bluuebunny/crossref_metadata_2025_split huggingface dataset:
713. The Clinical Impact of Implementation of a Multidisciplinary Endocarditis Team
Authors: El-Dalati Sami , Cronin Daniel , IV James Riddell , Shea Michael , Weinberg Richard , Washer Laraine , Stoneman Emily , Perry D Alexander , Bradley Suzanne F , Bradley Suzanne F , Burke James , Murali Sadhana , Fagan Christopher , Chanderraj Rishi , Christine Paul , Patel Twisha S , Fukuhara Shinichi , Romano Matthew , Yang Bo , Deeb Michael 
Published: January 2021

Abstract

Background
Infectious endocarditis is associated with substantial in-patient mortality of 15-20%. Effective management requires coordination between multiple medical and surgical subspecialties which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality.

Methods
The University of Michigan Multidisciplinary Endocarditis Team was formed on May 3rd, 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control that was identified using an internal research tool.
Figure 1

Table 1

Results
Between June 14th, 2018 and June 13th, 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria definite endocarditis and at least 1 American Heart Association indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1st, 2014 to June 30th, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (p&lt; 0.0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; p=0.12).
Table 2

Table 3

Table 4

Conclusion
Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications. In conjunction with previous studies demonstrating their effectiveness, this data supports that widespread adoption of endocarditis teams in North America has the potential to improve outcomes for this patient population.
Table 5

Disclosures
All Authors: No reported disclosures
719. Clinical Outcomes of Single versus Double Anaerobic Coverage for Intra-abdominal Infections
Authors: Raymond Lendelle , Cani Eris , Zeana Cosmina , Lois William , Park Tae 
Published: January 2021

Abstract

Background
Double anaerobic coverage (DAC) is often used for intra-abdominal infections (IAIs) post-operatively. The primary objective of the study was evaluating length of hospital stay (LOS), in-hospital post-operative complications, and re-admission within 30 days of discharge due to post-operative complications in patients who received piperacillin/tazobactam plus metronidazole versus piperacillin/tazobactam for IAIs post-operatively. The secondary objective was comparing in-hospital mortality and hospital-acquired Clostridioides difficile infections (CDI) between the two groups.

Methods
This was a retrospective, cohort study including adults with surgically managed IAIs at an urban community hospital between January 1, 2016 and June 30, 2019. The following data were collected: age, sex, body mass index, comorbidities, Charlson Comorbidity Index (CCI), 5-day post-operative body temperature, American Society of Anesthesiologists (ASA) pre-operative assessment score, surgical wound classification, and IAI diagnosis. Multivariate analysis and aggregate resampling of the sampling distribution were conducted. An alpha of &lt; 0.05 was considered statistically significant.

Results
Out of 163 patients, 96 patients received piperacillin/tazobactam plus metronidazole and 67 patients received piperacillin/tazobactam. The patients who received DAC were sicker with higher CCI (p=0.021) and 5-day post-operative body temperature (p=0.013). They were also at a higher risk for surgical site infections (p=0.002). Double anaerobic coverage was more often used for acute cholecystitis (p=0.0001) and gastrointestinal perforations (&lt; 0.0001). After adjusting for these variables, DAC was associated with longer LOS (median 9 days vs. 4 days, p&lt; 0.0001) and in-hospital post-operative complications (23% vs. 9%, p&lt; 0.0001). There were more re-admissions within 30 days of discharge due to post-operative complications in the single anaerobic coverage group (4% vs. 1%, p=&lt; 0.0001). In-hospital mortality (4% vs. 0%) and hospital-acquired CDI (1% vs. 0%) were only observed in DAC group.

Conclusion
Double anaerobic coverage was associated with no clinical benefit in surgically managed IAIs and in some cases may produce worse outcomes.

Disclosures
All Authors: No reported disclosures
720. Clinical Performance of Film Array Gastrointestinal Pathogen Panel in Diarrhea
Authors: Ananthanarayanan Rajalakshmi , Muhammed Niyas Vettakkara Kandy , Sasidharan Aswathy 
Published: January 2021

Abstract

Background
Infective diarrhea is a common problem. Multiplex Polymerase chain reaction (PCR) based pathogen diagnostics of diarrheal stool specimens are shown to be highly sensitive and rapid as opposed to conventional diagnostics.

Methods
We analyzed the performance of a multiplex PCR test, FilmArray (FA) gastrointestinal (GI) panel, on stool specimens in patients admitted with acute and chronic diarrhea to our hospital from December 2016 to December 2019 and compared the results with conventional diagnostic tests.

Results
A total of 98 patients were analyzed, 52 were males and 9 belonged to pediatric age. 92.9% patients presented with acute diarrhea. None were HIV positive. Among 98 tested, FA GI pathogen panel was positive for at least one pathogen in 39.8% patients. The yield was low for stool culture, 7.79%. In samples tested by FA GI pathogen panel, a single pathogen was identified in 27 patients (27.5%) while multiple targets were identified in 12 patients (12.2%). Majority (76.5%) had normal stool routine. Stool routine abnormality and positive GI pathogen panel did not correlate, as only 7 patients with abnormal stool routine had a positive result in FA GI pathogen panel, while 12 patients had negative result. Among the 39 patients with positive FA GI pathogen panel, only 6 had positive stool culture result. All stool culture positive sample also had GI pathogen panel positive result. Commonest organism in stool culture was Salmonella (5) while one patient had E. coli. Commonest organism in stool FA GI pathogen panel was also Salmonella, 12 isolates as a single pathogen and 5 as one among the multiple targets identified, making a total of 17 isolates. This is followed by Enteroaggregative E. coli (EAEC- 9) and Enteropathogenic E. coli (EPEC- 5). %). Only one had virus as pathogen (norovirus), no parasitic infection was identified. Multiple pathogens were identified in 12 patients. Clostridium difficile toxin was positive in 2 in whom multiple targets were identified. Among the chronic diarrhea syndrome, none had stool culture positivity while two had positive FA GI pathogen panel results and the organisms were Campylobacter and EAEC.
FA GI pathogen panel results

Multiple targets that are identified

Conclusion
FA GI panel detects a wide array of GI pathogens, better yield and has a quick turn-around-time compared to conventional tests like stool culture.

Disclosures
All Authors: No reported disclosures
725. Influence of An Emerging Pathogen, Streptococcus anginosus, on Clinical Outcomes in Pediatric Appendiceal Abscess
Authors: Watman Olivia F , Whyte Christine , Tristram Debra A 
Published: January 2021

Abstract

Background
Escherichia Coli is the most common primary pathogen in appendiceal abscess, but an increasing number involve Streptococcus anginosus (SA) as the primary isolate. Ten years of data from a regional medical center was reviewed to track changes in the microbiology and outcomes of this condition. We believe that SA is emerging as a significant pathogen in appendiceal abscess in children and it is associated with increased morbidity compared to more commonly encountered pathogens.

Methods
A medical records search was done (IRB#5194) for patients below age 18 from 1/2008 to 12/2017 with acute appendicitis with local/generalized peritonitis or peritoneal abscess. There were 557 records retrieved, of which 201 had appendiceal abscess. The records were further divided based on the type of operation and timing of abscess development. There were 104 laparoscopic, 34 open, 4 drain alone, 53 interval management with a drain, and 6 interval without a drain. The focus of the study is laparoscopic and open post operative abscess. 56 of the laparoscopic cases developed a postoperative abscess of whom 45 had culture and sensitivity data. 25 of the open cases developed a postoperative abscess of whom 24 had culture and sensitivity data.

Results
Of the 45 postoperative abscesses following laparoscopic procedure, the most common isolate was E. coli (34) followed by SA (13). Of the 24 postoperative abscesses following open procedure, the most common isolate was also E. Coli (17) followed by SA (6). Patients are divided into those who had any culture of SA (SA group), vs those who did not (non-SA group). For laparoscopic cases there was no difference between additional procedures needed. However for open procedures, the SA group had an average of 2.33 additional procedures needed compared to the 0.94 additional procedures for the non-SA group (p=0.024). Major adverse outcomes included one death from sepsis, abdominal compartment syndrome, and one patient needing bilateral salpingectomy, all in the SA group.

Conclusion
SA has emerged as an important and virulent pathogen in complex appendicitis in pediatric patients. It is sensitive to commonly used antibiotics, but is associated with increased risks of reoperation, additional drainage and adverse outcome for the sicker patients who require an open procedure.

Disclosures
All Authors: No reported disclosures
726. Investigation of Epidemiological Characteristics and Outcomes in Enteropathogenic Escherichia coli positive patients
Authors: Lusby Heather , Rand Kenneth , Beal Stacy 
Published: January 2021

Abstract

Background
New generation multiplex polymerase chain reaction (PCR) panels have led to the ability of rapid detection of Enteropathogenic Escherichia coli (EPEC). Although many studies have looked at the pathogenesis of this organism in the pediatric populations, fewer studies include adults. We aimed to determine if EPEC is pathogenic on its own, or has a predilection for certain populations based upon risk factors. This was achieved by comparing risk factors in patients positive for EPEC on the BioFire Gastrointestinal (GI) Pathogen Panel versus patients negative for all targets on the panel.

Methods
This is a single center case control study that was performed using a retrospective chart review from January 1, 2016 thru August 31, 2019. All patients were symptomatic with diarrheal illness and had a GI pathogen panel performed. The study group were patients that were EPEC positive. The control group were patients with a negative PCR panel that were matched three to one based upon age and gender. Chi-squared statistical analysis was used.

Results
792 patients were evaluated. In the adult group the EPEC positive actual length of stay (LOS) was 13.5 rather than 9.3 in the control. Although this was not statically significant this trended towards a longer LOS as seen in Table 1. In the pediatric population, both expected and actual LOS were statically longer viewed in Table 2. This may be due to these patients being more chronically ill at baseline, with a greater number of pediatric coronary artery disease and ulcerative colitis in the control. Males were more likely to test positive for EPEC at 69.86% in the pediatric population than in the adult population with statistical significance at p=0.0035. The pediatric population had more co-infections with EPEC at 57.53% with p&lt; 0.0001. This can be further seen in Table 3.
Table 1

Table 2

Table 3

Conclusion
In the adult EPEC positive patients there was no statistically significant difference in length of stay in comparison to negative control. This raises the question to if this is truly a pathogen in adults. In the pediatric population, our control group was likely more ill, which made it difficult interpret the significance of differences in LOS.

Disclosures
Kenneth Rand, MD, BioFire Diagnostics, Inc (Consultant, Grant/Research Support, Advisor or Review Panel member, Research Grant or Support) Stacy Beal, MD, FilmArray BioFire (Grant/Research Support)
727. Outcomes of Antibiotic Use in Ischemic Colitis
Authors: Poenaru Sonia , Sherazi Adeel , Suh Kathryn , Stuleanu Tommy 
Published: January 2021

Abstract

Background
Ischemic colitis (IC) is caused by inadequate blood flow to the colon. Most cases resolve with conservative management. Isolated right-sided colitis, peritonitis, shock, and vascular risk factors are predictors of severe disease which can be life-threatening and require surgery. Current guidelines recommend antibiotics for moderate/severe disease. This is based on results from animal models and concern for gut translocation of bacteria; there have been no comparative studies in humans. This study aims to evaluate whether there is benefit to antibiotic use in non-severe IC.

Methods
This is a single-center retrospective cohort study of adult patients hospitalized with IC from 2015-2018. Inclusion in the study required endoscopic, radiologic, operative, or histologic evidence of ischemic colitis. Patients were divided into mild/moderate and severe IC cohorts as per 2014 American College of Gastroenterology Guidelines. Primary outcomes were length of stay (LOS) and any adverse event, which is defined as a composite measure of pre-specified secondary outcomes including mortality, need for surgery, 1-year relapse, and bacteremia.

Results
Of 191 patients enrolled in the study, 130 had mild/moderate IC and 61 had severe IC. In mild/moderate IC groups there was no significant difference in total adverse events, although use of antibiotics was associated with a significant increase in LOS (Table 1). In the severe IC groups there was no significant difference in any primary outcomes, but mortality was lower at 3 and 6 months among patients who did not receive antibiotics.
Table 1

Conclusion
Antibiotics did not improve outcomes in mild/moderate IC, suggesting that conservative management may be sufficient in this group. Antibiotic use was associated with increased LOS in mild/moderate IC and with increased mortality in severe IC; it is not clear whether these associations are true antibiotic-mediated adverse effects or whether they simply reflect a tendency to use antibiotics more frequently in patients who are more unstable. Future prospective research is needed to establish clear guidelines for antibiotic indications, agent selection, and optimal treatment duration.

Disclosures
All Authors: No reported disclosures
729. Real World Efficacy of Bezlotoxumab for Prevention of Clostridioides Difficile Recurrence in Immunosuppressed Patients
Authors: Perreault Sarah , Schiffer Molly , Ruggero Michael , McManus Dayna , Topal Jeffrey E 
Published: January 2021

Abstract

Background
Bezlotoxumab has been shown to prevent recurrent episodes of C. difficile infection (CDI) in high risk patients. Current studies define therapeutic efficacy within the first 12 weeks when the risk of recurrence is greatest. However, the risk of recurrent CDI can occur beyond the 12-week window in the immunosuppressed population. Given that bezlotoxumab has detectable serum levels for up to 24 weeks after infusion, the primary endpoint is to determine overall efficacy in immunosuppressed patients with recurrent CDI at 4 weeks, 12 weeks, and 24 weeks after initial infusion. Secondary endpoints consist of risk factors for recurrent CDI, treatment of CDI, and antibiotics usage before and after bezlotoxumab.

Methods
This analysis included immunosuppressed patients at high risk for CDI recurrence who received bezlotoxumab from February 2017 to December 2019. Patients were excluded if they were not immunosuppressed, had no follow-up appointments, and/or without a C. difficile positive test. High risk antibiotics included fluoroquinolones, beta lactamase inhibitors, third generation cephalosporins, or carbapenems.

Results
Twenty-seven bezlotoxumab doses were given to 26 patients. Baseline characteristics for CDIs prior to bezlotoxumab is reported in Table 1. The overall CDI recurrence rate at all intervals after bezolotoxumab was 4 (15%), one recurrent CDIs occurred at &lt; 4 weeks, two recurrent CDIs occurred at 5-12 weeks, and one recurrent CDI at 13-24 weeks. High risk antibiotics were given in 2/4 (50%) of CDIs recurrences and 22/75 (29%) in the non-recurrence group. Of the four CDI recurrences, all were mild to moderate in disease severity given no evidence of colitis was seen on CT scan and a median Zar score of 1 (range 0-1) due to age &gt; 60 years.
Table 1: Baseline Characteristics

Conclusion
In immunosuppressed patients with CDI, bezlotoxumab is effective at reducing CDI episodes up to 24 weeks. Additionally, this highly antibiotic exposed population continued to receive benefit up to 24 weeks after bezlotoxumab.

Disclosures
All Authors: No reported disclosures
731. The Emergence of Mobile Colistin Resistance (mcr) Genes among Enteric Pathogens in the United States — 2008–2019
Authors: Tobolowsky Farrell A , Friedman Cindy R , Ryan Matthew , Birhane Meseret , Chen Jessica , Webb Hattie E , Beukelman Rachel A , Bokanyi Rick , Byrd David J , Connor Diana , Hanna Samir , Kimura Akiko , Mason Jordan L , McNamara Sara E , Meyer Stephanie , Moet Gary , Phan Quyen , Robbins Amy , Watkins Louise Francois 
Published: January 2021

Abstract

Background
Colistin, once seldom used clinically, has resurged as a “last resort antibiotic” for multidrug-resistant infections and is still used in animal agriculture in countries outside the United States. During 2015–2018, 8 plasmid-mediated, mobile colistin resistance genes (mcr-1 to mcr-8) were each found in one or more clinical, animal, food, and environmental bacterial sources. We describe the epidemiology of mcr genes in enteric pathogens from US patients.

Methods
State public health laboratories have performed whole-genome sequencing on enteric bacterial pathogens since 2015, and some have sequenced older isolates. We screened sequences of isolates collected through 2019 for mcr genes using a workflow based on ResFinder 3.0. State health officials interviewed patients for clinical and epidemiologic information, including demographics, hospitalization, and travel history.

Results
We identified 41 patient isolates with mcr genes collected from stool, urine, and blood during 2008–2019. These included 37 nontyphoidal Salmonella (31 mcr-1, 6 mcr-3), 2 Vibrio (both mcr-4), and 2 Shiga toxin-producing E. coli (both mcr-1). The median patient age was 34 years (interquartile range: 24–54) and 54% were female. Of 23 patients with comorbidity data, 2 (9%) had immunodeficiency, 2 (9%) had past abdominal surgeries, and 1 (4%) had cancer. Patients sought care at doctor’s offices (46%), emergency rooms (35%), and urgent care clinics (19%); 24% were hospitalized for the enteric illness. None died. Among 36 with information, 35 (97%) travelled internationally in the 12 months before illness; 30 (94%) of 32 traveled in the 7 days before. Only 4 (15%) of 27 had contact with a healthcare setting during their trip; common destinations were the Dominican Republic (35%), Vietnam (24%), Thailand (15%), and China (12%).

Conclusion
The data strongly suggest that many patients acquired infection abroad. Nearly one in four were hospitalized, raising concerns that plasmids carrying mcr genes could spread among patients hospitalized with infections caused by multidrug-resistant pathogens for which colistin is the only available treatment. The acquisition of mcr genes by US travelers highlights the need for a global approach to antimicrobial stewardship.

Disclosures
All Authors: No reported disclosures
735. Trends and Cost Analysis of Aspergillus Galactomannan testing at a Tertiary Medical Center
Authors: Treutel Peyton R , Carr Anna , Bathina Pradeep 
Published: January 2021

Abstract

Background
Aspergillus is a fungus spread by inhalation of spores that can lead to invasive (IA), chronic, or allergic aspergillosis. Risk factors for IA include neutropenia, hematological malignancy, allogenic stem cell (HSCT) or solid organ transplant, severe immunodeficiency, or prolonged steroid use. An alternative to invasive tissue sampling, the serum Galactomannan (AGM) test detects a polysaccharide cell wall component of Aspergillus and can be used to determine a probable diagnosis of IA. Accuracy of AGM is related to disease burden and thus has the highest sensitivity and specificity in patients with hematologic malignancy or Hematopoietic stem cell transplantation (HSCT) at 70-82% and 86-92%, respectively. Studies have shown sensitivity to decline in other populations, with solid organ transplants as low as 20%.

Methods
We performed a retrospective study of all patients who received the AGM test at UMMC from January 3, 2013 to December 31, 2019. Patient Cohort Explorer was used to obtain de-identified patient data from EPIC. We obtained the number of encounters and patients on whom the AGM test was performed along with other variables. Billing offices provided the self-pay cost per AGM test.

Results
A total of 6,404 AGM tests were performed on 2,126 patients during 4,315 encounters in the study period. With a total of 499, 574, 984, 1140, 851, 1175 and 1181 tests done respectively from 2013 to 2019, a increasing trend was noted. The patients ages ranged from 1 to 89 with a median age of 52 years. A total of 3,055 tests were ordered in females, and 3,349 were ordered in males.
At a cut off value (optical density index) of &gt; 0.5, 183 AGM tests resulted positive in 108 patients and at a cut of &gt; 1.0, 113 tests are positive in 70 patients. The rate of a positive AGM tests at &gt; 0.5 was at 2.85% and at &gt; 1.0 was at 1.76% over the study period. With the self-pay cost of each test at $134.54 in 2019 USD, the total cost of 6,404 tests was $861,594.16.

Conclusion
To our knowledge this data set constitutes the largest sample size of AGM testing. From our data, it seems that the rate of ordering this test has increased yearly. Relatively low percentage of these tests are positive, suggesting that it is most likely a large amount of these tests could have been ordered inappropriately or in the wrong clinical context.

Disclosures
All Authors: No reported disclosures