bluuebunny/crossref_metadata_2025_split huggingface dataset:
853. Epidemiology of Groups A, C, and G β-Hemolytic Streptococcal Pharyngitis
Authors: Lim James Ray Mata , Boyanton Bobby L , George Julie , Sims Matthew 
Published: October 2019

Abstract

Background
Treatment of Group A Streptococcus (GAS) pharyngitis is imperative to mitigate sequelae such as rheumatic heart disease. The need for treatment of Group C Streptococcus (GCS) and Group G Streptococcus (GGS) pharyngitis is unclear, as rheumatogenic sequelae have not been well documented. Our institution switched from culture to molecular confirmation testing for a negative rapid streptococcal antigen detection test. Cultures reported GAS whereas molecular testing reported GAS, GCS, and GGS. We performed a retrospective chart review to examine the epidemiological differences of GAS, GCS, and GGS pharyngitis.

Methods
Records were obtained of pharyngeal samples from patients sent for testing at Beaumont Health Laboratory. In all, 92,369 records were analyzed. There were 47,106 records of cultures from May 2012 through December 2014 and 45,263 records of molecular testing from May 2015 to December 2017. Samples positive for either GCS or GGS were reported as positive for Group CG Streptococcus (GCGS). Epidemiological factors were evaluated. If available, electronic records from GCGS positive samples were evaluated for clinical features, antibiotics used, and sequelae or complications reported.

Results
Molecular testing showed GAS positivity of 9.3% (n = 4,189) and GCGS positivity of 1.5% (n = 687). GCGS pharyngitis was more likely during the summer months and in young adults 13 years and older than children under 13 years. GAS pharyngitis was more likely during spring months and in children aged 4–9 years. Mean age of GCGS pharyngitis was 13 vs. 8.6 years for GAS pharyngitis. Similar results were obtained for GAS between culture and molecular testing records. Amoxicillin was most often prescribed for treatment of GCGS. There were few instances of severe GCGS exudative or recurrent pharyngitis that required hospitalization or tonsillectomy. There were no cases of rheumatic fever or rheumatic heart disease associated with GCGS.

Conclusion
This is the largest study based on our literature review to evaluate the epidemiology of GAS, GCS, and GGS pharyngitis in children and adults. We found a seasonal and age difference between GAS and GCGS. Complications were rare, and no rheumatogenic sequelae were noted from GCGS infections.

Disclosures
All Authors: No reported Disclosures.
854. Impact of Antimicrobial Stewardship and Rapid Diagnostics in Children with Staphylococcus aureus Bacteremia
Authors: Welch Stephanie N , Patel Rupal , Morris Lee , Dassner Aimee , Rozario Nigel L , Forrester Jeanne 
Published: October 2019

Abstract

Background
Rapid diagnostic testing (RDT) in combination with antimicrobial stewardship programs (ASPs) has been associated with improved outcomes in adults with Staphylococcus aureus bacteremia (SAB). Data in children are lacking. In January 2017, Atrium Health implemented a pediatric ASP with blood culture RDT. The objective of this study was to determine the impact of those interventions.

Methods
This was a retrospective, multicenter, quasi-experimental study of children ≤18 years with monomicrobial SAB from March 2015 to August 2016 (pre-intervention; PRE) and March 2017 to August 2018 (post-intervention; POST). The primary outcome was time to an optimal antibiotic. Secondary outcomes included time to effective antibiotic, total antibiotic exposure in the first 5 days, duration of bacteremia, infectious diseases (ID) consultation, time to central line removal, hospital and pediatric ICU length of stay (LOS), need for vasopressors or intubation, recurrence of SAB within 90 days, and inpatient mortality.

Results
Of 101 patients with SAB, 32 and 36 met inclusion criteria for the PRE and POST groups, respectively. The median time to optimal antimicrobial therapy decreased by 23 hours (PRE 44.3 hours vs. POST 21.3 hours; P = 0.008). Duration of bacteremia (65h vs. 40.9 hours; P = 0.028) and mortality (12.5% vs. 0%; P = 0.044) was also significantly reduced. Differences in median time to effective therapy (7 hours vs. 5.1 hours; P = 0.74), total antibiotic exposure in the first 5 days (160.4 hours vs. 152 hours; P = 0.4), hospital LOS (9.9 vs. 8.5 days; P = 0.25), and pediatric ICU LOS (7 vs. 4 days; P = 0.11) did not meet statistical significance, but trended downward. The POST group had more patients with ID consultation (78% vs. 89%, P = 0.23) and shorter time to central line removal (68 hours vs. 20 hours; P = 0.037). There was no difference in the need for vasopressors (3 vs. 3 patients; P = 0.99) or intubation (2 vs. 4 patients; P = 0.68). Throughout the study period, recurrence of SAB only occurred in one patient (PRE).

Conclusion
Concurrent implementation of RDT and an ASP in pediatric patients with SAB decreased time to optimal antimicrobial therapy, duration of bacteremia, and mortality. RDT coupled with timely feedback from an ASP contributed to improved SAB management and clinical outcomes in children.

Disclosures
All Authors: No reported Disclosures.
898. Influenza Vaccination Reduces Risk of Severe Outcomes among Adults Hospitalized with Influenza A(H1N1)pdm09, FluSurv-NET, 2013–2018
Authors: Garg Shikha , Beacham Lauren , Arriola Carmen S , O’Halloran Alissa , Cummings Charisse N , Reingold Art , Alden Nisha B , Yousey-Hindes Kim , Anderson Evan J , Monroe Maya , Kim Sue , Lynfield Ruth , Irizarry Lourdes , Muse Alison , Bennett Nancy M , Billing Laurie M , Thomas Ann , Talbot Keipp , McCaffrey Keegan , Fry Alicia M , Reed Carrie 
Published: October 2019

Abstract

Background
Influenza vaccination may reduce illness severity among those with influenza; however, data are limited. We determined whether outcomes were less severe among vaccinated compared with unvaccinated adults hospitalized with influenza over 5 seasons.

Methods
We included adults (≥18 years) hospitalized with laboratory-confirmed influenza during seasons 2013–2014 through 2017–2018 and identified through the US Influenza Hospitalization Surveillance Network (FluSurv-NET). Vaccination status was obtained through medical records, vaccine registries, and interviews. We excluded patients who were institutionalized, did not receive antivirals, or had unknown vaccine status or vaccine receipt <14 days before positive influenza test. We used inverse propensity score weighting to balance differences between vaccinated and unvaccinated groups and multivariable logistic and competing risk regression to evaluate the association between vaccination and outcomes including pneumonia, intensive care unit (ICU) admission, mechanical ventilation (MV), death, and ICU and hospital length of stay (LOS) in days. Models were adjusted for season and admission timing in relation to timing of antiviral treatment, symptom onset and season peak.

Results
Among 67,452 adults hospitalized with influenza, 43,608 were included; 47% were 18–64 years (38% vaccinated) and 53% were ≥65 years (65% vaccinated). Among patients with influenza A(H1N1)pdm09, vaccination was associated with decreased odds of ICU admission (odds ratio (OR) 0.81; OR 0.72) and MV (OR 0.66; OR 0.54) in adults 18–64 and ≥65 years, respectively; decreased odds of pneumonia (OR 0.83), death (OR 0.64) and shortened ICU LOS (relative hazard (RH) 0.82) in adults 18–64 years; and shortened hospital LOS (RH 0.91) in adults ≥65 years (figure). Vaccination was not associated with attenuation of severe outcomes in patients with influenza A(H3N2) and B.

Conclusion
Vaccination was associated with reduced odds of severe outcomes, including death, by up to 36% in adults hospitalized with influenza A(H1N1)pdm09. All adults without contraindications should receive annual influenza vaccination as there is evidence that it can improve outcomes among those who develop influenza despite vaccination.

Disclosures
All Authors: No reported Disclosures.
965. The Efficacy of Oral Β-lactam Antibiotics as Step-down Therapy for Acute Pyelonephritis
Authors: Hobbs Athena L V , Hemmige Vagish , Jaso Theresa , Lutat Katie , Shea Katherine M 
Published: October 2019

Abstract

Background
Often, oral β-lactams have been avoided for the treatment of pyelonephritis due to data suggesting lower efficacy vs. currently recommended therapy. However, increasing resistance and concerns for collateral damage of primarily recommended oral agents have increased interest in the use of oral β-lactams for the treatment of pyelonephritis. Authors sought to assess the impact of oral step-down β-lactam therapy compared with an alternative oral agent (fluoroquinolone or trimethoprim-sulfamethoxazole) in patients with acute pyelonephritis requiring hospitalization.

Methods
This is an IRB-approved, multicenter, retrospective study of hospitalized patients with acute pyelonephritis in six hospitals within two healthcare systems who received an IV cephalosporin followed by step-down therapy with either a β-lactam or an alternative agent (i.e., fluoroquinolone or trimethoprim-sulfamethoxazole). We theorize that oral β-lactams are noninferior to alternative oral agents for step-down therapy for pyelonephritis requiring hospitalization. Treatment success was defined as lack of 30-day urinary system-related re-admission. We calculated that 89 patients were required in each group to achieve 80% power with a noninferiority margin of 15% and assuming a cure rate of 85% as reported in previous literature.

Results
A total of 188 patients were included in the study; 115 and 73 who received an oral β-lactam and an alternative oral agent, respectively. There was no difference in treatment success when comparing the two groups (113 [98%] vs. 70 [96%]; P = 0.38). The mean length of hospital stay, number of patients treated with ceftriaxone inpatient, and the duration of IV therapy was the same in both groups, though mean duration of oral therapy was longer in the oral alternative group compared with the oral β-lactam group (9.5 [+ 3.7] vs. 8.2 [+ 2.7] days, respectively; P = 0.02). Baseline characteristics other than mean age were the same, as reported in Table 1.

Conclusion
When using 30-day urinary system-related readmission as a surrogate for treatment success, we found no difference between β-lactams vs. alternative agents for oral step down therapy for pyelonephritis requiring hospitalization.

Disclosures
All Authors: No reported Disclosures.
980. Effects of Integrase Strand-Transfer Inhibitor Use on Lipids, Glycemic Control, and Insulin Resistance in the Women’s Interagency HIV Study (WIHS)
Authors: Aldredge Amalia , Lahiri Cecile D , Summers Nathan A , Mehta C Christina , Angert Christine D , Kerchberger Anne Marie , Weiser Sheri , Konkle-Parker Deborah , Sharma Anjali , Adimora Adaora A , Bolivar Hector , French Audrey L , Golub Elizabeth T , Kassaye Seble , Gustafson Deborah , Ofotokun Igho , Sheth Anandi N 
Published: October 2019

Abstract

Background
Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended first-line HIV treatment. We recently demonstrated increased weight gain associated with INSTI use among women living with HIV (WLH) enrolled in the Women’s Interagency HIV Study (WIHS), raising concern for cardiometabolic consequences. We, therefore, evaluated the effects of INSTI use on lipids, insulin resistance, and glycemic control in WLH.

Methods
Data from 2008 to 2017 were analyzed from WLH enrolled in WIHS. Women who switched to or added an INSTI to ART (SWAD group) were compared with women who remained on non-INSTI ART (STAY group). Outcomes included changes in fasting total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and glucose; hemoglobin A1c; and incident insulin resistance (defined as homeostatic model assessment of insulin resistance [HOMA] score ≥2). Outcomes were measured 6–12 months before and 6–18 months after INSTI switch/add in the SWAD group with comparable time points in the STAY group. Linear regression models compared change over time in each outcome by SWAD/STAY group, adjusted for age, race, WIHS site, income, smoking status, statin use, and ART regimen at baseline.

Results
In total, 881 WIHS participants (182 SWAD and 699 STAY) were followed for a mean 1.8 (±1.1) years. Mean age was 49 (±8.8) years, BMI was 31 (±8.2) kg/m2, and 49% were Black. At baseline, SWAD vs. STAY was more likely to report NNRTI (vs. PI)-based ART and statin use (both P < 0.0001), but all baseline lipid and glucose variables were similar. Compared with STAY, the SWAD group experienced significantly greater decreases in HDL (−2.4 vs. +0.09 mg/dL, P = 0.03) and trended toward greater decreases in TC (−2.6 vs. −2.4 mg/dL, P = 0.07) at follow-up, without significant differences in TG or LDL. The SWAD group had significantly greater increases in A1c (+0.08% vs. −0.05%, P = 0.01) but trended toward lower incidence of insulin resistance (19% vs. 32%, P = 0.05).

Conclusion
Despite reported increases in weight, INSTI use was associated with only modest changes in lipid measurements and glycemic control during short-term follow-up of WLH compared with non-INSTI ART. Research is needed to elucidate long-term cardiometabolic effects.

Disclosures
Anandi N. Sheth, MD, MS, Gilead Sciences, Inc.: Research Grant.
1889. Clinical Features Distinguishing Enterovirus A71 and Enterovirus D68-Associated Acute Flaccid Myelitis in Colorado, 2013–2018
Authors: Messacar Kevin , Messacar Kevin , Spence-Davizon Emily , Osborne Christina , Press Craig , Schreiner Teri , Martin Jan , Messer Ricka , Maloney John , Burakoff Alexis , Barnes Meghan , Abzug Mark , Tyler Ken , Dominguez Samuel 
Published: October 2019

Abstract

Background
Several enteroviruses (EVs), including EV-A71 and EV-D68, have been associated with acute flaccid myelitis (AFM). Clinical features distinguishing AFM presentations associated with specific EV types are not well described.

Methods
EV-associated AFM was defined as any child presenting to Children’s Hospital Colorado in 2013–2018 who met the Council of State and Territorial Epidemiologists definition for confirmed AFM (flaccid limb weakness with longitudinal gray-matter-predominant spinal cord lesion on MRI) and had EV-A71 or EV-D68 identified in any biologic specimen (cerebrospinal fluid [CSF], nasopharyngeal [NP], oropharyngeal [OP], rectal) by VP1-specific RT-PCR and sequencing. Summative limb strength scores (SLSS) were calculated by adding Medical Research Council strength scores (1–5) for all limbs.

Results
Ten cases of EV-A71-associated AFM were identified, all from 2018; 8 cases of EV-D68-associated AFM were identified from 2013 (1), 2014 (4), 2016 (1), and 2018 (2) [Table 1]. Viral detection rates were higher in rectal and OP swabs in EV-A71 cases and NP specimens in EV-D68 cases. Virus was not detected in CSF of EV-D68 cases and in 1 EV-A71 case. EV-A71 cases were younger (median 19 vs. 100 months) and had neurologic onset earlier after prodromal symptom onset (median 1 vs. 5.5 days) than EV-D68 cases. Hand, foot, and/or mouth lesions distinguished EV-A71 cases, whereas respiratory symptoms were uniformly noted in EV-D68 cases. Associated neurologic findings more commonly associated with EV-A71 cases than EV-D68 cases included irritability, myoclonus, and ataxia. Weakness was more generalized with EV-A71 and more asymmetric with EV-D68, though patterns of brainstem and spinal cord involvement on MRI were similar. Compared with EV-D68, EV-A71 cases had milder weakness at onset and improved strength at 1- to 2-month follow-up (Figure 1), shorter length of stay (median 5.5 vs. 32 days) and a greater rate of full neurologic recovery (90% vs. 13%).

Conclusion
EV-D68 and EV-A71 are both associated with AFM with similar MRI findings, but cases can be distinguished by associated prodromal symptoms, neurologic findings, and outcomes. Timely collection and testing of nonsterile site specimens, particularly NP for EV-D68 and OP and rectal for EV-A71, are key to case identification.

Disclosures
All Authors: No reported Disclosures.
2849. Gut Microbiota Differences at the Time of Medical Intensive Care Unit (MICU) Admission Are Associated with Acquisition of Multi-drug-Resistant Organisms (MDROs) Among Patients Not Already Colonized with an MDRO
Authors: Bassis Christine , Seekatz Anna , Dangana Thelma E , Shimasaki Teppei , Yelin Rachel D , Schoeny Michael , Rhee Yoona , Ariston Michelle , Lolans Karen , Cornejo Cisneros Enrique , Aboushaala Khaled , Thabit Lina , Murray John , Sheng Jianrong , Ollison Stefanie , Bell Pamela B , Fogg Louis , Weinstein Robert A , Lin Michael Y , Young Vincent B , Hayden Mary K 
Published: October 2019

Abstract

Background
Among hospitalized patients, underlying variation in gut microbiota may confer differential risk for gut MDRO acquisition.

Methods
Rectal swab samples were collected from patients ≤2 days of MICU admission and then daily in the 27-bed MICU of an acute care hospital in Chicago, IL over 1 year. Patients were screened for MDRO colonization by selective culture (see Figure 1 for MDRO types); those with ≥2 swabs and MICU stays ≥3 days were studied. Bacterial 16S rRNA gene amplicon sequences were used for microbiota analysis. Medical records were reviewed.

Results
In preliminary analysis, 2,480 samples were collected from 627 patients who acquired 170 MDROs (Figure 1). Debilitation, co-morbidities, and certain medical devices were associated with MDRO acquisition, though admission MDRO status was not (table). While no interactions were detected between admission MDRO status and clinical predictors of MDRO acquisition, there were significant differences in gut microbiota composition at the time of MICU admission between patients colonized with an MDRO on admission and those not colonized (P < 0.001, using analysis of molecular variance (AMOVA) on distances). Therefore, we stratified our analysis by admission MDRO colonization status. For patients MDRO-colonized at admission, there were no significant differences in microbiota of patients who later did or did not acquire a new MDRO (AMOVA P-value = 0.32). For patients not MDRO-colonized on admission, there was a significant difference in microbiota of patients who later acquired an MDRO and those who did not (AMOVA P-value: 0.026). Differentially abundant operational taxonomic units (OTUs, based on 3% sequence difference) included OTUs classified as Anaerococcus and as other Clostridiales (higher in patients who remained uncolonized) and as Enterococcus (higher in patients who acquired an MDRO) (Figure 2). Diversity was also higher in patients who remained uncolonized (Wilcoxon test P-value: 0.035) (Figure 3).

Conclusion
Among patients not already colonized with an MDRO on admission, we identified gut microbiota differences associated with MDRO acquisition that could help explain patient-level variation in MDRO colonization resistance.

Disclosures
All Authors: No reported Disclosures.
2853. Innate Immune Response in Serum and Cerebrospinal Fluid of Neonates and Infants Infected with Parechovirus-A3 and Enteroviruses
Authors: Habuka Rie , Aizawa Yuta , Izumita Ryohei , Domon Hisanori , Terao Yutaka , Saitoh Akihiko 
Published: October 2019

Abstract

Background
Parechovirus-A3 (PeV-A3) and enteroviruses (EVs) are the most common viral causes of neonatal and infantile sepsis. We previously reported that the clinical manifestations of PeV-A3 infection—e.g., high body temperature, tachycardia, and poor peripheral circulation, but not cerebrospinal fluid (CSF) pleocytosis—tend be more severe than those of EV infection. We tested the hypothesis that innate immune responses to PeV-A3 and EVs are distinct.

Methods
Using serum and CSF samples, we investigated immune responses of febrile neonates and infants <4 months in Niigata, Japan, from 2015 through 2018. PeV-A and EV infections were diagnosed with real-time PCR. PeV-A3 infection was diagnosed by sequence analysis of the VP1 region. The control was clinically well patients without serum and CSF findings suggestive of bacterial or viral etiology. The Milliplex MAP human cytokine/chemokine magnetic bead panel (Merck Millipore, Germany) was used to analyze 22 cytokines/chemokines related to innate immunity in serum and CSF.

Results
We evaluated 14 PeV-A3-infected and 15 EV-infected patients and 8 controls. Serum levels of proinflammatory cytokines/chemokines (fractalkine, interferon-α2, interleukin [IL]-1 receptor α, IL-6, IL-8, and IL-15) were significantly higher in PeV-A3-infected patients than in EV-infected patients (P < 0.005). Serum cytokine/chemokine profiles of EV-infected patients did not differ from those of controls. However, while most pro- and anti-inflammatory cytokines/chemokines in CSF were elevated in EV-infected patients, levels were low or undetectable in PeV-A3-infected patients and controls (P < 0.005).

Conclusion
PeV-A3-infected patients had high serum levels of proinflammatory cytokines/chemokines, which may explain why clinical manifestations were more severe in this patient group than in EV-infected patients. Conversely, the limited or nonexistent innate immune response in CSF from PeV-A3-infected patients might explain the absence of CSF pleocytosis. These findings improve our understanding of the differing pathophysiological characteristics of PeV-A3 and EV infection in neonates and young infants.

Disclosures
All Authors: No reported Disclosures.
2900. High Rates of Experienced and Witnessed Opioid Overdose in PWID Receiving HCV Treatment: Data From the ANCHOR Study
Authors: Rosenthal Elana S , Nussdorf Laura , D’Amore Aaron , Brokus Christopher , Silk Rachel , Eyasu Rahwa , Mathur Poonam , Bijole Phyllis , Jones Miriam , Kier Randy , Sternberg David , Masur Henry , Kottilil Shyam , Kattakuzhy Sarah 
Published: October 2019

Abstract

Background
People who inject drugs (PWID) have significant morbidity and mortality associated with hepatitis C (HCV); however, harms associated with ongoing injecting drug use (IDU)—such as opioid overdose—may pose a more imminent risk, and often are not addressed as part of HCV treatment. Naloxone distribution is a simple, evidenced-based strategy to reduce mortality associated with opioid overdose.

Methods
ANCHOR is a single-center study embedded in an urban harm-reduction program evaluating treatment of HCV in PWID with chronic HCV, opioid use disorder (OUD), and IDU. Participants received HCV treatment and were offered collocated buprenorphine. At each study visit, patients self-reported experienced and witnessed overdose and were offered naloxone.

Results
The 100 enrolled participants are predominantly male (75%), median 57 years, black (93%) and inject opioids at least daily (58%). At baseline, 65% had ever experienced overdose, 91% had ever witnessed an overdose, and 35% had ever administered naloxone. Between day 0 and week 48, 15 patients (15%) experienced overdose; of which, 4 (4%) were fatal. The rate of experienced overdose was 15 overdoses per 100 person-years. In addition, 59 (59%) patients witnessed at least one overdose between day 0 and week 48. Seventy-three patients were dispensed naloxone at least once, and of those who witnessed an overdose, 48 (81%) administered naloxone. Nineteen (40%) patients who administered naloxone had never used naloxone before starting HCV treatment.

Conclusion
PWID with HCV, OUD, and ongoing IDU have high rates of personal and witnessed overdose during and after HCV treatment. Dispensing naloxone at HCV-related visits is highly acceptable among PWID, and results in high rates of naloxone utilization. To reduce morbidity and mortality in patients and their communities, ID providers should complement treatment of infections by prescribing naloxone for patients with OUD, ideally as part of a comprehensive package of harm reduction and OUD treatment.

Disclosures
All Authors: No reported Disclosures.