bluuebunny/crossref_metadata_2025_split huggingface dataset:
2541. Impact of a Combined Infectious Disease-Critical Care Medicine (ID-CCM) Track on Fellowship Recruitment
Authors: Bhanot Nitin , Min Zaw , Moffa Matthew , Walsh Thomas L , Como James D 
Published: October 2019

Abstract

Background
There has been a declining national trend in recent years of resident applications to Infectious Disease (ID) fellowship programs. This dearth of interested and available applicants has resulted in many programs failing to fill some or all of their fellowship slots. Our ID fellowship program, founded in 2013 at Allegheny General Hospital, had met with similar difficulty.

Methods
To increase the recruitment pool of candidates and combat the challenge to fill our positions, we incorporated a combined 3 year ID-Critical Care Medicine (CCM) track in 2016, initially with one of our two annual fellowship slots allotted to this track. This entailed a collaborative effort between the ID and CCM divisions, an internal application completion outlining the need and rationale for this combined program, and finally, approval from the institutional as well as the Accreditation Council for Graduate Medical Education (ACGME).

Results
The number of applicants interviewed from 2013 to 2016 for ID (pre-inception of the ID-CCM track), as well as those for ID, ID-CCM, or those interviewing for both tracks following 2016, were counted. We noted a consistent increasing trend in the numbers interviewed for both the ID (4, 8, and 12 total applicants) and ID-CCM (4, 10, and 12 total applicants) tracks over the three since the inception of our combined fellowship program; 3 additional applicants in years 2017 and 2018, and 5 in 2019, expressed interest in either ID or ID-CCM (Graph 1). This favorably amounted to filling our training positions.

Conclusion
Implementation of a combined ID-CCM fellowship program proved to be a viable strategy to increase the number of applicants at our institution. Given the success of having one dually-accredited slot, we have expanded the combined-track to both positions. As the first fully-integrated ID-CCM fellowship program in the country, we may be pioneering this novel training pathway for future physicians.

Disclosures
All authors: No reported disclosures.
2552. Using a Digital Escape Room as a Framework for Deliberate Practice of ID Fundamentals
Authors: Jeffres Meghan N 
Published: October 2019

Abstract

Background
Deliberate practice is defined as engagement in structured activities created specifically to improve performance in a domain. Deliberate practice is achieved when the following three conditions are met: (1) The student is motivated to practice and exert effort to improve performance, (2) The task takes into account the preexisting knowledge of the learner so the task can be correctly understood after a brief period of instruction, and (3) The learners are given immediate and informative feedback on performance. A digital escape room meets all the conditions for deliberate practice as well as creating a collaborative learning experience.

Methods
Eight puzzles and corresponding digital locks were created using Google Forms and implemented in an infectious diseases (ID) elective offered to third year pharmacy students. The content for escape room puzzles included clinical microbiology, antimicrobial spectrum and pharmacology. Facilitator and classroom logistical data were collected. Student satisfaction was assessed for through an online anonymous survey.

Results
20 small groups received a handout that contained learning objectives, rules, a Google Form link, escape room plot, 8 unique puzzles, and three hint tokens. 3 of 23 (13%) groups completed all 8 puzzles within 2 hours. Groups used 24 of 60 (40%) available hint tokens. The satisfaction survey was completed by 54 students, a 79% response rate. 93% of students indicated they were more engaged with thinking about the content than a typical classroom experience. 68% disagreed that the escape room framework made it difficult to focus on learning due to feeling stressed or overwhelmed. Constructive feedback themes were increasing clarity of puzzle directions and code nuances. Positive feedback themes were related to engagement, collaboration with peers, and variety of puzzles.

Conclusion
The escape room framework provides an engaging opportunity for the deliberate practice of ID fundamentals, a task student often find to be tedious. Using digital instead of physical locks allows the escape room to be deployed in a large classroom setting with one or two facilitators. Since Google Forms provides immediate and informative feedback, the role of the facilitator is respond to hint tokens and remediate the material with students.

Disclosures
All authors: No reported disclosures.
2558. Pharmacy Students’ Perceptions and Confidence to Recommend Appropriate Empiric Antibiotic Therapy in Infective Endocarditis Following Mannequin-Based Simulation
Authors: Kufel Wesley D , Leppien Emily , Lynch Sarah , Seabury Robert 
Published: October 2019

Abstract

Background
Mannequin-based simulation (MBS) has been shown to increase healthcare student confidence. Limited data describes the use of MBS for infectious diseases (ID) education, particularly among pharmacy students. The objectives of this study were to assess the effect of MBS on pharmacy student confidence to recommend appropriate empiric antibiotic therapy for infective endocarditis (IE), and to evaluate students’ perceptions of MBS.

Methods
This single-center, cross-sectional, electronic, anonymous survey was conducted in a second professional year skills education course at a 4-year Doctor of Pharmacy program. Students were provided a pre-survey following IE education via didactic, large classroom instruction, which occurred 2 weeks prior to MBS. The pre-survey asked participants to assess their confidence to recommend appropriate empiric antibiotic therapy for IE on a Likert scale from strongly disagree (1) to strongly agree (5). Participants were provided a post-survey following MBS. The post-survey included the pre-survey questions, as well as questions regarding demographics, and perceptions of MBS. Participation was voluntary.

Results
The survey was distributed to 58 students; 93% (54/58) and 90% (52/58) responded to the pre- and post-survey, respectively. Most were female (29/52, 56%) and 50% (26/52) had a Bachelor’s degree. Half were interested in an ID pharmacy experiential rotation (26/52, 50%), and most were interested in pursuing post-graduate residency training (30/52, 57%). The majority agreed or strongly agreed that MBS was an enjoyable learning experience (48/52, 92%) that improved their knowledge of IE (48/52, 93%). Additionally, most agreed or strongly agreed that MBS improved their learning compared with written case-based instruction (46/52, 89%). Students agreed or strongly agreed that MBS increased their confidence to recommend appropriate empiric antibiotics for IE (pre-survey: 70% vs. post-survey: 87%, P = 0.035).

Conclusion
MBS appeared to increase pharmacy student confidence in their ability to recommend appropriate empiric antibiotics for IE. Pharmacy students agreed that MBS was an enjoyable learning experience that improved their knowledge, and preferred MBS compared with written case-based instruction.

Disclosures
All authors: No reported disclosures.
149. Short vs. Long Course of Antibiotics for Uncomplicated Gram-Negative Bacteremia
Authors: Go James , Cotner Sarah , Burgess Donna R , Burgess David , Wallace Katie , VanHoose Jeremy , Arora Vaneet , Li Nannan 
Published: October 2019

Abstract

Background
Bloodstream infections (BSI) continue to be a major cause of morbidity and mortality in the United States; thus, the correct choice of antibiotics for an appropriate duration is imperative. However, there are limited recommendations on adequate duration of treatment of bacteremia caused by Gram-negative organisms. Therefore, treating an infection for an adequate duration to prevent complications while preventing adverse effects from unnecessary antibiotic exposure remains a balancing act. This study aims to compare clinical outcomes between patients treated with a short (7–10 days) vs. long (11–20 days) course of antibiotics for uncomplicated gram-negative bacteremia.

Methods
This single-center retrospective cohort study evaluated adult patients admitted between January 2007 to October 2018 with a blood culture positive for gram-negative bacteria. Data came from the University of Kentucky Microbiological Laboratory and Center for Clinical and Translational Science (CCTS) Data Bank. Patients included must have received appropriate antibiotics for at least 7 days. Appropriate antibiotics were defined as those to which the organism is susceptible with day one of therapy as the first day of appropriate antibiotic therapy. Patients were excluded if they were treated with aminoglycoside monotherapy, had polymicrobial bacteremia, or if treated for longer than 20 days of therapy.

Results
A total of 466 patients were identified (208 in the short-course group and 258 in the long course group). Gender and ethnicity were similar across both groups. The patients in the long course group had more ICU admissions compared with the short-course group (52.7% vs. 43.3%, P = 0.0426), tended to be older (57 ± 16.7 vs. 53 ± 15.9 years, P = 0.0119), had a higher Charlson Comorbidity Index (5.7 ± 3.6 vs. 4.6 ± 3.6, P = 0.0009) and remained admitted to the hospital longer (23.2 ± 25.6 vs. 15.8 ± 17.5 days, P = 0.0002). However, patients treated with a long course had no difference in 30-day mortality compared with the short-course group (3.9% vs. 3.4%, P = 0.7701).

Conclusion
Patients with an uncomplicated gram-negative BSI treated with a short course (7–10 days) of antibiotics do not appear to have a significant difference in 30-day mortality compared with those patients treated with a long course (11–20 days).

Disclosures
All authors: No reported disclosures.
150. Urinary Tract-Associated Gram-Negative Bacteremia: Impact of Treatment Duration
Authors: Badwal Jasmin K , Hand Elizabeth O , Lyons John M , Traugott Kristi A 
Published: October 2019

Abstract

Background
Gram-negative bloodstream infections are one of the leading causes of death in the United States. A select number of studies have been conducted evaluating various treatment durations; however, none have specifically focused on urinary sources. The purpose of this study was to compare the effect of short vs. long course of antimicrobial therapy on clinical and microbiological outcomes for urinary tract-associated gram-negative bacteremia (GNB).

Methods
This was a single-center, retrospective review from January 2016 to October 2018. Subjects were screened using a report of all positive GNB cultures. Hospitalized patients ≥18 years of age were included if they had a bacteremia from a urinary source and received an intravenous or a highly bioavailable oral agent for ≥7 days. Patients were excluded due to pregnancy, incarceration, inappropriate definitive therapy, polymicrobial bacteremia, unaddressed source control issues, or death during the treatment course. Short course (SC) was defined as 7–10 days, while long course (LC) was defined as >10 days. The primary composite outcome of treatment failure included both 30-day all-cause mortality and 90-day recurrence. Secondary outcomes included 30-day re-admission, 90-day mortality, resistance development, and C. difficile infection.

Results
A total of 207 patients were included: 45 patients received SC and 162 received LC. Both groups were similar at baseline in terms of comorbidities, intensive care unit (ICU) admission, and vasopressor initiation. No statistically significant difference in the primary composite endpoint was observed: 2/45 (4.4%) SC vs. LC 10/162 (6.2%), P = 0.66. There was also no difference in other secondary outcomes.

Conclusion
Consistent with prior studies, we were unable to find a significant difference in clinical failure rates between SC vs. LC for treatment of urinary tract-associated GNB. Generalizability to more complicated cases including those with inadequate source control may be limited; however, these data add to the body of literature supporting the use of shorter antibiotic durations.

Disclosures
All authors: No reported disclosures.
2575. Dramatic Time-Dependent Changes of Bacterial and Fungal Taxonomic Signatures in 4 Body Regions of ICU Patients
Authors: Wurm Philipp , Halwachs-Wenzl Bettina , Kashofer Karl , von Lewinski Dirk , Eisner Florian , Krause Robert , Gorkiewicz Gregor , Hoegenauer Christoph 
Published: October 2019

Abstract

Background
It has been hypothesized that intensive care unit (ICU)-related complications like nosocomial pneumonia or gastrointestinal dysfunction are associated with disturbances of normal host microorganisms. However, these alterations are largely unknown in ICU patients. The bacterio- and mycobiota in 4 body regions in 14 ICU patients was investigated after admission until death or discharge to other wards.

Methods
Medical ICU patients were sampled with pharyngeal swabs, endotracheal aspirates, gastric secretions and stools or rectal swabs (in constipated patients). V1-V2 (16S rRNA gene) and eukaryoitic ITS sequencing was performed as previously described as well as denoizing, transformation into amplicon sequence variants and analysis using qiime2 and LEfSe (LDA Score > 3.0, P-value < 0.05). For sequence classification databases SILVA 132 (16S) and UNITE version 7.2 (ITS) were used.

Results
Samples were obtained at multiple time points from day 1 up to day 47 with a median of 11 samples per patient (range 2 to 17). In 11 patients all intended body regions were sampled (stool was missing in two patients and gastric secretion in two patients). The length of ICU stay and number of antibiotics administered during ICU stay was associated with loss of diversity in all investigated body sites. Taxonomic profiling showed a significant reduction of physiological members from the oral and fecal microbial community (e.g., Clostridiales, Bacteroidales, Faecalibacterium spp. etc.) after 2 weeks at the ICU. In contrast, Enterococcus spp. and Staphylococcus spp. were enriched in the gastric and fecal microbiota. Candida spp. dominated fungal communities of all body sites investigated. Staphylococcus aureus was associated with ITS positive, Candida spp. dominated samples throughout all body sites, while Pseudomonas aeruginosa was associated with ITS-negative samples.

Conclusion
The length of the ICU stay and the number of different antibiotics administered during the stay at the ICU are associated with severe intestinal dysbiosis, determined by loss of physiological microbes, decreased bacterial richness and domination of low-diversity fecal microbiota. Early colonization of Candida spp. might favor a co-existance of a Staphylococcus spp.-dominated microbiota in the ICU.

Disclosures
All authors: No reported disclosures.
2581. An Invertebrate Model to Study Gut Microbiome Dysbiosis
Authors: Alnezary Faris S , Rashid Tasnuva , Begum Khurshida , Carlson Travis J , Gonzales-Luna Anne J , Alam M Jahangir , Garey Kevin W 
Published: October 2019

Abstract

Background
Antimicrobials disrupt the gut microbiota by reducing gut microbiome diversity and quantity. Galleria mellonella provides an invertebrate model that is inexpensive, easy to maintain, and does not require specialized equipment. This study investigated the feasibility of using G. mellonella as an in vivo model to evaluate the effect of different antimicrobials on gut microbiota.

Methods
To determine baseline gut microbiota composition, the gut contents of G. mellonella were extracted and genomic DNA underwent shotgun meta-genomic sequencing. To determine the effect of infection and antibiotic use, 30 larvae were injected (left proleg) with ~1 × 105 colony-forming unit (cfu) of methicillin-resistant Staphylococcus aureus (MRSA) and were randomized 1:1:1 to treatment with vancomycin (20 mg/kg) or a natural antimicrobial (Nigella sativa seed oil, 70 mg/kg; NS oil), or a combination. The larvae were kept at 37°C post-infection and monitored daily for 72 hours for activity, extent of cocoon formation/growth, melanization, and survival. Two larvae from each group were randomly selected and homogenized with PBS as controls. After 24 hours of incubation, gut contents were extracted and plated for MRSA and Enterococcus cfu counts.

Results
Metagenomics analysis showed the gut microbiota composition of G. mellonella larvae was dominated by a subset of closely-related Enterococcus species. After 24 hours of exposure, mean Enterococcus counts were 4 × 103 cfu in the vancomycin arm and 6.2 × 104 cfu in the NS oil arm. Mean MRSA counts were 3.3 × 105 cfu in vancomycin arm and 1.5 × 104 cfu in NS oil arm. The combination of vancomycin and NS oil had higher Enterococcus counts than the vancomycin alone arm (6.3 × 104 cfu vs. 4 × 103 cfu, respectively), suggesting that NS oil may have a role in protecting the gut microbiota.

Conclusion
This study provides preliminary evidence to support the potential use of G. mellonella to assess the in vivo effect of a natural and synthetic antimicrobial on the gut microbiota.

Disclosures
All authors: No reported disclosures.
2587. Etiology and Outcome of Acute Neonatal Infectious Encephalitis
Authors: Frankel Craig , Whyte Hilary , Chau Vann , MacGregor Daune , Mahant Sanjay , Branson Helen , Campigotto Aaron , Bitnun Ari 
Published: October 2019

Abstract

Background
There are very few studies on acute encephalitis with onset during the neonatal period. The objectives of this study were to investigate the etiology and salient clinical features of neonatal encephalitis.

Methods
Neonates with possible infectious encephalitis (IE) were prospectively enrolled. Inclusion criteria included encephalopathy (altered/fluctuating level of consciousness ≥24 hours) plus ≥2 of: fever/temperature instability; seizure(s); focal neurologic findings; CSF pleocytosis; EEG abnormalities consistent with encephalitis; neuroimaging abnormalities consistent with encephalitis. Neonates with a clear diagnosis of post-perinatal asphyxial encephalopathy or culture proven bacterial meningitis were excluded. Results shown as absolute numbers, proportions or medians [interquartile range] as appropriate.

Results
Fifty-nine neonates fulfilled the inclusion/exclusion criteria (June 2013–November 2018). Empiric acyclovir was initiated in 49 (83.1%) cases. An infectious etiology was identified in 25 (42.4%): enteroviruses (n = 15), HSV (n = 5), HHV6 (n = 2), parainfluenza 3 (n = 1), influenza A (n = 1), CMV (n = 1). A noninfectious cause was confirmed in 20 (33.9%): missed hypoxic-ischemic encephalopathy (n = 10), genetic/metabolic disorders (n = 7), ischemic/hemorrhagic stroke (n = 3). No specific etiology was identified in 14 (23.7%). Thirteen (52%) neonates with IE either died (n = 7) or suffered neurologic sequelae (n = 6). Deaths were attributable to HSV (n = 4), enteroviruses (n = 2) and HHV6 (n = 1). Neurocognitive sequelae were documented in one case each of enterovirus, HSV2, HHV6, CMV, parainfluenza 3 and influenza A. Differences between neonates with and without IE, respectively, included age in days of symptom onset (7 [6, 10] vs. 1 [0, 3]; P < 0.001), gestational age (37.0 [36.0, 39.0] vs. 38.6 [37.6, 40.0]; P = 0.045), peripheral leukocyte count (10.5 [IQR 5.9, 14.6] vs. 14.3 [IQR 10.7, 21.7]; P = 0.008) and CSF glucose (2.80 [IQR 2.3, 3.2] vs. 3.10 [2.8, 3.8]; P = 0.003).

Conclusion
Enteroviruses and HSV are the predominant causes of neonatal IE. Outcome of neonatal IE is poor with approximately half dying or suffering neurologic sequelae.

Disclosures
All authors: No reported disclosures.
152. Brevibacterium species: Case Series and Literature Review of an Emerging Opportunistic Cause of Bloodstream Infections
Authors: Shweta F N U , Gurram Pooja , Khalil Sarwat , Rodino Kyle , O’Horo John C 
Published: October 2019

Abstract

Background
Brevibacterium species are non-motile, catalase-positive, obligate aerobic gram-positive bacilli. Colonies are yellow to gray-white, non-hemolytic, smooth, 6.5% sodium chloride tolerant. B. fermentans post neurosurgical meningitis was first described in 1969 in an infant. B. casei remains the most commonly isolated species (Table 4). The most commonly reported syndromes are bloodstream infections (BSIs) and endocarditis. Despite these reports, this organism continues to be listed on CDC’s NHSN commensal database.

Methods
Isolates of Brevibacterium from clinical samples at Mayo Clinic, Rochester from January 1, 2014 to December 31, 2018 were identified. Charts were reviewed to determine patient demographics, immune status, source of culture, comorbidities, antibiotic susceptibility test (AST), length of stay (LOS) in hospital and intensive care unit (ICU), and mortality. Likelihood ratio (L-R) and Pearson correlation coefficient (PCC) of nominal data were calculated using the Chi-square test and Fischer exact test (FET). We defined statistical significance as P ≤ 0.05.

Results
We identified 48 isolates from 45 unique patients, 46% were females. Distribution of age, hospital and ICU LOS, and time to culture growth, and AST data are shown in Table 1. 15.5% patients received allogeneic or autologous stem cell (SCT), or solid-organ transplant (SOT) recipients. 89% cultures were from sterile sources and 68.75% were blood cultures. Of these, 63.64% were monomicrobial. 62% of isolates identified to species level were B. casei. 5 patients were treated; an additional 10 received active antibiotics for other indications. Statistically significant variables are reported in Tables 2 and 3. Thirty-day mortality was 13%. This was higher in patients with bacteremia (L-R: 5.3 [P = 0.02]) but FET was not statistically significance (P = 0.15).

Conclusion
Accurate diagnosis of Brevibacterium may require molecular techniques. At our center, SCT or SOT recipient status and recent chemotherapy were associated with bacteremia. In these patients, this organism could represent an opportunistic cause of BSI. AST data suggest that Vancomycin offers a reasonable empiric treatment option. Additional data are needed to further define host populations in whom this organism presents pathogenicity.

Disclosures
All authors: No reported disclosures.