bluuebunny/crossref_metadata_2025_split huggingface dataset:
2317. Excess Influenza-Attributable Mortality in Los Angeles County (LAC) for the 2013–2014 Through 2017–2018 Seasons
Authors: Traub Elizabeth , Rollin Louise , Gounder Prabhu 
Published: October 2019

Abstract

Background
Deaths caused by seasonal influenza are impossible to measure directly and are typically estimated using statistical models. We applied a previously developed model to Los Angeles County (LAC) data for the 2013–2014 through 2017–2018 influenza seasons.

Methods
Excess deaths attributable to influenza were estimated using a negative binomial regression model incorporating laboratory surveillance data and weekly counts of deaths with an underlying respiratory or circulatory cause of death. We obtained death data from the National Vital Statistics System. Population estimates for LAC were prepared by Hedderson Demographic Services for LAC Internal Services Department. The weekly total number of respiratory specimens tested and number positive for influenza or respiratory syncytial virus were provided by nine healthcare systems in LAC. Influenza-associated deaths in all ages are reportable to LAC Department of Public Health; confirmed reports are counted as observed deaths.

Results
The midyear LAC population increased from 10,019,362 in 2013 to 10,272,648 in 2017. The median number of observed influenza deaths reported to public health was 81 in 2015–2016 (minimum [min]: 56 in 2015–2015, maximum [max]: 288 in 2017–2018). The median number of seasonal deaths with an underlying respiratory or circulatory cause was 27,455 (min: 25,828, max: 28,732). The median estimate of influenza-attributable deaths was 1,478 (95% confidence interval [CI]: 823–2,613) in 2015–2016, with a min of 1,045 deaths (CI: 629–2,258) in 2013–2014 and a max of 1,905 (CI: 1,075–3,269) in 2017–2018.

Conclusion
Although influenza-associated deaths at all ages are reportable in LAC, a variety of barriers to reporting exist. Our estimates indicate that influenza-associated deaths in LAC are underreported. The more comprehensive modeled estimate of the burden of influenza can better inform local policy and planning decisions.

Disclosures
All authors: No reported disclosures.
2320. The Role of Ultraviolet Light, Atmospheric Ozone, and Humidity in Influenza Activity
Authors: Cano Cevallos Edison J , Tande Aaron J , O’Horo John C 
Published: October 2019

Abstract

Background
The interaction between influenza activity and environemental factor such as ultraviolet light index (UVI), atmospheric ozone (AO), and other related meteorological variables remains poorly understood. In the midst of climate change and increasingly poor performance of influenza vaccination, more information on influenza activity and its interaction with meteorological variables is critically needed.

Methods
Influenza A and B tests results by PCR from respiratory sources were collected from two large hospitals in Phoenix, AZ and Jacksonville, FL from January 1, 2014 to December 31, 2017. Publicly available meteorological data for each location was obtained from the National Oceanic and Atmospheric Administration. We excluded cases residing beyond 0.5° of longitude and latitude radius of the given meteorological data. A weekly index activity and maximum weekly values of meteorological variables were matched, and performed a correlation and regression analysis.

Results
A total of 5,238 influenza tests were performed during the study period. The influenza index showed an statistically significant weakly positive correlation with maximum CSUVI (r = 0.14; P = 0.0227) and mean zenith (r = 0.17; P = 0.0047). An statistically significant, positive correlation was observed between influenza index and atmospheric ozone (r = 0.23; P = 0.0001). Significant negative correlations were also observed with DBT, DPT, RH and HI (r = −0.27, r = −0.39, r = −0.13, r = −0.33, respectively; P < 0.04). The influenza index showed significant interactions in a univariate linear regression (Table 1). A relationship between influenza index and dew point temperature was observed in a multivariate model (OR = 0.66; CI95% 0.44–0.97).

Conclusion
To the best of our knowledge, this is the first report showing a significant interactions between influenza index, UVI and atmospheric ozone in two geographically distant locations. Further studies are needed to define the role of complex climatological patterns and influenza.

Disclosures
All authors: No reported disclosures.
2321. FluMex: A New Clinical Severity Index in Mexican Hospitalized Patients with Influenza
Authors: Aguirre-García Gloria Mayela , Magdalena Gamboa-Alonso Carmen , Purón-González Emma , Camacho-Ortiz Adrian 
Published: October 2019

Abstract

Background
Influenza virus infection is frequently characterized by a complex clinical behavior and outcomes can be fatal. There are many published scoring methods aimed for pulmonary infections and sepsis severity nevertheless they lack adequate sensitivity and specificity in patients with Influenza.

Methods
From 2013 to 2018, hospitalized patients from five hospitals from the Christus Muguerza health group from Monterrey, Mexico who had a positive rapid influenza-test and/or positive PCR for Influenza virus were enrolled. Risk factors for severity and mortality were evaluated calculating odds ratio with a binary logistic regression model and were adjusted for other factors. The new index was then compared with pneumonia severity scores by assessing area under the curve(AUC), sensitivity and specificity.

Results
We analyzed data from 125 patients hospitalized with confirmed Influenza infection. Less than 1% had received the corresponding seasonal influenza vaccine. Type 2 diabetes (T2D) and hypertension (HT) were the most prevalent comorbidities. Odds ratios were significant for age > 65 years, body mass index (BMI) > 30, T2D, HT, pulsoximetry < 90%, respiratory rate > 22 per minute, altered mental status, blood urea nitrogen (BUN) > 19 mg/dL, elevated lactate dehydrogenase (LDH), and an abnormal chest X-ray. The FluMex score was applied to a control group of 125 admitted patients with confirmed Influenza infection. AUC was 0.63 (CI 95%, 0.52–0.74; P < 0.05) for severity and 0.90 (IC 95%, 0.83–0.97; P < 0.05) for mortality, showing better predictive performance than other pneumonia and sepsis scores such as CURB-65, PSI, CROMI, SIRS, SOFA, qSOFA and ILI (Table 1).

Conclusion
The FluMex scoring system can be a useful tool for patients with suspected Influenza infection in predicting severity and mortality, helping to improve care and resource management.

Disclosures
All authors: No reported disclosures.
2327. 2018–2019 Seasonal Epidemiology of Infections Caused by Influenza Viruses and RSV in Ecuadorean Children Less than 5 Years of Age Residing at Opposite Extremes of Elevation
Authors: Jose Moubarak Marie , Bonville Cynthia A , Domachowske Joseph B , Suryadevara Manika , Salazar-Gomez Gloria M , Borbor-Cordova Mercy J , Sippy Rachel , Cueva-Aponte Cinthya , Ortiz-Prado Esteban , Hidalgo Ivan , Victoriano-Aguilar Guillermo , Pizarro-Fajardo Freddy 
Published: October 2019

Abstract

Background
The epidemiology of ambulatory acute respiratory tract infections (ARTI) caused by influenza viruses and respiratory syncytial virus (RSV) in young children is not well described in Ecuador. The seasonality of these infections vary across and within tropical countries experiencing different climates. Understanding trends that differ from one region to the next is needed to optimize implementation of effective preventive measures.

Methods
This 5-year prospective study compares the epidemiology of ARTI caused by influenza and RSV in children from Machala (6 m) and Quito (2,832 m), Ecuador. Children < 5 years presenting with ARTI for ≤7 days are eligible. Demographic and clinical data are gathered and a nasopharyngeal sample is collected for diagnostic testing using the Biofire FilmArray® respiratory panel platform that allows for the detection of 17 viruses.

Results
Between July 2018 and March 2019, we enrolled 446 subjects; 322 from Machala and 124 from Quito. Eighteen percent of the samples from Quito and 9% from Machala were positive for influenza viruses, while RSV accounted for 4% of the samples from Quito and 5% of those from Machala. The influenza B season at both elevations lasted 14 weeks, but started 5 weeks earlier in Machala (weeks 29–42 vs. weeks 34–47). Influenza B seasonal activity preceded influenza A at both sites. In Machala, the influenza A season began 6 weeks after the influenza B season (weeks 48–4), but overlapped with the influenza B season in Quito (weeks 45–2). In Machala, RSV was detected during the first week of surveillance (2018, week 29) but did not re-emerge to cause sustained activity until 2019, week 6. The RSV season began in Quito in 2018 during week 47, with sustained activity through the time of this report, 2019, week 12.

Conclusion
The 2018–2019 seasonal epidemiology of ARTI caused by influenza viruses and RSV differed between Ecuadorean children living close to sea level and those living at high elevation. Patterns of seasonal activity observed throughout the 5-year study period will facilitate decision-making regarding the optimal timing and duration for implementing existing and emerging prevention measures.

Disclosures
All authors: No reported disclosures.
2351. Rate and Consequences of Missed Clostridioides (Clostridium) difficile Infection Diagnosis from Non-disclosure of Clostridioides difficile Multiplex PCR Results. Two-Hospital Experience
Authors: Zacharioudakis Ioannis , Zervou Fainareti , Phillips Michael , Aguero-Rosenfeld Maria E 
Published: October 2019

Abstract

Background
It is common practice among microbiology laboratories in the United States to blind the BioFire FilmArray GI Panel results for Clostridioides (Clostridium) difficile (C. difficile) in fear of over-diagnosis of C. difficile infection (CDI).

Methods
We conducted a retrospective cohort study in 2 tertiary academic centers in New York to examine the rate of missed CDI diagnosis and the associated adverse outcomes from blinding the BioFire FilmArray GI Panel results for C. difficile. Of note, in one of the two included hospitals the list of daily positives is reviewed by an Infectious Diseases attending to determine whether cases have been tested for CDI and if not if they meet criteria for CDI. Adult patients with FilmArray GI Panel positive for C. difficile on admission to the hospital who lacked dedicated testing for C. difficile were included in the analysis and were stratified as possible, probable and definite cases of missed CDI diagnosis.

Results
Among the 144 adult patients with a FilmArray GI Panel test positive for C. difficile within 48 hours of hospital admission, 18 did not have a concurrent dedicated C. difficile testing. Eight patients were categorized as possible cases of missed CDI diagnosis, 5 as probable and 4 as definite, for a total of 17 cases of at least possibly missed CDI diagnosis. One case was considered to represent C. difficile colonization rather than infection for a rate of 6.9% of CDI over-diagnosis based on the FilmArray GI Panel results. Missed CDI diagnoses were associated with a delay in initiation of appropriate therapy, admission to the intensive care unit, hospital re-admission, colorectal surgery and death/discharge to hospice. Five out of 17 cases of missed CDI diagnosis (29.4%) lacked traditional risk factors for CDI.

Conclusion
In conclusion, the practice of concealing FilmArray GI Panel results for C. difficile may lead to a higher rate of missed CDI diagnosis than over-diagnosis and might need to be re-considered at least in patients with community-onset colitis of unknown etiology on presentation to the hospital.

Disclosures
All authors: No reported disclosures.
2376. Incidence of Clostridioides difficile Infection Among United States Medicare Advantage Enrollees
Authors: Heinrich Kirstin , Emir Birol , Ivanova Jasmina , Zhou Jingying , Yu Holly 
Published: October 2019

Abstract

Background
Clostridioides difficile infection (CDI) may be life-threatening, and individuals aged ≥ 65 years are at increased risk. CDI burden among Medicare fee-for-service enrollees and nursing home residents in the United States have been characterized previously. The present study aimed to describe the incidence of CDI among Medicare Advantage Enrollees (MAEs), who account for 34% of all Medicare beneficiaries with enrollment increasing annually since 2004.

Methods
De-identified claims data for this retrospective cohort study were collected from the Optum® Clinformatics® Data Mart and included MAEs aged ≥ 65 years with continuous enrollment for ≥ 1 year before January 1, 2016, followed through death or disenrollment. CDI incidence was defined using the International Classification of Diseases 9th Revision diagnosis code of 008.45 or 10th Revision code of A04.7 (other than admitting diagnosis) or by treatment with nontopical metronidazole, oral vancomycin, or fidaxomicin within 14 days of CDI test. Incident CDI cases were identified from January 1 to December 31, 2016, and required that no CDI occurred within the previous 60 days in 2016. Incidence in 2016 was calculated as CDI cases and CDI patients per 100,000 person-years (PY) of observation time.

Results
Of 2,542,341 MAEs analyzed, 15,201 patients (0.6%) experienced a total of 18,842 incident CDI episodes. Overall, incidence rates were 762.8 CDI cases and 616.5 CDI patients per 100,000 PY. Incidence increased with age (539.6, 847.3, and 1259.6 cases per 100,000 PY in patients aged 65‒74 years, 75‒84 years, and ≥ 85 years, respectively). Most episodes (50.9%) were community acquired; the remaining 37.7% and 11.4% of episodes were hospital acquired and indeterminate, respectively. CDI patients were more likely than non-CDI patients to be older (mean age, 78.3 vs. 76.1 years, P < 0.0001), be women (64.5% vs. 58.1%, P < 0.0001), or have comorbidities (mean Charlson comorbidity index score, 4.5 vs. 1.8, P < 0.0001).

Conclusion
CDI incidence rates in the Medicare Advantage population were similar to those reported previously in the Medicare fee-for-service population and nationally among adults aged ≥ 65 years. Data are consistent with a high CDI burden among older US adults.
Funding: Pfizer.

Disclosures
All authors: No reported disclosures.
2398. Effect of Eosinopenia and Binary Toxin on Clostridioides difficile Infection Clinical Outcomes
Authors: Carlson Travis J , Endres Bradley T , Le Pham Julie , Gonzales-Luna Anne J , Alnezary Faris S , Nebo Kimberly , Miranda Julie , Begum Khurshida , Alam M Jahangir , Garey Kevin W 
Published: October 2019

Abstract

Background
The ability of Clostridioides difficile to cause clinical disease in humans is dependent on toxin production. Significantly fewer eosinophils are seen in the peripheral blood of mice infected with a binary toxin positive (CDT+) C. difficile strain. Furthermore, the presence of CDT and eosinopenia have separately been associated with increased mortality in humans with C. difficile infection (CDI). We hypothesized that CDI due to a CDT+ C. difficile strain accompanied by peripheral eosinopenia would be associated with higher odds of inpatient mortality.

Methods
This multicenter, retrospective cohort study included all patients ≥ 18 years of age with toxigenic CDI in which specimen ribotype data were available as part of our ongoing surveillance study. The cohort was stratified by eosinophil count (0.0 cells/μL vs. > 0.0 cells/μL). The primary outcome was inpatient mortality. A logistic regression model was developed modeling inpatient mortality as a function of the available patient covariates. All P-values were from 2-sided tests, and results were deemed statistically significant at P < 0.05.

Results
A total of 688 patients from 13 institutions in six cities were included. Of those, 132 had a baseline eosinophil count of 0.0 cells/µL and 556 had a baseline eosinophil count > 0.0 cells/µL. While the odds of inpatient mortality were higher among patients with eosinopenia and those infected with a CDT+ ribotype, the combination of these variables remained an independent predictor of inpatient mortality after adjusting for CCI score, WBC count, and serum albumin level (OR, 7.84; 95% CI, 1.85–33.20; P = 0.005).

Conclusion
This is the first attempt to study the in vivo relationship between CDT presence, human immune response, and CDI clinical outcome. We identified an association between CDT presence with concomitant eosinopenia and worsened CDI outcomes. Healthcare facilities should consider identifying this important subset of patients at the time of CDI diagnosis. Future CDI drug development might benefit from targeting C. difficile properties that impair host immune response, which may in turn decrease adverse clinical outcomes associated with this disease.

Disclosures
All authors: No reported disclosures.
2406. Trends of Clostridioides difficile-Associated Diarrhea at a Tertiary Care Center in India
Authors: Khullar Swati , Chaudhry Rama , Agrawal Sonu , Kumar Lalit , Gupta Nitin , Wig Naveet , Ahuja Vineet 
Published: October 2019

Abstract

Background
Clostridioides difficile has been recognized as a significant cause of morbidity and mortality globally. Its infection can range from asymptomatic carriage to antibiotic-associated diarrhea and colitis. Reports of outbreak with the hypervirulent strain (N1/NAP1 Ribotype 027) has raised the concern on the magnitude and severity of C. difficile infections. This study aimed to determine the prevalence of C. difficile-associated diarrhea (CDAD) among the patients at a tertiary care hospital in India.

Methods
A retrospective analysis from January 2015-December 2018 was done to determine the trends of C. difficile infection. ELISA for detection of toxins A and B was performed on stool samples. A diagnosis of CDAD was made in all patients with stool samples positive for toxins A and B.

Results
Samples from 1311 patients were received from January 2015-December 2018 from patients with suspected nosocomial diarrhea. 9/1311 were culture positive for C. difficile, 7/9 were both culture and ELISA positive. A total of 74 patients were positive for ELISA for detection of toxins A and B. The prevalence of CDAD in the years 2015–2018 were as follows: 4.01% (10/249) in 2015, 10.03% (26/259) in 2016, 4.7% (21/446) in 2017 and 5.32% (19/357) in 2018, respectively. Malignancy was found to be the most common underlying pathological condition 15/69. Most common group of antibiotics used in these patients of CDAD were carbapenems 20/64. Amongst 82.6% (57/69) of the patients were hospitalized. Diarrhea was associated with fever in 40.5% (28/69) of the patients.

Conclusion
Our results show over all variable prevalence of CDAD over the years and was higher in the year 2016. Timely appropriate diagnosis, high index of suspicion in high-risk patients and proper implementation of antimicrobial stewardship programs may help in reducing morbidity and mortality in patients of CDAD.

Disclosures
All authors: No reported disclosures.
2408. Genotypic Corroboration of Epidemiologically Linked Clusters to Detect Outbreaks of C. difficile at a Tertiary Care Hospital
Authors: Bayoumi Nagla , McMillen Tracy , Aslam Anoshé , Kamboj Mini 
Published: October 2019

Abstract

Background
The Society for Healthcare Epidemiology of America (SHEA) recommends that surveillance for healthcare facility-onset C. difficile infections (HO CDI) be conducted to detect elevated rates or outbreaks of CDI and stratify data by hospital unit when possible to facilitate detection of clusters. At Memorical Sloan Kettering Cancer Center, strain typing of isolates using multi-locus sequence typing (MLST) is performed routinely and in real time to inform control efforts. Genotyping can conclusively establish or debunk transmission events based on routine surveillance. Management of C. difficile outbreaks is time and resource intensive.

Methods
A retrospective analysis was conducted to identify all nosocomial C. difficile cases between July 2013 and July 2018. Based on Memorial Sloan Kettering’s baseline surveillance data, a cluster of C. difficile was defined as three or more hospital-acquired cases (as defined by NHSN) on the same inpatient unit within a 7-day period. Data were analyzed to quantify the number of clusters observed and determine genetic relatedness among cases to detect an outbreak.

Results
A total of 1,116 HO CDI cases occurred during the 5-year time period. Annual nosocomial rates of CDI remained stable (P = 0.052). Eighty clusters were identified; 63 clusters had 3 cases within each cluster, 16 were each made up of 4 cases, and 1 cluster consisted of 5 cases. Two clusters had strain typing concordance amongst all 3 cases; strain type 42 and strain type 1. Among all the epidemiologically linked clusters over the 5-year period, only 2.5% were genetically linked suggestive of true outbreaks.

Conclusion
The majority of HO-CDI clusters detected on clinical surveillance are non-clonal. Genotyping should be routinely used to corroborate clusters identified on microbiological surveillance before costly outbreak control interventions are deployed.

Disclosures
All authors: No reported disclosures.
2422. Effectiveness of a Probiotic for Primary Prevention of Clostridium difficile Infection and Antibiotic-Associated Diarrhea among Hospitalized Patients Receiving Broad-Spectrum Antibiotics
Authors: Le Khanh-Linh , Young Heather , Jenkins Timothy C , Tapia Robert , Shihadeh Katherine C 
Published: October 2019

Abstract

Background
Prior to 2016, Denver Health Medical Center had a higher-than-expected rate of hospital onset Clostridium difficile infection (HO-CDI). A multifaceted CDI prevention plan was implemented, including the use of a probiotic as primary prevention for HO-CDI and antibiotic-associated diarrhea (AAD) in inpatients receiving broad-spectrum antibiotics. We aimed to study the effectiveness of probiotic use in this clinical context.

Methods
During the intervention, inpatient orders for a broad-spectrum antibiotic triggered a best practice advisory recommending once daily co-administration of 100 billion units of a probiotic containing Lactobacillus casei, L. rhamnosus, and L. acidophilus (BioK+ ®). To evaluate effectiveness and safety of this intervention, we performed a retrospective cohort study including adult inpatients who received > 24 hours of a broad-spectrum antibiotic between April 2016 and March 2018. The primary endpoint was the incidence of HO-CDI (> 3 days after admission) compared between patients who received antibiotics alone vs. antibiotics plus the probiotic. Secondary endpoints were the incidence of AAD, defined as a negative CDI test after antibiotic initiation, and the incidence of Lactobacillus species identified in clinical cultures.

Results
3,291 patients were included; 1,835 received antibiotics alone and 1,456 received antibiotics plus the probiotic. Baseline characteristics between groups were similar, except patients in the antibiotic alone group had a greater incidence of cirrhosis and proton-pump inhibitor use (16.1% vs 10.1%, P < 0.001; 39.1% vs 31.5%, P < 0.001). Length of stay and antibiotic days of therapy were longer in the antibiotic plus probiotic group [6 days (IQR, 3–11) vs 6 days (IQR, 4–12), P = 0.014; 4 days (IQR, 3–7) vs 5 days (IQR, 3–7), P < 0.001]. The incidence of HO-CDI (37, 2% vs 35, 2.4%; P = 0.450) and AAD (231, 12.6% vs 199, 13.7%; P = 0.362) were similar between groups. Lactobacillus was identified in at least one clinical culture from 0.2% (3/1835) and 0.3% (4/1456) of patients in the antibiotic alone group and antibiotic plus probiotic group, respectively (P = 0.497).

Conclusion
In hospitalized patients receiving broad-spectrum antibiotics, co-administration of a probiotic did not appear to reduce the incidence of HO-CDI or AAD.

Disclosures
All authors: No reported disclosures.