bluuebunny/crossref_metadata_2025_split huggingface dataset:
1141. Composition of Placental Cultures and Correlation with Maternal and Infant Blood Cultures in Mothers with Suspected Chorioamnionitis
Authors: Gordon Laurel , Adam Kaavya , Kelly Kristen , Amin Sachin , Harrington Amanda 
Published: January 2021

Abstract

Background
Placental culture is often used in combination with placental pathology in pregnant women with suspected chorioamnionitis. While multiple studies have looked at the correlation of placental cultures with neonatal outcomes, few have looked at the composition of placental cultures in terms of the number of organisms and their identification. Our study aims to describe such characteristics of placental cultures and to compare organisms found in placental cultures with those in maternal and infant blood cultures.

Methods
We performed retrospective chart reviews on mothers and infants for whom a placental pathology and culture was sent at Loyola University Medical Center between January 2017 and December 2019. We separated the mothers based the results of their placental cultures and pathologies and on the number of organisms found in each culture. We then analyzed the identification of organisms of the positive cultures and compared these organisms with positive infant and maternal blood cultures.

Results
A total of 208 placental cultures out of 279 sent (73.84%) were positive. 63 (30.29%) positive cultures were monomicrobial, while 145 (69.71%) cultures were polymicrobial. The most prevalent organisms found in all placental cultures were coagulase negative staphylococcus (26.44%), Streptococcus anginosus (16.83%), Corynebacterium species (14.90%), Lactobacillus species (14.90%), and Gardnerella vaginalis (13.94%). A small fraction of positive placental cultures was associated with positive infant and maternal blood cultures (4.33% and 3.85%, respectively). When comparing the organisms in placental cultures with those in maternal and infant blood cultures, 100% and 71% (respectively) of cases with both positive blood and placental cultures had shared organisms.
Distribution of most common organisms found in monomicrobial and polymicrobial placental cultures.

Distribution of placental cultures based on number of organisms.

Correlation of placental cultures with infant and maternal blood cultures.

Conclusion
The data collected from this study helps provide a biological profile of organisms found in placental culture for patients with suspected chorioamnionitis. Additionally, the data suggests that the organisms found in these cultures are often consistent with those found in maternal and infant blood cultures. The overall incidence of positive infant and maternal blood cultures is low as compared to positive placental cultures.

Disclosures
Amanda Harrington, PhD, Beckman Coulter (Scientific Research Study Investigator)
1143. Late-Onset Hearing Loss and Antiviral Therapy for Congenital Cytomegalovirus Infection
Authors: Medoro Alexandra K , Hanlon Cory T , Pifer Traci , Escamilla Maria Reyes , Shimamura Masako , Findlen Ursula M , Gerth Holly , Adunka Oliver , Malhotra Prashant , Sanchez Pablo J 
Published: January 2021

Abstract

Background
Congenital cytomegalovirus (CMV) is the leading non-genetic cause of sensorineural hearing loss (SNHL) in children. While SNHL is often present at birth, as many as 25% of congenital CMV-infected infants may develop late-onset hearing loss. Antiviral therapy improves hearing outcomes, but its effect on the occurrence of late-onset SNHL is not fully known. Thus, our objective was to describe the prevalence of late-onset SNHL among congenital CMV-infected children treated with antiviral therapy in the first month of age.

Methods
From 2013 to present, infants with congenital CMV infection referred to Nationwide Children’s Hospital’s (NCH) NEO-ID Clinic, Columbus, OH underwent complete evaluation including hearing testing. Pertinent demographic, clinical, laboratory, and radiographic data were obtained and managed using REDCap electronic data capture tools. Infants who passed the newborn hearing screen and subsequently developed late-onset SNHL were identified and compared with respect to receipt of antiviral therapy in the neonatal period. Statistical analyses were performed using GraphPad Prism for macOS version 8.3.0.

Results
During the 6-year study period, 99 infants had congenital CMV infection and 69 (70%) of them passed the newborn hearing screen. 46 (46%) neonates received antiviral therapy (1, ganciclovir; 38, valganciclovir; 7, both) for clinically apparent congenital CMV infection. One (2%) child developed late-onset SNHL.This infant was born at 37 weeks’ gestation (birth weight, 2525 g) with microcephaly (head circumference, 31 cm) and cerebral calcifications and was diagnosed with congenital CMV infection at 8 days of age. Treatment with valganciclovir was initiated at 9 days of age, and he developed mild unilateral SNHL at 1 month of age while on treatment and subsequently right severe-profound SNHL and left mild-moderate SNHL. In comparison, among 23 infants with clinically inapparent disease who passed the newborn hearing screen and did not receive antiviral therapy, 5 (22%) subsequently developed SNHL (p=0.014).

Conclusion
Infants who received antiviral therapy for clinically apparent congenital CMV infection had significantly less late-onset SNHL than untreated infants, thus supporting a hearing protective effect of antiviral treatment.

Disclosures
All Authors: No reported disclosures
1144. Prevention of Mother-to-Child Transmission of Hepatitis B at UNC Hospitals
Authors: Sayre Wesley M 
Published: January 2021

Abstract

Background
Hepatitis B virus (HBV) contributes to liver-related morbidity and mortality on a global scale. In mothers with active hepatitis B, up to 100% of mother-to-child-transmission (MTCT) is preventable. Guidelines from the American Association for the Study of Liver Diseases (AASLD) recommend that HBV vaccination and hepatitis B immunoglobulin (HBIG) be given to HBV-exposed infants in a timely manner to prevent up to 90% of MTCT. Additionally, AASLD guidelines recommend that women with high-risk HBV (those with viral load &gt;200,000 IU/mL and/or HBV e antigen [HBeAg] positivity) receive tenofovir prophylaxis to further prevent MTCT. In this chart review, we compared UNC Hospital’s prevention of MTCT measures to standing AASLD guidelines.

Methods
This retrospective chart review included data from all HBV-positive mothers giving birth at UNC Hospitals from April 1, 2014 through December 31, 2019. We investigated the HBV status of mothers, time to neonatal HBV vaccination, time to HBIG administration, maternal HBV viral load, maternal HBeAg status, and whether tenofovir was provided for high-risk mothers. Data was then compared to AASLD guidelines distributed in January 2017.

Results
We identified 99 HBV-positive pregnant women over a five-year period. The rate of timely administration of HBIG was 99%. The rate of timely hepatitis B vaccination was 97%. The single neonate who did not receive the HBV vaccination within 12 hours was born to a mother whose HBV testing was initially positive but confirmatory testing was negative. Most (65%) women had documented HBV viral load and 75% of women had HBeAg studies. Nine women were identified as high-risk, with only one not receiving tenofovir.

Conclusion
UNC Hospitals were compliant with AASLD guidelines regarding timely neonatal vaccination, providing nearly 99% of neonates with timely HBIG and all but three neonates with timely HBV vaccine. The majority of high-risk women identified received tenofovir prophylaxis. However, there is room for improvement in laboratory evaluation to identify other high-risk women. While initial data is reassuring, quality improvement measures include improving testing rate to determine risk status for HBV-positive mothers and further investigation of appropriate follow-up testing for both mothers and children.

Disclosures
All Authors: No reported disclosures
1145. The Role of Maternal Vaccination on Healthcare Visits for Acute Respiratory Infections in HIV-Exposed but Uninfected (HEU) Infants
Authors: Kao Carol M , Thomas Amanda S , Camacho-Gonzalez Andres , Sheth Anandi N 
Published: January 2021

Abstract

Background
HEU infants remain at higher risk for hospitalization and severe infection from common childhood illnesses. Maternal immunization during pregnancy with influenza and tetanus, diphtheria, pertussis (Tdap) vaccine is recommended and effective at protecting infants from vaccine-preventable infections.

Methods
We conducted a retrospective cohort study of pregnant women living with HIV (WLWH) who delivered and received prenatal care at Grady Memorial Hospital (GMH) between November 1, 2012 and June 30, 2018. Vaccination history was ascertained through the Georgia Registry of Immunization Transactions and Services or by review of electronic medical record. Mother and infant charts were reviewed. We defined acute respiratory infection (ARI) as infants who presented with symptoms or an admitting diagnosis suggestive of an ARI. Relative risks (RR) of identified care visits (clinic, ED/urgent care, hospitalization) in the 6 months post-partum between WLWH with varying vaccinations were compared with 95% confidence intervals.

Results
236 WLWH who delivered at GMH were identified (Table 1). Of those, 66 (28%) received only influenza, 32 (14%) received only Tdap vaccine, 64 (27%) received both and 74 (31%) did not receive any vaccines during pregnancy. There was a trend towards decreased risk of a clinic visit, emergency department/urgent care visit, or any healthcare-associated visit in the first 6 months of life for an ARI in infants born to mothers who received any vaccine during pregnancy versus none although not reaching statistical significance (Table 2). There was a trend towards decreased risk of hospitalization for an ARI in the first six months of life in infants born to mothers who received both influenza and Tdap vaccines during pregnancy versus unvaccinated (RR 0.55, 95%CI: 0.14-2.22). Infants born to mothers vaccinated tended to have higher gestational age than those that did not (Table 3).
Table 1. Demographic and Characteristics of Mothers

Table 2. Relative Risk of a Healthcare Visit in the first 6 months of life for URI in Vaccinated vs Unvaccinated Mothers

Table 3. Birth outcomes in HEU infants of Vaccinated vs Unvaccinated Mothers

Conclusion
There was a lower risk of healthcare visits for ARI in the first 6-months of life in HEU infants born to mothers who received antepartum vaccinations. Although not statistically significant, larger studies are needed to fully characterize the immune responses in this unique population.

Disclosures
All Authors: No reported disclosures
1147. Short Course of Voriconazole Therapy as a Risk Factor for Relapse of Invasive Pulmonary Aspergillosis
Authors: Shin Dong Hoon , Yoo Seung-Jin , Jung Jongtak , Jun Kang Il , Kim Hyungjin , Kang Chang Kyung , Song Kyung Ho , Choe Pyoeng Gyun , Park Wan Beom , Bang Ji-Hwan , Kim Eu Suk , Park Sang Won , Kim Hong Bin , Kim Nam-Joong , Oh Myoung-don 
Published: January 2021

Abstract

Background
Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection which usually occurs in immunocompromised patients. Recommended duration of voriconazole therapy is a minimum of 6-12 weeks for IPA, despite the lack of any firm evidence. In addition, risk factors for relapse of IPA are still unclear. Here, we explored risk factors for IPA relapse after initial treatment.

Methods
All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography (CT).

Results
Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P=0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P=0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors.

Conclusion
Less improvement in CT, and short duration of voriconazole therapy were the independent risk factors for relapse after treatment of IPA. Longer duration of therapy should be considered for those at higher risk of relapse.

Disclosures
All Authors: No reported disclosures
1150. Breakthrough Invasive Fungal Disease (IFD) in Patients with Acute Myeloid Leukemia (AML)
Authors: Wasylyshyn Anastasia , Linder Kathleen A , Maurer Stephen , Sheffield Virginia , Colon Lydia Benitez , Kauffman Carol A , Miceli Marisa 
Published: January 2021

Abstract

Background
Despite the use of antifungal prophylaxis, IFD remains a serious complication of AML causing extensive morbidity and mortality. This study seeks to clarify our experience with breakthrough infections in patients with AML.

Methods
This retrospective study included all adult patients undergoing induction chemotherapy for a new diagnosis of AML from June 2014 – Dec 2019 at the University of Michigan Hospital. Chart review determined co-morbidities, chemotherapy regimens, allogeneic hematopoietic cell transplant (HCT), antifungal prophylaxis, development of IFD, and outcomes. Patients were followed for 1 year from first induction chemotherapy. EORTC-MSGERC definitions for proven, probable, and possible IFD were used, as were MSGERC-ECMM definitions for breakthrough IFD.

Results
Of 251 patients, mean age was 61.8±14 years, 55% were men, and 73 (29%) underwent allogeneic HCT, 52 of whom developed GVHD. Thirty-one patients developed 33 IFD (12.3%): 4 proven, 12 probable, and 17 possible IFD. Four IFD occurred in patients with GVHD post-HCT; all were treated with high dose steroids and one received an anti-TNF agent. Of the 16 proven and probable IFD, 8 were breakthrough IFD. Mucormycosis occurred in 2 patients on voriconazole; fusariosis occurred in 3 patients taking fluconazole (2), or posaconazole (1). Aspergillosis occurred in 2 patients taking isavuconazole (1) or fluconazole (1), and pneumocystosis occurred in a patient receiving inhaled pentamidine. There were 8 non-breakthrough IFD, including 2 pneumocystosis, 4 aspergillosis, and 2 candidiasis. Risk for IFD increased with subsequent episodes of induction chemotherapy, p=.04.
Six of 8 patients with breakthrough IFD and 5 of 8 without breakthrough IFD died within 12 weeks of IFD diagnosis. Excluding the 15 patients who had only possible IFD, 69% (11/16) patients with proven/probable IFD died compared with 35% (77/220) patients without IFD, p=.01.

Conclusion
Patients with AML remain at risk for fatal IFD despite the use of antifungal prophylaxis. Failure of prophylaxis in our patients who developed breakthrough IFD was associated with a shift towards less common fungi.

Disclosures
All Authors: No reported disclosures
1153. Characterization of Invasive Mold Infections in Acute Leukemia and Hematopoietic Stem Cell Transplant Recipient Patients and Risk Factors for Mortality - a Single Center Experience
Authors: Kubat Ryan , Subramanian Praveen , Li Yanming , Hammoud Kassem , Eid Albert , Dias Ajoy , El Atrouni Wissam 
Published: January 2021

Abstract

Background
Invasive mold infections (IMIs) remain a significant cause of morbidity and mortality in patients with acute leukemia (AL) and those undergoing hematopoietic stem cell transplantation (HSCT). We describe the epidemiology of IMIs, the incidence of IMI in patients with acute myelogenous Leukemia (AML) post HSCT, and risk factors for mortality.

Methods
Patients were identified using ICD9 and ICD10 codes using a University of Kansas internal database from 2009-2019, microbiology records, and an AML HSCT database and were followed through May 1st, 2020. Patients’ electronic medical records were reviewed for inclusion. IMI was defined as proven or probable using the 2009 National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) guidelines. Incidence was calculated as IMI cases/100-person-years. Risk factors for overall mortality were evaluated using a Cox regression model.

Results
We included 138 patients: 79 developed IMI after HSCT (8 autologous, 71 allogeneic) and 59 developed IMI after AL diagnosis. Seventeen of the AL patients underwent HSCT after IMI diagnosis (12 within 100 days of IMI). Proven IMI occurred in 45 (32.6%) and probable IMI occurred in 93 (67.4%) patients. The most common prophylactic agent prior to IMI diagnosis was fluconazole (31.2%), with 21.0% receiving none. Aspergillus was the most commonly identified mold with 91 (65.9%) cases. The average treatment duration was 101 (range 0 - 799) days. The incidence of IMI in patients with AML who underwent HSCT was 2.35 cases/100 person-years. All-cause mortality among patients with AL or HSCT who developed IMI was 23.1% at 6 weeks, 34.1% at 12 weeks, and 61.2% at 1 year. On univariate Cox model, Karnofsky performance status &gt; 70 was associated with lower mortality (hazard ratio (HR) 0.317, 95% confidence interval (CI) [0.110, 0.914]) among HSCT recipients. ICU admission within 7 days prior to IMI diagnosis (HR 6.469, 95% CI [1.779, 23.530]) and each one point increase in BMI (HR 1.051, CI [1.001, 1.103]) were associated with increased mortality in the AL group.
Figure 1 - Invasive mold infections by pathogen in HSCT-recipients and acute leukemia patients from 2009-2019.

Figure 2 - Antifungal prophylactic agents prescribed for at least one week at time of IMI diagnosis

Table 1 - Univariate survival analysis calculated using a Cox proportional-hazards regression model among patients who developed IMI after HSCT and patients who developed IMI after acute leukemia diagnosis

Conclusion
IMIs are associated with significant mortality in HSCT recipients and AL patients; patients at higher risk for mortality include those with lower baseline Karnofsky scores, recent ICU admissions, and higher BMI at time of IMI diagnosis.

Disclosures
Wissam El Atrouni, MD, ViiV (Advisor or Review Panel member)
89. A Collaborative & Novel Antimicrobial Stewardship Initiative– Mandatory Approval of Peripherally Inserted Central Venous Catheters
Authors: Patel Sonal , Vazquez Jose A , Chase Aaron , Ebong Eti 
Published: January 2021

Abstract

Background
Central line-associated bloodstream infections result in thousands of deaths and billions of dollars annually. At the Augusta University Medical Center (AUMC), it was identified that ~50% of peripherally inserted central venous catheters (PICCs) that were placed for intravenous (IV) antibiotic administration were unnecessary. A novel initiative was implemented, which required antimicrobial stewardship/infectious diseases approval for PICC insertions if the indication was for IV antibiotic administration only. The objective of this study was to determine the impact of this initiative.

Methods
A retrospective observational study was conducted at the AUMC. All adult patients with a PICC line insertion order for IV antibiotic administration, between December 2017 and May 2019 were included. The vascular access team would forward requests for PICC insertions to the antimicrobial stewardship pharmacist. The pharmacist would approve/disapprove the PICC or recommend an infectious diseases consult. The variables collected were: infection types, infectious diseases consultation, reason for PICC denial and 30-day PICC-related complications.

Results
A total of 215 requests for PICC insertion (for IV antibiotics) were placed. Of these, 54% of the requests were denied, while 46% were approved. The reasons for PICC denial included: midline catheter preferred (47%), switched to oral antibiotics (33%), further work-up required (10%), or no antibiotics needed (7%). The types of infections treated were: bone and joint infections (28%), urinary tract infections (13%), intra-abdominal infections (12%), endocarditis/endovascular infections (11%), skin soft tissue infections (9%), pneumonia (7%), catheter-related bloodstream infections (6%), central nervous system infections (6%), bacteremia (4%) and others (4%).The infectious diseases consult team was involved in the care of 79% of the patients. Of those that received a PICC line, only 5% experienced any PICC-related complications. The overall cost savings for PICCs that were denied was ~ $294,000.

Conclusion
Mandatory antimicrobial stewardship/infectious diseases approval for PICC insertion can decrease healthcare cost and reduce the number of unnecessary PICC lines placed.

Disclosures
All Authors: No reported disclosures
1155. Clinical and Epidemiological Characteristics of Patients with Paracoccidioidomycosis in Asuncion Paraguay
Authors: Núñez Fátima M , Woc-Colburn Laila , Arredondo Norma , Samaniego Maria S , Benitez Gustavo G 
Published: January 2021

Abstract

Background
Paracoccidioidomycosis (PCM) is an endemic systemic fungal disease caused by Paracoccidioides brasiliensis. It is obtained exclusively in Latin American countries, and presents with a greater prevalence in South America. It is acquired through inhalation and spreads by lympho-hematogenous dissemination. Once the fungus has established itself in the body, it can affect any organ or tissue, but most commonly the skin, mucous membranes and lungs. It is a neglected disease, without mandatory notification, its impact is unknown.

Methods
Descriptive, observational, retro-prospective study with analytical components, The patients were adults (&gt;18 years), diagnosed with paracoccidioidomycosis who were hospitalized at the Instituto De Medicina Tropical Asunción-Paraguay during 2010-2019.

Results
There were 33 patients included in this study. Most patients were male (90%) and 10% were female, the mean age of 48. The main reason for consult was: oral lesion(s) (21%), difficulty swallowing (15%), and skin lesions (15%). The geographic regions with the highest prevalence rates (Fig1) were: Central, Cordillera and Caaguazú. The major risk factors for acquiring Paracoccidioidomycosis were farming (51%), smokers (66%) and alcoholism (42%). Only one patient was co-infected with HIV. The diagnosis was made either by culture or by biopsy results (Fig 2). All the patients were started on treatment with amphotericin B deoxycholate, with an average dose of 1,020 mg for induction and continued maintenance treatment with imidazoles. The mortality rate was 9.09%. The outpatient clinic follow up was low at 15% and 12 patients (80%) were treated successfully.
Figure 1: Paraguay Coutnry Map showing the most affected areas with Paracoccidioidomycosis.

Figure 2: Culture result.

Conclusion
This study suggests that paracoccidioidomycosis mainly affects men, farmers, associated with high tobacco consumption in Paraguay. Common clinical manifestations were oral lesion, skin lesions, and difficulty swallowing. There are no current IDSA guidelines for treatment thus we use the national Paraguayan treatment guidelines. This study highlights the need to further study PCM and establish global guidelines.

Disclosures
All Authors: No reported disclosures