bluuebunny/crossref_metadata_2025_split huggingface dataset:
1348. Mycobacterium Chimera Infection Following Cardiac Surgery: A Review of a Large Cohort of Cases in the United States
Authors: Kim Jani M , Costales Jessica K , Modjtahedi Bobeck , Bluestone Gary , Nomura Jim H 
Published: October 2019

Abstract

Background
Mycobacterium chimera (MC) is a nontuberculous mycobacterium associated with infections originating from heater-cooler devices following cardiac surgery globally from 2012 to 2016. Twenty-eight cases occurred within our health system in Southern California, the largest number of cases in the United States to date. We aim to summarize the clinical features, diagnosis, treatments, and outcomes of these cases.

Methods
We reviewed the electronic health records of 28 patients with identified MC infection who had index coronary artery bypass (CABG) and/or valve replacement surgery between 2014 and 2016. All diagnoses were confirmed by cultures speciated to MC by 16S partial DNA sequencing or Karius testing, except for one case. Patients were grouped by clinical presentation of disseminated disease (n = 18) or localized disease (n = 10). Treatment delay was calculated from the time of initial presentation to the start date of antibiotics and evaluation for surgical intervention.

Results
All patients who underwent CABG alone (n = 5) developed localized sternal wound infections, whereas patients who had valve replacement surgery (n = 23) developed either localized or disseminated disease. Disseminated disease carried a mortality rate of 40% in those with surgical source control vs. 72% in patients who were not surgical candidates (OR 6.6, 95% CI 0.8–55). The mortality rate of patients with localized sternal wound infections was 11% after incision/drainage and sternal wire removal (n = 9). Delay of antimicrobial treatment greater than 6 months in all 28 patients was associated with a mortality rate of 54% compared with 35% in patients who started treatment within 6 months (OR 2.2, 95% CI 0.47–10.35). Overall mortality rate of patients with MC infection was 42%.

Conclusion
Disseminated MC infection should be considered early in at-risk patients presenting with constitutional symptoms. In this review of 27 confirmed and 1 probable case of MC infection, disseminated infection only occurred in patients who underwent valve surgery while localized disease occurred in patients who underwent CABG. Surgical source control with early initiation of antimicrobial therapy is associated with improved outcomes. Optimal duration of antimicrobial treatment is still unknown.

Disclosures
All authors: No reported disclosures.
1349. Risk Factors for Extrapulmonary Tuberculosis in Greece, a Low Tuberculosis Burden and High Immigrant Receiving Country
Authors: Vassalos Constantine , Papaventsis Dimitrios , Koutelekos Ioannis , Panagi Marina , Vogiatzakis Evangelos , Vassalou Evdokia , Karabela Simona 
Published: October 2019

Abstract

Background
Although the most common site of tuberculosis (TB) is the lungs, spreading may occur to any part of the body, resulting in extrapulmonary tuberculosis (EPTB). We conducted a study to describe the clinical and epidemiological features of EPTB in Greece, a low TB burden country (<50 TB cases/million), in which immigrants from high TB burden countries make up >7% of the population.

Methods
We retrieved data for adults presenting with signs/symptoms consistent with EPTB from 2014 to 2015 registries of the Athens Chest Disease Hospital. EPTB was clinically, histologically or microbiologically diagnosed. We recorded age, gender, immigrant, or native status, site of disease, history of diabetes, smoking, and immunological status. Proportion ratios (PR) and 95% confidence interval (CI) were calculated to estimate risk factors for developing EPTB.

Results
We identified 277 (153 males) adult patients, 254 (91.7%) natives, and 23 (8.3%) immigrants, with signs/symptoms consistent with EPTB. Of 118/277 (42.6%) EPTB cases, 67 (57.6%) were males. No association with gender, diabetes, or smoking was shown between EPTB cases and non-cases. Immigrants were twice as likely to develop EPTB as natives (PR = 1.86 95% CI: 1.38–2.51 P < 0.001). Immigrants from high TB burden countries were 2 times as likely to develop nodal, pericardial, or pleural TB as the native population (Tables 1 and 2). Native patients > 60 years of age presenting with lymph node enlargement or with a pleural effusion were 3 times as likely to have TB disease as those aged <60 years (Table 2). In contrast, all immigrants with lymph node enlargement were EPTB cases (Table 1) and were <45 years old. Impaired immunological status increased the risk of developing EPTB by 62% in the native population (PR = 1.62 95% CI: 1.20–2.33 P < 0.001).

Conclusion
In a low TB burden country, EPTB is associated with old age and weak immune system due to possible extrapulmonary dissemination of latent TB. Considered to be at high-risk for developing EPTB, immigrants from high TB burden countries with signs and/or symptoms consistent with EPTB, albeit not transmitting the disease, need to be priority-wise tested for TB in order to be adequately treated.

Disclosures
All authors: No reported disclosures.
1360. Disseminated Mycobacterium abscessus Infections in Patients with Neutralizing Anti-interferon-gamma Autoantibodies Treated with Rifabutin-based Combination Regimens
Authors: Cheng Aristine , Sun Hsin-Yun , Wu Un-in , Sheng Wang-Huei , Chen Yee-Chun , Chang Shan-Chwen 
Published: October 2019

Abstract

Background
This prospective study aimed to describe the treatment and safety outcomes of rifabutin-based combinations which has been shown to be synergistic in vitro, for patients with refractory M. abscessus infections and neutralizing anti-IFNγ antibodies.

Methods
Patients failing at least two standard macrolide-based regimens were recruited from hospitals across Taiwan since August 2017. They received rifabutin (RFB > 300 mg/day) initially with azithromycin (AZR 500 mg/day) and at least one parenteral agent and were monitored thereafter clinically on a monthly basis and by 3–6 monthly PET-CT imaging.

Results
Of 12 referred patients, only four had complete evaluations. The median age was 41 years and follow-up duration was 543 (range 307–668) days. All patients had lung and lymph node disease, two also had liver, bone and joint involvements and all were HLA-DR 16:02, HLA-DQ 05:02 positive. Prior to starting RFB–AZR, they had received at least four successive antimycobacterial regimens, but showed progression of existing lesions (2) or new lesions (2). Following RFB–AZR, all four patients experienced adverse reactions, including reactive dermatoses (2), fevers (2), leukopenia (2), thrombocytopenia (1), hearing loss (1), acute kidney injury (1), which necessitated withdrawal of rifabutin (4), short-term steroid use (2), and replacement of tenofovir with entecavir for chronic hepatitis B (1). All patients recovered fully from these adverse effects. Rifabutin was successfully restarted on first attempt (3) and on third attempt (1). The longest symptom-free interval on RFB–AZR was 331 days and the lowest maintenance dose was RFB 150–AZR 250 thrice weekly. Follow-up PET-CT confirmed good resolution of previous hot spots (mean SUVmax −4.5) except for the patient who did not tolerate RFB 300 due to fever and nausea on the first re-challenge, whose PET-CT detected a slight increase in mean SUVmax +0.6 and was hospitalized for dry cough on daily AZR–ciprofloxacin. The latter eventually tolerated a lower daily dose RFB 150–AZR 250 and became asymptomatic.

Conclusion
Rifabutin is an oral agent that can be effectively combined with azithromycin in long-term maintenance regimens against M. abscessus in immunodeficient adults. Adverse effects are frequent early on; however, rechallenge appears to be safe and outcomes favorable.

Disclosures
All authors: No reported disclosures.
1362. A Case Series of Miliary Tuberculosis in North West London
Authors: Gorgui-Naguib Hannah , Cootauco Che , Sandhu Gurjinder , Papineni Padmasayee 
Published: October 2019

Abstract

Background
Miliary tuberculosis (mTB) is a severe presentation of TB with high mortality. We reviewed data from a cohort of patients with mTB in an area of London serving an ethnically diverse population with the highest TB endemicity in the UK.

Methods
Retrospective analysis of laboratory and medical records, radiology and microbiology results of patients with mTB identified from the London TB register from 2012 to 2019 from London North West Hospitals University NHS Trust.

Results
60 cases with mTB were recorded. 67% of the patients were male. Median age at diagnosis was 36 years (range 13 to 88 years). 60% of patients were South Asian ethnicity. Two patients were HIV positive and 4 had received anti-TNF treatment. 73% (44 patients) patients had miliary nodular opacities on chest radiograph. Of the 16 patients with no chest radiograph evidence of mTB, 14 had computed tomography (CT) of the chest which confirmed miliary nodules. Eleven patients were sputum acid-fast bacilli (AFB) smear-positive, and in 49 patients, culture of sputum isolated Mycobacterium tuberculosis. Ten patients did not have any positive microbiology but were treated for mTB on clinico-radiological basis. Forty patients had fully-sensitive TB; 2 were isoniazid-resistant and 1 multi-drug-resistant. 5 patients in our cohort also had spinal TB. Evidence of cerebral TB was found in 5/17 patients who had a CT brain. Tuberculomas were seen in 10/24 patients who had magnetic resonance imaging (MRI). Only 8 patients had both CT and MRI; MRI revealed2 patients with cerebral TB that CT did not, but this was not statistically significant (P = 0.1573). 7 patients were investigated with lumbar puncture, of which cerebrospinal fluid was smear and culture negative for all. All patients were treated with standard therapy with a mean length of treatment of 11 months. 33 patients have completed therapy. 7 patients died and 2 were lost to follow-up. Those who died had a mean age of 69 years compared with those who survived (44.2 years).

Conclusion
The diagnosis of mTB requires a high index of suspicion for central nervous system disease. Our cohort demonstrates that spinal disease needs to be considered in addition to cerebral TB, for which MRI may be the preferred imaging modality. Mortality in our cohort was associated with older age.

Disclosures
All authors: No reported disclosures.
1369. Clinical Manifestations, Treatment, and Outcome of Nontuberculous Mycobacteria (NTM) Infection in Adult-Onset Immunodeficiency Associated with Anti-interferon-gamma Autoantibodies in King Chulalongkorn Memorial Hospital
Authors: Jutivorakool Kamonwan , Vanichanan Jakapat 
Published: October 2019

Abstract

Background
There is an increase of anti-interferon-γ autoantibodies syndromes because it is now well recognized, especially in the Southeast Asia region. One of the clinical features is an infection caused by nontuberculous mycobacteria (NTM). NTM infection in patients with anti-interferon-γ autoantibodies is usually severe, recurrent, and disseminated. In this study, we describe the clinical characteristics, treatment, and outcome of NTM infection in patients with anti-interferon-γ autoantibodies

Methods
A retrospective cohort study was conducted at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, during 2010–2018. Demographic, clinical, and microbiological data were collected and analyzed.

Results
A total of 45 patients were enrolled in this study. Twenty-nine patients were males, and 16 patients were females. The most common clinical manifestations were fever with lymphadenopathy. The median age of the study population was 55 years. The most common organ that was infected was the lymph node (91%). Sweet’s syndrome (68%) was the most common immunological skin reaction. The proportion of infection caused by rapid-growing NTM was more prevalent than slow-growing NTM. The most common NTM was Mycobacterium abscessus (44.4%). The most common co-pathogen identified in this study was Salmonella (37.8%). All patients had positive antibody to interferon-γin the serum which was detected by enzyme-linked immunosorbent assay (ELISA) and mean optical density was 3.28. Fifty-one percent of the patients received long-term antimycobacterial therapy due to chronic active infection, new infections and relapsed. 22.2% of the patients developed a new infection during treatment. However, 28.9% of patients were completely cured of the infection during the follow-up period. The overall mortality rate was 11.1%

Conclusion
Adult-onset immunodeficiency with anti-interferon-γ autoantibodies is a unique clinical syndrome that has been recognized in Thailand. Treatment of this disorder requires a long duration of the combination of antimycobacterial agents. Sweet’s syndrome is an indicator of recurrence/relapse of NTM infection during the clinical course. Long-term monitoring and immunomodulator are essential for the management of this condition.

Disclosures
All authors: No reported disclosures.
1384. Mycobacterium marinum Infection: 21 Years of Experience at a Tertiary-Care Hospital
Authors: Castillo Almeida Natalia E , Gurram Pooja , Abu Saleh Omar 
Published: October 2019

Abstract

Background
Mycobacterium marinum is a slow-growing, non-tuberculous mycobacterium responsible for skin and soft-tissue infections (SSTIs), tenosynovitis, and osteomyelitis (OM). We conducted a retrospective study describing the risk, clinical course, and outcome of M. marinum infection.

Methods
Adult patients with culture-confirmed M. marinum infections were identified from the mycology laboratory at Mayo Clinic, Rochester from January 1998 to December 2018. M. marinum infection was defined as uncomplicated (limited to SST) and complicated (tenosynovitis, OM, or disseminated).

Results
Forty-six cases of culture-confirmed infection with M. marinum were included (Table 1). Only 16 cases (35%) reported a water exposure and 22 (48%) involved finger and/or hand trauma. The median time to diagnosis was 3.6 months. Most patients (76%) presented with uncomplicated M. marinum infection with skin lesions mainly localized in the upper limb (Table 2). QuantiFERON and PPD were positive in 4 (8%) and 2 (4%) cases, respectively. Granulomatous inflammation and positive special stains were noted in 34 (74%) and 11 (24%) cases, respectively. Cases with complicated M. marinum infection had a longer duration of symptoms and length of treatment (P < 0.05) (Table 3). Prior to diagnosis, 63% of patients received at least one antibiotic for bacterial SSTIs. More than 50% of the patients diagnosed with M. marinum received a one drug regimen and 8% did not initiate therapy. Median treatment duration was 4.4 months. Twenty-six cases (56%) had susceptibilities performed and treatment modifications were made in 10 cases (38%). From the patients that started therapy, 73% completed therapy and 33% were lost to follow up. Cured was achieved in 87% of cases that completed therapy, 2 cases (6%) had a recurrence, and only one patient with active malignancy had a positive blood culture and died. Twelve (44%) and 10 cases (37%) were cured with one and two-drug regimens, respectively.

Conclusion
Most patients with M. marinum infection present as an uncomplicated infection in the upper limb. Classical exposure was only suspected in a third of the cases. Patients with complicated M. marinum infection had a prolonged duration of symptoms and lengthy treatment. Most patients were successfully treated with a one and two-drug regimen.

Disclosures
All authors: No reported disclosures.
1385. Mechanism-Based, In Vitro Inhibition of Mycobacterium abscessus: Assessing β-Lactam Therapy
Authors: Dousa Khalid M , Kurz Sebastian G , Bethel Christopher R , Barnes Melissa D , Taracilla Magdalena A , Selvaraju Suresh , Jacobs Michael R , Kreiswirth Barry , Kasperbauer Shannon H , Daley Charles L , Bonomo Robert A 
Published: October 2019

Abstract

Background
M. abscessus (Mab) is an emerging pathogen, a highly drug-resistant rapidly-growing nontuberculous mycobacteria. Mab L, D transpeptidases (LdtMab 1–5), D,D carboxypeptidase and BlaMab β-lactamase are important targets. Herein, we tested the susceptibility of ceftaroline (TAR) and imipenem (IMI) alone and in combinations with two diazabicyclooctanone β-lactamase inhibitors (BLI), relebactam (REL) and avibactam (AVI), against representative clinical isolates belonging to the Mab complex and assessed the mechanism of inhibition using mass spectrometry (QTOF-MS)

Methods
Minimum inhibitory concentrations (MICs) of TAR and IMI with or without AVI and REL and a TAR-IMI combination with and without REL were determined using microdilution. Approximately 5 x 105 colony-forming units (CFU) per milliliter were inoculated into Middlebrook 7H9 broth supplemented with 10% (vol/vol) oleic albumin dextrose catalase and 0.05% (vol/vol) Tween 80. AVI or REL were added at fixed concentration of 4 µg/mL to serial dilutions of TAR or IMI. For the TAR-IMI combinations, IMI at 1 µg/mL, and serial dilutions of TAR were used. Mab isolates were incubated with test agents at 30°C for 48 h, and MIC was defined as lowest antibiotic concentration that prevented visible bacterial growth. (QTOF-MS) was used to assess intermediates of BlaMab, LdtMab1 and LdtMab2 with TAR, IMI, AVI, and REL

Results
In-vitro susceptibility testing on representative clinical Mab strains (table). MIC90 was > 128 μg/mL for TAR and 8 μg/mL for IMI. Combination of TAR and IMI lowered MIC’s of all clinical isolates to <0.06 μg/mL. Addition of REL or AVI lowered TAR MICs but had minimal or no impact on IMI or TAR-IMI MICs. Mass spectrometry analyses of BlaMab, LdtMab (1–2) alone and incubated with IMI, TAR, REL and AVI (figure). BlaMab β-lactamase bound the AVI and REL, but acyl complexes with TAR or IMI were not detected. LdtMab (1–2) form stable acyl complexes with AVI, REL, TAR, and IMI.

Conclusion
Addition of IMI to TAR lowers MICs of TAR against Mab to therapeutically achievable concentrations. It would be welcome news for clinicians who are treating patients with highly resistant Mab infection that the combination of TAR and IMI is commercially available and thus might be considered as part of a rescue regimen.

Disclosures
All authors: No reported disclosures.
1397. Risk Factors of Unfavorable Clinical Outcomes in Patients with Brain Abscess and Subdural Empyema in Korea
Authors: Cho Yunsuk , Ahn Sangmin , Sohn Yujin , Lee Yongseop , Hyun Jonghoon , Ji Lee Woon , Ho Kim Jung , young Ahn Jin , Jin Jeong Su , su Ku Nam , yong Choi Jun , Yeom Joon-Sup , Seong Hye 
Published: October 2019

Abstract

Background
Brain abscess is a fatal neurological infection, despite reduction of mortality rate on account of medical improvement. Therefore, we investigated to identify risk factors for poor clinical outcomes of patients with brain abscess and subdural empyema in Korea.

Methods
A retrospective analysis was conducted among patients treated for brain abscess or subdural empyema over a period of 11 years between May 2005 and July 2016 in a tertiary hospital, Seoul, South Korea. Based on medical records, we reviewed the clinical findings, therapeutic modalities and prognostic factors of brain abscess or subdural empyema. A multivariate analysis was performed to evaluate the independent risk factors of poor clinical outcomes. Unfavorable clinical outcomes were defined as death or neurologic deficit.

Results
In total, 121 patients were enrolled in this study. 79 (65.2%) were males and the mean age was 55.3 years. The common symptoms at presentation included a focal neurological deficit (52.8%), a reduced Glasgow coma scale (47%), headache (49.5%) and fever (22.3%). Gram-positive cocci were most frequently isolated as the causative microorganism. The most common location of brain abscess was the frontal lobe (32.5%), followed by parietal (18.7%) and temporal lobe (11.38%) and a subdural empyema (8.26%). 28-day mortality was 2.47% (3/121), and 43.8% (53/121) had long-term disability. In multivariate analysis, reduced GCS, headache at presentation and high blood urea nitrogen were independently associated with unfavorable clinical outcomes.

Conclusion
In this study, reduced GCS, headache at presentation and high blood urea nitrogen were significant risk factors for unfavorable clinical outcomes in patients with brain abscess and subdural empyema.

Disclosures
All authors: No reported disclosures.
1398. Clinical Performance of Film Array Meningitis/Encephalitis Multiplex PCR Panel in CNS Infection
Authors: Ananthanarayanan Rajalakshmi , Sasidharan Aswathy , Chandran Sarath 
Published: October 2019

Abstract

Background
Rapid identification of pathogen is important in the management of meningoencephalitis. A fully-automated multiplex PCR, the FilmArray (FA) meningitis/encephalitis (ME) panel, detects 14 pathogens simultaneously in an hour. As there is not much data on this, we undertook this study to understand its performance.

Methods
A retrospective analysis was done on patients, both adult and pediatric, admitted with meningitis/encephalitis syndrome between December 2016 and 2018 and who underwent the FA–ME panel (BioFire Diagnostics, USA) multiplex PCR test on CSF. The performance of the FA- ME panel was compared with that of routine tests done on CSF which is cell count, biochemistry, gram stain, bacterial culture, and other relevant tests.

Results
FA- ME panel was done in 259 patients and it detected pathogen in 61 (23.6%) patients with ME syndrome. Viruses accounted for 70.4%, bacteria 24.5%, and 2 patients had 2 organisms in a single sample (enterovirus and H. influenzae on both occasions). Enterovirus was the commonest accounting for 29 cases, followed by varicella in 11, pneumococci in 9. HHV 6, H. influenzae, Strep agalactiae and Listeria were the rest. Enterovirus meningitis showed seasonal prevalence; 24 out of 29 cases occurred during October till December. CSF bacterial culture yield was low, positive only in 8 (3%) cases and matched with FA ME panel in one sample which grew pneumococci; 7 other cultures grew either Gram-negative pathogens, rare organisms/ contaminants not included in FA ME panel. CNS tuberculosis was diagnosed in 6, 7 patients had aseptic meningitis due to tropical infections, 5 of which were dengue fever, 2 were scrub typhus. Overall, 191 patients (73.7%) were treated as CNS infection through FA ME panel were negative in 130 of these, rest had alternative diagnosis. Antibiotic de-escalation was better in the group with positive FA ME panel result.

Conclusion
FA-ME panel has better diagnostic yield compared with culture (26.3% vs. 3%). Viruses were commoner and majority were enteroviruses showing seasonal prevalence. Those bacteria that grew in CSF culture but not identified by FA ME panel were Gram-negative or unusual pathogens. Additional tests need to be used when considering post-traumatic or nosocomial meningitis, tuberculosis, and tropical infections.

Disclosures
All authors: No reported disclosures.