bluuebunny/crossref_metadata_2025_split huggingface dataset:
2803. Is Maternal Plasma Zika Virus Load Associated with Birth Outcomes and Maternal Disease Severity?
Authors: Pellerin Sarah , Funk Anna Louise , Tressières Benoit , Guyomard Stéphanie , Najioullah Fatiha , Poveda Jean-Dominique , Guerbois-Galla Mathilde , Fontanet Arnaud , Hoen Bruno 
Published: October 2019

Abstract

Background
Adverse fetal outcomes and infant birth defects may develop following Zika virus (ZIKV) infection during pregnancy, especially if this occurs in the first trimester. The aim of this study was to assess the relationship between plasma ZIKV load at the time of acute symptoms and (1) the rate and severity of birth defects in neonates born to mothers who had presented with ZIKV infection during pregnancy, and (2) clinical severity of maternal ZIKV infection.

Methods
Within a cohort of pregnant women living in the French territories in the Americas and exposed to ZIKV during the 2016 outbreak, we analyzed the data of women who developed a symptomatic infection confirmed by a positive plasma ZIKV RT–PCR, using the RealStar Zika virus RT–PCR Kit (Altona Diagnostics, Hamburg, Germany). Plasma ZIKV load quantification was based on the number of cycle times (CT) at which ZIKV RNA was detected (lower CTs indicating a higher viral load). Variables indicating clinical severity of infection included the number of symptoms experienced and the severity of rash. Birth defects possibly linked to ZIKV infection were defined as microcephaly, brain imaging abnormalities, and central nervous system dysfunction. Multivariable logistic regression was used to examine whether potentially ZIKV-related abnormalities were linked to changes in CT, and multivariable linear regression was used to identify clinical correlates with CT value.

Results
Of the 277 live-born neonates who were born to mothers who met the selection criteria, 15 (5.4%) had abnormalities possibly linked to ZIKV infection. The median (IQR) ZIKV RT–PCR CT values were similar, with 31.4 (29.3–33.2) and 31.8 (30.0–33.0), in women delivering normal neonates and those delivering neonates with defects, respectively (OR: 1.04, P = 0.685). Plasma ZIKV load was lower with every day since first symptom onset, and higher with each additional symptom experienced, as indicated by changes in CT of 0.3 (95% CI: 0.2 ‒ 0.5, P < .001) and −0.3 (95% CI: −0.5 ‒ −0.1, P = 0.002) for each unit, respectively.

Conclusion
No relationship was observed between plasma ZIKV load and abnormal pregnancy outcomes but higher plasma ZIKV load was associated with a more recent and severe maternal ZIKV infection.

Disclosures
All authors: No reported disclosures.
2806. Follow-up of Children with Confirmed Perinatal Zika Virus Exposure: The First 2-year experience in the Costa Rican Tertiary Pediatric Hospital
Authors: Brenes-Chacon Helena , Avila-Aguero Maria L , Camacho-Badilla Kattia , Naranjo-Zuniga Gabriela , Benavides Adriana , Soriano-Fallas Alejandra 
Published: October 2019

Abstract

Background
Costa Rica (CR) has local transmission of Zika Virus (ZIKV) Infection since February 2016. Perinatal exposure (PE) and infection (PI) cases have been documented. Following a national protocol, reporting and follow-up of patients is mandatory. 2018 data of CR reported 272 women with confirmed ZIKV infection during pregnancy. Even though neurological sequelae are described in PI, including microcephaly, affected patients can develop symptoms within months after birth with development, language, and behavior alterations.

Methods
Retrospective descriptive study of patients born from August 1, 2016 until July 31, 2018, with laboratory confirmed PE. Follow-up was performed at referral hospital.

Results
101 patients were enrolled (37% of all national confirmed perinatal ZIKV exposure during study period). Median age of first evaluation was 5 months (range: 0.6–21). 86/101 (86%) were classified as adequate term infants. 34/101 (33.7%) mothers got infected at first trimester, 55 (54.4%) at second, and 11 (10.8%) at third trimester. No data available in one. 8/101 (8%) patients had microcephaly at birth, with only 3/101 (3%) with persistence at follow-up, and 3/101 (3%) developed it later (after 9 months). 3/101 (3%) had confirmed congenital ZIKV syndrome (laboratory confirmation in symptomatic children), and 2 (2%) congenital ZIKV infection (laboratory confirmation in asymptomatic child). 6/101 (6%) had tone abnormalities and global development delay. 9 (9%) had central nervous system (CNS) ultrasound abnormalities, and 3 (3%) developed seizures. 2 (2%) had visual abnormalities, 1 (1%) had hearing impairment, 4 (4%) developed eating abnormalities, 6 (6%) developed language delay, and 4 (4%) had hyperactive behavior. All findings were divided according to maternal trimester of infection.

Conclusion
PI is a health problem in CR. Microcephaly at is infrequent, with international data showing it affects less than 1% of newborns. Most motor and development delay were documented in patients infected early during pregnancy, but specific language and behavior abnormalities also affected patients with later PE. Mortality was not documented, but significant CNS abnormalities were evident in congenital ZIKV syndrome patients.

Disclosures
All authors: No reported disclosures.
175. There Was a Fungus Among Us: A Cohort of Fungal Infectious Endocarditis Cases in East Tennessee
Authors: Morelli Morgan K , Lorson William , Shorman Mahmoud 
Published: October 2019

Abstract

Background
Fungal infective endocarditis (IE) represents less than 2% of all IE cases, but it carries a mortality rate as high as 50%. While cases of IE are on the rise in recent years due to the increased prevalence of persons who inject drugs (PWID), there are few published studies of fungus as the cause. Candida species is the most likely fungal pathogen in IE. Known risk factors include prosthetic heart valves, healthcare-associated infections, and injection drug use. Since fungi are a rare culprit in endocarditis, there is little information on incidence, treatment recommendations, and outcomes.

Methods
A retrospective cohort of patients with Candida IE was analyzed between October 2013 and September 2018 at a university hospital in East Tennessee. Demographic, microbiologic, substance use status, mortality, and echocardiographic data were collected.

Results
Nine patients with Candida IE met inclusion criteria. Mean age was 37, 67% were males. Risk factors included PWID, oral opioid abuse, previous valve surgery and autoimmune disease. 5 (55%) were caused by Candida albicans, 3 (33.3%) Candida paraipsalosis, and 1 (11%) grew both Candida tropicalis and albicans. Valves involved: 4 (66.7%) native tricuspid, 2 (22%) native aortic. 2 (22%) had native mitral, 1 (11%) had both tricuspid and mitral valve involvement. Echinocandins were used in 5 (55%) and 2 (22%) underwent surgery. There was 1 (11%) in-hospital mortality and 2 (22%) within 1 year of discharge (Table 1).

Conclusion
Fungal IE is a rare disease with high mortality and increasing incidence, especially in PWID. High index of suspicion is required for early diagnosis. Treatment is traditionally a combination of surgery and antifungal therapy. Although, medical treatment alone can be successful in patients who are not surgical candidates, such as in PWID.

Disclosures
All authors: No reported disclosures.
176. Streptococcus intermedius: A Study of 107 Isolates
Authors: Pandya Dhyanesh , Kannangara Don 
Published: October 2019

Abstract

Background
Streptococcus anginosus (SA), Streptococcus constellatus (SC), and Streptococcus intermedius (SI) constitute the S. anginosus group (SAG). The majority of SI reports are single or few cases and small series. In a 2017 study of 263 cases of SAG only 36 (13.7%) were identified as SI, responsible for pyogenic nonbacteremic infections. Another study (2001) found 14 SI out of 122 SAG isolates of which 12 were from abscesses. In some reports, SI was only identified after molecular sequencing as original culture reports were negative. We present results of the analysis of 335 SAG isolates during a 3-year period with much higher numbers of SI (107) 32%, and bacteremia (17) 16% than previously reported. SI isolates exceeded S. constellatus (77) 23% with SA being the majority (45%)151. Our study disclosed previously unreported sites of infection and differences in the type of bacteremia (monomicrobial vs. polymicrobial).

Methods
We reviewed the charts of 1321 Streptococcal isolates which included 335 SAG with 107 SI during the last 3 years, in patients admitted to our network hospitals. Age, sex, clinical findings, lab reports, procedures, imaging, and susceptibilities were analyzed.

Results
Age range was one month to 90 years with 167 males and 166 females. There were 335 SAG isolates, SA 151(67M/84F), SI 107(56M/51F) and SC 77 (47M/30F). 70% of SI patients were in the 40–80 age group. There were 17 SI bacteremias (all monomicrobial) compared with 26 SA (17%), with 14 (54%) polymicrobial and 11 SC with 5 polymicrobial l (46%). 16 isolates were from empyema fluid, 11 related to IVDU, 9 liver abscesses, 6 perforated bowel, 3 peritonsillar abscesses, 3 breast abscesses, 3 mandibular osteomyelitis, 3 neck infections, 3 myositis, 3 pancreas associated, 1 each of mandibular sialadenitis, epidural abscess, cranial osteomyelitis, brain abscess, vertebral osteomyelitis and remainder soft-tissue infections in extremities or face. Some were related to poor oral hygiene or dental procedures. One abdominal wall infection was from a toothpick puncture. Twenty-five were polymicrobial infections. There were 4 deaths, three attributable to SI infection. All isolates tested (32) were susceptible to penicillin (MIC 0.008–0.125 μg/mL), ceftriaxone (MIC = 0.032–0.125 μg/mL) and vancomycin (MIC 0.38–1.0 μg/mL).

Conclusion
SI appears to be underreported. All SI bacteremias in the study were monomicrobial in contrast to 54% SA and 45% SC blood cultures with multiple organisms. The most common isolation site was empyema fluid. Almost all isolates appeared to originate from oral or gastrointestinal flora. Several of the sites encountered have not been reported previously. All isolates tested were susceptible to penicillin, ceftriaxone, and vancomycin.

Disclosures
All authors: No reported disclosures.
614. Metabolic Interventions for the Resensitization of Daptomycin-Resistant (DAP-R) Streptococcus mitis-oralis Strains to DAP In vitro and Ex Vivo in a Simulated Model of Experimental Endocarditis (IE)
Authors: Somerville Greg , Powers Robert , Rose, Warren , Miro Jose , Bayer Arnold , Mishra Nagendra 
Published: October 2019

Abstract

Background
Streptococcus mitis-oralis is a leading cause of IE. Treatment of this pathogen is limited by frequent high-level β-lactam resistance and the propensity to develop high-level DAP-R during DAP exposure. The current study elucidated key metabolic perturbations associated with high-level DAP-R in prototype S. mitis-oralis strain 351, following in vitro selection of DAP-R by 10-day serial passage in sub-inhibitory DAP. Furthermore, to test translatability of such metabolic changes (see below), the synergistic activity of combinations of DAP plus a strategic metabolic inhibitor (i.e., fosfomycin) vs. DAP or fosfomycin alone was assessed, using DAP-R S. mitis-oralis strain 351-D10 (MIC >256 µg/mL) in vitro and in an ex vivo IE model.

Methods
MICs. E test Growth Curve: Optical density (OD600) determined spectrophotometrically at 0–8 hours glyceraldehyde-3-phosphatedehydrogenase (GAPDH) activity. Kit from BioVision®. Metabolomics: one-dimensional 1H NMR-MS and two-dimensional 1H-13C HSQC in vitro time-kill assay: Using sub-MIC/MIC drug concentrations (initial inoculum ~1 × 105 CFU/mL) for 0, 2, 4, 6, and 8 hours. Ex vivo IE model: Simulated endocardial vegetations (SEVs) quantitatively cultured at 0, 4, 8, 24, 32, 48, and 72 hours with DAP or fosfomycin alone or in combination.

Results
NMR metabolomics analysis identified a number of metabolite differences in the 351 D10 DAP-R vs. 351 DAP-S strain (Figure 1). These data are consistent with a significant reduction in GAPDH activity (a glycolytic enzyme) in 351-D10 vs. 351 strain. Based on these metabolic changes, fosfomycin (a phosphoenolpyruvate analog) was chosen as a strategic metabolic inhibitor to attempt to “resensitize” our DAP-R S. mitis-oralis strain to DAP. The combination of DAP + fosfomycin demonstrated synergistic killing of the DAP-R strain vs. DAP or fosfomycin alone in the in vitro time-killing assays. Moreover, the DAP-R strain was synergistically cleared from SEVs by DAP + fosfomycin in the ex vivo IE model.

Conclusion
Taken together, these data indicate there are unique metabolome signatures associated with the DAP-R phenotype in S. mitis-oralis. In addition, these data provide support for further studying the use of strategic S. mitis-oralis metabolic inhibitors in additional strain-sets to resensitize DAP-R strains to DAP, using in vitro, ex vivo and in vivo models.

Disclosures
All authors: No reported disclosures.
2206. Patterns of Care and Outcomes in Elderly Patients Hospitalized with Community-acquired Pneumonia in the United States
Authors: Rastogi Radhika , Deshpande Abhishek , Le Phuc , Yu Pei-Chun , Imrey Peter , Hashmi Ardeshir , Rothberg Michael 
Published: October 2019

Abstract

Background
Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in the elderly. Few studies compare the elderly (>65) and very elderly (≥85 years). We aimed to describe characteristics and patterns of care for very elderly patients hospitalized with CAP.

Methods
We conducted a retrospective cohort study using administrative data from 2010 to 2015 of about 660 US hospitals in the Premier database. Adults aged ≥65 years hospitalized with CAP, identified by either a principal ICD-9 code of pneumonia or a principal diagnosis of sepsis or respiratory failure coupled with a secondary code for pneumonia, were included. We compared demographics, insurance status, comorbidities, presentation characteristics and treatments among three age groups: 65–74, 75–84, and ≥ 85 years.

Results
The final sample included 488,382 patients aged ≥65 years, a third of whom were ≥85 years. Geriatricians cared for <1% of patients during hospitalization, regardless of patient age. Compared with those aged 65–74 years, the patients ≥85 were more likely to be female, of white race, have Medicare insurance, and a principal diagnosis of aspiration pneumonia (17.1% vs. 7%) (Table 1). The oldest group had higher rates of cardiac comorbidities, chronic kidney disease and dementia, but lower rates of diabetes, obesity, pulmonary disease, and smoking. On presentation, more of the very elderly had concomitant urinary tract infections. They were less likely to receive opiates and benzodiazepines, but more likely to receive foley catheters and antipsychotic medications. Antibiotics given in the first 2 days were similar across the groups. Fewer very elderly patients were admitted to the ICU or got ventilation compared with younger groups. More of the very elderly were discharged to hospice and fewer were discharged home. Compared with younger ages, the very elderly had similar lengths of stay but lower costs, and higher in-hospital mortality and 30-day readmission.

Conclusion
The very elderly represent a unique population with distinct clinical characteristics and outcomes from younger elderly patients. They have different co-morbidities and appear to receive less aggressive treatment with lower costs and higher mortality despite similar lengths of stay.

Disclosures
All authors: No reported disclosures.
2207. Narrowing Antibiotic Spectrum of Activity for Trauma-Associated Pneumonia Through the Use of a Disease-Specific Antibiogram
Authors: Ting Michelle , Radosevich John , Weinberg Jordan , Nailor Michael D 
Published: October 2019

Abstract

Background
Organism susceptibilities for trauma-associated pneumonia (TAP) differ from those in other groups of patients, including the critically ill. The purpose of this study was to identify common organisms and their susceptibilities in the respiratory isolates of trauma patients diagnosed with pneumonia within the first 7 days of hospital admission, and to create a disease-state antibiogram specific to TAP to guide empiric antibiotic therapy in this patient population.

Methods
This study was an IRB-approved, retrospective chart review of adult trauma patients with pneumonia admitted between September 1, 2015 and August 31, 2018 were evaluated. Patients included were diagnosed with and treated for pneumonia, with respiratory cultures drawn within the first 7 days of admission; both culture-positive and culture-negative patients were included. Subgroup antibiograms were made for a diagnosis made on days 1–3, 4–5, and 6–7.

Results
There were 131 patients included with a median age of 45; 85% were male, and 31% were illicit drug users. The majority of patients (63%) had ventilator-associated pneumonia, and most respiratory samples (77%) were obtained via bronchiolar lavage. Cultures were positive in 109 patients and negative in 22. There were 144 total isolates; 54% were Gram-negative bacteria. The most common Gram-negative pathogens were Haemophilus influenzae (16%) and Klebsiella pneumoniae (15%). The most common Gram-positive pathogen was Staphylococcus aureus; 9% of all patients grew methicillin-resistant S. aureus. With culture-negative patients counted as susceptible, ceftriaxone monotherapy and ceftriaxone + vancomycin susceptibility were 85% and 94% of patients, respectively. Susceptibilities to cefazolin, ampicillin/sulbactam, cefepime, piperacillin/tazobactam, and levofloxacin were 49%, 69%, 91%, 90%, and 92%, respectively. Illicit drug use and day of pneumonia diagnosis did not appreciably affect antibiotic susceptibilities.

Conclusion
For TAP diagnosed within the first 7 days of hospital admission, ceftriaxone monotherapy is adequate as empiric therapy, including in ventilated patients. The addition of vancomycin can be considered in patients with MRSA risk factors or who are critically ill.

Disclosures
All authors: No reported disclosures.
181. Antimicrobial Susceptibility Trends and Risk Factors for Antibiotic Resistance in Pseudomonas aeruginosa Bacteremia: A 10-Year Experience at a Korean Tertiary Hospital
Authors: Suk Kang Jin , Moon Chisook , Jun Mun Seok 
Published: October 2019

Abstract

Background
Bacteremia due to Pseudomonas aeruginosa is associated with high mortality and inappropriate initial antimicrobial therapy leads to worse outcomes. We aimed to analyze clinical characteristics of P. aeruginosa bacteremia and risk factors for antibiotic resistance and investigate their antimicrobial susceptibility trends.

Methods
We retrospectively reviewed the medical records of patients with P. aeruginosa bacteremia admitted to a tertiary hospital between January 2009 and March 2019.

Results
A total of 242 patients were identified and the median age was 70 years [interquartile range (IQR) 57.6–75.4]. Hepatobiliary tract (28.5%) was most common primary site of infection, followed by respiratory tract (20.2%) and urinary tract (15.7%). Out of 197 (81.4%) patients treated with susceptible antibiotics and the median duration of active antibiotic therapy was 10 days (IQR 4–15.5). The percentages of susceptible P. aeruginosa to amikacin, aztreonam, cefepime, ceftazidime, ciprofloxacin, colistin, gentamicin, imipenem, meropenem, piperacillin–tazobactam, and ticarcillin-clavulanate were 90.1%, 57.9%, 77.3%, 74.8%, 74.4%, 99.2%, 91.3%, 76.0%, 76.0%, 69.4%, and 51.2%. There were 24.8% carbapenem-resistant P. aeruginosa (CRPA), 36.4% multidrug-resistant P. aeruginosa (MDRPA), and 15.3% extensively drug-resistant P. aeruginosa (XDRPA). Susceptible P. aeruginosa to gentamycin and ticarcillin-clavulanate were significantly decreased in 2014–2019 than that in 2009–2013 (both; P < 0.001). Resistance rates to carbapenems and fluoroquinolones tended to increase over time. CRPA, MDRPA, and XDRPA were significantly associated with delayed active therapy (>48 h) (all; P < 0.001). Independent risk factors for CRPA were urinary tract infection (adjusted odds ratio [aOR], 3.4; 95% confidence interval [CI], 1.5–7.8), underlying hematologic malignancy (aOR, 3.0; 95% CI, 1.1–8.3) and cerebrovascular accident (aOR, 2.6; 95% CI, 1.1–5.9), hospital-acquired infection (aOR, 2.5; 95% CI, 1.0–6.1), and co-colonization with multidrug-resistant organisms (aOR, 2.2; 95% CI, 1.1–4.4).

Conclusion
The identification of risk factors for antibiotic resistance and analysis of antibiotics susceptibility are useful for early initiation of appropriate antibiotics in patients with P. aeruginosa bacteremia.

Disclosures
All authors: No reported disclosures.
196. Impact of BioFire FilmArray® Blood Culture Identification on the Management of Staphylococcus aureus Bacteremia
Authors: Nguyen Kiet , McKamey Lacie , Green Sarah 
Published: October 2019

Abstract

Background
Staphylococcus aureus bacteremia (SAB) is associated with 30-day mortality rates that are as high as 20 to 40%. In order to reduce mortality and treatment failures, SAB management should include prompt infectious diseases (ID) consult, repeat blood cultures, source control, intravenous antibiotics for the entirety of treatment, and optimal treatment duration. The objective of this study was to determine the impact of BioFire FilmArray® Blood Culture Identification (BCID) on the implementation of these standard of care measures in the management of SAB across a large health system.

Methods
This study was an IRB approved, retrospective chart review evaluating the impact of rapid diagnostics on the management of SAB before and after implementation of BCID. The composite endpoint consisted of mortality at 30 days, persistent SAB (≥7 days), and recurrence of S. aureus infection within 30 days. Patients were included if they were ≥18 years old and at least one blood culture was positive with S. aureus. The pre-BCID period was between September 1, 2016 and March 31, 2017. The post-BCID period was between April 1, 2017 and July 31, 2018. Fisher’s exact test, student’s t-test, and descriptive statistics were used in the analysis.

Results
A total of 200 patients met eligibility (pre-BCID, n = 102; post-BCID, n = 98). The composite endpoint was met in 34% of patients in the pre-BCID group and 29% in the post-BCID group (P = 0.45). Mortality at 30 days (17% vs. 17%, P = 1.00), persistent SAB (16% vs. 13%, P = 0.69), and rates of recurrence within 30 days (4% vs. 1%, P = 0.37) were similar between groups. ID consult increased after BCID implementation (83% vs. 92%, P = 0.001). More patients in the post-BCID received appropriate durations of antibiotics (75% vs. 86%, P = 0.04) and had decreased time, in hours, to definitive therapy (7 ± 17 vs. 1 ± 5, P ≤ 0.05).

Conclusion
The management of SAB after implementation of BCID did not show a decrease in the primary outcome but did show an improved time to appropriate therapy. A larger study is needed to determine whether improved time to appropriate therapy translates to an improvement in patient outcomes.

Disclosures
All authors: No reported disclosures.