bluuebunny/crossref_metadata_2025_split huggingface dataset:
168. Epidemiology, Risk Factors and Outcome of Bloodstream Infection Within the First Year After Kidney Transplantation
Authors: Siritip Napadol , Nongnuch Arkom , Dajsakdipon Thanate , Thongprayoon Charat , Cheungpasitporn Wisit , Bruminhent Jackrapong 
Published: October 2019

Abstract

Background
Bloodstream infections (BSIs) are an important cause of morbidity and mortality among kidney transplant (KT) recipients, especially within the first year. We investigated for an epidemiology, risk factors and outcome of this specific infection following KT.

Methods
We conducted a retrospective study of all adult KT recipients who developed BSI within the first year after KT from January to December 2016 at a large referral single transplant center in Bangkok, Thailand. The cumulative incidence of BSI after transplant was estimated with Kaplan–Meier methodology. Clinical characteristics, microbiological data, and outcome were extracted. Risk factors for BSI were assessed with multivariate Cox proportional hazards models.

Results
A total of 26 (15.2%) episodes of BSI occurred in 171 KT recipients, 58.5% of them were men and the mean ± SD age was 43 ± 12 years. The majority received deceased-donor allograft (58.5%) and induction therapy (59%). The Kaplan–Meier estimated for BSIs were 12.3% at 3 months, 13.5% at 6 months, and 15.2% at 12 months after KT. Gram-negative bacteria were responsible for 92% of BSI, with Escherichia coli was the most common causative pathogen (65%) and 71% of those produced extended-spectrum β-lactamases enzyme. The genitourinary tracts were the predominant source of BSIs (85%). In a multivariate analysis, the second kidney transplantation [HR, 4.55; 95% CI, 1.24–16.79 (P =0.02)] and receiving induction therapy [HR, 3.05; 95% CI, 1.15–8.10 (P<0.03)] were associated with BSI. One patient (4%) developed acute cellular rejection and one patient (4%) died from septic shock.

Conclusion
One-sixth of KT recipients could develop gram-negative bloodstream infection within the first year after KT especially those underwent the second transplantation or received induction therapy.

Disclosures
All authors: No reported disclosures.
2767. Variation in Incidence of Pediatric Herpes Zoster by First- and Second-Dose Varicella Vaccine Formulations
Authors: Weinmann Sheila , Irving Stephanie , Koppolu Padma , Naleway Allison , Belongia Edward , Hambidge Simon , Jackson Michael L , Klein Nicola , Lewin Bruno , Liles Elizabeth , Marin Mona , Smith Ning , Weintraub Eric , Chun Colleen 
Published: October 2019

Abstract

Background
Varicella (VAR) and measles-mumps-rubella (MMR) vaccines are recommended for children at ages 12–15 months and 4–6 years. These are administered as separate MMR and VAR vaccines (MMR+VAR) or as combined measles-mumps-rubella-varicella (MMRV) vaccine. Herpes zoster (HZ), caused by wild-type or vaccine-strain varicella-zoster virus, can occur in children after varicella vaccination. It is unknown whether HZ incidence after varicella vaccination varies by vaccine formulation or simultaneous receipt of MMR.

Methods
Using data from six integrated health systems, we examined HZ incidence among children who turned 12 months old during 2003–2008 and received varicella and MMR vaccines according to routine recommendations. All HZ cases ≥ 21 days after first varicella vaccination were identified using ICD-9 codes from inpatient, outpatient, emergency room encounters, and claims data, through 2014. HZ incidence was examined by vaccine formulation (MMR+VAR, MMRV, or VAR without same-day MMR) and doses received and compared using incidence rate ratios (IRR).

Results
Among 199,797 children, we identified 601 HZ cases. Crude HZ incidence after first-dose MMR+VAR (18.6 [95% CI 11.1–29.2] cases/100,000 person-years) was similar to the rate after first-dose MMRV (17.9 [95% CI 10.6–28.3] cases/100,000 person-years), but approximately double the rate among those with first-dose VAR without same-day MMR (7.5 [95% CI 3.1–15.0] cases/100,000 person-years); see Table 1. The IRR for HZ after first-dose MMR+VAR or MMRV, compared with VAR, was 2.5 (95% CI 1.4–4.4; P = 0.002). When examining any first or second dose formulation, crude HZ incidence was lower after the second varicella vaccine dose (13.9 cases/100,000 person-years), than in the period before the second dose (i.e., between first and second doses or after the first dose in children with only one dose; 21.8 cases/100,000 person-years, P < 0.0001). HZ incidence was also lower after two varicella vaccine doses in each of the three first-dose formulation groups.

Conclusion
HZ incidence among children varied by first-dose varicella vaccine formulation and number of varicella vaccine doses. Regardless of the first-dose varicella vaccine formulation, children who received two vaccine doses had lower HZ incidence after the second dose.

Disclosures
All authors: No reported disclosures.
2788. Case Report: Severe Community-Acquired Human Adenovirus 7 Infection in a Mother and Son
Authors: Bradford William , Priyank Kumar , Weber Devin , Pettengill Matthew 
Published: October 2019

Abstract

Background
We present the case of a 42-year-old male (Patient 1) with a history of morbid obesity and cirrhosis of unclear etiology who died of acute hypoxic respiratory failure and devastating encephalitis after community-acquired infection with human adenovirus 7 (HAdV7) in spite of antiviral treatment with Cidofovir. Patient 1’s course is outlined in Figure 1. During his stay, the patient’s mother (Patient 2) was also hospitalized in the same unit following a similar presentation with 10 days of flu-like symptoms that progressed to ARDS requiring intubation. Patient 2 recovered from her infection with no specific antiviral treatment.

Methods
N/A.

Results
These cases illustrate particularly fulminant presentations of HAdV7 infection and highlight the high pathogenicity of HAdV7 compared with other adenovirus subtypes. Severe lower respiratory tract HAdV7 infections have been reported most commonly as outbreaks of respiratory illness among military recruits and infants. A notable recent outbreak of HAdV-7d in New Jersey in 2016–2017 resulted in 12 confirmed cases with 4 deaths; however, all deaths occurred in patients with significant medical comorbidities.1 In a case particularly striking for its similarity to the one presented here, a healthy 44-year-old male along with his 68-year-old father were hospitalized with human adenovirus 7 days infection in Chicago in December 2014, with the son requiring ECMO for ARDS and the father briefly requiring ICU-level care.2

Conclusion
While our patient’s case is by no means unprecedented, it does represent an uncommon and potentially serious infection that points to need for continuing nosocomial testing efforts and deserves special attention in outbreak settings. In the future, perhaps use of the extant vaccine for human adenovirus serotypes 4 and 7 (currently licensed for military personnel3) could be expanded for use in civilian populations could be explored and potentially expanded for use in outbreak settings.

Disclosures
All authors: No reported disclosures.
2790. Respiratory Viral Testing and Antimicrobial De-escalation Among Hospitalized Patients at a Tertiary Care Facility, 2015–2016: A Matched Cohort Study Series
Authors: Ciccone Emily J , Kinlaw Alan C , Miller Melissa B , Weber David J , Juliano Jonathan J , Jhaveri Ravi , Willis Zachary 
Published: October 2019

Abstract

Background
The use of multiplex respiratory viral panels (RVP) is increasing. They have the potential to reduce unnecessary antibiotic use, but data are limited on their clinical effectiveness. Our objective was to estimate risk differences for antimicrobial de-escalation (discontinuation, intravenous to oral, or spectrum narrowing) between different sequences and results of RVP and rapid polymerase chain reaction (PCR) tests for influenza +/− respiratory syncytial virus.

Methods
We conducted a retrospective chart review of adults (age ≥18 years) admitted to a floor or stepdown unit at University of North Carolina Hospitals who had a respiratory viral test (RVT) within 48 hours of admission between September 2015 and April 2016. We estimated 3-day RDs for the relation between RVT and antimicrobial de-escalation. To control confounding and account for the 37-hour mean lag between PCR (faster) and RVP (slower) tests resulting, we leveraged the treatment decision design over a series of 1:1 matched cohort studies. Each targeted a clinically relevant scenario: (1) ordering RVP test (vs no RVP order) after learning PCR status; (2) learning RVP+ result (vs. no RVP result) after knowing PCR status; (3) learning RVP+ result (vs. RVP–) after knowing PCR–status; and (4) learning RVP+ result (vs. RVP–) given no prior PCR. For each subcohort, referent patients were matched to index patients by race, gender, RVT in prior month (y/n), age (±10 years), and season (±1.7 months).

Results
The overall cohort (n = 1,342) was 61% White, 29% African American, and 51% female. Median age was 56 years (IQR 39–69). Across all matched subcohorts (Figure 1), the matching success rate was 79–88% and referent frequency of antimicrobial de-escalation ranged 0.6%–1.9%. In scenario 1, ordering RVP results was associated with higher de-escalation (3-day RD 7.6%; 95% confidence intervals [CI] 3.2%, 12.1%). In scenarios 2–4, learning RVP+ results was associated with more frequent de-escalation (3-day RDs 14.8%, 13.8%, and 15.4%).

Conclusion
RVP testing and positive RVP results were associated with increased antimicrobial de-escalation, although de-escalation was overall infrequent. Future research should assess effect modification across subgroups and evaluate cost-effectiveness.

Disclosures
All authors: No reported disclosures.
184. Channeling Alexander Fleming: Efficacy of Penicillin (PCN) to Treat Staphylococcus aureus (SA) Bacteremia
Authors: Mathews Samantha K , Zuckerman Richard A , Calderwood Michael S , Martin Isabella W , Parsonnet Jeffrey 
Published: October 2019

Abstract

Background
Up to 20% of SA isolates in the United States are penicillin-susceptible (PSSA); however, treatment with penicillin has been discouraged because of concern that routine testing may miss strains that have the capacity to produce clinically significant ß-lactamase in vivo. We performed a retrospective analysis to determine whether PCN therapy for the treatment of PSSA bacteremia was of comparable efficacy and safety to standard therapies.

Methods
We identified all episodes of SA bacteremia (March 18, 2010–July 23, 2018). SA penicillin susceptibility testing in our lab was performed by broth microdilution followed by nitrocefin ß-lactamase testing per CLSI guidelines on these isolates. A retrospective chart review was performed and our primary outcome was a composite endpoint of clinical success (no change in PSSA therapy due to persistent or worsening signs and symptoms, no PSSA bacteremia recurrence or persistence, and no infection‐related mortality). Microbiologic failure was defined as either failure to clear bacteremia/infection or recurrence after completion of therapy. Patients were followed until last contact with our medical system, the only tertiary center in the region. We compared our rates of success, mortality, and adverse drug reaction to historical SA bacteremia controls from the literature.

Results
PSSA accounted for 13% (130/971) of SA bloodstream episodes. Nineteen patients with PSSA (15%) were treated with PCN and 79% (15/19) achieved the primary endpoint of clinical success. Of the 4 patients who did not achieve the endpoint, 2 developed rash and were switched to a different antibiotic and 2 died from complications of sepsis. One of the patients died after clearing blood cultures but had DIC and a catastrophic intracranial hemorrhage, the other died of overwhelming sepsis after 4 days (2 days nafcillin, 2 days PCN) with continued bacteremia. Thus, our only microbiologic failure was due to early death from sepsis. Rates of success, mortality and drug reaction were similar to prior reports of alternative standard therapies (Table 1).

Conclusion
PCN is a viable treatment option for PSSA bacteremia as identified by routine laboratory testing. Further study will include characterizing the presence of ß-lactamase in these patient’s isolates.

Disclosures
All authors: No reported disclosures.
189. A Case Series of Elizabethkingia meningosepticum Bacteremia in the Cancer Population
Authors: Hyun Lee Dae , Mehra Ishita , Chandrasekhar Sanjay , Mirza Abu-Sayeef , Shenoy Rahul , Topham Annie , Nanjappa Sowmya , Greene John 
Published: October 2019

Abstract

Background
Elizabethkingia meningosepticum (E. meningosepticum) is a ubiquitous microorganism previously known as Chryseobacterium meningosepticum. It is emerging as a pathogen responsible for bacteremia in immunocompromised patients such as cancer patients especially those with a history of prolonged hospital stay and frequent instrumentations.

Methods
A retrospective chart review of all cases over 10 years in Moffitt Cancer Center showed a total of three patients with E. meningosepticum infection.

Results
First patient (history of multiple myeloma) underwent endoscopy complicated by aspiration pneumonia and blood culture positive for E. meningosepticum infection. He was treated with ciprofloxacin, cefoxitin, minocycline and metronidazole and was discharged in stable conditions after 10 days. The second patient (current acute myelogenous leukemia) had neutropenic fever in the setting of recent chest port infection. Blood culture from chest port showed E. meningosepticum and was treated with ciprofloxacin, meropenem and minocycline successfully. The third patient (history of esophageal adenocarcinoma and acute myelogenous leukemia) had history of recent pneumonia and cellulitis who came in with recurrent neutropenic fever. Blood culture was positive for E. meningosepticum and was treated with ciprofloxacin and minocycline. However, the infection was complicated by multiorgan failure and required tracheostomy. As these three cases illustrate, E. meningosepticum bacteremia has high 28- day mortality rate (41%).

Conclusion
Early identification of the pathogen along with empiric treatment with a fluoroquinolone and/or minocycline is indicated to reduce morbidity and mortality.

Disclosures
All authors: No reported disclosures.
192. Augmenting Utility of Rapid Diagnostic Testing in Treatment of Gram-Negative Bacteremia with Stewardship Intervention
Authors: Gerges Jessica , Raja Karan , Patel Mitesh , Patel Ruben , Chen Brandon , Philips Mona 
Published: October 2019

Abstract

Background
Rapid diagnostic tests (RDT) can identify pathogens in bloodstream infections (BSI) in less than 24 hours. Our institution utilizes an RDT for blood cultures (BCx) that can detect various organisms and resistance determinants. A retrospective evaluation conducted in our institution calculated the negative predictive values (NPV) of various Gram-negative pathogens and susceptibility to target antimicrobials in the absence of detected resistance markers. Resultant NPV >90% for E. coli and K. pneumoniae to ceftriaxone support use of RDT with stewardship intervention for more rapid de-escalation of antimicrobial therapy in patients with resistance marker-negative BSI.

Methods
In our facility, all positive BCx are processed through RDT. In the post-intervention group, pharmacists monitored RDT results and provided recommendations. Our IRB-approved, prospective study assessed time to antimicrobial de-escalation in treatment of resistance marker-negative E. coli and K. pneumoniae BSI before (January 1 to December 31, 2018) and after Stewardship intervention (January 1 to March 31, 2019). Secondary outcomes included days of therapy (DOT) of target narrow-spectrum β-lactams, carbapenems, and non-carbapenem anti-pseudomonal (NCAP) β-lactams, length of stay (LOS), and treatment failure. Data were analyzed using the Fisher exact or Chi-square and t-test for categorical and continuous data, respectively.

Results
Of the 12,893 evaluated RDT results in the pre-intervention group and 2,238 post intervention, 41 and 12 patients met inclusion criteria, respectively. Baseline characteristics were similar in both groups. Time to de-escalation to a target agent was decreased by 24 hours after stewardship intervention (50 v 74.6 hours) (P = 0.14). There were no statistically significant differences in DOTs for target agents (5.19 v 5.25 DOT; P = 0.48), carbapenems (1.29 v 1.08 DOT; P = 0.41), or NCAP β-lactams (1.73 v 2.33; P = 0.25). Treatment failure (2 in each group; P = 0.17) and LOS (10.9 v 11.9 days; P = 0.4) were similar between groups. Protocol compliance and intervention acceptance rate was approximately 60%.

Conclusion
Appreciation of NPVs and utilization of stewardship intervention allowed for early de-escalation of empiric therapy in patients with resistance marker-negative E. coli and K. pneumoniae bacteremia.

Disclosures
All authors: No reported disclosures.
203. Correlating Cardiac PET Results with Intra-Operative Findings in Infectious Endocarditis
Authors: El-Dalati Sami , Weinberg Richard , Murthy Venkatesh , Owczarczyk Anna , Riddell Jamie , Cinti Sandro , Fagan Christopher 
Published: October 2019

Abstract

Background
Care for patients with infectious endocarditis is complicated by delays in diagnosis and relatively low sensitivity of existing diagnostic algorithms, particularly the Duke Criteria. In recent years, cardiac positron emission tomography (PET) has been identified as a useful tool in detecting occult endocardial infections. Multiple prospective studies have demonstrated that when incorporated with conventional imaging modalities cardiac PET can improve the sensitivity of the Duke Criteria by 27–38 percent. These studies used as their gold standard for diagnosis the consensus opinion of an endocarditis team and were characterized by a relatively low percentage of patients who underwent surgery. We reviewed 4 years of surgically managed IE cases at a tertiary care center where cardiac PET was used to aid diagnosis.

Methods
Between July 1, 2014 and December 31, 2018 we retrospectively reviewed 68 surgically managed cases of endocarditis. Cases were identified using ICD-9 and ICD-10 codes of patients who underwent surgical valve replacement for endocarditis as well as all patients who had cardiac PET scans to rule out endocarditis. Variables including PET results, operative findings, valve culture, pathology and PCR testing were recorded.

Results
14 patients were identified who underwent cardiac PET prior to their surgical intervention. 9 cases were classified as possible endocarditis by Duke Criteria and 10 involved prosthetic valves. 12/14 scans were interpreted as suggestive of or consistent with endocarditis. Twelve positive PETs were associated with either operative findings of infection and/or positive PCR testing on the excised valve (positive predictive value: 100%). The 2 patients with negative scans were found to have noninfectious vegetations intra-operatively, negative valve cultures and negative pathology.

Conclusion
Cardiac PET correlates closely with intra-operative findings in patients with endocarditis. In patients with suspected endocarditis it may help guide surgical decision making. Cardiac PET should be considered for addition to the Modified Duke’s Criteria similar to the European Society of Cardiology guidelines.

Disclosures
All authors: No reported disclosures.
207. High Severity and Mortality Due to Methicillin-Susceptible Staphylococcus aureus Infections in a Colombian Hospital
Authors: Ordonez Diaz Karen M , Baron Laura M , Garcia Juan M , Cristancho Edilberto , Alzate John , Carvajal Lina P , Echeverri Aura M , Rincon Sandra , Reyes Jinnethe , Arias Cesar A 
Published: October 2019

Abstract

Background
Methicillin-susceptible Staphylococcus aureus (MSSA) infections are considered less severe than those caused by methicillin-resistant S. aureus. However, we have observed an important increase in severe cases of invasive MSSA infections in a hospital in Pereira, Colombia. Here, we characterize the clinical outcomes and epidemiology of these infections.

Methods
We included adult and pediatric patients hospitalized between February 2018 and April 2019 presenting with invasive infections caused by MSSA. All isolates were sent to a central laboratory to confirm identification. We determined cefazolin MICs at standard (105 CFU/mL) and high inoculum (107 CFU/mL) by broth microdilution and a rapid test to detect cefazolin inoculum effect (CIE). The CIE was defined as an increase of MIC to ≥16 µg/mL when tested at high inoculum. Clinical data (demographics, intensive care unit (ICU) admission, therapy and mortality) were obtained from medical records.

Results
A total of 60 patients were included in the study and 41.6% were women. Most (63.3%) infections were hospital-associated. Bacteremia was the most frequent type of infection (71.6%). The mean duration of hospital stay was 24.5 days (IQR, 14–44). 61.6% of patients were admitted to the ICU with a mean length of stay of 14 days (IQR, 7–30). Mortality at 30 days was 28.3% (17 out of 60 patients) and was slightly higher (30.2%) in patients with bacteremia. Early mortality (48 h) was 10% (n = 6). Most patients (75%) received β-lactams (28.8% cefazolin and 84% oxacillin). 18 patients (33%) had isolates that exhibited the CIE but most (n = 11) received oxacillin. Among 17 patients who died, 35% had received antibiotics other than β-lactams (5 vancomycin, 1 ampicillin-sulbactam) and two did not received any therapy due to rapid death. The mean duration of antibiotic therapy was 11 days. Source control was deemed appropriate in 65% of the cases.

Conclusion
An increase in severe invasive infections caused by MSSA was observed in our hospital with a high proportion of patients requiring ICU care. A significant proportion of patients received inappropriate treatment. Due to the aggressive nature of invasive MSSA infections, efforts to optimize appropriate therapy for these infections are urgently needed in Colombia.

Disclosures
All authors: No reported disclosures.