bluuebunny/crossref_metadata_2025_split huggingface dataset:
299. Paediatric Collaborative Network on Infections in Canada (PICNIC) Study of the Current Landscape of Gram Negative Bacteremias
Authors: Lu Alice X , Tsang Kara , Barton Michelle , Frankel Craig , McDonald Jane , Bowes Jennifer , Gunawan John , Fanella Sergio , Alghounaim Mohammad , Coumeau Jeannette , Leifso Kirk , Slinger Robert , Robinson Joan , Khan Sarah 
Published: January 2021

Abstract

Background
Antimicrobial resistance is a public health threat, invasive infection from multi-drug resistant gram-negative (MDRGN) pathogens is associated with significant morbidity and mortality. The incidence of MDRGN bacteremia in Canada is rising, and pediatric data is limited.

Methods
This retrospective chart review of paediatric patients with gram negative bacteremia in a multicenter PICNIC database (n=7 centers) from 2013 to 2017. MDRGN was defined as enterobacteriaceae that were resistant to third generation cephalosporins (including ESBL, CPE). Ethics approval was obtained at all sites, and data was entered into a secure REDCAP database, descriptive statistics are described herein.

Results
Of the 676 bacteremia patients in the database, 214 (31.7%) were gram negative pathogens. E. coli was the most frequent pathogen (59.8%, of which 22 of 128 were MDR), followed by Klebsiella (31.8%, of which 9 of 68 were MDR). Of the 31 MDRGNs, 19 were ESBL, 1 was a CPE, and 11 were nonspecific mechanisms of resistance. There were no multidrug resistant Pseudomonas, Stenotrophomonas, or Acinetobacter. The majority of patient were less than 3 months of age (59.3%) and were male (58.8%). The majority had an underlying comorbid condition; hematoncologic diagnosis accounting for 14.5%. Length of stay varied from 1 to 742 days (mean 72, standard deviation 88). 11% required admission to ICU, 10% required removal of a intravascular catheter, 7% required a change in ventilation status, 2% requiring procedural source control, and there was an 8% mortality rate. Treatment duration greater than 14 days occurred in 123 patients (61% of patients).

Conclusion
This preliminary analysis of a multicenter review of pediatric gram negative bacteremias demonstrates a higher risk in neonates with comorbid conditions. A surprisingly prolonged treatment duration of greater than 14 days occurred in the majority of patients. Further analysis to assess factors associated with prolonged treatment durations, MDR infection, and complications is required. Gram negative bacteremia remains a significant cause of morbidity and mortality in pediatric patients.

Disclosures
All Authors: No reported disclosures
300. Pediatric Center Evaluation of the BioFire® Blood Culture Identification 2 Panel Versus the Original BioFire®FilmArray® Blood Culture Identification Panel for the Detection of Microorganisms and Resistance Markers in Positive Blood Cultures
Authors: Pierce Kristina B , Barr Rebecca , Hopper Aubrie , Bowerbank Charlotte , Shaw Anne , Pearson J , Aldave Matt , Tate Abby , Dickey Mandy , Holmberg Kristen , Lu Daisy , Koch Karen , Daly Judy 
Published: January 2021

Abstract

Background
Studies show a rising annual incidence of severe sepsis, with bloodstream infections continuing to impact children. Rapid identification of causative agents and timely administration of targeted therapy can positively impact patient outcomes and improve antibiotic stewardship.
The BioFire® Blood Culture Identification 2 (BCID2) Panel (BioFire Diagnostics, LLC), an updated version of the FDA-cleared BioFire® FilmArray® Blood Culture Identification (BCID) Panel, designed for use on positive blood cultures (PBCs), assesses 43 analytes, including 17 novel analytes (8 bacterial, 2 fungal, and 7 antimicrobial resistance genes), with a similar turnaround time.

Methods
De-identified residual PBCs for which clinician-ordered testing per standard of care (SoC) had been performed were enrolled and tested with an Investigation-Use-Only version of the BCID2 Panel. Only one positive bottle per patient was enrolled. Results of BCID2 and BCID were compared.

Results
116 PBCs (48 aerobic and 68 anaerobic) were evaluated using the BioFire BCID2 Panel and results were compared to the BioFire BCID Panel. Of the 116 cases, 103 were positive on both the BioFire BCID2 Panel and the BioFire BCID Panel. Ten cases were negative on both tests. While the two panels showed 97% agreement, three cases were discrepant. Using culture (SoC) as the tiebreaker, two cases were false positive and one case was false negative on the BioFire BCID Panel. In all three cases, results from culture and the BioFire BCID2 Panel were in agreement. As expected, no organisms were detected on the BioFire BCID2 Panel in PBCs from 10% (12/116) of PBC bottles where culture identified only organisms that are not part of the panel menu. With the BioFire BCID2 Panel’s expanded platform, two cases identified as Enterobacteriaceae on the BioFire BCID Panel were identified to the genus level on the BioFire BCID2 Panel; 31 cases detected to the genus level on the BioFire BCID Panel were identified to the species level on the BioFire BCID2 Panel.

Conclusion
Overall, the BioFire BCID2 Panel performed well against the BioFire BCID Panel for identification of bloodstream pathogens and provided additional discrimination of some pathogens to the genus or species level.
Data presented are from assays that have not been cleared or approved for diagnostic use.

Disclosures
All Authors: No reported disclosures
313. Using a Clinical Decision Prediction Tool to Improve Empirical Antimicrobial Therapy in Ceftriaxone-Resistant Enterobacterales Bloodstream Infections
Authors: McDougal Elizabeth , Justo Julie Ann , Kohn Joseph , Bookstaver P B , Winders Hana R , Al-hasan Majdi 
Published: January 2021

Abstract

Background
There are several clinical tools for prediction of antimicrobial resistance. However, their utility in management of bloodstream infections (BSI) due to resistant bacteria remains unclear. This quasi-experimental cohort examined the impact of utilization of the extended-spectrum beta-lactamase (ESBL) prediction score on time to initiation of appropriate antimicrobial therapy (AAT) in BSI due to ceftriaxone-resistant (CRO-R) Enterobacterales.

Methods
Adults with first episodes of monomicrobial BSI due to CRO-R Enterobacterales at Prisma Health-Midlands Hospitals in South Carolina from January 2010 to December 2017 were included. Antimicrobial stewardship intervention was implemented in January 2014 consisting of real-time alerts for positive blood cultures and rapid diagnostics for identification of bloodstream isolates. The ESBL prediction score was used to stratify risk of resistance prior to conventional antimicrobial susceptibility results. Student’s t-test was used to compare mean time to AAT before and after intervention.

Results
Among 92 patients with BSI due to CRO-R Enterobacterales, median age was 66 years, 52 (57%) were men, 68 (74%) had community-onset BSI, and 52 (57%) had urinary source of infection. Escherichia coli 52 (57%) and Klebsiella species 27 (29%) were the most common bloodstream isolates and the majority 63 (68%) produced ESBLs. There were no significant differences in demographics or clinical characteristics of patients before (n=45) and after (n=47) antimicrobial stewardship intervention. Mean time to AAT was 3.2 days prior and 1.7 days after utilization of ESBL prediction score (p=0.021). Results were consistent among ESBL-producing Enterobacterales (time to AAT 2.8 before and 1.8 days after intervention, p=0.025).

Conclusion
Utilization of the ESBL prediction score as part of a real-time antimicrobial stewardship intervention significantly reduced time to AAT in BSI due to CRO-R and ESBL-producing Enterobacterales. The ESBL prediction score represents a viable tool to improve antimicrobial management in clinical settings that lack access to multiplex PCRs for detection of antimicrobial resistance genes and novel methods for rapid phenotypic antimicrobial susceptibility testing.

Disclosures
Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)
49. Clinical Characteristics of the 2019 Eastern Equine Encephalitis Virus Outbreak in Michigan
Authors: Ladzinski Adam T , Rumschlag Matthew T , Mehta Aditya , Edewaard Eric , Boapimp Pimpawan , Morgan Larry , Hollstein Rolf Dieter , Jagger Brett W 
Published: January 2021

Abstract

Background
Eastern Equine Encephalitis Virus (EEEV) is a mosquito-borne alphavirus responsible for unpredictable outbreaks of severe neurologic disease in humans. While the vast majority of human EEEV infections are either asymptomatic or clinically nonspecific, a minority of patients develops neuroinvasive disease (EEE), which is a devastating illness with a mortality of at least 30%. No treatments are known to be effective. EEEV infection is relatively rare in the United States, with an annual average nationwide incidence of 7 cases between 2009 and 2018. However, 2019 was an exceptionally active year for human EEEV disease, yielding 38 nationwide confirmed cases, including 10 in Michigan, comprising the state’s largest outbreak to date.

Methods
EEE cases were identified by a regional network of physicians. Cases were defined by presentation with clinical symptoms of encephalitis, and by identification of EEEV IgM antibodies or RNA in cerebrospinal fluid (CSF), or EEEV-specific IgM in serum as confirmed by plaque reduction neutralization test. Radiographic images were evaluated and clinical data abstracted through chart review and clinical follow-up where possible.

Results
Records from 7 patients were identified and reviewed. The median age was 64, with a male predominance, and all presented in August. Notably, commercial arboviral CSF serology was uniformly negative on the initial CSF sample, and diagnosis was not made until a mean of 23 days (range: 12–38 days) after presentation. Testing in public health laboratories yielded the diagnosis in 5 out of 7 cases. Imaging findings were heterogeneous, but most patients exhibited abnormal findings in the thalamus and/or basal ganglia, and one patient displayed prominent pons and midbrain abnormalities. 4 patients died, while 2 patients survived with severe neurologic sequelae, and 1 patient recovered without sequelae. One patient underwent a limited postmortem examination, which revealed diffuse meningoencephalitis and focal vascular necrosis.

Conclusion
EEE is a frequently fatal condition whose diagnosis is often delayed, and for which no effective treatments are known. Improved diagnostics are needed to facilitate further clinical studies of EEE and encourage the development of potential therapies.

Disclosures
All Authors: No reported disclosures
51. A Review of Human Herpesvirus 6 and Central Nervous System Disease in Oncology Patients
Authors: Handley Guy H , Hasbun Rodrigo , Okhuysen Pablo C 
Published: January 2021

Abstract

Background
Human herpesvirus 6 (HHV-6) infects most of the human population. With immunosuppression it can reactivate and cause clinical syndromes of central nervous system (CNS) dysfunction. Much of the literature describes cases after hematopoietic stem cell transplantation (HSCT), ranging from encephalitis to a defined post-transplant acute limbic encephalitis syndrome (PALE). Outside of HSCT, studies of HHV-6 encephalitis in cancer patients are limited to case reports.

Methods
In this retrospective review, we present data from all patients admitted to MD Anderson Cancer Center between March 2016 and December 2018 that met established definitions for encephalitis, aseptic meningitis or HHV-6 PALE with detectable HHV-6 DNA in the cerebrospinal fluid (CSF) detected using either the Viracor or Biofire® Meningitis Encephalitis (ME) Panel testing platforms and no other identified etiology. We extracted demographic features, known risk factors, imaging findings, CSF analysis, treatments and patient outcomes from medical records.

Results
725 patients underwent HHV-6 testing during the study timeframe, with 19 (2.6%) cases of HHV-6 mediated CNS disease identified. Most patients, 13/19 (68%), had undergone HSCT. Median time to presentation was 31 days post-transplant. Survival at 240 days after transplant was 62% often with long-term neurologic sequelae. CSF tended to have lymphocyte predominance and nearly all patients had peripheral lymphopenia. Other at risk populations identified included 2/19 (11%) patients who received chimeric antigen receptor (CAR) T-cell therapy, 2/19 (11%) who received biologic immunotherapy, and 2/19 (11%) who had non-HSCT hematologic malignancy. Notable discordance among testing platforms was found in 5/9 (55%) of patients receiving both testing platforms.
CSF and Laboratory Analytes

Findings and Outcomes in HSCT Patients

Findings and Outcomes in Non-HSCT Patients

Conclusion
In addition to HSCT patients, HHV-6 reactivation leading to CNS disease also occurs in settings such as following adoptive T cell therapy or biologic immunotherapy. Significant diagnostic discordance exists between testing platforms.

Disclosures
Rodrigo Hasbun, MD, MPH, Biofire (Consultant)
52. A Nationwide Analysis of the Trends and Outcomes of Cryptococcal Meningitis in the United States
Authors: Mansoor Armaghan-e-Rehman , Sarwari Arif R 
Published: January 2021

Abstract

Background
Cryptococcal Meningitis (CM) is the most common presentation of invasive cryptococcosis. Seen in patients with and without HIV, CM is associated with significant morbidity and mortality. We present findings from a nationwide analysis of patients admitted with CM in the United States between 2007 and 2016.

Methods
The national inpatient sample (NIS) database was queried for all inpatient visits for Cryptococcal Meningitis between January 2007 and December 2016. Logistic regression models were used to determine risk factors for mortality, prolonged admissions, and delays in obtaining an initial lumbar puncture.

Results
The number of admissions for CM decreased during the study interval, from 3590 in 2007 to 2830 in 2016. Mortality did not change over this period (9.9%), however length of stay and inpatient cost significantly increased (P = 0.003 and P &lt; 0.001 respectively). The proportion of patients with HIV declined from 70.7% to 54.0% (P &lt; 0.001). HIV patients had a lower risk of mortality (OR = 0.77, CI 0.68–0.86, P &lt; 0.001), whereas Africa-American, Hispanic and Native American ethnicities had a significantly increased association with mortality. Delay in lumbar puncture beyond the first 24 hours was independently associated with mortality, with an OR of 1.55 (CI 1.31–1.82, P &lt; 0.001). . Patients admitted on a weekend, those of African-American ethnicity, and those without a known history of HIV were more likely to have delays in obtaining an early LP.

Conclusion
Inpatient mortality for patients with CM continues to remain high, with an increasing proportion of patients without underlying HIV infection. We found significant deviations in management of CM from IDSA guidelines, and an independent association of delay in early lumbar puncture with worsened patient outcomes.

Disclosures
All Authors: No reported disclosures
53. Incidence of Bloodstream Infections and Outcomes in Patients with Severe COVID-19 Pneumonia
Authors: Papamanoli Aikaterini , Yoo Jeanwoo , Mojahedi Azad , Jacob Robin , Grewal Prabhjot , Dhaliwal Simrat , Coritsidis Alexandra , Nakamura Jacquelyn , Fung Jenny , Hotelling Jessica , Rawal Sahil , Karkala Nikitha , Tsui Stella T , Abata Joshua , Psevdos George , Kalogeropoulos Andreas , Marcos Luis 
Published: January 2021

Abstract

Background
Coronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies.

Methods
We reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-ﬂow O2). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia.

Results
A total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8–6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P&lt; 0.001) per additional day.
Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469)

All Microorganisms Isolated from Blood Cultures

Conclusion
The incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab.

Disclosures
All Authors: No reported disclosures
57. clinical Characteristics and Outcomes of Patients Hospitalized with COVID-19 in New Orleans, LA: A Cohort Study
Authors: Silver Victoria , Chapple Andrew , Feibus Allison H , Beckford Jeremy , Halapin Natalie , Barua Delphi , Gordon Angellica , Baumgartner William , Vignes Seth , Clark Cullen , Kamboj Sanjay , Lim Stephen , Mackey Scott , Seal Paula , Kanter Joseph , Clement Meredith E 
Published: January 2021

Abstract

Background
In Louisiana, deaths related to COVID-19 have disproportionately occurred in Black persons. Granular data are needed to better understand inequities and develop prevention strategies to mitigate further impact on Black communities.

Methods
We conducted a retrospective cohort study of patients admitted to an urban safety net hospital in New Orleans, LA with reactive SARS-CoV-2 testing from March 9–31, 2020. Clinical characteristics and outcomes of Black and other racial/ethnic group patients were compared using Wilcoxon rank-sum test and Fisher’s exact tests. We examined Day-14 status using an ordinal scale to assess race and outcome.
Table 1. Demographics and Comorbidities by Race for Patients Hospitalized with COVID-19

Table 2. Clinical Characteristics at Presentation by Race for Patients Hospitalized with COVID-19, March 2020

Results
This study included 249 patients. Median age was 59, 44% were male, 86% were age ≥65 years or had ≥1 comorbidity. Overall, 87% were Black, relative to 55% Black patients typically hospitalized at our center. Black patients had longer symptom duration at presentation (6.41 versus 5.88 days, p=0.05), and were more likely to have asthma (p=0.008), but less likely to have dementia (p=0.002). There were no racial differences in initial respiratory status or laboratory values other than higher initial LDH in Black patients. Patient age and initial oxygen requirement, but not race (adjusted proportional odds ratio = 0.92, 95%CI: 0.70–1.20), were associated with worse Day-14 outcomes.
Figure 1: Admissions over time by Race

Figure 2a: Hospital outcomes by Race over the Follow-up period

Figure 2b: Day-14 Outcomes by Race

Conclusion
Our results demonstrate minor racial differences in comorbidities or disease severity at presentation, and Day-14 outcomes were not different between groups. However, Black patients were disproportionately represented in hospitalizations, suggesting that prevention efforts should include strategies to limit SARS-CoV-2 exposures in Black communities as one step towards reducing racial inequities related to COVID-19.
Figure 3a: Logistic Regression for Initial Oxygen Requirement

Figure 3b: Cumulative Logistic Regression for Ordinal Day-14 Outcomes

Disclosures
Meredith E. Clement, MD, FHI360 (Consultant)Gilead (Research Grant or Support)Janssen (Scientific Research Study Investigator)
58. Clinical Characteristics of SARS-CoV-2 Among Confirmed and Suspected Cases in Tennessee
Authors: Talj Rana , Rankin Danielle A , Nicotera Janet , Howard Leigh , Halasa Natasha B 
Published: January 2021

Abstract

Background
On March 11, 2020, a pandemic due to SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), was declared. The disease spectrum varies from asymptomatic detection to severe disease. Data on community versus hospitalized cases are limited. We aim to evaluate and compare the epidemiological and clinical characteristics associated with SARS-CoV-2 infection among suspected and confirmed COVID-19 cases primarily diagnosed in the ambulatory setting and compare their illness presentation.

Methods
We are prospectively enrolling a longitudinal cohort of laboratory-confirmed or suspected COVID-19 subjects and their close contacts. Suspect cases are defined as anyone who developed fever and/or Covid-19 like-symptoms in the post-Covid-19 era without proven SARS-CoV-2 detection. We consented and interviewed subjects over the phone to capture detailed sociodemographic data, medical and social histories, and clinical characteristics of the illness.

Results
From March 20 to June 16, 2020, 463 subjects were enrolled (Figure 1). Of those, 178 were SARS-CoV-2 positive [164 adults and 13 pediatric (&lt; 18 years) cases] and 192 were COVID-19 suspected (111 adults and 78 pediatric cases). Adult confirmed cases were more likely to be Hispanic and have an underlying medical condition but less likely to be white compared to suspected cases (Table 1). Pediatric confirmed cases were more likely to be Hispanic and have smoke exposure, but less likely to have a travel history compared to suspected cases (Table 1). Both adult and pediatric confirmed subjects had fatigue, headache and cough as the most common symptoms reported. Cough, muscle aches and chest tightness were more likely to be reported in pediatric confirmed than suspected cases; whereas loss of taste, smell and appetite, diarrhea and fever ≥ 100.4 were documented more often in adult confirmed than suspected cases (Figure 2).
Figure 1. Cumulative enrollment of subjects by day

Table 1. Sociodemographic characteristics among confirmed and suspected COVID-19 cases

Figure 2. Adults and pediatrics, confirmed and suspected cases, by clinical presentation

Conclusion
We observed differences of clinical presentation between confirmed and suspected cases among both pediatric and adult participants. Further research is needed to determine whether these differences are due to disease severity or absence of proven COVID-19. We are collecting serial nasal swabs, blood and stool specimens, on which future testing will confirm SARS-CoV-2 infection in suspected subjects.

Disclosures
Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)