bluuebunny/crossref_metadata_2025_split huggingface dataset:
2277. Comparison of 30-day Crude Mortality Rates in Patients with Bloodstream Infections (BSIs) Caused by Colistin Susceptible-(ColS-CRKp) vs. Colistin and Carbapenem-Resistant Klebsiella pneumoniae(ColR-CRKp)
Authors: Tarik Aslan Abdullah , Bıçakçıgil Asiye , Canan Gürsoy Nafia , Liste Ümran , Tozluyurt Abdullah , Otlu Barış , Sancak Banu , Dağ Osman , Sain Güven Gülay , Akova Murat 
Published: October 2019

Abstract

Background
Colistin is a last resort antibiotic against infections with CRKp. Its increased use has led to resistance to this antibiotic.

Methods
This was a single-center, retrospective, cohort study including all CRKp BSIs treated between January 1, 2014 and July 31, 2018. Antibiotic therapy was appropriate if initiated within 5 days from the onset of BSI including at least an active drug with an adequate dosage. Exclusion criteria were missing key data, death < 24 h after inclusion, subsequent episodes in the same patients, pregnancy, polymicrobial BSI, < 18 years of age, no ID consultation, no carbapenemase gene detection by multiplex PCR for blaKPC, blaNDM, blaVIM, blaIMPand blaOXA48. EUCAST breakpoints were used for antibiotic susceptibilities. Colistin MIC was determined by using broth microdilution. FDA criteria were applied for tigecycline susceptibility

Results
Among 174 CRKp BSIs, 129 met all inclusion criteria. Susceptibility to antibiotics was as follows: colistin (51.9%), tigecycline (67.4%), gentamicine (38.0%), amikacin (43.0%), meropenem (32.6%), ciprofloxacin (18.6%), TMP-SMX (24.0%), ceftazidime (7.8%), cefepime (7.8%).
66.1% and 19.4% of the patients received inappropriate therapy in ColR-CRKp and ColS-CRKp groups, respectively (P ≤ 0.001). We incorporated interaction between colistin susceptibility and inappropriate therapy into multivariate logistic regression analysis (MLRA) that was constructed for identification of independent risk factors for 30-day mortality. The variables having P ≤ 0.1 in crude analysis were included in MLRA. After checking correlation between variables by Pearson correlation analysis and multicollinearity analysis, the final model was builded. The results are shown in Table 2.

Conclusion
Colistin resistance and inappropriate therapy were not associated with decreased mortality individually, however their interaction significantly increased 30-day mortality rate (OR: 4.04; 95% CI: 1.62–10.02; P = 0.003).85.5% of ColR-CRKp isolates produced an OXA-48 enzyme which can be inhibited by ceftazidime–avibactam, but not available in our setting, treatment with this agent may have altered the mortality rates. Thus, high rate colistin resistance among CRKp isolates remains as a significant cause of mortality in our setting.

Disclosures
All authors: No reported disclosures.
2281. Ceftolozane–tazobactam (C/T) Treatment Outcomes in Immunocompromised (IC) Patients with Multidrug-Resistant (MDR) Pseudomonas aeruginosa (PA) Infections
Authors: Hart Delaney E , Gallagher Jason C , Puzniak Laura A , Hirsch Elizabeth B , Hirsch Elizabeth B 
Published: October 2019

Abstract

Background
Evaluations of clinical use and real-world outcomes following C/T treatment exist; however, data assessing outcomes in IC patients are limited. This study evaluated treatment patterns and clinical outcomes of IC patients treated with C/T for MDR PA across 15 US hospitals.

Methods
Adult IC inpatients treated for ≥ 24 hours with C/T admitted between 12/14–5/18 for MDR PA infections were included in this retrospective multicenter cohort study. IC was defined as patients with previous solid-organ transplant (SOT), diseases that suppress resistance to infection (HIV/AIDS, leukemia, lymphoma), or receipt of immunosuppressants, chemotherapy, radiation, long-term low-dose (≥ 1 month) or recent high-dose steroids (> 5 days). Clinical and microbiologic data were extracted from electronic records. The primary outcomes were all-cause 30-day mortality and clinical cure, defined as no escalation/additional therapy and improved signs and symptoms from baseline to end of therapy. PA isolates were characterized as MDR if non-susceptible to ≥ 3 classes of antipseudomonal agents. Classification and regression tree (CART) analysis was used to identify the 30-day mortality split in APACHE II scores.

Results
Seventy patients were included; 58 (83%) had received immunosuppressive agents, 47 (67%) had history of SOT, and 19 (27%) had diseases suppressing resistance to infection. Mean patient age was 57 ± 14 years, median (interquartile range) patient APACHE II and Charlson Comorbidity Index scores were 18 (12.5) and 5 (3.75), respectively, with 33 (47%) receiving ICU care at C/T initiation. The most frequent infection sources were respiratory (56%), wound (11%), intraabdominal (10%), and blood and urine (9% each), with 36% having a polymicrobial culture. All-cause 30-day mortality was 19% (n = 13) with clinical cure achieved in 48 (69%) patients. CART analysis identified the 30-day mortality split at APACHE II score > 25 (76% vs. 24%; P = 0.002).

Conclusion
Of 70 IC patients treated with C/T for MDR PA, clinical cure was achieved in 69% and mortality was 19%, consistent with other evaluations reporting on a cross section of patient populations. C/T represents a promising agent for treatment of PA resistant to many traditional antipseudomonal agents in this high-risk population.

Disclosures
Elizabeth B. Hirsch, PharmD, Merck: Grant/Research Support, Research Grant; Nabriva Therapeutics: Advisory Board; Paratek Pharmaceuticals: Advisory Board
2282. Empiric Antimicrobial Therapy and Clinical Outcomes of Infections due to ESBL-producing Klebsiella pneumoniae
Authors: Wendy Fujita Ayako , Clarke Lloyd , Kusztos Amanda E , Doi Yohei 
Published: October 2019

Abstract

Background
Currently, carbapenems are the treatment of choice for invasive infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). However, clinical data supporting this practice are generated largely from cases caused by ESBL-producing Escherichia coli. We aimed to describe the empiric treatments and clinical outcomes of patients infected with ESBL-producing Klebsiella pneumoniae (ESBL-Kp) at UPMC Presbyterian Hospital in Pittsburgh, PA.

Methods
This retrospective study included all adult patients from inpatient admissions at UPMC Presbyterian Hospital who were diagnosed with ESBL-Kp infections. Carbapenem-resistant cases were excluded. Types of cultures included blood, respiratory, urine, and wound. Only one type of culture per patient was included. Demographic and clinical data were collected from the electronic medical records. The study was approved by the University of Pittsburgh IRB.

Results
One-hundred sixty-four patients had ESBL-Kp infection between September 2016 and August 2018. Excluded were those who were considered colonized by the organism and therefore not treated (n = 15); treated with non-carbapenems as definitive therapy (n = 29); or were discharged before final susceptibilities (n = 14). In total, 70 patients met inclusion criteria. Eighteen had bacteremia, 24 had pneumonia, 13 had UTI, and 12 had wound infections. Most common sources of bacteremia included catheter-associated, intra-abdominal infection, and pneumonia. Median age of patients was 62 years. Mean Charleston Comorbidity Index was 4.6. Empiric treatment was divided between three classes: BL-BLI (n = 27, 38.6%), cephalosporins (n = 21, 30%) and carbapenems (n = 18, 25.7%). Twelve patients (17.1%) died during hospitalization. Average hospital length-of-stay was 33.2 days.

Conclusion
Although infections with ESBL-Kp are relatively uncommon, patients have high mortality and prolonged hospitalizations. Treatment practices, including which infections are considered colonization vs. true infection, as well as choice of empirical therapy, vary widely at our institution. Data are still needed to assess mortality outcomes in patients treated empirically with carbapenems vs. non-carbapenems, particularly in high-inoculum infection sites such as pneumonia.

Disclosures
All authors: No reported disclosures.
2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study
Authors: Fong Raymond K C , Donoghue Stephen G , Shafi Humaira , Yen Tan Seow , Boon Lee Wee , Chiu Kit Wong Edmund , Alalageri Vijaya S , Seah Jonathan 
Published: October 2019

Abstract

Background
Numerous reports have emerged about the neurotoxic effects of ertapenem. A recent study supports carbapenem use for the treatment of extended spectrum β-lactamase (ESBL)- producing Gram-negative bacteremia. This will likely bolster the use of ertapenem as it is a convenient choice to complete antibiotic treatment in an outpatient setting. This study aims to review the incidence of neurotoxicity with ertapenem and the risk factors associated with it.

Methods
A retrospective nested cohort study was conducted in Changi General Hospital in Singapore from January 2015 to Decemeber 2016. All patients who received at least 24 hours of ertapenem were identified. Those who exhibited ertapenem-associated neurotoxic effects were selected as cases while those who did not were included in the pool of controls and randomly selected at a 1:3 ratio.

Results
A total of 544 patients were treated with ertapenem in our hospital during this 2-year period. Twenty-five patients (incidence 4.6%) developed neurotoxic manifestations and 75 patients were included as controls. Acute confusion was the commonest reaction (n = 19, 76%) followed by hallucinations (n = 8, 32%) and seizures (n = 5, 20%). Baseline characteristics were similar in both groups; the median age of the cases was 79 years (IQR 71–83 years) and 14 (56%) were males. The median duration of ertapenem use before neurotoxicity occurred was 7 days (IQR 5–11days). The median Naranjo ADR probability score for cases was 7 (range 5 to 7) which suggests a probable relationship. Univariate analysis showed that renal impairment (with CrCl< 60 mL/minute) (OR 3.31, 95% CI 1.03–10.64), a history of a vulnerable brain (including stroke and epilepsy etc)(OR 2.61 95% CI 1.03–6.61) increased the risk of neurotoxicity. Neurotoxicity was also significantly associated with longer hospitalization (median 21 days, p = 0.03).

Conclusion
Our study suggests that renal impairment or a history of vulnerable brain may increase the risk for ertapenem-associated neurotoxicity. Hence, caution should be exercised when ertapenem is used to treat these individuals. Future prospective studies to further evaluate risk and to derive a prediction scoring system may help to reduce the incidence of neurotoxic adverse events with ertapenem use.

Disclosures
All authors: No reported disclosures.
2284. Treatment and Clinical Outcomes Among Infected Patients with Colistin-resistant Klebsiella pneumoniae Bacteremia.
Authors: Prawang Abhisit , Santimaleeworagun Wichai , Changpradub Dhitiwat , Thunyaharn Sudaluck , Puttilerpong Chankit 
Published: October 2019

Abstract

Background
In recent years, the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) and colistin-resistant Klebsiella pneumoniae (CoRKP) is one of the leading causes of nosocomial infection worldwide. It has become a public health concern and high mortality, which the few treatment options are available. Salvage treatment caused by CoRKP is still unknown. Here, we explored the 14-day and in hospital mortality to understand the threat to clinical and public health. In addition, we determined the treatment regimen for salvage therapy due to CoRKP bacteremia.

Methods
This was a single-center retrospective cohort study conducted from 2016 to 2018. A total of 96 patients with bacteremia were included; they were classified into three groups according to the infected pathogens with non-carbapenem-resistant Klebsiella pneumoniae (non-CRKP); CRKP and CoRKP. Treatment regimen, 14-day mortality and in hospital mortality were reviewed and compared.

Results
Fifty-eight, 10 and 28 patients infected with non-CRKP, CRKP and CoRKP, respectively. The 14-day mortality rate of patients infected with non-CRKP, CRKP and CoRKP was 12.07%, 40% and 60.71%. In hospital mortality was 24.41%, 70% and 82.14%, respectively. All of mortality outcomes had statistically significant different between both of the CoRKP and CRKP group compare to non-CRKP group (P < 0.05). The treatment regimen associated with a favorable outcome on 14-day survival rate in patients with bacteremia due to CoRKP was the antibiotic combination therapy included aminoglycoside (gentamicin or amikacin) with fosfomycin with or without tigecycline. In addition, combination therapy should be avoided prescribing of colistin which supported by lowest survival rate.

Conclusion
Patients infected with CoRKP bacteremia was the highest 14-day and in hospital mortality. However, the new salvage regimen consisting of aminoglycoside with fosfomycin with or without tigecycline combination was associated with favorable the 14-day survival rate.

Disclosures
All authors: No reported disclosures.
2293. Revival of Polymyxins: A Single-Center Historical Cohort of Critically Ill Patients in Brazil
Authors: Maria Dantas de Maio Carrilho Claudia , Bento Talizin Thalita , Lopes Camila R , Patruceli Azevedo Isabella , Paes Kesia , Maria Alves da Silva Leticia , Magalhaes Carvalho Grion Cintia , Tibery Queiroz Cardoso Lucienne , Maria Boll Karine , Alexandrino Servolo Medeiros Eduardo 
Published: October 2019

Abstract

Background
The epidemiological scenario of multidrug-resistant bacteria has brought polymyxins back to medical prescriptions, as they are last-line therapy against carbapenem-resistant bacteria. There is a lack of knowledge of which is the best way to use this drug, especially in critically ill patients. We aimed to evaluate polymyxin use in an intensive care unit (ICU) in a university hospital and to describe its epidemiological characteristics.

Methods
This historical cohort included all consecutive patients who used polymyxins to treat ventilator-associated pneumonia from January 1, 2017 to January 31, 2018, during hospitalization in an ICU from a public university hospital, endemic for carbapenem-resistant bacteria, in Londrina, Brazil. Microbiological processing for diagnosis followed the guidelines from the Clinical and Laboratory Standards Institute (CLSI). Statistical analyses were performed using MedCalc for Windows, version 18.9 (MedCalc Software, Ostend, Belgium) and significance level adopted was 0.05.

Results
There were 179 patients; median of age was 57 years (IQR: 40.0 - 70.75). Polymyxin B was the most prescribed polymyxin (97.2%). Most of the patients had comorbidities (72.6%). Age was higher in the group of patients who died (60.0 vs. 36.5 years, P < 0.0001). Comorbidities prevalence was higher in non-survivors (80.7% vs. 38.2%, P < 0.0001). Sequential Organ Failure Assessment (SOFA) score on polymyxin prescribing day was higher in non-survivors (8.0 vs. 7.0, P = 0.0093), as well as Simplified Acute Physiology Score 3 (SAPS 3) score (70.7 vs. 59.35, P = 0.0003). Thirty-day mortality was 43%. Analysis of 14-day survival showed a higher mortality for patients who had sepsis (Log-rank test, P = 0.0284) and septic shock (Log-rank test, P = 0.0065). Acinetobacter baumannii was the most common etiologic agent, in 125 samples (73.9%), with 97.6% of resistance to carbapenem and 5.6% of resistance to polymyxins.

Conclusion
Polymyxin B was the most prescribed polymyxin. Age was higher in non-survivors, as well as comorbidities prevalence, SOFA and SAPS 3 scores. Patients with sepsis and septic shock showed a 14-day higher mortality. Acinetobacter baumannii was the most isolated agent. Carbapenem resistance was high.

Disclosures
All authors: No reported disclosures.
2305. Incidence of Active Cytomegalovirus Infection and Its Influence on Outcome Among Non-Immunosuppressed Cirrhotic Adults Requiring Critical Care in Liver-ICU
Authors: Shah Dhara B , Gupta Ekta , Ramalingam Archana , Siva Rao Pasupuleti Samba , Gauri Mitra Lalita , Maiwall Rakhi , Kumar Sarin Shiv 
Published: October 2019

Abstract

Background
Cytomegalovirus (CMV) infection is not very uncommon in critically ill patients as per the studies in past decade. However, the incidence of active CMV infection and its association with clinical outcomes have not been studied for critically ill non-immunosuppressed cirrhotic adults.

Methods
We prospectively evaluated active CMV infection (CMV-plasma-DNAemia; > 500 IU/mL) by real-time polymerase chain reaction and clinical outcome in sero-positive (anti CMV IgG-positive) critically ill non-immunosuppressed adults with chronic liver diseases (all cirrhotics) at day 0, 7, 14 and 21 in Liver-ICU. Patients with prior CMV infection (on day 0) were excluded.

Results
A total of 166 blood samples were collected from 84 enrolled Liver-ICU patients [73 men, median age: 49.5 years, interquartile range (IQR): 40–57.5]. Of 84, 29 died/discharged before day 7, leaving 55 patients in study. Cumulative incidence of active CMV infection was 30.9% (95% confidence interval, CI: 19.1–44.80) at 7-day follow-up. The incidence rate (or density) of active CMV infection was 2.75% per person-day (95% CI: 1.68–4.26% person-day) during 21-day follow-up. Acute on chronic liver failure (n = 12, 63.16%; P = 0.003) was the most common clinical presentation among patients with active CMV infection. On multivariate analysis, significant factors for active CMV infection were bacterial infections (P = 0.031, odds ratio (OR): 0.07, 95% CI: 0.01- 0.78) and leucocytosis (P = 0.047, OR: 1.15, 95% CI: 1.00–1.32). ICU-Mortality did not differ between patients with and without active CMV infection (90% vs. 88.57%, P = 1.00). In Cox-regression analysis, active CMV infection was not independently associated with time to death [Hazard Ratio (HR) = 1.18, 95% CI: 0.65 to 2.15, P = 0.58] as well as length of stay (LOS) in ICU (9.50, IQR 8–16.50 vs. 12, IQR 8–18 days; HR: 1.12; 95% CI: 0.64–1.97, P = 0.68).

Conclusion
Incidence rate of active CMV infection is considerable in critically ill non-immunosuppressed cirrhotic adults. This study did not find significant association of active CMV infection with ICU-mortality and LOS in ICU among critically ill cirrhotic patients. Further studies with optimum frequency for monitoring of active CMV infection are needed to clarify its impact on clinical outcomes.

Disclosures
All authors: No reported disclosures.
2310. No Recurrence in Recovered People with CCHF: A Cross-Sectional Study From Turkey, Preliminary Report
Authors: Koksal Iftihar , Aksoy Firdevs , Kaya Selcuk , Tas Mustafa , Yilmaz Gurdal 
Published: October 2019

Abstract

Background
Crimean-Congo hemorrhagic fever (CCHF) is a widespread, tick-borne disease of humans. CCHF is an endemic in Turkey, and since 2004 many cases have been reported from different regions in the country. CCHF infection in humans can lead to antibody responses that can be protective but there is limited data about the immunity of CCHF. The aim of this study was to investigate the possibility of recurrence of CCHF in people who previously had this disease.

Methods
The patients who were diagnosed with CCHF between 2005 and 2018 were followed up and contacted via phone in order to answer several survey questions about CCHF. Patients who still live in the same places, who have high risks of disease transmission because of husbandry or farming and high potential of contact with ticks were included in this study. Those who changed their living place and stopped husbandry or farming were excluded from this study. The questions in the survey are the following: Have you had CCHF after your discharge from the hospital?; Has there been any tick contact?; Did you ever get a tick removed from your body? Did you or your family members have CCHF at the same time or at different periods of time? Has anyone had CCHF in the area you live? Do your animals have ticks? Do you live in the same place? Have you changed your job?

Results
Ninety-nine out of 351 patients who were contacted via phone had data eligible to be included in the criteria. The amount of time elapsed after the discharge of the patients was between 1 and 14 years in average. None of the patients had experienced CCHF disease again. Also, 6 of these patients were bitten by ticks repeatedly (2–5 times). An average of 7–10 years had passed since the transmission of the disease by the patients.

Conclusion
The results show that the CCHF disease creates an immune response and this response continues for a long time. The findings will be more enlightening with the measurement of the serum antibody levels of patients.

Disclosures
All authors: No reported disclosures.
2316. RSV Mortality: 19 Years’ Experience in a Pediatric Hospital in Argentina
Authors: Gentile Angela , Florencia Lucion Maria , del Valle Juárez María , Soledad Areso María , Paglieri Lucia , Agustina Pirker María , Bakir Julia , Viegas Mariana , Goya Stephanie , Mistchenko Alicia S 
Published: October 2019

Abstract

Background
Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection (ALRI) in children. We aimed to describe the clinical–epidemiological pattern and risk factors for mortality associated with RSV infection.

Methods
Prospective, cross-sectional study of ALRI in children admitted to a Children’s Hospital among 2000–2018. Viral diagnosis was made by fluorescent antibody techniques or real-time PCR. We compared clinical–epidemiological characteristics of RSV infection in nonfatal vs. fatal cases. Multiple logistic regression was used to identify independent predictors of mortality.

Results
From a total 16,018 patients with ALRI, 13,545(84.6%) were tested for respiratory viruses, 6047 (45%) were positive: RSV 81.1% (4,907), influenza 7.5% (456), parainfluenza 6.9% (419) and adenovirus 4.4% (265). RSV had a seasonal epidemic pattern coinciding with months of lowest average temperature. RSV mortality rate: 1.7% (83/4,855). Fatal cases had a higher proportion of: prematurity (P < 0.01), perinatal respiratory history (P < 0.01), malnourishment (P < 0.01), congenital heart disease (P < 0.01), chronic neurological disease (P < 0.01) and pneumonia as clinical presentation (<0.01). No significant difference between gender was observed. The annual mortality rate distribution was not stable over the study period with the highest mortality in the year 2002. Most deaths occurred among children who had complications: respiratory distress (80.7%), sepsis (31.3%) and atelectasis (13.2%). Independent predictors of RSV mortality were: moderate to severe malnourishment OR 3.64 (95% CI 1.96–6.74)P < 0.01, chronic neurological disease OR 3.99 (95% CI 2.04–7.79) P < 0.01, congenital heart disease OR 4.10 (95% CI 2.36–7.15)P < 0.01 and age under 6 months OR 1.96 (95% CI 1.23–3.11)P < 0.01.

Conclusion
RSV showed an epidemic seasonal pattern. Malnourishment, chronic neurological disease, congenital heart disease, age under 6 months and pneumonia were the independent risk factors for RSV mortality.

Disclosures
All authors: No reported disclosures.