bluuebunny/crossref_metadata_2025_split huggingface dataset:
906. Surgical Site Infections in Children with Beta-Lactam Allergy: A Matched Cohort Study
Authors: Huang Felicia Scaggs , Mangeot Colleen , Sucharew Heidi , Simon Katherine , Courter Joshua D , Risma Kimberly , Schaffzin Joshua K 
Published: January 2021

Abstract

Background
Surgical site infections (SSIs) are a significant cause of morbidity and mortality. The administration of appropriate pre-operative antimicrobial prophylaxis (AMP) reduces SSI risk and beta-lactam antibiotics are considered the most effective agents. Studies in adult patients found increased SSI risk in patients with documented beta-lactam allergy (BLA) due to use of second line AMP agents. The SSI risk in BLA pediatric patients is not well-described.

Methods
We conducted a retrospective matched cohort study of patients (1-19 years-old) who underwent a surgical procedure at a quaternary pediatric hospital during 2010-2017. Patients with documented BLA at the time of surgery were matched 1:1 to patients with no BLA by age at surgery, National Surgical Quality Improvement Program (NSQIP) category, surgical calendar year, and presence of complex chronic conditions (CCC). AMP by BLA status was considered appropriate if recommended by the 2013 American Society of Health-System Pharmacists (ASHP) guidelines, antibiotic class appropriate, or recommended by an infectious disease physician. McNemar’s test was used to assess differences in SSI rates and antibiotic regimen appropriate for BLA status between BLA and no BLA groups.

Results
Of the 11878 surgical procedures among 9781 patients during the study period, 1021(9%) of patients had a reported BLA and we matched 972. SSI was rare in both groups and there was no significant difference in rates (18 (1.9%) in no BLA, 17 (1.8%) in BLA, p=1.0). BLA were more likely to receive an antibiotic regimen considered inappropriate for BLA status (22%) compared to no BLA (3%) with 89% receiving a beta-lactam-containing AMP regimen (p&lt; 0.01).

Conclusion
BLA was not associated with increased SSI risk in the pediatric patients studied. Interestingly, a significant proportion of children with a documented allergy received a beta-lactam for AMP. This suggests some providers recognize that allergy labels are inaccurate and may be comfortable administering beta-lactam AMP regardless of allergy status.

Disclosures
All Authors: No reported disclosures
910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs
Authors: Henderson John T , Cari Evelyn Villacorta , Leedy Nicole , Thornton Alice , Burgess Donna R , Porterfield J Zachary 
Published: January 2021

Abstract

Background
There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes.

Methods
All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis.

Results
390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days.
In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay.
FIGURE 1: Reported Substances Used

FIGURE 2: Comorbidities

FIGURE 3: Types of Severe Infectious Complications

Conclusion
We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them.

Disclosures
All Authors: No reported disclosures
911. Assessment of Representativeness of IPD Surveillance Conducted by the National Microbiology Laboratory of Canada
Authors: Nepal Rajeev M , Dion Stephane B , Grajales Ana Gabriela , Major Maria , Cane Alejandro , Vojicic Jelena 
Published: January 2021

Abstract

Background
Understanding the evolving epidemiology of Streptococcus pneumoniae serotypes is important for assessing the current and potential future immunization programs. In Canada, Invasive pneumococcal disease (IPD) is mandatory reportable to provincial/territorial public health. Provinces and territories voluntarily submit annual IPD data to the Canadian Notifiable Disease Surveillance System (CNDSS), which publishes information on IPD cases and incidence rates, however serotype data are not available. Provinces/territories also voluntarily submit IPD isolates to the National Microbiology laboratory (NML) for serotyping; provinces that conduct their own serotyping submit this information. The NML produces comprehensive IPD surveillance reports including serotype distribution; due to lack of population denominator, no incidence rates are available. The two surveillance programs are not linked. The objective of the study is to assess the representativeness of the NML surveillance as compared to the CNDSS and provincial reportable diseases databases.

Methods
Over the study time period (2010-2017), we compared annual IPD case counts between the NML and CNDSS reports. Due to the difference in age grouping between CNDSS and NML, comparison was limited to these groups: all age, &lt; 5, 5-14 and &gt; 15 years. In addition, the IPD counts from NML were compared to data from four largest provinces.

Results
For &lt; 5 group, NML reported 91% of CNDSS case count whereas for 5-14 and &gt; 15 years of age, it was 81% and 79%, respectively. Compared to the corresponding provincial databases, NML reported 91%, 97%, and 93% case counts for Ontario, British Columbia, and Alberta, respectively, while it was only 47% for Quebec. Further analysis revealed that the discrepancy in Quebec is the result of under-representation of &gt;5 populations.
Figure 1: Comparison of age stratified IPD case counts between CNDSS and NML

Figure 2. Comparison of all age IPD case counts between NML and provincial databases

Conclusion
IPD surveillance conducted by NML has been instrumental to gain insight into the evolving epidemiology of S. pneumoniae serotypes in Canada. Comparisons of IPD counts from NML surveillance reports with reportable disease databases revealed different levels of concordance across provinces and age groups. The limitations of NML surveillance including incomplete or inconsistent reporting should be taken into consideration when interpreting the data.

Disclosures
Rajeev M. Nepal, PhD, Pfizer (Employee) Stephane B. Dion, PhD, Pfizer (Employee) Ana Gabriela Grajales, MD, Pfizer (Employee) Maria Major, B.Sc., MPH, Pfizer (Employee) Alejandro Cane, MD, Pfizer (Employee) Jelena Vojicic, MD, Pfizer (Employee)
912. Beyond the Usual Suspects in Invasive Mold Infections: Public Health Surveillance Identifies Clinical Diversity
Authors: Beer Karlyn , Kelly Hilary , Blakney Rebekah , Revis Andrew , Perry Lewis , Bentz Meghan , Berkow Elizabeth L , Lockhart Shawn R , matkovic Eduard , Thomas Stepy , Oliver Nora , Webster Andrew , Pouch Stephanie M , Pouch Stephanie M , Farley Monica M , Jackson Brendan R 
Published: January 2021

Abstract

Background
Invasive mold infections (IMI) such as aspergillosis and mucormycosis are often fatal among immunocompromised patients and cause high-profile outbreaks. Public health surveillance for IMI is challenging; most epidemiologic studies are limited to transplant and cancer patients at greatest risk of IMI. The established Mycoses Study Group (MSG) case definition is useful for clinical trials but lacks sensitivity. To address these challenges, we created IMI surveillance within the Georgia Emerging Infections Program. Here, we describe cases identified through this system, using both the MSG criteria and a novel, more sensitive surveillance case definition.

Methods
To identify potential IMI cases, we captured 2,363 positive fungal laboratory results, including cultures, histopathology, and galactomannan tests, within a 60-day window at three large Atlanta hospitals during April 2018–March 2019. We excluded yeast and dimorphic fungi, hair and nail specimens, and cystic fibrosis patients. Potential cases underwent chart review and were classified by 2 physicians as proven, probable, or non-case according to MSG criteria. Cases that partially met MSG probable criteria and included antifungal treatment were classified as surveillance cases; definitions were mutually exclusive (Fig 1).

Results
Of 120 potential IMI cases, 46 (38%) met an IMI case definition: 8 proven, 9 probable, and 29 surveillance cases (Fig 2). Of cases, 14 (30%) involved transplant or cancer in the previous year; 8 of these were proven or probable cases. IMI presented primarily as sinusitis among proven cases (50%), and pulmonary infections among probable (56%) and surveillance (45%) cases. Most surveillance cases were caused by Aspergillus spp. (72%) and accounted for all 5 cutaneous IMI (fig 3). Over 80% of cases vs. 10% of non-cases had antifungal treatment.

Conclusion
Of IMI cases identified, nearly two thirds had evidence of infection but did not meet an MSG case definition. MSG captured over half of transplant and cancer-associated cases, but these were uncommon overall, revealing most IMI lack classical risk factors. A more sensitive surveillance case definition can capture a broader spectrum of IMI patients receiving antifungal treatment to help guide clinical and public health interventions.

Disclosures
All Authors: No reported disclosures
914. Epidemiology of Patients with ESKAPE Pathogen Bloodstream Infection in the US Military Health System
Authors: Vostal Alexander C , Grance Melissa , Chukwuma Uzo , Morales Carlos , Lanteri Charlotte , Telu Kalyani , Parmelee Edward , Powers John H , Mende Katrin 
Published: January 2021

Abstract

Background
Bloodstream infections (BSI) are associated with both inpatient mortality and substantial morbidity in the United States. We sought to characterize the epidemiology of BSIs with ESKAPE pathogens on patients served by the United States Military Healthcare System (MHS), which actively prospectively captures clinical and microbiological data from US service members and their beneficiaries.

Methods
We performed a retrospective analysis of MHS patients with blood cultures positive for ESKAPE pathogens (E. faecium, S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, and Enterobacter spp.), as well as Neisseria gonorrhoeae and Raoultella spp. between January 2010 and December 2015. Microbiological data from the Navy and Marine Core Public Health Center was retrospectively collated with clinical and demographic data from the MHS Data Repository.

Results
We identified 7,404 patients who experienced 8,791 episodes of ESKAPE (including N. gonorrhoeae and Raoultella spp.) BSI. The patients were predominately active duty (N=688) or retired (N=2,517) Armed Forces service members and their dependents (N=2,361). Further, 59.4% were male and 47.5% were &gt;65 years old. A total of 5,594 (75.5%) of BSI episodes were associated with hospital admission, with an average length of stay of 14.9 days (SD of 27.5 days) and 47.4% (N=2,650) of those admissions were associated with an ICU stay averaging 8.6 days (SD of 18.0 days). The most common pathogens detected were E. coli (34.6%, N= 3,042) followed by S. aureus (28.0%,N=2,464), with 7.6% and 40.7% of isolates resistant to ceftriaxone and methicillin, respectively. We found a larger proportion of E. coli BSI in females (47.4% versus 26.2%) and S. aureus BSI in males (32% versus 21.9%). The frequency of A. baumannii BSI in younger patients, ages 18-30, was an average 4.5 fold higher than in older age groups (30-50, 50-65 and &gt;65).

Conclusion
We noted epidemiological differences in the burden of ESKAPE pathogen BSIs, in various populations including sex and age specific risk factors in a population served by the MHS. Further work is underway to evaluate risk factors for infection and outcomes with pathogens with in vitro resistance controlling for factors such as age, gender, co-morbid diseases and severity of illness.

Disclosures
All Authors: No reported disclosures
919. Understanding Intermittent Detection of Multidrug-Resistant Organisms (MDROs) in Rectally Colonized Patients
Authors: Sansom Sarah , Lin Michael Y , Schoeny Michael , Fukuda Christine , Bassis Christine , Shimasaki Teppei , Dangana Thelma E , Moore Nicholas M , Yelin Rachel , Liu Sophia , Young Vincent B , Rhee Yoona , Tabith Lina , Sheng Jianrong , Cisneros Enrique Cornejo , Murray John , Chang Kyle , Lolans Karen , Ariston Michelle , Rotunno William , Ramos Hazel , Li Haiying , Aboushaala Khaled , Iwai Naomi , Hayden Mary K 
Published: January 2021

Abstract

Background
MDRO detection in colonized patients may be intermittent for reasons that are incompletely understood. We examined temporal patterns of gut MDRO colonization after initial MDRO detection by rectal swab screening, and determined the relationship of culture positivity to the relative abundance of corresponding MDRO operational taxonomic units (OTUs) identified by 16S rRNA gene sequence analysis.

Methods
Rectal or fecal swabs were collected daily from MICU patients 1/11/2017-1/11/2018. First MICU admissions with ≥2 swabs and MICU stays ≥3 days were studied. Samples were cultured for vancomycin-resistant enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE) and P. aeruginosa (CRPA), and extended-spectrum β-lactamase-producing (ESBL) Enterobacteriaceae by selective media. Resistance mechanisms were confirmed by phenotypic methods and/or PCR. Limit of detection was similar for different MDROs (24-52 CFU/sample). OTU categories corresponding to MDRO species were identified by taxonomy and BLAST. Multilevel regression models estimated the association between MDRO detection and relative abundance of the corresponding OTU.

Results
796 unique patients with 3519 swabs were studied. Median (IQR) age was 64 (51-74) years, MICU length of stay was 5 (3-8) days, and number of samples-per-patient was 3 (2-5). Following initial MDRO detection, the probability of subsequent detection varied by MDRO type, and was highest for VRE and lowest for CRPA [Figure 1]. Within each sample, we found a significant association between MDRO detection and relative abundance of the corresponding OTU [Table 1]. In contrast, relative OTU abundance in the first sample with MDRO detection was not predictive of odds of future MDRO detection (p &gt;0.05 for all comparisons). Carriage of &gt;1 MDRO did not affect the odds of MDRO detection in later samples.
Figure 1. Probability of Subsequent MDRO Detection after First Positive Varies by MDRO Type

Table 1. Higher Mean Corresponding OTU Relative Abundance Within Each Sample is Associated with MDRO Detection

Conclusion
MDRO culture positivity in rectally colonized patients was correlated with relative abundance of the corresponding OTU in the same sample. Serial detection of different MDRO types was variable, possibly due to distinct microbial community dynamics of different MDRO types. Intermittent failure to detect MDROs could result in misattribution of MDRO acquisition, resulting in inappropriate investigation or intervention.

Disclosures
All Authors: No reported disclosures
922. Increasing incidence of obstructive sleep apnea in patients with HIV: A nationwide database analysis
Authors: Mansoor Armaghan-e-Rehman , Badami Varun M , Sharma Sunil , Sarwari Arif R 
Published: January 2021

Abstract

Background
There is an increasing recognition of the burden of chronic non-communicable diseases in patients living with HIV. Fatigue, somnolence and mood symptoms are often reported in this patient population, leading to concern for undiagnosed OSA. We aimed to use the National Inpatient Sample (NIS) to determine incidence of OSA in patients with HIV, and its impact on inpatient outcomes.

Methods
All index admissions reported to the NIS between 2007 and 2016 were included in the analysis. Logistic regression models were used to determine demographic risk factors, as well as comorbid conditions associated with OSA, and the impact of OSA on inpatient outcomes

Results
There was a significant increase in the number of admissions for HIV patients with a comorbid condition of OSA from 766 in 2007 to 3250 in 2016 (p-value &lt; 0.001), corresponding to an annual increase of 15.5%. In patients with OSA, obesity was less often reported in HIV patients (16.0%) vs non-HIV patients (18.6%). HIV-positive patients with OSA had a significant association with hypertension, heart failure, obesity, diabetes, lipodystrophy, renal failure and disorders of pulmonary circulation. OSA was not a risk factor for inpatient mortality. Peak incidence of OSA was reported earlier in females compared to males.

Conclusion
There has been a significant increase in the reported incidence of OSA in patients with HIV, likely representing an increase in awareness of OSA, as well as a true increase in OSA incidence in the post-combination antiretroviral therapy era.

Disclosures
All Authors: No reported disclosures
66. Impact of a Pharmacist-Driven Azithromycin De-escalation Protocol for Community-Acquired Pneumonia
Authors: Shakeraneh Pegah , Steele Jeffrey , Seabury Robert , Thomas Stephen J , Paolino Kristopher M , Miller Christopher , Probst Luke A , Kufel Wesley D 
Published: January 2021

Abstract

Background
Ceftriaxone and azithromycin are common empiric antibiotics for community-acquired pneumonia (CAP). Despite low suspicion for atypical infection, azithromycin is often continued for a full course. Negative laboratory data for atypical bacteria may assist with azithromycin de-escalation. Thus, a pharmacist-driven azithromycin de-escalation protocol was implemented for immunocompetent, non-intensive care unit (ICU) patients treated for CAP. The primary outcome was to compare azithromycin duration before and after protocol implementation. Secondary outcomes included hospital length of stay (LOS) and all-cause 30-day readmission.

Methods
This was a single-center, quasi-experimental study of hospitalized, non-ICU patients treated with azithromycin and a beta-lactam for CAP. The pre- and post-intervention cohorts were from 07/01/2018–04/30/2019 and 07/01/2019–04/30/2020, respectively. Patients were included if they were ≥18 years old, diagnosed with CAP, and had a negative Legionella pneumophila urinary antigen and negative nasopharyngeal swab PCR for Mycoplasma pneumoniae and Chlamydia pneumoniae. Patients were excluded if they were immunocompromised, admitted to an ICU, prescribed azithromycin for an alternative indication, or had evidence of atypical bacteria.

Results
After exclusion criteria were applied, 90 and 100 patients were included in the pre- and post-intervention cohorts, respectively. Demographic and clinical characteristics were mostly similar between cohorts. This initiative was associated with a statistically significant decrease in azithromycin duration (2 days (IQR 1–2.75) vs. 5 days (IQR 3–6), p &lt; 0.001) and hospital LOS (3 days (IQR 2–5) vs. 5 days (IQR 3–8.25), p &lt; 0.001). No statistically significant difference was observed for all-cause 30-day readmission (14 days (15.6%) vs 13 days (13.0%), p=0.614).

Conclusion
Implementation of a pharmacist-driven azithromycin de-escalation protocol for CAP was associated with reduced azithromycin duration and hospital LOS, but not all-cause 30-day readmission.

Disclosures
Jeffrey Steele, PharMD, Paratek Pharmaceuticals (Advisor or Review Panel member) Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)
923. Long-term Mortality after Histoplasma Infection in People Living with HIV
Authors: Cherabie Joseph , Larson Lindsey , Rutjanawech Sasinuch , Franklin Alexander , Hendrix Michael J , O’Halloran Jane A , Presti Rachel M , Powderly William , Spec Andrej 
Published: January 2021

Abstract

Background
Histoplasmosis is a common opportunistic infection afflicting people living with HIV (PLWH) globally. There are no data on long term survival of PLWH with histoplasmosis.

Methods
We conducted a single-center retrospective cohort study of PLWH diagnosed with histoplasmosis between 2002 and 2017. Data collected included demographics, clinical characteristics, treatment, and mortality. Patients were categorized into three groups based on length of survival after diagnosis: early mortality (death within 90 days), late mortality (death at or after 90 days), and survivors. Between group differences in demographic and clinical characteristics were assessed using Chi square for categorical variables and Mann-Whitney U non-parametric tests for continuous variables. Mortality was compared using Cox proportional hazards. Insurance type (i.e. private versus public option) served as a surrogate indicator of socioeconomic status (SES). Patients diagnosed with histoplasmosis in or after 2008 were considered a part of the modern ART era, regardless of treatment regimen.

Results
Our review found 54 PLWH infected with histoplasmosis from 2002-2017. Overall mortality was 37%, with 14.8% early mortality and 22.2% late mortality. Median survival time in the early mortality group was 13.5 days (IQR 2.5-41 days), and 338 days (IQR 180.5-803.3) in the late mortality group. Compared to the late mortality group, survivors were over 6 times more likely to have suppressed HIV viral load at last observation (HR 6.19, p=0.013). Median HIV viral load at last observation was lower among the survivors (2 log copies/ml, IQR 0, 4.5) compared to the late mortality group (4.1 log copies/ml, IQR 2.6,5.5) (p=0.010). Survivors were twice as likely to have private insurance, but this did not reach statistical significance (HR 2.19, p=0.14). There was no statistically significant difference in survival based on the availability of modern ART (p=0.85). The year of diagnosis made no difference with regards to survival (p=0.914).
Baseline Characteristics of PLWH with Histoplasmosis

HIV-related Characteristics of PLWH with Histoplasmosis

Conclusion
Histoplasmosis continues to be associated with high mortality among PLWH. Improved long-term survival is seen in patients with suppressed HIV viral loads.

Disclosures
Andrej Spec, MD, MSCI, Astellas (Grant/Research Support)Mayne (Consultant)Scynexis (Consultant)