bluuebunny/crossref_metadata_2025_split huggingface dataset:
1780. Congenital Cytomegalovirus: What Are the Rates of Maternal Screening, Diagnostic Amniocentesis, and Elective Termination?
Authors: Njue Annete , Marguilis Andrea , Lyall Matthew , Nuabor Weyinmi , Marks Morgan , Russell Kevin , Sinha Anushua 
Published: October 2019

Abstract

Background
Congenitally transmitted cytomegalovirus (CMV) is the leading infectious cause of deafness and intellectual impairment among infants. Due to lack of effective preventive and curative treatments, routine CMV screening of pregnant women is generally not recommended by clinical guidelines or public health authorities, but is conducted on an opportunistic basis by specific healthcare systems and providers. This targeted review describes the rate of reported maternal screening for CMV infection and subsequent pregnancy outcomes.

Methods
PubMed and Embase were searched to identify English-language articles reporting the rate of screening for CMV maternal infection (Objective 1), the acceptance rate for diagnostic amniocentesis (Objective 2), and the elective termination rates due to CMV infection (Objective 3) in Europe and Israel. No date limit was applied.

Results
Seventeen articles published between 2000 and 2018 were included. Routine CMV screening of pregnant women in the absence of country-level guidelines appears to be common in France and Israel (table). Conversely, in Portugal, where country-level guidelines exist for preconception screening, a high proportion of women are not screened (table). Acceptance rates of diagnostic amniocentesis among women with CMV infection vary considerably across countries, with the highest rates reported in Israel (73%) and the lowest in Italy (16%). Elective termination rates were higher among women who underwent amniocentesis vs. those who did not and those with primary CMV infection vs. those with nonprimary infection. Conversely, one study in Israel showed higher termination rates among patients who did not undergo amniocentesis vs. those who did (35.5% vs. 7.3%).

Conclusion
The available data indicate that routine screening is carried out in some countries to a variable degree. There is an unmet need for effective prevention and management options to help prevent unnecessary termination of pregnancy.

Disclosures
All authors: No reported disclosures.
1785. Dengue Outbreaks and Predominant Circulating Virus Serotypes and Genotypes over More Than Two Decades in a Hyper-endemic Region
Authors: Dar Lalit , Choudhary Aashish , Brijwal Megha , Sahu Monalisa , Sachdev Janya 
Published: October 2019

Abstract

Background
Dengue is the most widespread arboviral disease globally. Serotyping of dengue viruses and their genotyping is important in tracing the epidemiology of the disease, monitoring trends and anticipating the possibility of outbreaks in a community.

Methods
This study is a retrospective analysis, based on data from a tertiary care center from Delhi, India and their correlation with reported literature on circulation and outbreaks of dengue in this region of north India since 1996, when the first virus isolation confirmed outbreak of dengue was reported by our virology laboratory (an Apex Laboratory of the National Vector Borne Disease Control Program, Government of India).Circulating serotypes of DENV were detected and identified from serum samples of suspected dengue patients with fever of 5 days duration or less, by virus isolation in cell culture and/or by real-time or conventional reverse transcription polymerase chain reaction (PCR). Representative serum samples of patients with suspected dengue with duration of fever <5 days were inoculated onto the C6/36 clone of Aedes albopictus cells, and the isolates were identified by indirect immunofluorescence using serotype-specific monoclonal antibodies. Sequencing was done for representative strains as required.

Results
The predominant serotypes identified were DENV 2 (1996), followed temporally by DENV 1 (1997–2002), DENV 3 (2003–2007), DENV 1 (2008–2012), DENV 2 (2013–2015), and DENV 3 (2016–2018). In 2003, Delhi became hyper-endemic for dengue, with all dengue serotypes co-circulating. Predominant serotypes continued to circulate for 3–6 years. Outbreaks occurred either in the year a serotype was re-introduced after a gap of a few years to become the predominant serotype, or in the following year; except in 2015, when there was a genotypic lineage change in a DENV 2 serotype which had been predominant since 2 years prior to the outbreak year.

Conclusion
Re-introduction of a dengue serotype which was out of circulation for a few years can precipitate an outbreak. Analysis of temporal patterns and close monitoring of circulating virus strains, particularly at either end of the transmission season, may help in early prediction of the trend for a given year, providing an opportunity to put in place control measures well in time.

Disclosures
All authors: No reported disclosures.
1789. Frequency of Chikungunya, Dengue, and Zika Virus in Acute Febrile Illness in Paired Urine and Serum Samples in Mexico
Authors: Perez Alba Eduardo , Alfaro Rivera Christian G , Bocanegra Ibarías Paola , Flores Treviño Samantha , Camacho-Ortiz Adrian , Morfin-Otero Rayo , Garza-González Elvira 
Published: October 2019

Abstract

Background
Given the nonspecific clinical presentation that dengue (DENV), Zika (ZIKV), and chikungunya viruses (CHIKV) have, nucleic acid amplification tests have become the primary diagnostic tool. Multiplex real-time PCR assays have been approved for their use in the qualitative detection of ZIKV in urine but there are few data regarding CHIKV and DENV. We report the frequencies of PCR detection for DENV, ZIKV and CHIKV in paired urine and serum samples in Mexico.

Methods
We included patients with acute febrile illness from five centers, located in Guadalajara and Monterrey, from September 2016 to December 2018. Viral RNA was extracted from samples, reverse transcribed and subjected to real-time PCRs specific for DENV, CHIKV, and ZIKV. Patients were considered a positive case if any of the three tests were positive. The obtained data were analyzed using descriptive statistics.

Results
A total of 978 patients were included. A positive result was obtained in 331 patients (33.84%): 184 for ZIKV, 129 for DENV, and 18 for CHIKV. The tests were positive in both specimens in 56 (30.4%), 29 (22.4%), and 4 (22%) of the cases, respectively, while an isolated positive urine test was found in 74 (40%), 5 (3%) and 4 (22%) of the cases. Two patients were positive for both ZIKV and DENV, and two were positive for both ZIKV and CHIKV.

Conclusion
Acute febrile illness was potentially attributable to infection with one or two of the studied arboviruses in up to 34% of our patients. Out of all the cases, 25% were positive only in urine samples. Therefore, some diagnosis could be missed when analyzing only serum-based tests. Paired serum and urine sampling should be recommended when detecting arbovirus in acute febrile illness.

Disclosures
All authors: No reported disclosures.
1979. Five-Year Impact of an Antimicrobial Stewardship Program on Nosocomial Candidemia: An Interrupted Time-Series Analysis Study
Authors: Bedini Andrea , Meschiari Marianna , Franceschini Erica , Mussini Cristina 
Published: October 2019

Abstract

Background
Antimicrobial stewardship programs allow a reduction in antibiotic prescription and, consequently, in the incidence of multidrug-resistance infections. However, the impact on nosocomial candidemia is still unclear.

Methods
The present study is an interrupted time-series (ITS) before-after study, based on an ecological time-trend analysis. Since 2014, an antimicrobial stewardship program (ASP) has been implemented at an Italian tertiary-care hospital. The first objective of the program was to reduce carbapenem consumption, through an active and computerized surveillance of all carbapenem prescriptions, each of which was checked and validated by ID specialists always after audit of the cases with treating physicians. We retrospectively evaluated the changing in the consumption of antimicrobials, carbapenems, and in the incidence of candidemia, during two study periods: before (2007–2013) and after (2014–2018) the implementation of the ASP.

Results
The implementation of ASP was followed by a significant decrease in antibiotic consumption, which was consistent through the following 5 years. At the end of the study, total antibiotic consumption has decreased by 38.476 DDDs per 100 patient-days (PDs) per quarter (95% CI: −21.784 to −55.168; P < 0.001) and carbapenems decreased by 4.452 DDD per 100 PDs per quarter (95% CI: −3.658 to −5.246; P = 0.001). After 5 years of ASP, incidence of candidemia decreased by 2.034 episodes per 1,000 PDs per quarter (95% CI: −0.738 to −3.330; P = 0.003), decreasing, at the end of 2018, by 53% compared with the expected value if the program had not been implemented.

Conclusion
At our Institution, the ASP had a positive impact on the consumption of carbapenems, and antimicrobials. The incidence of candidemia was also favorably affected by the program, reversing the trend after 2014. The ASP, even if not directly targeted to fungal infections, indirectly caused a reduction in the incidence of candidemia, probably reducing the number of patients colonized by Candida spp.

Disclosures
All authors: No reported disclosures.
1990. A Strategy of Mandatory Infectious Disease Consultations on Hospital-acquired Clostridium difficile Infection and Antimicrobial Utilization
Authors: Hou Cindy , Vyas Nikunj M , Levin Todd P , Condoluci David 
Published: October 2019

Abstract

Background
An antibiotic stewardship program (ASP) is critical to ensure the appropriateness of treatment for infections and to help avert Clostridium difficile infection (CDI). In a three-hospital system, infection preventionists (IP) found that hospital-acquired CDI rates were higher than expected in spite of a robust ASP program. The Medical Executive Board mandated infectious diseases (ID) consults for all patients with sepsis, severe sepsis, and septic shock. If consults to ID are mandatory, the hypothesis is that this may help to lower antibiotic days of therapy (DOT)/1,000 patient-days (PD) and HO-CDI rates.

Methods
The ASP program started in November 2014, and mandatory ID consults for all types of sepsis started in March 2016. Data were selected from the time period between 2014 (Quarter 1) to 2017 (Quarter 2). The IP assessed the HO-CDI, and business intelligence generated a monthly report of the total number of ID consults (for any infectious diagnosis). The researchers retrospectively analyzed the data and then performed Pearson correlation statistics.

Results
Data on ID consults at hospital sites A, B, and C were correlated against DOT/1000 PD. Hospital A was statistically significant (P = 0.015) for a moderate correlation—where higher ID consults contributed to decreased DOT/1,000 PD. Hospital B showed moderate significance (P = 0.002), and the strongest correlation was at hospital C (P = 0.0007). Then ID consults at all three hospital sites were compared against HO-CDI rates. Hospital A (P = 0.76) and Hospital B (0.18) did not achieve any correlation. Hospital C was strongly correlated (P = 0.004).

Conclusion
In a three-hospital system, mandatory ID consults led to moderate to strong correlations with decreased DOT/1,000 PD. However, HO-CDI rates were most likely to decrease at only of the hospitals. Overall, ID consultations should be considered as an antimicrobial stewardship strategy to address the appropriateness of antibiotics and to combat CDI.

Disclosures
All authors: No reported disclosures.
1998. Impact of Rapid Blood Culture Identification with Real-Time Antimicrobial Stewardship (ASP) in Patients with Staphylococcus aureus (S. aureus) and Enterococcus spp. Bacteremia at a Large Academic Medical Center
Authors: Ryan Russo Hannah , Phe Kady , Al Mohajer Mayar , Hirase Jessica 
Published: October 2019

Abstract

Background
The initiation of appropriate antimicrobial therapy is dependent on timely identification of the pathogen. FilmArray Blood Culture Identification Panel (BCID) is a rapid, multiplex polymerase chain reaction (PCR) panel that identifies 24 pathogens and 3 antibiotic resistance genes associated with bloodstream infections within 1 hour of growth. The purpose of this study was to compare the clinical impact of rapid BCID testing vs. standard blood culture processing, both coupled with real-time ASP, in patients with S. aureus and Enterococcus spp. bacteremia.

Methods
This was a single-center, retrospective chart review conducted as a pre-post intervention quasi-experimental study. The pre-intervention group included adult patients with S.aureus and Enterococcus spp. bacteremia identified by standard blood culture processing (PRE) and the post-intervention group included those identified by rapid BCID testing (POST). The primary endpoint was time in hours from positive Gram stain to initiation of optimal antimicrobial therapy [defined as vancomycin (VAN), linezolid (LZD), daptomycin (DAP), or ceftaroline for methicillin-resistant S. aureus (MRSA); nafcillin or cefazolin for methicillin-susceptible S. aureus (MSSA); DAP or LZD for VAN-resistant Enterococcus (VRE); VAN or ampicillin (if susceptible) for VAN-susceptible Enterococcus (VSE)]. Secondary endpoints included time to active therapy (defined as an antimicrobial to which the organism was susceptible), time to identification of pathogen, length of hospital stay (LOS) after positive culture, and 30-day mortality.

Results
132 patients were included. Mean time to optimal therapy decreased from 21.4 hours PRE to 10.7 hours POST (P = 0.048). Time to optimal therapy was shorter POST for MSSA [59.2 hours PRE vs. 25.8 hours POST (P < 0.001)] and VRE bacteremia [24.6 hours PRE vs. 5.6 hours POST (P = 0.005)]. Time to identification of pathogen decreased from 75.6 hours PRE to 2.7 hours POST (P < 0.001). Groups did not differ in time to active therapy, LOS, nor 30-day mortality.

Conclusion
Antimicrobial Stewardship coupled with rapid BCID testing significantly decreased time to pathogen identification as well as time to optimal therapy in patients with S. aureus and Enterococcus spp. bacteremia, most notably for MSSA and VRE.

Disclosures
All authors: No reported disclosures.
1999. Does Pharmacist-Driven Methicillin-Resistant Staphylococcus aureus PCR Nasal Screening Decrease Time to De-Escalation of MRSA Coverage in Patients with Pneumonia?
Authors: Waters Dustin , Putich Anthony 
Published: October 2019

Abstract

Background
Vancomycin and linezolid are antibiotics used in cases where methicillin-resistant Staphylococcus aureus (MRSA) is suspected, including in cases where MRSA is suspected to be the cause of pneumonia. MRSA nasal PCR has been shown to have a high negative predictive value when used to rule out MRSA pneumonia. The purpose of the current study was to determine whether a pharmacist-driven MRSA PCR nasal screening protocol would decrease the time to de-escalation or discontinuation of anti-MRSA therapy when utilized for pneumonia.

Methods
Patients were analyzed in two cohorts, those who received vancomycin or linezolid therapy from October 2012 to February 2013 (before pharmacist-driven MRSA nasal PCR protocol; n = 88) and those who received vancomycin from October 2016 to February 2017 (pharmacist-driven MRSA nasal PCR protocol; n = 105). During the study period, pharmacists were given the authority, via protocol to order an MRSA nasal PCR when vancomycin or linezolid was ordered for the indication of pneumonia. Subsequently, after a negative MRSA nasal PCR, pharmacists would contact the prescriber, and let the prescriber know that the MRSA PCR was negative, and then discontinue anti-MRSA therapy. The primary outcome was duration in hours of active anti-MRSA therapy. Secondary outcomes evaluated were the number of anti-MRSA antibiotic doses ordered, and the number of vancomycin troughs ordered.

Results
Patients in the pre-pharmacist driven cohort received vancomycin or linezolid for a median of 44.19 hours, whereas patients in the pharmacist-driven MRSA PCR protocol period received anti-MRSA therapy for a median of 19.1 hours (P < 0.0001). Additionally, prior to the initiation of the pharmacist-driven MRSA nasal PCR protocol, patients received 349 doses of anti-MRSA therapy, compared with 283 doses in the pharmacist MRSA nasal swab protocol group (P < 0.0001). There were also fewer vancomycin troughs ordered in the pharmacist MRSA nasal PCR protocol group (76 vs. 48, P < 0.0009).

Conclusion
A pharmacist-driven protocol for ordering MRSA nasal PCR led to a statistically significant decrease in the time to discontinuation of vancomycin or linezolid for suspected MRSA pneumonia when the MRSA nasal PCR was negative.

Disclosures
All authors: No reported disclosures.
2022. Antibiotic Prescribing Behavior Among Surgeon
Authors: Apisarnthanarak Anucha , Jantarathaneewat Kittiya , Chansirikarnjana Siriththin , Tidwong Nattapong , Mundy Linda 
Published: October 2019

Abstract

Background
A comparative study was conducted to evaluate prescribed antibiotic (AB) use in surgical patients with the Transtheoretical Model of Behavior (TTM) and Theory of Planned Behavior (TPB).

Methods
A survey was conducted at Thammasat University Hospital from January 1 to 31, 2019. We evaluated the appropriateness of AB uses in the surgical department reported per the hospital’s Drug Use Evaluation (DUE) form. After review of the DUE, in-depth interviews were conducted to all prescribers to explore antibiotic prescribing behavior based on TTM vs. TPB, using a standardized data collection tool. Data collected included demographics, indications, appropriateness of AB uses, the individual prescriber’s behavior based on TTM and TPB. The five TTM stages of change were categorized precontemplation, contemplation, preparation, action, and maintenance. In TPB assessment, we evaluated attitude toward AB uses, subjective norm to AB uses behavior, and perceived behavior control of AB uses behavior.

Results
There were 92 AB uses from 64 prescribers; 70 (70/92; 76%) used antibiotics appropriately. The majority of AB uses (62/92; 67%) were for treatment of infections. The most common reasons for inappropriate AB uses included inappropriate AB choices for treatment and prophylaxis of SSIs (n = 11, 50%) and inappropriate duration (n = 8, 36%). Physicians categorized in higher stages of TTM (action and maintenance) were strongly correlated with appropriate AB uses, while there was no correlation between the total TPB score and appropriateness of AB uses. By multivariate analysis, the TTM action and maintenance (aOR = 7.95; P = 0.02) and self-reported prescribers who considered patients as first priority (aOR = 4.02; P = 0.04) were associated with appropriate AB uses, while neurosurgical procedures (aOR = 0.13; P = 0.003) and antibiotic prescriptions for surgical prophylaxis (aOR = 0.15; P = 0.04) were associated with inappropriate AB uses.

Conclusion
Antibiotic prescribers categorized by TTM stages strongly correlated with appropriate AB uses. Additional studies to assess appropriate AB prescribing behavior, based on TTM stages of change, offer an opportunity to optimize surgical care.

Disclosures
All authors: No reported disclosures.
2025. Evaluation of the Impact of an Antimicrobial Stewardship Program in a Tertiary Hospital in Northern Italy: Efficacy of a Persuasive Approach on Antibiotics Consumption and Rate of Clostridium difficile Infection
Authors: Chiari Erika , Mangioni Davide , Pollastri Ester , Signorini Liana , Moioli Giovanni , Paraninfo Giuseppe , Van Hauwermeiren Evelyn , Saccani Barbara , Bertelli Davide , Festa Elena , Caruso Arnaldo , Stellini Roberto , Castelli Francesco 
Published: October 2019

Abstract

Background
Antimicrobial resistance (AMR) situation in Italian hospitals and regions represents a major public health threat [ECDC, 2017]. Antimicrobial stewardship programs (ASPs), particularly when based on local epidemiology, have been beneficial in optimizing antibiotic therapy as well as reducing hospital rates of Clostridium difficile infection (CDI) and AMR [Akpan MR, Antibiotics 2016]..

Methods
Our ASP program has been conducted at Spedali Civili General Hospital of Brescia, Northern Italy (1300-bed tertiary hospital), between the beginning of 2016 and the end of 2017. A preliminary analysis of local epidemiological data was performed (Table 1). Seven groups (“districts”) were identified according to microbiological and clinical similarities. This was a persuasive-based ASP. First, we trained physicians on general principles of AS, then guidelines for the management of “difficult-to-handle” infections were drafted based on international guidelines and local microbiological data (Table 2)..

Results
Here we show the results of pre-ASP (2015) vs. post-ASP (2018) analysis on antibiotic consumption (AC) and CDI rates. AC is expressed in DDD/100 bed-days. The overall hospital AC decreased from 84.31 to 76.84 (−9%), consistently with national recommendations [Italian National Plan against AMR, 2017]. In accordance with the local guidelines developed within our ASP, carbapenem consumption decreased from 5.77 to 4.87 (−16%) and fluoroquinolones (FLQ) from 14.45 to 9.94 (−31%). At the same time piperacillin/tazobactam use increased from 5.53 to 8.46 (53%). 3°–4°G cephalosporins and glycopeptides consumption slightly reduced from 11.78 to 11.42 (−3%) and from 4.07 to 3.83 (−6%), respectively. AC of the different districts involved is reported in Table 3. CDI rates decreased from 0.0434/100 bed-days in 2015 to 0.0315/100 bed-days in 2018 (−27%) (Figure 1).

Conclusion
Our ASP was a persuasive-based program in a setting of high AMR rates. In the short term, it has shown a positive impact in improving AC (in particular of broad-spectrum antibiotics with a high risk of resistance selection and CDI) and CDI rates. Audits for local guidelines adherence and the evaluation of AC, AMR and CDI rates are ongoing as long-term quality measures for assessing the impact of our ASP.

Disclosures
All authors: No reported disclosures.
2027. What Are the Views Among Pakistani Physicians Toward Antimicrobial Resistance and Hospital Antimicrobial Stewardship Programs? A Multi-Site Qualitative Study
Authors: Hayat Khezar , Rosenthal Meagen , Hassan Gillani Ali , Zhai Panpan , Ji Wenjing , Chang Jie , Hu Hao , Fang Yu 
Published: October 2019

Abstract

Background
Antimicrobial resistance (AMR) is a major public health issue that the world is facing in the 21st century and implementation of antimicrobial stewardship program (ASP) is one of the recognized approaches to combat AMR. Little is known on the views among Pakistani physicians regarding AMR and the benefits of hospital ASP implementation. This study was aimed to investigate the perception and attitude of physicians about AMR and ASP.

Methods
Qualitative face-to-face and telephonic interviews were conducted by using purposive sampling method with 22 physicians working in seven tertiary care public hospitals of Punjab, Pakistan. All interviews were audio-recorded and transcribed verbatim. Qualitative software was used, and a thematic analysis conducted.

Results
Three major themes were identified: (1) the growing concern of AMR in Pakistan, (2) the role(s) of healthcare professionals in antibiotic prescribing and infection control, and (3) managing antibiotic resistance in hospitals. Poor healthcare facilities, insufficient trained medical staff, and inadequate resources were the key barriers in the implementation of ASP in Pakistan.

Conclusion
Physicians of public sector tertiary care teaching hospitals have shown poor familiarity toward hospital ASPs but the concept of hospital ASPs in Pakistan can be established by using the distinct themes that originated during this study. Overall, the attitude of physicians was positive toward its enforcement in all types of hospital settings including teaching hospitals.

Disclosures
All authors: No reported disclosures.