bluuebunny/crossref_metadata_2025_split huggingface dataset:
1487. Recent Resurgence of Salmonellosis-Related Mortality in the United States, 1990–2015
Authors: Panchal Palak , Sorvillo Frank , Dworkin Mark S 
Published: October 2019

Abstract

Background
Non-typhoidal salmonellosis is one of the most common causes of foodborne illness in the United States. The objective of this study was to update the epidemiology of salmonellosis-related mortality in the United States by examining multiple-cause-of-death data (MCOD).

Methods
MCOD data from the National Center for Health Statistics (NCHS) for the years 1990–2015 were analyzed. Mortality rates and 95% confidence intervals (CI) were calculated for age, sex, race/ethnicity, year, and state. Poisson regression models were used to examine temporal trends. Logistic regression was used to determine whether selected comorbid conditions were associated with salmonellosis-related deaths.

Results
Overall, 1,987 salmonellosis-related deaths (3.17%) were identified as an underlying and/or associated cause of death. The average annual age-adjusted mortality rate was 0.027 per 100,000 person-years. Salmonellosis mortality rates were higher among males with an age-adjusted rate ratio (RR) of 1.89 (95% CI, 1.79–2.01) compared with females. Mortality rates were higher among non-Hispanic Blacks and Asian/Pacific Islanders with an age-adjusted RR of 2.46 (95% CI, 2.19–2.77) and 2.06 (95% CI, 1.67–2.55) compared with Whites, respectively. The highest number of salmonellosis deaths were reported among the 75–84 year age group (n = 467; 24% of all cases). A significant decrease in trend was observed in age-adjusted salmonellosis mortality rates from 1990 to 2015. Since 2006, a significant increase of 66% in mortality rates was observed. Among selected comorbid conditions, HIV, acute renal failure, cancers affecting bone marrow, and diseases of the digestive system were associated with salmonellosis deaths with odds ratios of 11.51 (95% CI 8.78–15.10), 3.09 (95% CI, 2.01 = 4.75), 2.81 (95% CI, 1.67–4.74), and 2.82 (95% CI, 2.34–3.40), respectively.

Conclusion
Salmonellosis is an underlying and/or associated cause of death, especially among those with immune senescence and suppression. Despite a substantial decline in mortality rates, since 2006 rates have increased, a concerning trend. If rates continue to increase, an evaluation of Salmonella prevention efforts will be warranted.

Disclosures
All authors: No reported disclosures.
1603. Observation of Treatment Outcomes During an Outbreak of Multidrug-Resistant Shigella sonnei Infections in a Retirement Community—Vermont, 2018
Authors: Gharpure Radhika , Francois Watkins Louise , Francois Watkins Louise , Fialkowski Veronica , Collins Jennifer P , Strysko Jonathan , Marsh Zachary A , Tagg Kaitlin A , Meservey Elizabeth H , Adediran Azizat , Schroeder Morgan N , Wadhwa Ashutosh , Fullerton Kathleen E , Friedman Cindy R , Friedman Cindy R 
Published: October 2019

Abstract

Background
In 2018, CDC and the Vermont Department of Health investigated an outbreak of multidrug-resistant Shigella sonnei infections in a retirement community. Most Shigella infections are self-limited, but antibiotics are indicated for severe illness and sometimes to limit transmission. The Clinical and Laboratory Standards Institute has not yet established breakpoints for azithromycin, so laboratories cannot report resistance. Although breakpoints exist for ciprofloxacin, isolates with one fluoroquinolone resistance mechanism typically have minimum inhibitory concentrations within the susceptible range (≤ 0.25 µg/mL).

Methods
We reviewed charts for treatment outcomes of outbreak patients to evaluate clinical and microbiologic response. We defined clinical failure as ≥ 3 loose stools per day for ≥ 1 day after completion of antibiotics and microbiologic failure as a positive stool culture after completion of antibiotics. We used broth microdilution to perform antimicrobial susceptibility testing, and whole-genome sequencing to identify resistance mechanisms.

Results
Among the 24 patients with culture-confirmed Shigella infection, 4 were hospitalized and 2 died. All isolates were multidrug-resistant (Table 1) and harbored mechanisms for resistance to ampicillin, ceftriaxone, trimethoprim-sulfamethoxazole, azithromycin, and ciprofloxacin. Fifteen patients received one course of ciprofloxacin, 5 received multiple courses of antibiotics, and 4 received no antibiotics. Overall, 6 patients had treatment failure (Table 2); all 4 patients who received azithromycin had subsequent clinical failure and 2 also had microbiologic failure. Two patients had failure after ciprofloxacin (1 clinical, 1 microbiologic).

Conclusion
This outbreak of highly resistant shigellosis highlights the importance of comprehensive susceptibility testing and systematic outcome studies. Evidence of treatment failure after azithromycin suggests that an appropriate clinical breakpoint is needed to inform clinical decision-making. Ciprofloxacin treatment failures were observed in patients with a susceptible strain harboring a resistance mechanism, warranting further investigation.

Disclosures
All authors: No reported disclosures.
1609. Using a Novel Rapid Test to Investigate a Multistate Outbreak of Coccidioidomycosis Among US Residents Returning From Mission Trips in Baja California, Mexico, June–July, 2018
Authors: Toda Mitsuru , Caceres Diego H , Gonzalez Francisco J , Pomeroy Mary , Bergeron Genevieve , Wilson Eliza , Franklin Patrick , Kresl Laura , Lunquest Kristy , Raybern Chelsea , Ratner Adam J , Chiller Tom M , Jackson Brendan R , Lindsley Mark , McCotter Orion 
Published: October 2019

Abstract

Background
In August 2018, New York City health authorities notified CDC of two students with pneumonia and rash following mission trips to Mexico. Send-out Coccidioides serology tests took 7 days for results to return. Both students and five additional travelers from four states were diagnosed with coccidioidomycosis. A seroepidemiologic survey implicated soil-disturbing activities at a single site as a likely source. Given the time to diagnosis observed, we examined the use of a novel one-hour lateral flow assay (LFA).

Methods
We interviewed and collected sera from people who traveled with seven case-patients during June‒July 2018 and performed LFA, enzyme immunoassay (EIA), and immunodiffusion (ID). We asked travelers about exposures and symptoms and compared test results with reports of ≥1 coccidioidomycosis symptom(s) within 6 weeks of travel.

Results
Of 133 travelers, we interviewed 108 (81%) and collected sera from 75 (56%). Majority were male teenagers. One-third (34%, 37/108) reported symptoms, and of those, 43% (16/37) sought healthcare. Four were hospitalized, including one in intensive care, for a median of 7 days (range 3–12). Only six (6%) had previously heard of coccidioidomycosis. One-third (32%, 24/75) tested LFA positive, 10 (13%, 10/75) EIA positive, and eight (11%, 8/75) ID positive. Seventy-one percent (17/24) with positive LFA reported symptoms, compared with 83% (10/12) with positive EIA, 100% with positive ID (8/8), and 31% (16/51) with negative LFA. Of 51 travelers with negative LFA, we observed one positive EIA and no positive ID.

Conclusion
In this outbreak that resulted in a high attack rate and prolonged hospitalizations, the rapid one-hour LFA appeared as a useful screening tool compared with send-out testing, which took at least 7 days to return. The proportion of symptomatic LFA-positive travelers was nearly as high as for those with positive EIA, and we observed agreement with EIA and ID-negative results. Whether 12 people with positive LFA but negative EIA and ID truly had infection is unclear. Further evaluation to examine sensitivity and specificity of LFA are needed. Additionally, greater education is needed for groups traveling to coccidioidomycosis-endemic areas.

Disclosures
All authors: No reported disclosures.
1742. Kinetics of CMV Viremia with Letermovir Prophylaxis in the First 100 Days post Hematopoietic Cell Transplantation (HCT): A Single-center Experience
Authors: Zavras Phaedon D , Stern Anat , Su Yiqi , Fang Jiaqi , Giralt Sergio , Perales Miguel , Maloy Molly , Seo Susan K , Papanicolaou Genovefa 
Published: October 2019

Abstract

Background
Letermovir (LTV) is approved for the prevention of CMV infection in CMV seropositive (R+) HCT recipients. Low rates of CMV breakthrough viremia have been reported with LTV prophylaxis. We studied the kinetics of CMV reactivation up to day (D) +100 in patients (patients) receiving LTV prophylaxis and compared them to historical controls not receiving LTV.

Methods
Retrospective cohort study of CMV R+ recipients of peripheral blood or marrow allografts at MSKCC during 2017–2018. Routine LTV prophylaxis was implemented in MSKCC in December 2017. Patients were categorized based on LTV prophylaxis to LTV group (LTV prophylaxis) and no LTV group [managed with preemptive therapy (PET)]. Routine CMV monitoring was performed weekly by a qPCR assay in plasma from D +14 through D +100. CMV viremia was defined as any detectable CMV viral load (VL). Clinically significant CMV viremia (csCMV) was defined as any CMV VL treated preemptively. CMV end-organ disease (EOD) was assessed by standard criteria. LTV resistance was tested at Viracor-Eurofins Laboratories after May 2018.

Results
Of 193 R+ HCT, 98 (50.8%) were in the LTV and 95 (49.2%) in the no LTV group. CMV viremia occurred in 43 (43.9%) patients in LTV and 63 (66.3%) in no LTV (Figure 1). CMV viremia occurred earlier in LTV compared with no LTV (median, 19 vs. 26 days post HCT, respectively, P = 0.009). The duration of CMV viremia was shorter in LTV compared with no LTV (median 16 days vs. 35 days, respectively; P < 0.0001). The peak CMV VL was lower in LTV compared with no LTV (median, 137 IU/mL vs. 578 IU/mL, respectively); P < 0.0001. Rates of csCMV viremia were significantly lower in LTV compared with no LTV (5.1% vs. 54%, respectively); P < 0.0001 (Figure 2). LTV group received a total of 134 PET-days and no LTV group received 2,160 PET-days by D +100. No patient in LTV developed CMV EOD, while two patients in no LTV developed CMV duodenitis. LTV resistance was documented in 2 patients (2% of the LTV group). Overall survival by D +100 was similar between LTV and no LTV groups.

Conclusion
Implementation of LTV prophylaxis significantly reduced rates of csCMV infection and resulted in 93.8% reduction in total PET days. Among patients with csCMV viremia, LTV group had a shorter duration of viremia and lower peak CMV VL compared with no LTV.

Disclosures
All authors: No reported disclosures.
1754. Pre-Transplant Vaccination Rates in Solid-Organ Transplant Recipients
Authors: Friedman Daniel , Belga Sara , Burton Catherine , Preiksaitis Jutta , Kabbani Dima 
Published: October 2019

Abstract

Background
Recipients of solid-organ transplants (SOT) are at increased risk of vaccine-preventable illnesses. Because of the immunosuppression administered following SOT, live vaccines are generally contraindicated post-SOT, and response to inactivated vaccines may be suboptimal. National and international guidelines recommend optimizing immunizations prior to SOT. We analyzed rates of vaccination for SOT candidates in a cohort of adult kidney and liver transplant recipients.

Methods
A retrospective chart review of adult kidney, kidney/pancreas (KP) and liver transplant recipients was conducted between 2014 and 2016. We calculated the rates of vaccinations of the following vaccines: pneumococcus, meningococcus, Hepatitis A and B, Haemophilus influenzae type B, measles, mumps, rubella, polio, tetanus, diphtheria and pertussis.

Results
300 patients were included (147 kidney, 14 KP, 139 liver). Liver recipients were older (mean age 53 vs. 50; P = 0.028) and less likely to have had a previous transplant (5.8% vs. 21.1%; P < 0.001) or a living donor (15.8% vs. 32.3%, P = 0.01). Liver recipients were more likely to have been vaccinated against hepatitis A (106 [53.9%] vs. 28 [17.4%]; P < 0.001). Kidney and KP recipients were more likely to have received at least 1 dose of hepatitis B vaccine (138 [85.7%] vs. 91 [65.5%]; P < 0.001) or at least 1 dose of any of the pneumococcal vaccines (PSV23 94 [67.6%] vs. 92 [57.1%]; P = 0.062; PCV13 130 [80.7%] vs. 93 [66.9%]; P = 0.006; pneumococcal vaccine not clarified 47 [29.2%] vs. 14 [10.1%]; P < 0.001). No difference was observed with regards to other vaccines (Table 1). Being a kidney transplant recipient increased the odds of getting at least 1 dose of hepatitis B, tetanus/diphtheria/acellular pertussis (Tdap), measles, and pneumococcal vaccine (OR = 1.75, 95% CI [1.063–2.864]; P = 0.028)

Conclusion
In our cohort, kidney transplant recipients were more likely to have received pre-transplant vaccination. Despite the availability of local and international guidelines, vaccination in SOT candidates remains suboptimal and further study of barriers to implementation of these guidelines is warranted to inform future quality improvement initiatives.

Disclosures
All authors: No reported disclosures.
1755. Assessment of Vaccine Rates in Solid-Organ Transplant Recipients and Identification of factors Associated with Completion of Vaccination
Authors: Parraga Acosta Tommy J , Hanna Zachary W , Daering Nicholas J , Vahia Amit T , Alangaden George J 
Published: October 2019

Abstract

Background
Vaccine administration is an essential component of pre and post-transplant care. Although Society guidelines for vaccination of solid-organ transplant recipients (SOT) are published, rates of vaccination remain low and potential factors influencing these rates are not well identified.

Methods
A retrospective review of electronic medical records (EMR) was done for all adult SOT patients who underwent transplantation from January 2015 to December 2016 at Henry Ford Hospital, Detroit, MI. Sociodemographic data, comorbidities, and vaccination status at 1-year post-SOT for influenza, pneumococcus, hepatitis A and B, Tdap, and Td vaccines were assessed from EMR and the Michigan Care Improvement Registry. Data were analyzed using SAS 9.4 software, univariate analysis was done with Chi-square test, t-test, and multivariate analysis with logistic regression.

Results
530 patients underwent SOT during the study period. Characteristics of the study population are shown (Table 1). The median age was 59, mean Charlson Comorbidity Index was 5.25, 58.3% had smoking history. At 1-year post SOT, 88.7% had received ≥1 vaccine(s), whereas 11.3% received no vaccines. Most patients received vaccines before SOT. Influenza (69.4%) and pneumococcal (69.3%) vaccines were the most administered (Table 2). On univariate analysis, pre-SOT visits with a primary care provider (PCP), transplant team or PCP based at our institution were significantly associated with vaccination (Table 3). On multivariate analysis, PCP based at our institution (odds ratio [OR], 2.03 [95% confidence interval {CI}, [1.06–3.88], P = 0.033) and pre-SOT PCP visits (OR 1.47, [95% CI 1.11–1.96], P = 0.008) were significantly associated with vaccine uptake. Smoking history negatively impacted vaccine uptake (Table 4). Patients who had received the influenza vaccine(s) were significantly associated with increased uptake of other vaccines (P < 0.0001).

Conclusion
Despite guidelines, vaccination rates in SOT patients remain low at our institution. Factors associated with improved vaccination were institution-based PCP, pre-SOT PCP visits and receipt of influenza vaccines. A multidisciplinary approach is required for the optimization of vaccination rates in the SOT population.

Disclosures
All authors: No reported disclosures.
1758. Epidemiology of Invasive Mycoplasma and Ureaplasma Infections Early after Lung Transplantation
Authors: Baker Arthur W , Messina Julia A , Maziarz Eileen K , Saullo Jennifer , Miller Rachel , Miller Rachel , Wolfe Cameron R , Arif Sana , Reynolds John M , Perfect John R , Alexander Barbara D 
Published: October 2019

Abstract

Background
Mycoplasma and Ureaplasma species can cause invasive infections early after lung transplant that are difficult to diagnose and associated with substantial morbidity, including hyperammonemia syndrome. Data on the epidemiology and clinical outcomes of these infections are needed to inform clinical management and screening protocols for donors and recipients.

Methods
We retrospectively collected clinical data on all patients who underwent lung transplantation at our hospital from January 1, 2010 to April 15, 2019 and subsequently had positive cultures or PCR studies for M. hominis or Ureaplasma spp. Patients with positive studies from only the genitourinary tract were excluded. We analyzed donor and recipient clinical characteristics, treatment courses, and outcomes for up to 2 years after transplant.

Results
Of 1055 total lung transplant recipients, 20 (1.9%) patients developed invasive infection with M. hominis or Ureaplasma spp. M. hominis caused the first 10 infections (2010–2016), and Ureaplasma spp. caused 10 subsequent infections (2017–2019). Date of first positive culture or PCR study occurred a median of only 19 days after transplant (range, 4–90 days). Median donor age was 31 years (range, 18–45 years), and chest imaging for 16 (80%) donors revealed airspace disease compatible with aspiration. Infection outside of the respiratory tract was confirmed for 13 (65%) recipients, including 8 patients with M. hominis empyemas (Figure 1). Ten (50%) patients developed altered mental status that was temporally associated with infection; 8 (80%) of these patients had elevated serum ammonia levels, including 3 patients with M. hominis infection. Median duration of therapy was 6 weeks (IQR, 4–9 weeks), consisting of combination antimicrobial regimens for nearly all patients. Additional postoperative complications were common, and 11 (55%) patients died within 1 year after transplant (median, 117 days; IQR, 65–255 days) (Figure 2).

Conclusion
Ureaplasma and M. hominis infections occurred early after lung transplant and were associated with substantial morbidity and mortality. Transplant clinicians should have low thresholds for performing specific diagnostic testing for these organisms. Protocols for donor and recipient screening and management need to be developed.

Disclosures
Rachel Miller, MD, Synexis: Research Grant.
1768. Dengue Virus Infection in Solid-Organ Transplant Recipients: Case Series and Literature Review
Authors: Rosso Fernando , Sanz Ana M , Parra-Lara Luis Gabriel , Moncada Pablo A , Vélez Juan D , Caicedo Luis A 
Published: October 2019

Abstract

Background
Dengue fever is the most prevalent arbovirus among humans, its incidence has increased since the re-emergence, and Colombia is a hyperendemic country for this infection. The number of solid-organ transplant (SOT) recipients, at risk of acquiring dengue virus infection, is constantly increasing, and there are few data regarding the clinical course and outcomes of dengue infection among this population. The aim of this study was to describe dengue virus infection in SOT recipients in Cali, Colombia.

Methods
We present a case series of SOT recipients with dengue virus infection, diagnosed by World Health Organization criteria and a positive NS1 and/or IgM dengue antibodies, which were attended at the FVL from 2001 to 2018. Furthermore, we performed a literature review regarding dengue infection in SOT recipients.

Results
A total of 20 patients were included: 17 kidney and 3 liver recipients. The median age was 50.5 years (IQR = 31–63.5), 65% were female. The median time from transplant to dengue was 27.6 months (IQR = 3.82–59.12), and 3 patients had the infection in the first month after the transplant. The most common symptoms were fever (95%), myalgia, headache, and abdominal pain. Warning signs were present in 75% of patients, thrombocytopenia and hemorrhagic manifestations were present in 30% and 15%, respectively. 35% of patients were classified as severe dengue, and 45% were managed at the intensive care unit. Regarding laboratory findings, six patients had transaminases elevation more than three times the upper limit and 7 had serum creatinine elevation, which returned to normal levels. All patients were discharged and none of them had alterations in the graft function. To date, there are approximately 180 reported cases of dengue in SOT recipients (Table 2).

Conclusion
Dengue represents a threat among SOT recipients. Unlike other reports, all patients in this series had a full recovery after the infection, suggesting that timely and effective management of patients and the access to high complexity services could prevent fatal cases.

Disclosures
All authors: No reported disclosures.
1772. Factors that Influence Viral Load in Patients Infected with Influenza Over Multiple Seasons
Authors: Shaw-Saliba Katy , Hsieh Yu-Hsiang , Rothman Richard E 
Published: October 2019

Abstract

Background
The factors that influence influenza viral load are poorly understood, but may have important implications for viral transmission and disease severity. We explored the relationship between patient and virus factors on influenza viral load across 4 consecutive influenza seasons.

Methods
Adult influenza-positive patients presenting to emergency departments in Baltimore, MD and Taipei, Taiwan between 2014 and 2018 were consented and enrolled. Nasopharyngeal (NP) samples and detailed paired data on symptom duration, demographics, and vaccination were collected. Viral load was inferred using the cycle threshold (Ct) values from quantitative real-time RT–PCR assays for 299 samples and influenza subtype was determined. Bivariate and multivariate analyses were conducted.

Results
Viral load was impacted by both patient and virus characteristics. Older age and shorter duration of symptoms was associated with a higher viral load (age: Ct difference -0.04, P = 0.022. symptoms: each increasing day, Ct difference +1.02, P < 0.001). Seasonal variability was observed, with the highest viral load associated with the 2014–2015 predominant H3N2 subtype (Ct 21.69, P < 0.001), where there was also a vaccine mismatch. Across seasons, H1N1 was associated with a lower viral load than H3N2 (Ct value + 2.66, P < 0.001). There was not association between gender and immunosuppression on viral load.

Conclusion
Our study demonstrates that both host and virus factors that can affect Ct values and inferred viral loads. As anticipated, higher viral load, were found to be associated with older age and shorter duration of symptoms; interestingly infection with the H3N2 subtype, traditionally associated with more severe disease was also associated with higher viral loads. Future-focused studies are required to better characterize these relationships, and directly evaluate relevance to both transmission and disease severity.

Disclosures
All authors: No reported disclosures.