bluuebunny/crossref_metadata_2025_split huggingface dataset:
693. Shaking Things Up: Direct-to-PCR Viral Detection off Swabs Using Shaker-Mill Homogenization
Authors: Morehouse Zachary P , Proctor Caleb , Ryan Gabriella , Nash Rodney J 
Published: January 2021

Abstract

Background
As the number of viral diseases are on the rise, it is critical to continue to innovate and advance diagnostic, treatment, and surveillance methods surrounding viral infections. Currently, one of the most reliable methods for viral infection detection are polymerase chain reaction (PCR) based assays. These assays often involve procedures of swabbing a patient, processing the sample to lyse the virus, extract, and purify it’s nucleotides, and then run the purified genetic material via PCR for detection of a gene product needed to confirm the patient’s suspected diagnosis. This process requires time to complete and is dependent on the availability of the reagents and plastics required to complete the lysis, extraction, purification, and amplification procedures. Herein, we have developed a method to detect virus off a swab using solely shaker-mill based mechanical lysis and the transfer of the viral lysate directly to a PCR based assay, bypassing the reagent heavy and time consuming extraction and purification steps.

Methods
Using Human Coronavirus 229E (HCoV-229E) as a model system, we spiked swabs with clinically relevant levels of the virus for proof-of-concept testing. Swabs were spiked in serial dilutions from 1.2e7 copies/mL to 1.2e1 copies/mL. The swabs were then placed in 2mL tubes with viral transport media (VTM) to mimic the specimen collection procedures in the clinic prior to processing via shaker-mill homogenization. After homogenization, 1 uL of viral lysate was run in RT-qPCR for amplification of the nucleocapsid (N) gene, qualifying viral detection from the sample.

Results
HCoV-229E spiked swabs were run through the two-step process of homogenization direct to RT-qPCR for viral detection. After running 54 swabs, we confidently determined our limit of detection to be 1.2e3 viral copies/mL with 96.30% sensitivity in vitro.

Conclusion
We have successfully proven that shaker-mill homogenization provides sufficient viral lysis off swabs, where the resulting lysate can be used directly in PCR based assays for the detection of virus. This finding allows for decreased run time in traditional PCR based diagnostics and reduces the reagents and plastics required for each sample, ultimately reducing the cost and time of each viral test when compared to traditional PCR based methods.

Disclosures
Zachary P. Morehouse, MS, OMS-III, Omni International Inc (Consultant) Caleb Proctor, BS, Omni International Inc (Employee) Gabriella Ryan, BS, Omni International Inc (Employee) Rodney J. Nash, PhD, Omni International Inc (Employee)
694. Unexpected Diversity of Rotavirus Genotypes in Pediatric Population
Authors: Koukou Dimitra , Chatzichristou Panagiota , Tatsi Elizabeth-Barbara , Liakopoulou Theodota , Chronopoulou Genovepha , Michos Athanasios , Syriopoulou Vassiliki 
Published: January 2021

Abstract

Background
Rotavirus (RV) is the leading cause of viral gastroenteritis in children. Although RV genotypes differ geographically and temporally, five are the predominant genotypes circulating worldwide. Aim of our study was to monitor possible changes in distribution of Rotavirus genotypes circulating in Greek pediatric population during the post vaccine era.

Methods
Demographic data and fecal samples were collected from children ≤15 years old with symptoms of acute gastroenteritis who visited emergency units of Pediatric Hospitals in Greece from September 2016 to August 2019. Samples were tested for RV Group A antigen with rapid immunochromatographic assay. Positive samples were further G and P typed employing RT-PCR, semi-nested multiplex PCR and Sanger sequencing of the VP7 and VP4 genes.

Results
A total of 660 children participated in the study with median age 31±29 months. Males outnumbered females (59%). Most of them lived in urban cities (85%). RV genotyping distribution was G4P[8] (41%), G1P[8] (22%), G2P[4] (14%), G9P[8] (8%), G9P[4] (5,5%), G12P[8] (2%) and G3P[8] (1,8%). Unusual and mixed genotypes were identified in 3,2% and 2,5% of the samples respectively. During 2016-2017 and 2017-2018, G4P[8] was the predominant genotype in 67% and 51% of the annual samples. However, in 2018-2019 the most common genotypes were G9P[8] and G9P[4] (33% in total) followed by G2P[4] (27%). Interestingly, the genotype G9P[4] was not detected at all in the first two years of the study.

Conclusion
This study indicates diversity of the predominant RV genotypes in Greek children during 2016-2019. The emergence of G9 as the most common genotype as well as the significant detection of uncommon ones highlight the importance of continuous surveillance of RV genotyping during the post vaccine period.

Disclosures
All Authors: No reported disclosures
696. Bartonella quintana Endocarditis, A Case Series
Authors: Dieringer Thomas D , Huang Glen , Allyn Paul R , Klausner Jeffrey 
Published: January 2021

Abstract

Background
Homelessness has been a growing issue in the United States and worldwide. Bartonella quintana, the causative agent of “Trench fever”, is a well known illness among homeless populations in urban centers. While many cases of B. quintana are self limited, the disease can have advanced presentations including endocarditis. We present a short case series of three cases of B. quintana infective endocarditis (IE) in homeless individuals in Los Angeles and review the literature of cases of B. quintana IE in the homeless population.

Methods
Here we report three cases of B. quintana IE encountered in homeless individuals at the University of California, Los Angeles (UCLA) hospital system. A literature review was also conducted. PubMed was searched for published cases of human IE secondary to B. quintana in homeless individuals.

Results
All three patients were male with ages ranging from 39 to 57 years old with a history of homelessness and alcohol use. Presentations were subacute to chronic in nature consisting of constitutional symptoms as well as a range of symptoms corresponding with heart and renal failure. Each patient was found to have varying degrees of aortic insufficiency with either identified aortic valve vegetation or valvular thickening. Diagnosis was made with a combination of Bartonella serologies and whole genome sequencing PCR. All three patient’s courses were complicated by renal failure at varying points limiting the use of gentamicin for the full treatment course. Two patients ultimately underwent aortic valve replacement due to severe aortic insufficiency and completed therapy with doxycycline and rifampin. A single patient was discharged with plan to complete doxycycline and rifampin therapy however was lost to follow up.
A literature review of 10 manuscripts describing 13 cases of B. quintana IE were identified. All the patients were male and the median age was 45. Six of the cases were in Europe and eight were in North America. All cases had left sided valve involvement (10 aortic, 6 mitral, 3 both valves). No cases of right sided IE were identified.

Conclusion
B. quintana IE should be considered in homeless patients with a clinical presentation concerning for IE. A combination of serology and PCR testing can be useful in diagnosis of this uncommon cause of infective endocarditis.

Disclosures
Jeffrey Klausner, MD, MPH, Nothing to disclose
698. 8 Years of Infective Endocarditis in Intravenous and Non-Intravenous Drug Users a Single Center Experience
Authors: Alpizar-Rivas Rodolfo M , Balda Javier , Elarabi Salwa , Jaber Bertrand , Nader Claudia 
Published: January 2021

Abstract

Background
Despite advances in diagnosis and management, infective endocarditis (IE) is associated with considerable morbidity and mortality. Given the emergence of drug- resistant organisms, it is unclear whether this has impacted the characteristics and outcomes of IE among intravenous drug users (IDUs) and non-IDUs.

Methods
We conducted a single center retrospective cohort study. 306 records of hospitalized adults diagnose with IE by ICD-9/ICD-10 codes were identified from 2011 to 2018. 244 patients met criteria. IRB approval was obtained. The baseline demographic, microbiologic, echocardiographic variables and outcomes were extracted from the chart, and compared between IDUs and non-IDUs.

Results
112 (45.9%) patients were IDUs and significantly younger (mean age 36 vs. 64, p&lt; 0.001). Both methicillin-sensitive (44.6% vs. 23.5%, p&lt; 0.001) and methicillin-resistant (29.5% vs. 13.6%, p= 0.002) Staphylococcus aureus associated IE were more prevalent in IDUs compared to non-IDUs. Streptococcus species (22.7% vs 11.6%, p=0.02), excluding Enterococcus species, and coagulase-negative Staphylococcus (12.1% vs 1.8%, p=0.002) were significantly more prevalent in non-IDUs. IE in IDUs were more likely to have tricuspid valve vegetations (56.3% vs. 13.6%, p&lt; 0.001), whereas non-IDUs were more likely to have mitral valve (39.4% vs. 25%, p=0.02) and aortic valve vegetations (46.2% vs. 15.2%, p&lt; 0.001). 19% of patients with IE underwent valve replacement within 6 months, and 17% died within 90 days. A multivariable model that included age, gender, and IDU status, age was the only variable that remained independently associated with 90-day mortality (adjusted OR 1.031; 95% CI 1.006, 1.057; p&lt; 0.01).

Conclusion
In this single-center experience, we found that methicillin-sensitive Staphylococcus aureus was the dominant organism among IDUs and non-IDUs. We also found that methicillin-resistant Staphylococcus aureus was significantly more prevalent among IDUs with IE. Provably related to an increase prevalence of colonization with resistant organisms in the community. Despite the shift in prevalence of methicillin-resistant Staphylococcus aureus among IDUs, there was no increased 90-day mortality risk after adjustment for age and gender.

Disclosures
All Authors: No reported disclosures
699. A Retrospective Review of the Progression of Cardiac Vegetations with treatment
Authors: Khan Roomana , Asghar Saleeha , Kak Vivek 
Published: January 2021

Abstract

Background
The purpose of our study was to assess the natural history of cardiac vegetations in native valves(NVIE) including changes in size and/or resolution with adequate treatment, as well as analyze factors that influence initial size.

Methods
We did a retrospective review of 102 patients discharged with a diagnosis NVIE at a community hospital. These patients were then screened to see if they received an adequate course of antimicrobial therapy and had follow up echocardiograms. The primary outcome measured was the change in vegetation size. We also assessed secondary measures including pathogen identified, the valve involved, complications, and associated IDU and any co-infections.

Results
31 patients fulfilled the study criteria and showed an initial mean vegetation size of 170mm upon initial echocardiography. The follow-up size after antibiotic treatment was 78mm suggesting a statistically significant relationship between antibiotic completion and reduction in vegetation size. (p-value 0.005).
T-Test was used for subgroup analysis and showed that the initial size of vegetations was significantly larger in IDUs (311) when compared to non-IDU (92)(p-value= 0.026).Patients who had embolic phenomena had significantly larger initial vegetations than those with no embolic complication.
Initial vegetation size was significantly larger for people with embolic complications (308 mm vs 82.65 mm, p-value 0.013).We also found that patients with Staphylococcal endocarditis had larger vegetations than those with non-staphylococcal endocarditis (264 vs 39, p-value 0.001). and treatment led to a larger decrease in vegetation size (152 vs 7, p value 0.007)

Conclusion
Our small study suggests that successful treatment of NVIE does lead to a decrease in vegetation size though resolution of the vegetation does not occur. We also found that embolic phenomenon tended to occur with larger vegetations with our study suggesting that a vegetation &gt; 3 cm was more likely to embolize. Our study also shows that vegetations in NVIE in injection drug users were larger than those in non-IDU and vegetation size is larger in patients with staphylococcal endocarditis however successful treatment in these patients also leads to a larger decrease in size of these vegetations

Disclosures
All Authors: No reported disclosures
700. Ampicillin-Ceftriaxone Versus Ampicillin-Gentamicin for Definitive Therapy of Enterococcus faecalis Infective Endocarditis: A Propensity Score-Matched,Retrospective Cohort Analysis
Authors: Shah Niyati H , Shutt Kathleen A , Doi Yohei , Doi Yohei 
Published: January 2021

Abstract

Background
The mortality rate for Enterococcus faecalis infective endocarditis (EIE) is high. Ampicillin-ceftriaxone (AC) has emerged as an alternative antibiotic regimen with lower toxicity compared to ampicillin-gentamicin (AG), but evidence regarding its success in reducing EIE-associated mortality in the United States is limited. We retrospectively compared mortality in EIE patients treated with AG versus AC.

Methods
We conducted a retrospective, propensity score-matched, cohort analysis of EIE patients treated with AG or AC from 2010 to 2017 at three hospitals in Pittsburgh, Pennsylvania. Patients were included in the analysis if they were treated for EIE with either AC or AG as the pathogen-directed antibiotic regimen for at least forty-eight hours. We assessed 90-day mortality as the primary outcome, and in-hospital mortality, length of hospital stay, hospital readmissions, adverse events, and relapse of bacteremia as the secondary outcomes.

Results
A total of 190 patients with EIE (100 treated with AC and 90 with AG) were included. Ninety-day mortality was significantly higher in the AC group than the AG group (21% vs 8%, p = 0.02). After propensity score-matching, 56 patients in each group remained for the outcomes analysis. We observed similar rates of 90-day mortality (6% vs 4%, p = 0.55), bacteremia relapse (0 patients in both cohorts), treatment failure (0% vs 1%, p = 0.50), and 90-day hospital readmission (24% vs 23%, p = 0.85) in the AC and AG-treated patient cohorts. Adverse events were more common in patients treated with AG, and more patients in the AG cohort switched antibiotic regimens than in the AC group.

Conclusion
EIE patients treated with AC have similar mortality rates as those treated with AG, while AG is associated with increased toxicity and adverse events. Larger, multi-center studies are still needed to compare the two antibiotic regimens.

Disclosures
All Authors: No reported disclosures
702. Characteristics of Infective Endocarditis (IE) and Predictors of 90-day Mortality Among People Who Do and Do Not Inject Drugs with IE in Seattle, Washington
Authors: Corcorran Maria A , Stewart Jenell C , Lan Kristine F , Gupta Ayushi , Muggli Tanner N , Sharninghausen Jody C , Takasugi Jordan , Tietjen Ty J , Glick Sara N , Seshadri Chetan , Koomalsingh Kevin , Gibbons Edward F , Harrington Robert , Dhanireddy Shireesha , Dhanireddy Shireesha , Kim H Nina 
Published: January 2021

Abstract

Background
People who inject drugs (PWID) are at high risk for IE and account for a growing proportion of IE cases in the United States. We describe key characteristics of IE and predictors of 90-day mortality among people who do and do not inject drug at two large academic medical centers.

Methods
We used a string-searching and pattern-matching algorithm within all discharge (DC) summaries to query the electronic medical record (EMR) for cases of IE among adults ≥18 years of age at two academic medical centers in Seattle, Washington from December 1, 2013 to July 31, 2019. All cases were chart reviewed by a member of the study team to confirm a clinical diagnosis of IE and verify housing and PWID status, the latter defined as any injection drug use in the 3 months prior to admission. Microbiology and valve involvement were extracted from DC summaries and chart-reviewed where needed. Deaths were obtained from Washington state death index, which links to our EMR. Descriptive statistics were used to compare PWID and non-PWID with IE, and Kaplan-Meier log rank tests and Cox proportional hazard models were used to assess for predictors of 90-day mortality.

Results
We identified 387 patients with IE, 44% (n=166) of whom were PWID. When compared to non-PWID, PWID were younger (median age 33 vs. 55 years, p&lt; 0.001) and more likely to be female (48% vs. 31%, p=0.001), homeless (41% vs. 9%, p&lt; 0.001), have coagulase-positive Staphylococcal IE (69% vs. 32%, p&lt; 0.001), and have right sided IE (66% vs. 26%, p&lt; 0.001). Seventeen percent (n=64) of patients died within 90 days of admission, including 14% (n=23) of PWID and 19% (n=41) of non-PWID, with no difference in 90-day mortality between these groups (log-rank p=0.3). In univariate analyses, having left sided IE was the only predictor of 90-day mortality (HR 4.79, 95% CI 2.18 – 10.5).

Conclusion
Despite PWID being significantly younger and having a much higher frequency of right sided IE, they had similar 90-day mortality to non-PWID in this contemporary, urban cohort of hospitalized IE patients.
Table 1. Demographic Characteristics of People Who Do and Do Not Inject Drugs with Infective Endocarditis at Two Seattle Hospitals, 2014 – 2019

Disclosures
All Authors: No reported disclosures
704. Evaluation of Risk Factors and Outcomes of Early Left Ventricular Assist Device Infections
Authors: Shealy Stephanie , Milgrom Alexander , burns Stephen , Ferraro Hunter , Collins Amanda , Cox Jenna , Derrick Caroline , Mardis Andrew , Grubbs James , Weissman Sharon , Justo Julie Ann , Bookstaver P B 
Published: January 2021

Abstract

Background
Infection is a major complication of placement of left ventricular assist devices (LVADs) for patients with end stage heart failure. This study aimed to identify risk factors and evaluate outcomes of early LVAD specific and related infections in a community teaching hospital.

Methods
This was a single-center, retrospective cohort study that included adult patients with placement of LVAD from October 2012 – December 2019. LVAD specific infection was defined as a pump, cannula, pocket, or percutaneous driveline infection and LVAD related infection was defined as infective endocarditis, mediastinitis, or bloodstream infection. The primary outcome was early LVAD specific or related infection within 90 days of implantation. Secondary outcomes included time to infection, risk factors of and time to recurrent infection, and time to death. Multivariate logistic regression was used to ascertain risk factors for early infection. Cox regression was used to ascertain association with time to outcome variables.

Results
Of 160 patients who had LVADs placed during the study period, 26 experienced early LVAD infection. The majority of infections were caused by Staphylococcus spp. (32.1%). Risk factors for early infection are summarized in Table 1. Risk factors identified included placement of HeartMate III device when compared to HeartMate II and BMI &gt; 40kg/m2. Increased hazard rate of infection was demonstrated for patients with HeartWare and HeartMate III devices compared to HeartMate II (HR 2.344; 95% CI 1.22,4.496; p-value 0.01; and HR 2.858; 95% CI 1.231, 6.635; p-value 0.015, respectively), those with BMI &gt;40 (HR 2.437; 95% CI 1.131, 5.252; p-value 0.023), and those with history of diabetes (HR 1.736; 95% CI 1.012, 2.987; p-value 0.045). No risk factors were identified in the multivariate regression model for recurrent infection. Time to death was increased among patients with A1C &gt; 6.4 at baseline (HR 1.028; 95% CI 1.002, 1.054; p-value: 0.032) and among patients who experienced early LVAD infection (HR 3.824; 95% CI 1.928, 7.584; p-value &lt; 0.001).

Conclusion
HeartMate III device and BMI &gt; 40kg/m2 were identified as risk factors for early LVAD infection. Time to mortality was decreased among patients that experienced an early LVAD infection.

Disclosures
Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)
707. Infective Endocarditis and Medication Assisted Treatment in Opioid Use Disorder
Authors: Loomis Katherine , Canamar Catherine , Dubè Michael 
Published: January 2021

Abstract

Background
A challenging feature in those with opioid use disorder-associated infective endocarditis (OUD-IE) is the duration and route of treatment, which often requires long inpatient stays. Those with OUD-IE often experience opioid withdrawal in the hospital, putting them at risk of leaving care prior to completion of treatment.
Initiation of medication-assisted treatment (MAT) with opioid agonists, including buprenorphine or methadone, has the potential to mitigate withdrawal and decrease morbidity and mortality among this high-risk population. We hypothesized that inpatient MAT will increase IE treatment adherence.

Methods
We conducted a single-center retrospective chart review study of adults (age &gt; 18 years) with OUD-IE from 10/2015-09/2019. Vizient database was used to identify cases using ICD-9 and ICD-10 codes for IE and OUD. Manual chart review was done to confirm cases of OUD-IE using the modified Duke criteria for IE (Table 2) and evidence of active opioid use. Our primary outcome was treatment adherence defined as inpatient completion of treatment or transfer to another care facility for completion of treatment. Chi-squared test was used for categorical variables, t-test for continuous variables, and odds ratio (OR) with 95% confidence interval (CI) to evaluate our primary outcome.
Table 2

Results
There were 49 confirmed patients with 89 unique admissions associated with OUD-IE (Figure 1). Of those, 71% were male, and the median age was 45 years (range 20-72). The majority were homeless (63%) and hepatitis C antibody positive (82%) (Table 1).
There were 81 evaluable admissions with 8 (9%) excluded due to intubation. Of those, 18 (22%) received inpatient MAT and 63 (78%) did not. Mortality rate was high, with 11 inpatient deaths. Among those admissions where MAT was given, 14 of 18 (78%) adhered to treatment, compared to 21 of 63 (33%) who did not receive MAT (p&lt; 0.001). Significantly, only 4 of 18 (22%) who received MAT left AMA, compared 39 of 60 (65%) who did not receive MAT (p=0.001), excluding 3 who died. Those who received inpatient MAT were 7 times more likely to adhere to treatment (OR=7.0; 95% CI=2.05, 23.91) compared to those who did not (Table 3).
Figure 1

Table 1

Table 3

Conclusion
Patients with OUD-IE were more likely to adhere to treatment if they receive inpatient MAT.

Disclosures
All Authors: No reported disclosures