bluuebunny/crossref_metadata_2025_split huggingface dataset:
2537. #IDDailyPearl: A Twitter Tool to Enhance Literature Engagement on Busy Infectious Diseases Consult Services
Authors: Cowell Annie N , Wooten Darcy 
Published: October 2019

Abstract

Background
Social media platforms enable on-demand, open-access learning which is attractive for busy clinicians and trainees. Additionally, teaching that occurs in a clinically contextualized, case-based setting in real time has the potential to be more effective than traditional didactics. We piloted a teaching tool to enhance learning and engagement with the literature for fellows on the infectious diseases (ID) consult service.

Methods
During a clinical service rotation, ID faculty posted a brief daily teaching point on Twitter under the hashtag “#IDDailyPearl” with a link to the relevant article. Tweets were required to be related to a patient case, associated with an article, and could not include patient identifiers.

Results
Over a 3-month period, there were 134 tweets that fit our criteria, with 103 tweets posted by UCSD faculty and 45 by faculty from other institutions. The most common topic was endocarditis and bacteremia (16.4%), followed by fungal infections (11%), tuberculosis (9.4%), and antimicrobials (9.4%) (Figure 1). Article types included review articles (21.6%), retrospective cohort studies (20.2%), case reports (13.5%), randomized controlled trials (12.1%), prospective cohort studies (9.4%), and guidelines (8.8%). Most articles cited were published after 2015 (61.6%), and were from infectious diseases journals (58.2%). The average journal impact factor was 13 (range 0.07–79), with Clinical Infectious Diseases as the most commonly mentioned journal (20.2%). Tweets were “liked” 14.5 times (range 0–80) and re-tweeted 4.6 times (range 0–33). The twitter engagement rate per tweet was 6.3% (range 2.2 to 12%) and article links were clicked 19 times (range 3–164). We are currently identifying Tweet characteristics associated with increased engagement rates.

Conclusion
Our study provides a snapshot of the literature used to teach while on the ID clinical service and lays the groundwork for identifying teaching points that receive the most engagement. This tool enables teaching points and high-yield articles to be shared within and across institutions. Future studies will examine the impact that this tool has on fellow and faculty learning, and engagement with and knowledge of the current literature.

Disclosures
All authors: No reported disclosures.
147. Non-Fermenting Gram-Negative Bloodstream Infection: A Multicenter Retrospective Cohort Study
Authors: Pascale Renato , Giannella Maddalena , Corcione Silvia , Roberto Giacobbe Daniele , Bussini Linda , Pancaldi Livia , Rosselli Del Turco Elena , Giuseppe De Rosa Francesco , Viscoli Claudio , Viale Pierluigi 
Published: October 2019

Abstract

Background
Few data exist on clinical characteristics, therapeutic management and outcome of patients with Non-Fermenting Gram-negative bloodstream infection (NFGN-BSI). Our aim is to describe a large cohort of patients with NFGN-BSI and to investigate risk factors for 30-day mortality. Further, the impact of the new difficult to treat resistance (DTR) definition will be investigated.

Methods
Retrospective multicenter study of patients diagnosed with NFGN-BSI at three large Italian hospitals (Bologna, Genova, Torino), over a 4-year period (2013–2016). Exclusion criteria: age <18 years, clinical data not available, polymicrobial BSI, death within 72 hours from drawing index blood cultures (BCs). Carbapenem resistance (CR) was defined according to 2015 CDC definitions, and DTR as resistance to all β-lactams and fluoroquinolones. Active empiric therapy (AET) was defined as at least one in vitro active drug administered within 24 hours from drawing index BCs. Endpoint was all-cause 30-day mortality.

Results
521 patients with NFGN-BSI were analyzed: 63.3% male, median age 67 (IQR 55–78) years, median Charlson index 6 (IQR: 3–7). Most episodes were hospital acquired 72.9%. Etiology distribution: Pseudomonas aeruginosa 69.9%, Acinetobacter baumannii 19.6%, and Stenotrophomonas maltophilia 10.6%. CR and DTR rates were 38.6% and 26.9%. Main infection sources were deemed as primary 50.7%, CVC-related 26.5%, and lower respiratory tract 16.3%. Source control and ID consultation were performed in 33.4% and 47.6% of cases. AET rate was 38.2%. Empiric and definitive antibiotic treatment cohorts consisted of 377 and 472 patients, respectively. There was high heterogeneity in antibiotic choice with 30 and 48 different regimens in empiric and definitive cohort, respectively. Combination therapy was administered in 22.3% of empiric cohort and in 37.3% of definitive cohort patients. Independent risk factors for 30-day mortality were age (HR 1.03, 95% CI 1.01–1.05, P = 0.001), SOFA (HR 1.25, 1.15–1.36, <0.001), DTR (HR 2.73, 1.60–4.65, <0.001), and AET (HR 0.50, 0.25–0.99, 0.05).

Conclusion
High heterogeneity in therapeutic management of patients with NF-GNBSI was observed. DTR was a strong predictor of mortality, AET was associated with improved outcome.

Disclosures
All authors: No reported disclosures.
2542. ID-Psych Addiction Rounds: A New Model to Address Opioid Use Disorder For Patients on the Infectious Disease Consult Service
Authors: West William , Eckhardt Benjamin , Cohen Gabriel M 
Published: October 2019

Abstract

Background
ID physicians often treat the infectious sequelae of opioid use disorder (OUD) and are uniquely poised to link hospitalized patients to substance use resources. In a large safety net hospital, we launched a multi-disciplinary initiative to ensure that patients on the ID consult service with OUD were always offered medication-assisted treatment (MAT). We used infections as “sentinel” events to identify patients with OUD and described the clinical characteristics of the high-risk patient population jointly consulted by ID and Psychiatry teams. This healthcare workforce initiative aimed to expand the role of ID providers in the opioid epidemic and decrease barriers to buprenorphine prescribing.

Methods
Every 2 weeks, ID fellows identified patients on their consult lists with infectious complications of OUD. Focused discussions were then held with the Psychiatry service and discussion of each patient continued at subsequent case conferences with attention paid to re-engaging those lost to follow-up. We performed chart abstraction of demographic and clinical characteristics as part of a quality improvement initiative.

Results
From October 2018 to March 2019, 23 patients were discussed at 10 case conferences with input from attendings, fellows, housestaff, social workers, and representatives from a novel Primary Care Safety Net program. The average patient age was 43 (range 24–50). Patients were predominantly male (65%), heroin users (90%) with high rates of HIV (22%) and untreated HCV (40%). ID-related infections included endocarditis (39%), osteomyelitis (31%), skin and soft-tissue infections (17%) and spinal abscesses (17%). The median time for a patient to be presented at an ID-Psych Addiction Rounds was 7 days (IQR 4.5–11.5). The mean length of hospitalization was 30 days (range 2–112). MAT was initiated in 75% of patients (41% buprenorphine; 59% methadone). The 30-day lost to follow-up rate was exceedingly high, with 80% of post-hospital appointments being missed.

Conclusion
ID physicians can effectively link hospitalized patients with OUD to substance use resources. A multi-disciplinary approach is key to addressing the opioid epidemic. Future work should explore how to create effective post-hospital transitions to decrease those lost to follow-up.

Disclosures
All authors: No reported disclosures.
2548. Provider Adherence to Cervical Cancer Screening in HIV Patient Populations
Authors: Brett Catherine , Puckett Hannah , Potter Devin , Ahuja Divya , Badmus Olabisis 
Published: October 2019

Abstract

Background
Antiretroviral therapy has nearly normalized the life expectancy of people living with HIV (PLWH). However, malignancies still remain a major cause of morbidity and mortality in PLWH, and thus an important part of the clinical visit is age appropriate screening and referral to care, from Lancet 2019 for the poster. Most cases of cervical cancer occur in women who were either never screened or were screened inadequately. Over-screening for cervical cancer, on the other hand, leads to unnecessary stress and procedures, adding increased costs to the patient and to the healthcare system. The central aim of this project is to evaluate provider adherence at the Immunology Center (IC) to cervical cancer screening guidelines and to identify factors associated with over and underscreening.

Methods
A retrospective chart review from January 1, 2015, to December 31, 2017 was performed. Study included HIV-seropositive women seen at the IC between April 2014 and June 2018. Exclusion criteria includes prior hysterectomy, abnormal cytology, cervical excision procedures, or other causes of immunosuppression.

Results
Of the 803 HIV-positive women identified, n = 262 met criteria for inclusion in the study. Overall adherence was 48%, with statistical significance found in cervical cancer screening between MDs and NPs, with an OR = 2.51 (P < 0.01). In regard to gender of provider, statistical significance in over screening was found between male and female providers, with an OR = 4.3 (P < 0.01), and in under screening between male and female providers, with an OR = 0.43 (P < 0.05). Over screening led to 44 excess pap smears over a 2-year period, yielding an excess cost of $6461. HPV co-testing was underutilized, with only one-third of encounters having HPV testing performed.

Conclusion
This project gives us the opportunity to reeducate and retrain the clinical staff and practitioners providing cervical cancer screening at the Immunology Center. This is an ongoing quality improvement project, where adherence will be reassessed on a continuous basis at one-year intervals to ensure compliance with guidelines-based cervical cancer screening among female HIV seropositive patients at the Immunology Center.

Disclosures
All authors: No reported disclosures.
2549. Variance Between Clinicians and Guidelines in Management of HIV/HCV Coinfection
Authors: Naggie Susanna , Sulkowski Mark , Schulz Jenny , King Edward , Schwartz Zachary 
Published: October 2019

Abstract

Background
Clinicians often encounter patients requiring simultaneous treatment for both HIV and HCV. Although several resources help clinicians identify potential drug interactions, these resources do not account for other factors that should be considered when selecting HIV and HCV regimens, such as renal function, HLA-B*5701 status, and HCV genotype. We developed an online decision support tool based on HIV and HCV guideline recommendations. We report data comparing guideline recommendations with the initial treatment plans of clinicians using the tool.

Methods
In May 2018, American Association for the Study of Liver Diseases (AASLD)/IDSA and DHHS treatment recommendations were applied to 304 unique HIV/HCV coinfection case scenarios based on a simplified set of patient variables: current ART/HCV therapy, HIV and HCV genotypes, liver histology, renal function, HLA-B*5701 status. We then developed an online decision support tool that enables clinicians to specify a patient scenario using these variables. After clinicians select their currently intended HIV and HCV treatment from among the guideline-recommended first-line options, guideline recommendations for that specific patient case are shown, and clinicians are asked if this information changed their treatment plan.

Results
From August 2018 to March 2019, 505 participants (n = 303 ID/HIV, n = 68 hepatology/GI, n = 58 IM/FP/GP/addiction, n = 76 other; n = 229 North America, n = 118 Europe) entered 694 patient case scenarios in the HIV/HCV coinfection tool. In 36% of patient case scenarios (248/694), clinicians were unsure or were planning a treatment not recommended by guidelines. All treatment choices that were inconsistent with guidelines are shown in the table. Not all clinicians self-identified the impact of the tool, but in the subset of 174 patient case scenarios where they did, 47 identified their initial treatment plan as different from the guidelines. Of these, 32% (15/47) changed their treatment plan based on the recommendations, 40% (19/47) had barriers to implementing the recommendations, 23% (11/47) were still undecided, 4% (2/47) disagreed with the recommendations.

Conclusion
This online treatment decision support tool shows substantial variability between clinicians’ treatment plans and HIV and HCV treatment guidelines for 36% of case scenarios.

Disclosures
All authors: No reported disclosures.
2570. A Randomized Controlled Trial of Lactobacillus rhamnosus GG on Multidrug-Resistant Organism (MDRO) Colonization
Authors: Rauseo Adriana M , Hink Tiffany , Reske Kimberly , Seiler Sondra , Bommarito Kerry , Fraser Victoria J , Burnham Carey-Ann D , Dubberke Erik R 
Published: October 2019

Abstract

Background
MDRO present a greater threat to public health than ever before, and antimicrobial options are decreasing. Altered colonic microbiota following antimicrobial exposure allows for subsequent colonization by MDRO. Ingestion of prophylactic Lactobacillus rhamnosus GG (LGG) could be an approach to prevent the spread of, and subsequent infection due to MDRO, by promoting a healthy bacterial milieu within the colon.

Methods
This is a prospective, double-blinded, randomized clinical trial in which a total of 87 subjects on broad-spectrum antibiotics were randomized to receive LGG twice daily (n = 43) vs placebo (n = 44). Stool or rectal swab specimens were collected for culture at enrollment, every 3 days during admission, and at discharge. Selective media were used to detect the following MDRO: Clostridioides difficile (CD), vancomycin-resistant Enterococcus (VRE), and antibiotic-resistant Gram-negatives (GN). The primary outcome was MDRO acquisition. Secondary outcomes included analysis for loss of any MDRO if colonized at enrollment, and acquisition or loss of individual MDRO.

Results
Subjects in both groups had similar prevalence of colonization with any MDRO at study enrollment (LGG 40% vs. placebo 39%), with similar colonization prevalence for individual MDRO (Figure 1). There was no difference in any MDRO acquisition (LGG 27%, placebo 33%, OR 1.36, 95% CI 0.42–4.41) or any individual MDRO acquisition (Figure 2). There was also no difference in loss of any MDRO (LGG 18%, placebo 24%, OR 1.44, 95% CI 0.27–7.68) or any individual MDRO (Figure 2).

Conclusion
LGG administration did not prevent acquisition of MDRO or accelerate loss of MDRO colonization.

Disclosures
All authors: No reported disclosures.
2578. Narrow-Spectrum Antibiotic Treatment of Clostridium difficile Infection Improves Preservation of Intestinal Metabolic Profile
Authors: Park Seoyoung , Yanagi Karin , Kane Anne , Snydman David R , Vickers Richard , Thorpe Cheleste M , Lee Kyongbum 
Published: October 2019

Abstract

Background
Commensal gut bacteria are thought to protect against C. difficile infection (CDI) by producing metabolites that inhibit C. difficile germination and growth. Alternatively, the protective effect could reflect nutrient competition or other mechanisms of chemical communication that also involve the host. CDI treatment using a broad-spectrum antibiotic such as vancomycin (VAN) dramatically depletes commensal bacteria. This dysbiosis can persist for several weeks after end-of-therapy (EOT), and is associated with increased recurrence risk. In this study, we investigate the hypothesis that treating CDI with a more selective antibiotic reduces collateral damage to the intestinal microbiota, preserving or restoring a CDI-inhibitory metabolic profile.

Methods
Stool samples were collected from CDI patients treated with either a narrow- (RDZ) or broad-spectrum antibiotic (VAN) at days 1, 10 (EOT), 25, and 40. Global metabolite profiles were measured by untargeted LC-MS.

Results
Untargeted metabolite analysis showed broad differences in the metabolic activity of intestinal microbiota of RDZ- and VAN-treated subjects (Figure 1). At EOT, 28% of LC-MS features detected in both RDZ and VAN samples were differentially present (FDR corrected P-value <0.05). Over 80% of the differentially present features were elevated in the RDZ group, indicating diminished capacity of microbiota from VAN subjects to generate diverse metabolic products. Pathway analysis found significant differences in purine, taurine, tyrosine, and bile acid metabolites. The VAN group showed a 5-fold decrease in free taurine, a major conjugation substrate of primary bile acids released by bacterial bile salt hydrolases. VAN treatment also decreased fermentation products of aromatic amino acids and amino sugars derived from mucin degradation. Oligosaccharides were the major metabolite class elevated in VAN subjects.

Conclusion
Our data suggest that RDZ treatment correlates with enhanced preservation of bacteria-derived ligands regulating intestinal immune function and substrates of bacterial metabolism. These metabolic profile differences between a narrow- and broad-spectrum antibiotic may contribute to their varying efficacy in preventing CDI recurrence.

Disclosures
All authors: No reported disclosures.
2582. The Association Between Dietary Fiber and Diet and Gut Colonization with Clostridium difficile
Authors: Sethi Ajay , Eggers Shoshannah , Mares Julie , Christensen Krista , Gangnon Ronald , Suen Garret , Watson Lauren , Shirley Daniel , Shukla Sanjay , Poulsen Keith , Malecki Kristen , Peppard Paul , Safdar Nasia 
Published: October 2019

Abstract

Background
There is little research on the relationship between diet and Clostridium difficile infection. Animal studies have shown potential benefits of dietary fiber in modulating C. difficile infection.

Methods
In 2016–2017, we carried out a microbiota study among adults in the Survey of the Health of Wisconsin, a population-based health survey collecting data on a wide range of health determinants and outcomes. We administered the Dietary History Questionnaire and asked about risk factors for C. difficile and collected fecal samples for 16S rRNA sequencing of gut microbiota and cultured for C. difficile. Dietary components were standardized to 1,000 kcal energy intake. Logistic regression was used to examine diet factors associated with C. difficile colonization. The quasi-conditional association test (QCAT) was performed to identify taxa that were significantly associated with fiber intake.

Results
In our general population sample of adults [(N = 238; 58% female; mean (range) age = 54 (18–94)], the prevalence of gut colonization with C. difficile was 9.2% (18 toxigenic/3 non-toxigenic). After adjusting for age, sex, and antibiotic use, C. difficile colonization was associated with usual daily fiber consumption over the last year. ORs (95% CI) in the highest vs. lowest quartile were 0.18 (0.03, 0.89) for total fiber, 0.09 (0.01, 0.77) for soluble fiber, and 0.10 (0.1, 0.80) for insoluble fiber. Lower odds of C. difficile colonization were associated with greater consumption of dark green vegetables and less consumption of solid fats, total saturated fats, and added sugar, but not significantly. Omega 3 fatty acids and fruit consumption were either non-monotonically or not associated with C. difficile colonization. Higher levels of total dietary fiber intake were also associated with increased colonization by bacteria within the order Clostridiales, the families Coriobacteriaceae, Lactobacillaceae, and Veillonellacea, and the genera Bifidobacterium, and Lactobacillus.

Conclusion
Higher average daily dietary fiber (total, soluble, and insoluble) appears to be associated with lower odds of gut colonization with C. difficile. Future research should examine the impact of dietary interventions on C. difficile colonization and infection.

Disclosures
All authors: No reported disclosures.
2590. Streptolysin O Enhances Binding of the Group A Streptococcal NAD+-Glycohydrolase Toxin to Oropharyngeal Keratinocytes
Authors: Velarde Jorge J , Lynskey Nicola , Piai Alessandro , Chou James , Wessels Michael 
Published: October 2019

Abstract

Background
Streptolysin O (SLO) and the NAD+-glycohydrolase (NADase) are co-toxins secreted by group A Streptococcus (GAS) that play a significant role in virulence. NADase requires SLO for translocation into the host cell cytoplasm, a process termed cytolysin-mediated translocation (CMT). Recently, we noted that interaction of the two toxins mutually increased their stability. Although NADase is predicted to bind to the host cell surface, this interaction is incompletely understood. Here, we investigate potential mechanisms by which NADase binds to oropharyngeal keratinocytes.

Methods
The amino terminal region of NADase has been implicated in CMT, but the structure of the putative translocation domain has not been characterized. We determined the solution structure of this domain by NMR spectroscopy. We used flow-cytometry and confocal microscopy to investigate whether NADase could interact directly with oropharyngeal keratinocytes. Finally, since we expect that NADase and SLO are co-expressed from the same operon, are secreted in a coordinated fashion, and interact in solution, we tested whether SLO affects NADase binding to host cells.

Results
The solution structure of the NADase translocation domain revealed a β-sandwich fold with an elongated N-terminal intrinsically disordered region. Structural homology searches (DALI) identified a potential carbohydrate binding module, suggesting the translocation domain could play a role in glycan binding. We also demonstrated by flow-cytometry that purified recombinant NADase toxin is able to independently interact with the cell surface of oropharyngeal keratinocytes. Importantly, interaction with SLO significantly enhanced the association of NADase with the cell surface, resulting in a 5-fold increase of the geometric mean fluorescence intensity.

Conclusion
The structure of the NADase translocation domain reveals a potential carbohydrate binding module, which may mediate binding of the toxin to a cell-surface glycan. Binding of NADase to host cells is markedly enhanced by its interaction with SLO. We conclude that interaction of the two toxins contributes to the CMT process by functionally increasing the local concentration of NADase at the cell surface.

Disclosures
All authors: No reported disclosures.