bluuebunny/crossref_metadata_2025_split huggingface dataset:
1763. The Use of Haploidentical Donors Compared with HLA-Matched Unrelated Donors is Associated with Increased Risk of BK Viruria and Hemorrhagic Cystitis
Authors: Morgan. Scott Mary , Slade Michael , Lawrence Steven 
Published: October 2019

Abstract

Background
BK virus-associated hemorrhagic cystitis (BK-HC) is a common and often serious complication of hematopoietic cell transplantation (HCT). Studies have suggested a higher incidence of BK-HC in patients receiving haploidentical (haplo) HCTs compared with those receiving matched unrelated donor (MUD) transplants.

Methods
We retrospectively identified all adult patients receiving HCT from MUD or haplo donors at Washington University School of Medicine between January 1, 2011 and January 1, 2016. Via informatics queries, we obtained the results of every urine BK test performed on these patients. Patients with BK viruria were then evaluated for BK-HC and graded according to established criteria. The last day of follow-up was April 31, 2017.

Results
503 MUDs and 140 haplos were identified for inclusion in the study. Haplo patients were significantly more likely to be nonwhite (21% vs. 5%, P < 0.001) and were younger (median age: 51.5 vs. 55, P = 0.01). Conditioning regimens were also significantly different; haplos were less likely to receive myeloablative conditioning (44% vs. 57%, P < 0.001) and busulfan-based conditioning (13% vs. 39%, P < 0.001), but were more likely to receive total body irradiation-based conditioning (83% vs. 26%, P < 0.001). Haplos were also more likely to have undergone previous allogeneic HCT (26% vs. 6%, P < 0.001). The cumulative incidence of both BK viruria and BK-HC were significantly higher in haplos (both P < 0.001). This was observed at 100 days, 180 and 365 days (Table 1).

Conclusion
We found a significantly higher incidence of both BK viruria and BK-HC in patients receiving haplo HCT compared MUD HCT. Significant demographic and clinical imbalances exist between our two cohorts and attribution of increased risk for BK-HC to donor type vs. other factors should be further explored.

Disclosures
All authors: No reported disclosures.
1767. Incidence of Respiratory Syncytial Virus Infection among Adults Undergoing Hematopoietic Stem Cell Transplantation: A Prospective Study from India
Authors: Abdul Samad Sameer , Dar Lalit , Kumar Lalit , Brijwal Megha , Choudhary Aashish , Ray Animesh , Jethani Jyoti 
Published: October 2019

Abstract

Background
Respiratory Syncytial Virus (RSV) is an important cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients; progression from Upper Respiratory Tract Infection (URI) to Lower Respiratory Tract Infection (LRTI) may occur in 30%–40% of transplant recipients with associated high fatality. Data on disease burden due to RSV among adult HSCT recipients is limited with no earlier reports from India.

Methods
We prospectively studied 50 HSCT recipients who underwent hematopoietic stem cell transplantation at our institute from January 2017 onwards. Patients were followed up for a period of 18 months post-transplant, initially during stay in transplant unit and subsequently on out-patient basis and telephonically for any episode of acute respiratory tract infection. Information on symptoms and signs at presentation as well as basic hematological and radiological investigations were collected. Nasal and throat swabs from symptomatic patients were taken in viral transport medium and tested for RSV by real-time RT–PCR. As per institute policy patients had received prophylaxis with acyclovir and itraconazole till day +30 post-transplant.

Results
A total of 68 episodes of acute respiratory tract infection were tested for RSV during the follow-up period (mean ± standard deviation = 12 ± 5 months; 11 patients expired during follow-up period). Of these 21 were URI episodes, 46 were acute bronchitis episodes and 1 was a pneumonia episode. Two episodes tested positive for RSV in two autologous HSCT recipients, both belonging to RSV-B subtype, one from a URI episode on day 163 of HSCT and the other from a pneumonia episode on day 8 after HSCT. Both recovered without specific targeted treatment against RSV. The incidence of RSV infection in post-HSCT adult patients calculated from this study is 4% per year.

Conclusion
There is significant incidence of RSV infection among post-HSCT adults in India. Nevertheless, institution of targeted treatment options depends on weighing the cost and risk against benefit of using them. RSV-B subtype as seen in this study also is less virulent and less likely to lead to LRTI compared with RSV-A. Clinical predictors of poor outcomes can also help to decide upon prophylaxis. Larger studies focusing on preventing progression to LRTI need to be done.

Disclosures
All authors: No reported disclosures.
1784. The Value of a Systematic Screening of Influenza Virus and Vaccination on Emergent Admissions to a Cardiac Intensive Care Unit (C-ICU)
Authors: Galar Alicia , Vicent Lourdes , Sousa-Casasnovas Iago , Valerio Maricela , Juárez Miriam , Catalán Pilar , Devesa-Cordero Carolina , Bruña Vanesa , Martínez-Sellés Manuel , Bouza Emilio , Muñoz García-Paredes Patricia 
Published: October 2019

Abstract

Background
Influenza is a potential inducer of acute cardiac events. However, the incidence of influenza in patients admitted to a C-ICU, the accuracy of clinical suspicion and the compliance of influenza vaccination of high-risk patients, are not well known. Objectives: To evaluate the incidence of influenza at C-ICU admission during influenza season, the potential underdiagnosis and the vaccination rate.

Methods
Prospective study at a tertiary institution including all patients admitted to a C-ICU during 2017–2018 flu season. A nasopharyngeal swab was collected at admission from all patients who consented (198/201, 98.5%) and tested using Xpert® Flu/RSV assay. Clinical data were registered.

Results
Influenza was detected in 14/198 (7.1%) patients (11 FluA, 3 FluB) and initially suspected by the cardiologist in 57.1% cases. When compared with patients without influenza, flu-positive patients had more respiratory (21.4% vs. 6.0%, P = 0.03) or neurologic diseases (21.4% vs. 4.3%, P < 0.01), contact with relatives with flu-like illnesses (35.7% vs. 14.4%, P = 0.03), antimicrobials use (71.4% vs. 36.4%, P = 0.01) and need for mechanical ventilation (28.6% vs. 3.3%, P < 0.01). Reasons for C-ICU admission between both groups were similar. All patients promptly received oseltamivir and no patient with flu died (0 vs. 3.8%, P = 0.46) despite a high rate of severe presentations (85.7%) and related complications (78.6%). Seasonal flu vaccination was received by 44.9% of the patients admitted to the C-ICU and 52.0% of patients who had indication for flu vaccination. The incidence of influenza in the vaccinated and non-vaccinated population (with flu vaccine indication) was, respectively 12.6% vs. 4.1% (P = 0.08). Flu episodes in vaccinated patients required less mechanical ventilation (20% vs. 75%, P = 0.05) and showed a trend toward shorter length of in-hospital stay (6 vs. 15d, NS). Risks factors for no vaccination despite indication were: younger age (67 vs. 75y-o, P < 0.05) and less comorbidity (Charlson index 4 vs. 5, P < 0.01).

Conclusion
Seven percent of patients admitted to the C-ICU had influenza, only half of the influenza cases diagnosed were suspected at admission and only half of the patients with indication for flu vaccination, received the vaccine. A clinical score to recognize influenza in these patients is needed.

Disclosures
All authors: No reported disclosures.
1786. An Automated Method to Assess Oligonucleotide Primer and Probe Complementarity to Genomic Targets in Infectious Disease qPCR Assays
Authors: Sinha Rohita , Wissel Mark , Bartlett Katelyn , Grantham James , Kleiboeker Steve 
Published: October 2019

Abstract

Background
Success of real-time TaqMan PCR (qPCR) in detecting pathogen targets and quantifying pathogen load is dependent upon frequent assay monitoring. This is due to i) the high degree of complementarity needed between primers / probes and genomic targets for assay accuracy and ii) natural pathogen variation and evolution. Failure to monitor and refine may result in false negativity or under quantification. Here we present a bioinformatics tool to identify potential problems resulting from newly discovered genomic mutations in primer/probe regions.

Methods
The tool performs an unbiased and automated search of the NCBI database, collects relevant genomic sequences based on user-defined Taxon-ID and executes a Python program to discard synthetic sequences. A profile of primer-probe sequence complementarity to targets is then generated. While the tool can be used for any microbe, here we present results for our laboratory’s cytomegalovirus (CMV) qPCR primer-probe analysis. In addition, our laboratory’s traditional approach utilizing alignment software was performed (download of all CMV sequences (~10,000) followed by iterative alignment building of these against our primers and probes). The amount of time to perform the automated and manual methods was recorded.

Results
The tool retrieved 8,732 sequences from NCBI and compared these to the CMV qPCR primers and probes. The tool found 2,501 alignments between the primers / probes and the downloaded genomic data (~15 minutes to finish (6 CPUs)). A total of 64% (1,624/2,501) of BLASTn alignments were exact matches between all primers / probes and viral genomic sequences. 17.5% (439/2,501) of alignments had 1 mismatch at either 5’ or 3’ terminus, and 1% (25/2,501) of alignments had two mismatches with the primers / probes. Similar results were found using a primarily manual approach (which took approx. 5 hours computing time and 20 hours of labor).

Conclusion
This new bioinformatics approach performed indistinguishably vs. a manual approach and did so in minutes rather than days. Both methods led to the conclusion that, by virtue of our design involving overlapping primers and probes, none of the identified mismatches are predicted to lead to false negativity or under quantification in our current CMV qPCR assay.

Disclosures
All authors: No reported disclosures.
1788. The Utility of Next-Generation Sequencing for Detection of Candidate Pathogens in Bronchoalveolar Lavage Fluid from Pediatric Patients with Respiratory Failure
Authors: Takeuchi Suguru , Kawada Jun-ichi , Horiba Kazuhiro , Okuno Yusuke , Okumura Toshihiko , Suzuki Takako , Torii Yuka , Kawabe Shinji , Wada Sho , Ikeyama Takanari , Ito Yoshinori 
Published: October 2019

Abstract

Background
In the field of infectious diseases, identification of etiologic pathogen is essential for definitive diagnosis and decisions regarding appropriate management. Bronchoalveolar lavage fluid (BALF) is considered a sterile type of specimen that is suitable for detecting pathogens of respiratory infections. Recently, next-generation sequencing (NGS) has been applied in the field of infectious diseases and has enabled us to identify pathogenic microorganisms comprehensively. The aim of this study was to comprehensively identify pathogens using NGS in BALF samples from immunocompetent pediatric patients with respiratory failure.

Methods
Ten patients hospitalized in the pediatric intensive care unit with respiratory failure were included. BALF samples obtained in the acute phase were used to prepare DNA- and RNA-sequencing libraries. The libraries were sequenced on MiSeq, and the sequence data were analyzed using metagenome analysis tools.

Results
A mean of 2,041,216 total reads were sequenced for each library. A significant number of four types of bacterial reads was detected in three BALF samples with DNA-sequencing, whereas pathogenic respiratory viruses were detected in seven of 10 patients with RNA-sequencing.Candidate pathogens were detected in three patients in whom etiologic agents were not identified by conventional methods. A summary of the detected pathogens is listed in Table 1. Sequence coverage and depth of each reference bacterial and viral genome are shown in Figures 1 and 2, respectively. The complete genome of enterovirus D68 was identified in two patients without underlying diseases, and phylogenetic analysis suggested that both strains belong to subclade B3, which is an epidemic strain that has spread worldwide in recent years.

Conclusion
We demonstrated the utility of the NGS-based approach for detection of candidate pathogens in BALF from pediatric patients with severe respiratory failure. Our results suggest that NGS can be applied for comprehensive molecular diagnostics as well as surveillance of pathogens in the field of infectious diseases.

Disclosures
All authors: No reported disclosures.
1991. Implementation of Rapid Turnaround PCR Bacterial/Viral Panel Testing in Community-acquired Pneumonia Decreases LOS, Antibiotic Cost, Antibiotic Charges, and Antibiotic Use
Authors: Shadowen Rebecca D , Doshi Akash , Ndzi Rene , Kazimuddin Faraaz 
Published: October 2019

Abstract

Background
Community-acquired pneumonia (CAP) is a significant infection contributing to hospitalization, morbidity, mortality, intensive care, antibiotic use, and healthcare costs. Antibiotic stewardship aims to improve appropriate antibiotic use which addresses these same issues. Accurate, confirmed diagnosis upon presentation of CAP patients using Respiratory Bacteria/Viral (RBVP) Polymerase Chain Reaction (PCR) panels can significantly impact outcomes in the CAP patient population.

Methods
In this cross-sectional study, commercially available RBVP PCR panels were used. Comparison of CAP patient populations was done before PCR use (2014–2015 control group) and after implementation (2016–2017 intervention group) using a provider choice intervention following education and order availability. Providers were educated via multiple means with lectures, individual meetings, online brief presentation, and group discussions. A nursing computer-based learning module was also developed and required to be completed. Independent sample t-test and binary logistic regression were used to analyze data.

Results
Out of total 2,523 observations in the study, 1,994 (79.03%) were in the control group and 529 (20.96%) were in the intervention group. An independent sample t-test showed significant differences in the mean of length of stay (LOS) (P = 0.04, 95% CI: 8.67–9.36), total antibiotic cost (TAC) (P = 0.000, 95% CI: 486.61–550.45), antibiotic charges (ACH) (P = 0.048, 95% CI: 1,815.79–2,009.75), and antibiotic defined daily doses (DDD) (P = 0.039, 95% CI: 6.84–7.42). Binary logistic regression results revealed statistical significance in LOS (P = 0.01, 95% CI: 0.9251–0.9902) and TAC (P = 0.000, 95% CI: 0.9989–0.9994). Actual savings per patient were LOS 0.88 days, TAC $202.73, ACH $240.23, and DDD 0.77.

Conclusion
The use of RBVP PCR panel testing in CAP patients decreases antibiotic use, LOS, and cost of care. This correlated with antibiotic de-escalation providing a significant contribution to antibiotic stewardship. PCR panel testing with rapid turnaround is widely available and cost effective.

Disclosures
All authors: No reported disclosures.
1997. Real-World Impact of Accelerate Pheno Implementation with Antimicrobial Stewardship Intervention
Authors: Kinn Patrick M , Percival Kelly M , Ford Bradley A , Ince Dilek 
Published: October 2019

Abstract

Background
Accelerate Pheno® (AP) is a novel diagnostic system that provides rapid identification and antibiotic susceptibility results for most commonly isolated organisms within hours of blood culture (BC) positivity. There are little data on this technology’s real-world implementation with antimicrobial stewardship intervention and effect on optimal targeted therapy.

Methods
AP was implemented at UIHC in September 2018 and paired with antimicrobial stewardship team (AST) review. AST recommendations were provided in real time during weekday hours and through a retrospective review process for off-hours results. Microbiologic and clinical data were collected prospectively. Due to inconsistencies in instrument performance identified after the first month, two post-implementation periods (Group A = October 2018–January 2019; Group B = February 2019–mid-April 2019) were analyzed to assess quality improvement efforts during clinical roll-out.

Results
In the 6.5-month combined period, 690 unique BC samples were run on AP and reviewed by AST (417 in A; 273 in B). Performance of the technology improved, with 78.9% (329/417) of isolates in Grp A identified vs. 85.3% in Grp B (233/273). Percentage of runs with progression to antibiotic susceptibility improved from 76.1% to 92.3%. Over both time periods, AST intervened on 277 samples (Figure 1). Recommendations (bug-drug mismatch, de-escalation, dose optimization, and infectious disease consult) were accepted at a rate of 97.4%. Time from BC positivity to optimal therapy was 15.3 hours (Figure 2).

Conclusion
Implementation of AP with AST review resulted in rapid identification and antibiotic susceptibility results with early optimization of antimicrobial therapy. Highest impact was seen in the management of patients with resistant Gram-negative infections. Oversight of the implementation by a partnership of clinical microbiology and the antimicrobial stewardship team was critical in identifying real-time implementation issues and opportunities for quality improvement. Though real-world performance was slightly inferior to published trial data, the instrument’s exceedingly fast time to AS represents a significant advantage over other systems and enhances clinical care and patient safety particularly when paired with AST intervention.

Disclosures
All authors: No reported disclosures.
2002. BioFire® Filmarray® Pneumonia Panel: A Powerful Rapid Diagnostic Test for Antimicrobial Stewardship
Authors: Furukawa Daisuke , Kim Brian , Jeng Arthur 
Published: October 2019

Abstract

Background
BioFire® Filmarray® Pneumonia Panel (BFPP) is a multiplex PCR panel that identifies 33 common bacterial and viral pathogens seen in community- and hospital-acquired pneumonias. It rapidly identifies these pathogens in addition to 7 antibiotic resistance genes on sputum and bronchioalveolar lavage samples in 1 hour. As one of the test centers for this panel, our institution utilized this panel for clinical and laboratory use. We reviewed the impact of BFPP on antimicrobial stewardship, particularly its role in early discontinuation of empiric antibiotics and prompt initiation of optimized targeted therapy.

Methods
We retrospectively reviewed all cases by which BFPP was ordered. We reviewed medical records of each case to identify the results of the panel, culture data, antibiotics used, and subsequent clinical intervention.

Results
43 tests were ordered in total. 17 were for clinical use by an infectious disease specialist and 26 were randomly obtained by the microbiology lab. All 17 clinical cases were intervened upon with the following interventions: discontinuation of anti-pseudomonal antibiotics (8 cases), discontinuation of anti-MRSA antibiotics (5 cases), discontinuation of azithromycin (4 cases), discontinuation of carbapenem (1 case), prevention of inappropriate antibiotic escalation or initiation of inappropriate antibiotics (2 cases), and early IV to PO transition (3 cases). Of the random 26 samples ordered by lab, 13 had opportunities for antibiotic de-escalation if a physician were notified of the results. Viruses were identified in 15 samples with coronavirus being the most common. Virus was the sole pathogen in 9 of the 15 samples. Bacterial pathogens were identified in 20 samples that were reported as normal flora by conventional culture; none of these cases led to or potentially could have led to antibiotic escalation as the sole intervention.

Conclusion
Clinical use of BFPP had 100% intervention rate with all interventions leading to de-escalation of antibiotics or prevention of inappropriate antibiotics use. Though over-identification of colonizers is a potential limitation, BFPP is a powerful tool for antibiotic stewardship that results in rapid interventions to achieve optimal targeted therapy.

Disclosures
All authors: No reported disclosures.
2005. Successful Implementation of a Procalcitonin Algorithm Associated with Reduction in Antibiotic Days
Authors: McCoury John B , Fugit Randolph V , Bessesen Mary T 
Published: October 2019

Abstract

Background
Randomized controlled trials of procalcitonin (PCT)-based algorithms for antibacterial therapy have been shown to reduce antimicrobial use and improve survival. Translation of PCT algorithms to clinical settings has often been unsuccessful.

Methods
We implemented a PCT algorithm, supported by focus groups prior to introduction of the PCT test in April 2016 and clinician training on the PCT algorithm for testing and antimicrobial management after test roll-out. The standard PCT algorithm period (SPAP) was defined as October 1, 2017 to March 31, 2018. The antimicrobial stewardship team (AST) initiated an AST-supported PCT algorithm (ASPA) in August 2018. The AST prospectively evaluated patients admitted to ICU for sepsis and ordered PCT per algorithm if the primary medical team had not ordered them. The ASPA period was defined as October 1, 2018–March 31, 2019. The AST conducted concurrent review and feedback for all antibiotic orders during both periods, using PCT result when available. We compared patient characteristics and outcomes between the two periods. The primary outcome was adherence to the PCT algorithm, with subcomponents of appropriate PCT orders and antimicrobial discontinuation. Secondary outcomes were total antibiotic days, excess antibiotic days avoided, ICU and hospital length of stay (LOS), 30-day readmission and mortality. Continuous variables were analyzed with Student t-test. Categorical variables were analyzed with chi-square or Mann–Whitney test, as appropriate.

Results
There were 35 cases in the SPAP cohort and 57 cases in the ASPA cohort. There were no differences in demographics or infection site (Table 1). Baseline PCT was ordered in 57% of the SPAP cohort and 90% of the ASPA cohort (P = 0.0006) (Table 2). Follow-up PCT was performed in 23% of SPAP and 76% of ASPA (P < 0.0001). Antibiotics were discontinued per algorithm in 2/35 (7%) in the SPAP cohort and 25/57 (44%) in the ASPA cohort (P < 0.0001). Total antibiotic days was 7 (IQR 4–10) in the SPAP cohort and 5 (IQR 2–7) in the ASPA cohort (P = 0.02). There was no significant difference in LOS, ICU LOS, 30-day readmission, or mortality (Table 4).

Conclusion
A PCT algorithm successfully implemented by an AST was associated with a significant decrease in total antibiotic days. There were no differences in mortality or LOS.

Disclosures
All authors: No reported disclosures.