bluuebunny/crossref_metadata_2025_split huggingface dataset:
1413. Trends in Risk of Respiratory Syncytial Virus Hospitalizations in Preterm Infants Over a 10-Year Period
Authors: Kong Amanda M , Winer Isabelle H , diakun david , Bloomfield Adam , Gonzales Tara 
Published: January 2021

Abstract

Background
The American Academy of Pediatrics (AAP) recommended respiratory syncytial virus (RSV) immunoprophylaxis (RSV-IP) to reduce the risk of severe RSV hospitalization (RSVH) for certain infants &lt; 35 weeks gestational age (wGA) until 2014, when the AAP no longer recommended use among infants born &gt;29 wGA without other medical conditions. Studies have shown that RSV-IP utilization subsequently decreased among these infants, as well as infants born &lt; 29 wGA from whom RSV-IP is still currently recommended. We described RSVH rates among preterm (PT) infants &lt; 35 wGA compared to term infants from 2008-2019.

Methods
We identified infants born between 7/1/2008 and 7/30/2019 in the MarketScan® Commercial and Multi-State Medicaid claims databases. Infants with a code for birth at &lt; 35 wGA were classified by wGA. Those with a code for full-term without major health problems were classified as term. Infants contributed follow-up time during the RSV season (November to March) while &lt; 6 months old, summarized as infant-seasons (days of follow-up during the RSV season divided by 151 [number of days in an RSV season]) (Table 1). Using diagnoses codes, we identified RSVH during each RSV season for infants &lt; 6 months. Unadjusted rate ratios comparing PT infants to term infants were calculated to account for seasonal variation in virus circulation.
Number of Infants and Follow-up Time

Results
The number of infants contributing time at &lt; 6 months old during the RSV season and their follow-up time are shown in Table 1. There were 796 RSVH among Commercial PT infants, 6,486 RSVH among Commercial term infants, 2,501 RSVH among Medicaid PT infants, and 13,962 RSVH among Medicaid term infants during the 10 seasons in the database. RSVH rates for PT infants tended to increase over time, with the exception of the 2009-2010 season for Medicaid infants (Table 2). Rate ratios comparing PT to term infants also increased after the 2014 guidance change (Figure 1 and 2). The risk of 29-34 wGA infants compared to term infants approximately doubled in the 5 years after the guidance change (Table 2).

Comparisons of RSV Hospitalization Rates for Preterm vs. Term Infants &lt; 6 Months Old

Rate Ratios for RSV Hospitalization Rates for Commercial Infants &lt; 6 Months Old

Rate Ratios for RSV Hospitalization Rates for Medicaid Infants &lt; 6 Months Old

Conclusion
After the change in AAP recommendations for RSV-IP, increases in RSVH rates for infants born at 29-34 wGA compared to term were found. This was also true for &lt; 29 wGA infants for whom RSV-IP is recommended, although the effect sizes were smaller.

Disclosures
Amanda M. Kong, DrPH, Sobi (Other Financial or Material Support, I am an employee of IBM Watson Health which received funding from Sobi to conduct this analysis.) david diakun, BS, Sobi (Grant/Research Support) Adam Bloomfield, MD, Sobi NA (Employee) Tara Gonzales, MD, Sobi, Inc. (Employee)
1416. Assessing the potential for interspecies transmission of Clostridioides difficile on dairy farms
Authors: Redding Laurel , Webb Terry , Barnhart Denise , Baker Linda , Bender Joseph , Kristula Michaela , Kelly Donna 
Published: January 2021

Abstract

Background
Clostridioides difficile (CD) can cause severe colitis in humans and many species of animals. It is thought that farm animals could be a reservoir for CD and that farm workers could therefore be at increased risk of colonization and infection with CD. While pigs and swine farm workers have been shown to be colonized with identical clones of CD, the zoonotic transmission of CD from animals to people has not been definitively demonstrated, and no studies have examined whether dairy farm workers, who are generally in closer contact with animals than swine farmers, are at increased risk of being colonized or infected with CD. The aim of this study was to assess whether dairy calves and farm workers harbored genetically similar isolates of CD.

Methods
First, we validated a glove-juice protocol to detect CD spores on the hands of farm workers. Volunteers’ hands were inoculated with serially diluted suspensions of non-toxigenic CD organisms, and hand rinsates underwent broth enrichment and anaerobic culture. Second, we collected fecal samples from 5 randomly selected dairy calves (&lt; 7 d of age) from each of 23 farms in southeastern Pennsylvania, northern Maryland, and Delaware. We focused specifically on dairy calves, as the prevalence of CD is highest in this age group. Third, using the glove-juice protocol, we collected hand rinsates from 38 dairy farm workers who work closely with calves. Only 4 of these workers were willing to submit fecal samples along with their hand rinsates. All fecal samples and hand rinsates underwent broth enrichment and anaerobic culture for CD.

Results
Validation of the glove juice protocol showed that CD could be recovered successfully from all hand rinsate dilutions (up to 10-6). When applied to farm workers, this method yielded CD in none of the hand rinsates (0%, 95% CI 0.0-92.2%). CD was also not detected in any of the human fecal samples. However, CD was detected from calf fecal samples on 10 farms (43.5%, 95% CI 20.8%-80.0%).

Conclusion
While the zoonotic transmission of CD cannot be ruled out, our results suggest that contact with dairy animals is not likely to be associated with an increased risk of acquiring CD via the fecal-oral route. The glove-juice protocol appears to be a useful tool for studying the epidemiology of CD in populations where obtaining fecal samples is difficult.

Disclosures
All Authors: No reported disclosures
1429. Meningococcal Disease Outbreak in a Refugee Reception Identification Center in Greece and Administration of Mass Antibiotic Prophylaxis
Authors: Magaziotou Ioanna , Tsiodras Sotirios , Xirogianni Athanasia , Tseroni Maria , Syrigonaki Katerina , Stoli Artemis , Tsekou Aikaterini , Papandreou Anastasia , Sapounas Spyros , Panagiotakopoulos George , Theodoridou Maria , Tzanakaki Georgina , Georgakopoulou Theano 
Published: January 2021

Abstract

Background
An increased likelihood of transmission of communicable diseases such as invasive meningococcal disease (IMD) exists in refugee camps. Herein, we describe an outbreak investigation of 5 IMD cases among immigrants in Greece.

Methods
Epidemiological, clinical and laboratory data (culture and molecular identification) as well as the public health management concerning an outbreak of meningococcal disease in a refugee Reception Identification Center (RIC), are described.

Results
During the period 17th January - 17th February 2020, five cases of IMD in refugees were reported to the National Public Health Organization (NPHO). Four cases were from Afghanistan and resided in the RIC of Lesvos Island; two females aged 2 yo and 21 yo and two males 13 yo and 6 yo. The fifth case, a 4 month old male of Syrian nationality, exhibited symptoms after moving to an inland accommodation center (AC) from Lesvos RIC, on December 2019. Four of the cases presented with meningitis and septicaemia. All cases recovered and had no common exposure other than shared geographic space. Neisseria meningitidis was identified by molecular typing (mPCR, PorA, MLST, WGS) in all cases at the National Meningitis Reference Laboratory; 3/5 cases were identified as MenB, porA 7-2,4, and ST-3129 (new clone) while 2/5 (21 yo female, 13 yo male) as MenY, porA: 5.2, ST-22cc. To prevent secondary cases, antimicrobial chemoprophylaxis via Directly Observed Therapy (DOT) was administered to 4.024 Afgan close contacts (26.7% of the total Afgan population). MenACWY and MenB vaccination was recommended in response to outbreak among persons aged &lt; 20 years old. No new IMD case occurred in the RIC during a follow-up period of 4 months.

Conclusion
The detection of a new clone in Greece of Chinese and Taiwanese origin through migrants, further underlines the need of enhanced surveillance for early detection, molecular typing, immediate intervention with antibiotic prophylaxis and/or supplemental vaccination in order to prevent IMD in refugee camps.

Disclosures
All Authors: No reported disclosures
1432. Population-based Surveillance of Carbapenem-Resistant Enterobacteriaceae (CRE) in Alameda County, 2017-2020
Authors: Horwich-Scholefield Sam , Lloyd Tyler , Varghese Vici , Yette Emily , Huang Sandra , Pandori Mark 
Published: January 2021

Abstract

Background
Infections caused by carbapenem-resistant Enterobacteriaceae (CRE), especially those that are carbapenemase-producing (CP), are difficult to treat and result in high mortality— the Centers for Disease Control and Prevention (CDC) designates CRE an urgent level threat to public health. Alameda, a northern California county with 1.67 million residents, mandates submission of all carbapenem-resistant isolates Escherichia coli, Klebsiella spp., and Enterobacter spp. We assessed the genetic profiles of CRE isolates and compared to aggregate US data from the same time period.

Methods
Isolates are submitted to the Alameda County Public Health Laboratory (ACPHL), where antimicrobial resistance genetic markers are identified by whole genome sequencing (WGS) using single-end, 150-cycle reactions in a MiSeq (Illumina). Resistance genes were identified using pipelines built in Geneious and confirmed with Resfinder. All epidemiological analyses were conducted using R (Version 4.0).

Results
ACPHL performed WGS on 226 CRE isolates submitted between June 2017 and February 2020. A total of 34/95 (36%) Klebsiella spp., 17/60 (28%) E. coli, and 10/71 (14%) Enterobacter spp. a carbapenemase enzyme. Among all Enterobacteriaceae, 21/226 (9%) produced the New Delhi-metallo-β-lactamase (NDM) carbapenemase (Table 1). Among all CRE, 17/226 (8%) were Klebsiella pneumoniae with the multilocus sequence type (MLST) of ST-258. All six Klebsiella pneumoniae ST-35 and ST-11 isolates produced a carbapenemase (Table 2).
Table 1: Carbapenemases, Extended Spectrum β-Lactamases (ESBL) and Other β-Lactamases by Organism

Table 2: Organism, Multilocus Sequence Type (MLST) and Carbapenemases Present

Conclusion
Compared to US data, Alameda County Klebsiella spp. were nearly half as likely to produce any carbapenemase, and E. coli were three times more likely to produce an NDM carbapenemase. CP-CRE represented a wide array of MLST, with the globally distributed KPC-producing outbreak strain ST-258 being the most frequently identified. Two strains that have been associated with hypervirulent and multidrug resistant infections in Asia, K. pneumoniae ST-35 and ST-11, were also reported.

Disclosures
Sam Horwich-Scholefield, MPH CIC, Merck (Research Grant or Support)
1436. Use of Whole Genome Sequencing to Characterize Antimicrobial-resistant Salmonella Berta Isolates from Clinical and Retail Meat Sources
Authors: M’ikanatha Nkuchia M , Jacques Rachael , Faucette David , Lisa Dettinger , Libuit Kevin , Tate Heather 
Published: January 2021

Abstract

Background
Antimicrobial resistance (AMR) in foodborne pathogens of animal origin, including non-typhoidal Salmonella (NTS) are a public health concern. Pennsylvania conducts integrated surveillance for AMR in NTS isolates from human and animal sources in collaboration with the National Antimicrobial Resistance Monitoring System (NARMS).

Methods
During 2009-2014, Salmonella enterica isolates from various types of meat purchased from randomly selected retail outlets in southeastern Pennsylvania were analyzed by pulsed-field gel electrophoresis (PFGE). We compared PFGE patterns from meat with clinical isolates in the Pennsylvania surveillance database. All meat isolates and a subset of matched clinical isolates were tested for susceptibility to antimicrobial agents. Eleven isolates with indistinguishable PFGE patterns were analyzed by whole genome sequencing (WGS). Sequence data were uploaded to the FDA’s GalaxyTrakr platform for quality assessment, genome assembly, AMR gene detection, and phylogenetic inference via single-nucleotide polymorphism (SNP) analysis.

Results
PFGE patterns of 86 (48.6%) of 177 meat isolates had PFGE matches to 1,665 clinical isolates; 40 distinct PFGE patterns were represented among the shared patterns. Seventeen (43%) of the 40 shared PFGE patterns (with ≥1 isolate(s) from both sources) were considered multi-drug resistant (MDR). Among the 48 S. Berta pattern JAXX01.0001 isolates, 5 (10.9%) and 2 (100%) from human and meat sources respectively were MDR including resistance to amoxicillin and ceftriaxone. WGS analysis of one isolate from ground turkey meat (PNUSAS061602) was genetically related to clinical isolates including two within 9 and 11 SNPs [Figure]. Presence of genes that hydrolyze extended spectrum cephalosporins (ESC), [blaCMY, blaHERA, or blaTEM], was identified in eight (two meat and six clinical) isolates. One meat isolate was resistant to six antibiotics including ceftriaxone.
Figure 2. Single nucleotide polymorphism (SNP) distance matrix showing relatedness in non-typhoidal Salmonella isolates from retail meat (n=2) and human (n=9) sources — Pennsylvania, 2010-2014. One S Berta from retail meat was separated from two clinical two clinical isolates by 9 and 11 SNPs. Second isolate from meat was separated from those associated with human infections by 14 (n=1), 17 (n=1) and ≥20 (n=7).

Conclusion
WGS analysis revealed clinically relevant ESCs genes in closely related S. Berta isolates from human and animal sources. Presence of these genes in NTS highlights the need for enhanced One-Health surveillance and judicious use of antibiotics in humans and food-animal production.

Disclosures
All Authors: No reported disclosures
1440. The Genetic Basis for a Neisseria gonorrhoeae Clinical Isolate That Contains mtrR-79 Mutation But Is Highly Susceptible to Antibiotics Effluxed by the Mtr Pump System
Authors: Huang Jianzhong , Ingraham Karen 
Published: January 2021

Abstract

Background
Neisseria gonorrhoeae (NG) possesses multiple drug efflux systems that play an important role in evading antibiotics in the treatment for gonorrhea and in helping this pathogen to evade innate antimicrobial defenses during infection. The mtrR-79 and mtr120 mutations in the promoter region between mtrR and mtrCDE are common mutations contributing to overexpression of the MtrCDE efflux pump resulting in increased efflux to multiple antibiotics including macrolides, β-lactams and tetracycline. However, we found a NG clinical isolate that contains the mtrR-79 mutation but is highly susceptible to antibiotics effluxed by the MtrCDE pump system.

Methods
PCR amplification, DNA sequencing and natural transformation were used to investigate the genetic basis responsible for the increased susceptibility by this isolate.

Results
We amplified by PCR the individual genes of mtrCDE, respectively, from this susceptible isolate as well as a NG isolate that contains the mtrR-79 mutation with increased efflux; there was no difference in the size of PCR products between the susceptible isolate and the isolate with increased efflux, indicating there was no large deletion/insertion in these genes. DNA sequence analysis of mtrCDE revealed the susceptible isolate also contained a loss-of-function mutation ΔGC from a 6 GC repeat GCGCGCGCGCGC in mtrC resulting in MtrC A117 frameshift predicted to produce a truncated MtrC protein that results in a low efflux phenotype. Natural transformation of the susceptible isolate with a wild type mtrC and selection with ciprofloxacin generated transformants that corrected the ΔGC mutation and restored the increased efflux phenotype.

Conclusion
Our results indicate that genotyping of mtrR and the promoter region between mtrR and mtrCDE is insufficient to predict increased efflux phenotype and provide direct evidence that NG isolates with elevated efflux is able to genetically revert to low efflux via loss-of-function mutations in the coding region of the efflux pump genes.

Disclosures
Jianzhong Huang, PhD, GlaxoSmithKline (Employee, Shareholder) Karen Ingraham, MS, GlaxoSmithKline (Employee, Shareholder)
119. Procalcitonin to Guide Antibiotic Therapy for Respiratory Infection: A Systematic Review of Systematic Reviews
Authors: York Joshua A , Varadarajan Maithili , Yates Joseph R , Barlow Gavin 
Published: January 2021

Abstract

Background
Antimicrobial resistance is an international calamity; closely linked to antibiotic use. Safely reducing antibiotic course length and overall use are imperative. Procalcitonin (PCT) is a biomarker expressed in serum in response to bacterial infection. Systematic reviews (SRs) evaluating PCT as an adjunct to guide antibiotic therapy have been performed but its use remains contentious. The aim of this SR of SRs was to evaluate the extent to which PCT impacts the likelihood of antibiotic initiation and antibiotic duration in cases of respiratory infection.

Methods
A systematic search of databases using an a priori strategy was conducted. SRs which reported an outcome related to antibiotic initiation and/or duration in the context of respiratory infection were included. Data extraction was performed by the first author and checked independently by a second author. The quality of SRs was assessed by two authors independently using ROBIS criteria. Disagreements were resolved by consensus with a third author. Results are presented narratively and in tabular format (Table 1 and Table 2).

Results
13 SRs were included (see PRISMA diagram). The number of respiratory patients included in these SRs ranged from 308 to 6708 (median = 3457). There was a consistent finding of a statistically significant reduction in antibiotic initiation in the PCT study group compared to the control group (Table 1). SRs that meta-analysed antibiotic duration (n = 9) as a difference in days showed a median reduction of 2.15 days (reduction range 0.80 to 3.83 days) with PCT use.
PRISMA Diagram

Table 1: Summary of odds ratios/ risk ratios in antibiotic initiation with the use of PCT

Conclusion
PCT use leads to a reduction in antibiotic initiation for respiratory diseases. It also results in a decrease in antibiotic duration, but this finding was not consistently statistically significant. There are no data presented in the SRs about the impact of this on antimicrobial resistance.

Disclosures
All Authors: No reported disclosures
1467. Association between Pathogen Load in the Upper Respiratory Tract and Severe Acute Respiratory Infections in Guatemalan Adults: Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pneumoniae, Klebsiella pneumoniae
Authors: Hamid Sarah , Milucky Jennifer , Shang Nong , Wolff Bernard , Van Beneden Chris , Winchell Jonas , López María Reneé , Clasen Thomas , McCracken John P 
Published: January 2021

Abstract

Background
The causal attribution of bacterial pathogens to severe acute respiratory infections (SARI) is challenging because many bacteria are frequently detected in the upper respiratory tract of asymptomatic persons. Quantification of pathogen load may help differentiate asymptomatic pathogen carriage from clinically significant infection. We aimed to determine whether real-time PCR (rt-PCR) cycle threshold (Ct) values, as a proxy for bacterial load, differ between adults with SARI and asymptomatic adults.

Methods
Adults with SARI (acute onset of fever and cough, requiring hospitalization) were frequency matched to asymptomatic adults (enrolled from trauma and orthopedic inpatient wards) by age group, catchment area, and enrollment date at three surveillance sites in Guatemala. Nasopharyngeal and oropharyngeal specimens were collected from all participants and tested for pathogens using rt-PCR. Using the Wilcoxon rank sum test, we compared the distributions and median Ct values between ill and asymptomatic adults in whom Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pneumoniae, and Klebsiella pneumoniae were detected.

Results
Between October 2013 and October 2015, 304 adults with SARI and 174 asymptomatic adults were enrolled (Table). M. catarrhalis, S. aureus, and S. pneumoniae were detected with similar frequency in both groups. H. influenzae and K. pneumoniae were detected more frequently in asymptomatic adults. We found the greatest difference in Ct value distributions between ill (median Ct=30.8) and asymptomatic adults (median Ct=35.6) with S. pneumoniae detections (p&lt; 0.01) (Figure). Median Ct values of H. influenzae (29.3 vs 31.1, p=0.04) and M. catarrhalis (29.2 vs 31.5, p=0.05) were also lower among adults with SARI.
Frequency of select bacterial pathogen detection among adults with SARI and among asymptomatic adults, Guatemala, 2013-2015

Distributions of Ct values among adults with SARI and asymptomatic adults in whom a given bacterial pathogen was detected

Conclusion
Pathogen loads of S. pneumoniae, H. influenzae, and M. catarrhalis were higher among adults with SARI than among asymptomatic adults, suggesting that Ct values may provide insight into SARI etiology for some pathogens, despite the similar frequency of detection among both ill and asymptomatic adults. Future work will normalize Ct values to account for variation in testing and analysis and explore the use of Ct values to estimate population attributable fractions of respiratory infections.

Disclosures
All Authors: No reported disclosures
1474. Impact of 13-valent Pneumococcal Conjugate Vaccine (PCV13) on Non-bacteremic Pneumococcal Pneumonia (NBPP) among Adults in the United States, 2013-2017
Authors: Gierke Ryan , Matanock Almea , Shang Nong , Farley Monica M , Schaffner William , Thomas Ann , Reingold Art , Harrison Lee , Schleiss Katherine , Burzlaff Kari , Petit Susan , Alden Nisha B , Pilishvili Tamara 
Published: January 2021

Abstract

Background
PCV13 was recommended for U.S. children in 2010 and for adults ≥ 65 years in 2014. Vaccine coverage among adults ≥ 65 years was 43% in 2017. We evaluated PCV13 impact on NBPP among adults.

Methods
NBPP cases (clinically or radiographically confirmed pneumonia and a positive pneumococcal urine antigen test (PUAT) in a hospitalized adult aged ≥ 18 years) were identified at select hospitals in 10 sites within CDC’s Active Bacterial Core surveillance during 2013-2017. NBPP rates (per 100,000) were estimated using U.S. Census Bureau population denominators and adjusted for the proportion of pneumonia patients tested by PUAT and the number of pneumonia admissions in the catchment area.

Results
Between 2013 and 2017, 4,430 NBPP cases were identified. Adults aged ≥ 65 years accounted for 49% of cases. Case fatality rate was 6%. From 2013 to 2014, rates of NBPP declined from 153 to 90 (41% reduction, 95%CI 28%, 51%) in ≥ 65 year-olds; 60 to 40 (34% reduction, 95%CI 22%, 45%) in 50-64 year-olds; and 15 to 10 (36% reduction, 95%CI 25%, 47%) in 18-49 year-olds. From 2014 to 2017, rates of NBPP increased in all ages, but remained below 2013 rates (Figure).
Figure. Estimated Annual Non-Bacteremic Pneumococcal Pneumonia Incidence by Age Group, 2013–2017

Conclusion
Reductions in NBPP among adults were primarily due to indirect effects of PCV13 use in children, with no additional declines following PCV13 introduction for adults aged ≥ 65 years.

Disclosures
Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant) Nisha B. Alden, MPH, CDC (Grant/Research Support)