43 (49%) patients – 8/43 (19%) were receiving MERO-based therapy, 13/43 (30%) were receiving a non-MERO-based therapy.

Conclusion
Discordance between ERTA and MERO susceptibility was more common in Enterobacter spp. Majority of isolates tested negative for a carbapenemase. MERO and fluoroquinolones were the most frequently used antibiotics for treatment of CDE infections.

Disclosures
All authors: No reported disclosures.
2267. Epidemiology of Candida auris Candidemia in a Teaching Hospital in North of Oman: One-Year Survival
Authors: Eatemadi Arash , Al Wahibi Aiman , Al shibli Hilal , Al reesi Ali 
Published: October 2019

Abstract

Background
Recent emergence of Candida auris as a multidrug resistant fungal pathogen, is a serious concerns for public health. However, there is a paucity of reported cases from Oman. Literature search resulted in finding only 7 cases from Oman, reporting C. auris infections in the articles first published in 2017. However, the rate of isolatin is increasing.

Methods
In this study, we included the results of all positive blood cultures of C. auris in Suhar teaching hospital from May 2018 (date of first detection) till end of April 2019. Further confirmation of the species was performed by MALDI-TOF and antibiotic susceptibility test (AST) by Vitek 2 in central public health laboratory (CPHL) of Oman.

Results
We detected 13 patients (9 females, 4 males). The mean age was 58.61% years (28–76 years). All candidemic patients had serious underlying conditions, including prolonged hospital stay or extensive and prolonged antimicrobial exposure or medical comorbidities (8 of 13). The time from hospital admission to onset of C. auris candidemia was 8–49 days, with a median of approximately 27 days. The most common isolated co- pathogen from blood culture was K. pneumonia (without regard to Coagulase-negative staphylococci). As average, every patient received 4.8 kind of different antibiotics in mean 88 doses before candidemia developed and piperacillin–tazobactam was the most common used antibiotics. AST was done just for 5 patients and revealed high-level resistance to fluconazole and Amphotricin B while, Echinocandins (anidulafungin, caspofungin) were fully sensitive and voricunazole had intermediate sensitivity. Mean duration of anti-fungal treatment was 12.5 days (5 – 26 days). 8 patients treated by Echinocandins (4/8 died), 4 by Fluconazole (3/4 died) and one without treatment discharged. 30-day all-cause mortality was 61.5%.

Conclusion
In Oman, C. auris has been reported from many hospitals. Resistance to several antifungal agents and persistence in the hospital environment make this organism a potential menace for the treating physician and the infection control personnel. In our hospital, every candidemic patient should be treated with Echinocandins and assumed to be resistant to Fluconazole until proven otherwise according to results of AST.

Disclosures
All authors: No reported disclosures.
2286. Evaluating the Impact of Ceftolozane/Tazobactam on Clinical Outcomes in Patients with Multi-Drug-resistant Pseudomonas aeruginosa Pneumonia
Authors: Mills Matthew , MacWhinnie Ashley , Do Timmy 
Published: October 2019

Abstract

Background
Ceftolozane/tazobactam is a novel cephalosporin and β-lactamase inhibitor antibiotic that has shown to have potent activity against Pseudomonas aeruginosa including strains exhibiting multi-drug resistance (MDR). The purpose of this study was to evaluate ceftolozane/tazobactam efficacy in MDR P. aeruginosa pneumonia compared with historical standard of care.

Methods
This was a retrospective cohort study of patients hospitalized across AdventHealth Central Florida campuses with MDR P. aeruginosa pneumonia from January 1, 2017 through December 31, 2018. This study included patients ≥ 18 years of age with a diagnosis of pneumonia and a positive respiratory culture with MDR P. aeruginosa. The primary outcome of this study was the rate of clinical cure by day 14 of definitive therapy. Secondary outcomes included 30-day readmission rate, average hospital length of stay (LOS), cost of admission, average ICU LOS after initiation of definitive antibiotic, and total days of antibiotic exposure for pneumonia. Data were analyzed with statistical computer software utilizing independent samples t-test and chi square tests of independence as appropriate.

Results
A total of 115 patients were included in the final analysis, 62 patients treated with ceftolozane/tazobactam and 53 patients treated with historical standard of care. Rate of clinical cure was similar between patients treated with ceftolozane/tazobactam, 72.6% (n = 45), and those treated with historical standard of care, 67.9% (n = 36), {X2 (1) = 0.297, p = 0.683}. Other outcomes assessed were also similar between groups except for average hospital length of stay (42.7 days vs. 30.3 days t(113) = 2.054, p = 0.042), and cost of admission ($78,550 vs. $47,681, t(113) = 2.458, p = 0.016), which were significantly greater in the ceftolozane/tazobactam treatment group.

Conclusion
In patients diagnosed with MDR P. aeruginosa pneumonia, clinical cure rates were not significantly different between those treated with ceftolozane/tazobactam compared with historical standard of care. Significantly greater hospital length of stay and cost of admission was associated with use of ceftolozane/tazobactam, although many patient factors may have influenced these results.

Disclosures
All authors: No reported disclosures.
2289. Bacterial Causes of Acute Bacterial Skin and Skin Structure Infections (ABSSSI) in Patients with Intravenous Drug Use (IVDU): Phase 3 REVIVE Studies
Authors: Huang David B , Noviello Stephanie S , Balser Barbara , Scaramucci Amy E , Desplats Eve , Corey G R 
Published: October 2019

Abstract

Background
Opioid addiction in the United States has reached epidemic proportions threatening public health. This analysis evaluates the baseline characteristics and bacterial causes of ABSSSI in patients who were IVDU from two parallel Phase 3 trials comparing the treatment of iclaprim with vancomycin.

Methods
A total of 621 patients who were IVDU from two parallel Phase 3, double-blind, randomized (1:1), active-controlled, multinational, multicenter trials (REVIVE-1 and REVIVE-2) were analyzed both separately and pooled. This post-hoc analysis summarizes the baseline bacterial causes of ABSSSI identified among IVDU. Per protocol, ABSSSI (major abscesses, cellulitis, or wound infections) were defined as having either the presence of purulent or seropurulent drainage before or after surgical intervention of the wound or at least 3 of the following signs and symptoms: discharge, erythema (extending at least 2 cm beyond the wound edge in any direction), swelling and/or induration, heat and/or localized warmth, and/or pain and/or tenderness to palpation. IVDU was defined based on subjected-reported medical history. At the baseline visit, ABSSSI were sampled for microbiological culture. Cultures were performed locally, and isolates were submitted to the central microbiology laboratory.

Results
Among IVDU with ABSSSI, average age was 44 years, 67.6% were male, average lesion size was 322 cm2, 10.8% had abnormal renal function (CrCl ≤ 90 mL/minute), and 3.9% had bacteremia. The bacterial causes of ABSSSI among IVDU are shown in the Table.

Conclusion
IVDU, a growing population, are vulnerable to ABSSSI. S. aureus, including MRSA, and S. anginosus group were the most commonly identified bacterial causes of ABSSSI in patients who are IVDU. Therefore, antibiotic selection should cover these bacteria among IVDU who present with an ABSSSI.

Disclosures
All authors: No reported disclosures.
2294. Comparative Evaluation of Ertapenem and Clindamycin Plus Gentamicin for the Treatment of Postpartum Endometritis
Authors: Schweiger Krislyn , Donaghy Henry , Meirowitz Natalie , Ahn Seunjun , Doan Thien-Ly 
Published: October 2019

Abstract

Background
Clindamycin plus gentamicin (C/G) is the most commonly used regimen for the treatment of postpartum endometritis. With a similar spectrum of coverage and once daily dosing, ertapenem is an attractive alternative. The purpose of this study was to evaluate the efficacy of ertapenem compared with C/G, for the treatment of postpartum endometritis.

Methods
This was a retrospective chart review (IRB-approved) of patients treated with either ertapenem or C/G for endometritis, from July 2017 to July 2018. Patients receiving agents from both groups were excluded. Data collected included: demographics, ante- and intrapartum course, including efficacy parameters and antimicrobial use. Secondary objectives included a safety outcomes and patient quality analysis. Appropriate statistical analysis was performed.

Results
A total of 81 patients were included (40 in C/G arm, 41 in ertapenem arm). No differences in mean length of stay (5.98 vs. 5.61 days in C/G and ertapenem, P = 0.61), readmission within 14 days, or mortality were seen. No patients developed acute kidney injury, C. difficile infection, or ototoxicity. All patients in the ertapenem arm had appropriate dosing, compared with 27.5% in C/G arm (P < 0.0001). Inappropriate dosing in 79% of C/G group was attributed to under-dosing of gentamicin. For quality measures, patients in C/G arm had more nighttime interruptions (3 vs. 1 interruptions per patient). 46% of patient in the ertapenem group had no overnight interruptions compared with 0% in C/G group. There were 2 suspected wound infections in the C/G group, but none in ertapenem group.

Conclusion
No difference in efficacy was seen between ertapenem and C/G for treatment of postpartum endometritis Ertapenem was associated with less inappropriate dosing and fewer nighttime interruptions Improvement in patient experience and reduction of nursing workload may outweigh the small additional cost of ertapenem.

Disclosures
All authors: No reported disclosures.
2306. Impact of Cytomegalovirus Disease on New-Onset Dementia: Population-Based-Matched Case–Control Cohort Study
Authors: Hwa Lee Kyoung , Eun Kwon Da , Do Han Kyung , Hoon Han Sang , Goo Song Young 
Published: October 2019

Abstract

Background
The association of human cytomegalovirus (CMV) with dementia is still controversial. Previous studies suggested that serostatus of latent CMV infection assessed by serum CMV IgG could play a role in development of neurodegeneration with cognitive impairment. This study is aimed to evaluate the relation of CMV tissue invasive diseases to vascular dementia and Alzheimer’s dementia.

Methods
The ICD-10 codes from the National Health Insurance Database covering 50 million people were used to collect the patient group (n = 687) aged ≥ 40 years with CMV tissue invasive end-organ diseases and control group (n = 3,435) matched by non-CMV infection, age and sex with 1:5 ratio. The subjects were retrieved for enrolled patients during 2010–2014 with wash-out period for 6 years, and followed until December 2016.

Results
Multivariate regression model adjusted by age and sex showed a significantly higher incidence rate of dementia (odds ratio [OR], 2.10 and 95% confidence intervals [CI], 1.45–3.05) in patients with CMV disease. According to the type of dementia, the risk of vascular dementia in patient group (OR, 3.31 and 95% CI, 1.30–8.41) was higher than Alzheimer’s dementia (OR, 1.74 and 95% CI, 1.09–2.78). In the age subgroup analysis adjusted by sex, patients aged 40–59 years with CMV disease had a higher risk of dementia than those aged ≥ 60 years (OR, 12.3 [95% CI, 3.2–47.6] vs. 1.8 [95% CI, 1.2–2.7], P = 0.010).

Conclusion
CMV disease independently increased the risk of vascular dementia as well as Alzheimer’s dementia.

Disclosures
All authors: No reported disclosures.
2309. Could Mean Platelet Volume Predict Platelet Count Recovery in Dengue Virus Infection?
Authors: Sanz Ana M , Martinez Diana M , Valencia Andrea , Flórez Liliana , Tovar Diego , Parra-Lara Luis Gabriel , Rosso Fernando 
Published: October 2019

Abstract

Background
Dengue fever, a major public health problem throughout tropical and subtropical regions, has often unpredictable clinical evolution and outcomes. Thrombocytopenia is a common laboratory finding in dengue fever and severe dengue during the dengue critical phase. To the best of our knowledge, there is no clinical data about patient and disease factors that could predict in a short time the platelet recovery. Mean platelet volume (MPV), a measurement of platelet size, has a strong inverse correlation with platelet count and could indirectly reflect bone marrow activity. The aim of this study was to describe the behavior of MPV during the platelet count nadir and recovery.

Methods
An observational prospective study was conducted. We included patients with confirmed dengue virus infection with SD BIOLINE Dengue Duo kit (Abbott, Santa Clara, USA; former Alere Inc., Waltham, USA) attended at Fundación Valle del Lili, Cali - Colombia. Blood count was analyzed by xn-3000 system impedance method (Sysmex, Kobe, Japan). Laboratory and clinical data were recollected from clinical charts and clinical laboratory database. Platelet count (PC) and MPV were measured repeatedly during clinical management. Time was measured from the first blood count. A non-parametric analysis with a cubic smoothing spline was performed for platelet count and MPV.

Results
A total of 54 patients were analyzed from April 2016 to January 2016. 50% of patients had at least three blood counts. The median of the lowest PC was 112,500/L (IQR = 67,000–148,500), and the median of the highest MPV was 11. 25 fL (IQR = 10. 42–12. 15). MPV increased from the first blood count until day six, while platelets presented slight fluctuations. On the sixth day after first blood count, MPV presented a high peak that suggests an inverse relationship with a platelets decrease (Figure 1).

Conclusion
MPV increased with thrombocytopenia during the critical period and its decline precedes platelet count recovery. MPV could be useful to predict the platelet count recovery.

Disclosures
All authors: No reported disclosures.
2311. Bacteremia Is Not Commonly Detected in Ebola Virus Disease
Authors: Matson Matthew J , Massaquoi Moses , Sprecher Armand , Giuliani Ruggero , Edwards Jeffrey K , Dekker John P , Ricotta Emily , Feldmann Friederike , Feldmann Heinz , Munster Vincent J , Chertow Daniel S 
Published: October 2019

Abstract

Background
Rates of bacteremia in Ebola virus disease (EVD) are not currently known. Given the potential for secondary bacterial infection during acute EVD, current treatment guidelines recommend empiric use of broad-spectrum antibiotics. We sought to determine rates of bacteremia among patients evaluated for EVD at the ELWA-3 Ebola Treatment Unit in Monrovia, Liberia during the 2013–16 West Africa epidemic.

Methods
Deidentified blood samples and matched clinical data from 235 Ebola virus (EBOV)-positive patients and 102 EBOV-negative patients were evaluated under a University of Liberia Pacific Institute for Research and Evaluation IRB-approved protocol. 0.2 mL aliquots of frozen whole blood samples collected at triage, prior to the administration of antibiotics, were inoculated into BD BACTEC Peds Plus bottles and incubated under aerobic conditions in a BD BACTEC FX40 for 5 days in the National Institute of Allergy and Infectious Disease Biosafety Level 4 laboratory in Hamilton, MT. Positive samples were sub-cultured on nonselective sheep blood agar and chocolate agar and pure colonies were selected for identification by 16S sequencing and by matrix assisted laser desorption ionization time-of-flight mass spectrometry.

Results
No difference in rates of bacteremia was detected among EBOV-positive vs. EBOV-negative patients – 3.8% and 3.9%, respectively. Predominant isolates included Staphylococcus epidermidis and other coagulase-negative staphylococci, thought consistent with contaminants. Pathogenic species included Staphylococcus aureus and possibly Paenibacillus spp.

Conclusion
These data suggest that bacteremia does not commonly complicate EVD. However, as both prolonged sample storage and low culture volume may negatively affect sensitivity, additional molecular analyses are needed to support this conclusion.
The Intramural Research Program of the National Institutes of Health supported this work.

Disclosures
All authors: No reported disclosures.
2312. Mortality of Severe Dengue Patients Admitted to Intensive Care Units over 15 Years: Have We Improved?
Authors: Rosso Fernando , Parra-Lara Luis Gabriel , Sanz Ana M , Ospina-Tascon Gustavo A , Granados Marcela 
Published: October 2019

Abstract

Background
Dengue mortality can be preventable in endemic regions. However, access to intensive care units (ICU) and continuous monitoring strategies are limited in developing countries. In 2010, WHO dengue clinical practice guidelines (CPG) were implemented in the Americas region which strengthened hospital healthcare management and prioritized early ICU admission in severe dengue cases. We hypothesized that early access to the ICU might decrease the mortality of patients with dengue. This study aimed to describe trends in dengue cases and mortality in the ICU for 15 years in Cali, Colombia.

Methods
An observational retrospective study about dengue cases treated in adult ICU was conducted, in the Fundación Valle del Lili. We included cases between 2001 to 2015 years. Clinical data were collected from the ICU database and medical charts. A Cochran-Armitage test for trend was used to assess the presence of an association between fatal cases and total cases in dengue patients at ICU during the study period, and to evaluate differences in the mortality cases before and after the implementation of the dengue CPG.

Results
A total of 49,962 episodes of attention in ICU were analyzed, and 70 cases with severe dengue and dengue shock attended in ICU were included. The median age was 42 years (IQR = 24–60), eight cases were older than 65 years, and 54% were male. Five fatal cases were reported during this period. The fatal cases had a length of stay in ICU of 2 days (IQR = 1–4) vs. 2 days (IQR = 1–3) for nonfatal cases. Overall mortality for dengue cases in the ICU was 7.14%. The highest mortality was presented in 2007 with 33.33% (1/3), and after 2010 there were no fatal cases. Dengue mortality showed a decreasing linear variation over time in the ICU (p = 0.047); also there was a statistically significant difference over time in adults mortality before and after of implementation of dengue CPG (P = 0.029).

Conclusion
Dengue mortality cases in the ICU have decreased in the last 15 years, which is related to early admission to the ICU and continuous clinical monitoring.

Disclosures
All authors: No reported disclosures.