bluuebunny/crossref_metadata_2025_split huggingface dataset:
1470. Linezolid for Treatment of Urinary Tract Infections Caused by Vancomycin-resistant Enterococci
Authors: Pontefract Benjamin , Madaras-Kelly Karl 
Published: October 2019

Abstract

Background
Urinary tract infections (UTI) caused by vancomycin-resistant enterococcus (VRE) are difficult to manage due to lack of effective oral treatment options. Linezolid is an antibiotic with activity against VRE that is available orally, but only 30% of each dose is excreted in the urine. Data on the efficacy of linezolid in the treatment of UTI is limited. The purpose of this analysis was to assess the comparative efficacy of linezolid to other VRE-active antibiotics in the treatment of UTI.

Methods
A national retrospective cohort of inpatient veterans with a positive urine culture for VRE during years 2013 through 2018 was developed. Patient demographics, vital signs, urinary symptoms, antibiotics prescribed, and 14-day post-treatment outcomes were collected. Patients without UTI symptoms, urine cultures with < 105 CFU/mL (<103 CFU/mL for catheterized patients), or patients not treated with VRE-active antibiotics were excluded. Odds ratios were used to compare linezolid and non-linezolid antibiotics for 14-day VRE bacteriuria, UTI retreatment, and death endpoints.

Results
Of 3,846 urine cultures identified with VRE, 624 (16%) patients were eligible for evaluation of UTI symptoms. Of these, 92/624 (15%) met study criteria. The primary reason for exclusion was asymptomatic bacteriuria [339/532 (64%)]. Linezolid was prescribed in 54/92 (59%) of cases. Comparators included penicillin’s [12/92 (13%)], nitrofurantoin [11/92 (12%)], daptomycin [7/92 (8%)], tetracycline’s [6/92 (7%)], and others [2/92 (2%)]. Between linezolid and comparator groups, mean (+S.D.) patient age [70 (12) vs. 68 (13) years, P = 0.45] and Charlson Comorbidity Index [8.9 (3.1) vs. 8.3 (3.5), P = 0.39] were similar. Negative outcomes were uncommon: 7% VRE bacteriuria, 8% UTI re-treatment, 4% death. No difference in [(OR) +95% CI] between linezolid and comparators was observed: positive VRE bacteriuria [0.3 (0.1, 1.9), P = 0.20], UTI retreatment [1.8 (0.3, 10.0), P = 0.49], death [1.4 (0.1, 16.1), P = 0.79].

Conclusion
Most patients with a VRE positive urine culture who received antibiotics did not meet diagnostic criteria for UTI, and negative outcomes were uncommon. Linezolid and comparator regimens with VRE activity were effective for treating mild VRE UTI.

Disclosures
All authors: No reported disclosures.
1486. Evaluation of the Impact of Homelessness on Presentation and Outcomes of Gram-Negative Sepsis
Authors: An Chiu Chiao , Werge Dominique A , Arab Niki , Palafox Miguel , Minejima Emi 
Published: October 2019

Abstract

Background
Low socioeconomic status has been shown to contribute to an increase in mortality and intensive care unit (ICU) admission in patients with sepsis. The role of homelessness on outcomes of gram-negative sepsis is currently unknown. The primary objective was to evaluate the impact of homelessness on presentation and outcomes compared with low socio-economic status patients with housing.

Methods
Single-center, retrospective cohort study of hospitalized adults with Enterobacteriaceae infections between 2015 and 2017. Medical charts were reviewed for pertinent data. Patients were grouped as homeless (H) vs. non-homeless (NH) and compared for patient characteristics, clinical presentation, and course. Primary outcome was 30-day mortality. Secondary outcomes were 30-day re-admission and hospital length of stay (LOS).

Results
198 patients were included; 68 in H group vs. 130 in NH group. H group were younger (mean 51 years vs. 57 years, P = 0.01), more likely to be male (71% vs. 37%, P < 0.01) and non-Hispanic White (57% vs. 21%, P < 0.01). Two groups had similar comorbidities, except H group had more liver dysfunction (16% vs. 7%, P = 0.05); however, less heart failure (7% vs. 18%, P = 0.03). H group had a more severe presentation with higher rate of ICU admission (57% vs. 41%, P = 0.04) although initial SOFA score (median 6 vs. 4, P = 0.14) and need for vasopressors (16% vs. 18%, P = 0.19) were similar. Urinary tract infection (37% vs. 45%, P = 0.36) and bacteremia (38% vs. 42%, P = 0.76) were the most common sources. Total antibiotic duration was similar (median 7d, P = 0.61); H group received more empirical vancomycin (16% vs. 7%, P = 0.05) and fluoroquinolones as definitive therapy (13% vs. 8%, P = 0.05). 30d mortality was similar (13% vs. 8%, P = 0.21); however, H group had significantly prolonged LOS by 4d (median 9 days vs. 5 days, P < 0.01) and higher 30 days re-admission (41% vs. 18%, P < 0.01).

Conclusion
Within a medically underserved population, homeless patients with gram-negative sepsis were younger and had more liver disease compared with patients with housing. As this group had increased utilization of healthcare resources including need for ICU-level care, prolonged LOS, and 30-day re-admission, additional targeted interventions to prevent and optimally treat Enterobacteriaceae infections in homeless patients may be needed.

Disclosures
All authors: No reported disclosures.
1493. Creation and External Validation of a Clinical Prediction Rule for Diarrheal Etiology Using Natural Language Processing
Authors: Howard Joel Iverson , Aoki Joni , Ferraro Jeffrey , Haaland Ben , Pavia Andrew , Leung, Daniel T 
Published: October 2019

Abstract

Background
Infectious diarrheal illness is a significant contributor to healthcare costs in the US pediatric population. New multi-pathogen PCR-based panels have shown increased sensitivity over previous methods; however, they are costly and clinical utility may be limited in many cases. Clinical Prediction Rules (CPRs) may help optimize the appropriate use of these tests. Furthermore, Natural Language Processing (NLP) is an emerging tool to extract clinical history for decision support. Here, we examine NLP for the validation of a CPR for pediatric diarrhea.

Methods
Using data from a prospective clinical trial at 5 US pediatric hospitals, 961 diarrheal cases were assessed for etiology and relevant clinical variables. Of 65 variables collected in that study, 42 were excluded in our models based on a scarcity of documentation in reviewed clinical charts. The remaining 23 variables were ranked by random forest (RF) variable importance and utilized in both an RF and stepwise logistic regression (LR) model for viral-only etiology. We investigated whether NLP could accurately extract data from clinical notes comparable to study questionnaires. We used the eHOST abstraction software to abstract 6 clinical variables from patient charts that were useful in our CPR. These data will be used to train an NLP algorithm to extract the same variables from additional charts, and be combined with data from 2 other variables coded in the EMR to externally validate our model.

Results
Both RF and LR models achieved cross-validated area under the receiver operating characteristic curves of 0.74 using the top 5 variables (season, age, bloody diarrhea, vomiting/nausea, and fever), which did not improve significantly with the addition of more variables. Of 270 charts abstracted for NLP training, there were 41 occurrences of bloody diarrhea annotated, 339 occurrences of vomiting, and 145 occurrences of fever. Inter-annotator agreement over 9 training sets ranged between 0.63 and 0.83.

Conclusion
We have constructed a parsimonious CPR involving only 5 inputs for the prediction of a viral-only etiology for pediatric diarrheal illness using prospectively collected data. With the training of an NLP algorithm for automated chart abstraction we will validate the CPR. NLP could allow a CPR to run without manual data entry to improve care.

Disclosures
All authors: No reported disclosures.
1497. Relapsing Clostridium difficile Infection: Resolution with Combined Patient Choice Fecal Microbiota Transplantation, Vancomycin Taper, and Vancomycin Suppression
Authors: Shadowen Rebecca D , Edds Steven A 
Published: October 2019

Abstract

Background
Clostridium difficile infection (CDI) results in approximately a half a million cases and 15,000 deaths annually in the United States. Relapse rates vary between 20 and 50% and account for frequent readmissions and morbidity. Application of treatment modalities for relapsing cases resulting in complete resolution is reported here.

Methods
An observational analytical cohort study was done from June 2014 to December 2018 by offering options to patients for treatment of their CDI relapse. Each chose between Fecal Microbiota Transplantation (FMT; N = 52), Vancomycin po 6-week taper (VTa; N = 4), or Vancomycin 125 mg po daily 6-month suppression (VSu; N = 18). The FMT was given either as a liquid NG instillation (FMT-L) twice 12–24 hours apart (N = 47) or 20 capsules (FMT-C) given over 90 minutes (N = 5). Patients were followed for at least 8 weeks after treatment with readmissions tracked for 6 months in all cases. Fisher exact test was used for statistical significance.

Results
No patient was readmitted to the hospital for CDI-associated problems during the term of this study. More men choose po Vancomycin with more women choosing FMT (VTa/VSu Female 38%: Male 62% and FMT Female 80%: Male 20%; P < 0.01). Overall, initial response rate was 90%. Resolution of CDI was highest among the FMT-L (95.7%; N = 45/47; P = 1) and the VSu (94%; N-17/18; P = 1). The VTa group had 75% resolution (N = 3/4; nsd). The FMT-C arm showed a 40% success rate (N = 2/5; nsd). Treatment failures (N = 7) chose re-treatment with 6 cases repeating VTa having one relapse responding to FMT-L. One relapse in the VSu group responded to a 6 months daily Vancomycin suppressive course. The only statistically significant difference was in male to female ratios. Cost of therapy was highest for FMT-L $2326, FMT-C $1870, VSu $965, and VTa $700 average per course.

Conclusion
This report integrates options in treatment that follows the relapsing CDI patient to complete resolution. This eliminated hospital readmission and further morbidity. Allowing the patient freedom of treatment option was well received. Of the treatment arms, FMT-L and VSu were equivalent in outcomes, followed by VTa and FMT-C. FMT-L as 2 instillations provides higher response rates than previously reported. This was a small sample size; however, primary study endpoints of no hospitalizations and complete resolution were attained.

Disclosures
All authors: No reported disclosures.
1499. Distribution and Clinical Implication of Isolation of Multidrug-Resistant Microorganisms in Patients with Intra-Abdominal Infections
Authors: Kyung Yoon Young , Yeon Kim Jeong , Lee Hojin , Bean Kim Sun , Hun Kim Jong , Wook Sohn Jang , Ja Kim Min 
Published: October 2019

Abstract

Background
The aim of this study was to determine the prevalence and the clinical significance of multidrug-resistant microorganisms (MDROs) isolated from patients with intra-abdominal infections.

Methods
This cohort study was conducted at a 1,051-bed university-affiliated hospital in the Republic of Korea, between 2016 and 2018. The subjects included patients with intra-abdominal infections who had identified causative organisms. Patients with spontaneous bacterial peritonitis were not included in our study. Identification and antimicrobial susceptibility testing were done by standard criteria as defined by the Clinical and Laboratory Standards Institute.

Results
During the study period, a total of 627 non-duplicated clinical isolates were collected from 430 patients. Among these patients, 196 patients (45.6%) were suffered from generalized peritonitis while 234 (54.4%) affected by localized peritonitis or abscesses. In total, 152 (35.3%) were affected by healthcare-associated infections. The overall mortality and the 28-day mortality rate were 6.3% and 5.8%, respectively. Distribution of causative microorganisms was as follows: aerobic gram-positive (40.5%), aerobic gram-negative (56.1%), anaerobic (1.9%), and fungal (1.4%) pathogens. Escherichia coli (24.2%) was isolated most frequently, followed by Enterococcus spp. (23.9%), Klebsiella spp. (16.3%), and Streptococcus spp. (11.8%). The MDROs represented 15.8% of the total of isolated micro-organisms (figure). In the multivariable logistic regression analysis, isolation of MDROs (odds ratio [OR], 3.72; 95% confidence interval [CI], 1.53–9.04), hypoalbuminemia (OR, 5.56; 95% CI, 1.25–24.75), immunosuppressant (OR, 6.29; 95% CI, 1.96–20.18), and underlying renal diseases (OR, 4.29; 95% CI, 1.66–11.11) were found as independent risk factors for 28-day mortality.

Conclusion
In conclusion, our study indicates that MDROs are widespread in the patients with intra-abdominal infections. Furthermore, the isolation of MDROs was associated with poor clinical outcomes. For the appropriate selection of empirical antibiotics, local epidemiology of causative microorganisms and patterns of antimicrobial resistance should be continuously monitored.

Disclosures
All authors: No reported disclosures.
1508. Carbapenem vs. Non-carbapenem as Empiric Regimens for Bacteremia Caused by ESBL Producing Escherichia coli and Klebsiella pneumoniae in Children: Preliminary Study
Authors: Park Saera , Lee Jina 
Published: October 2019

Abstract

Background
The clinical efficacy of non-carbapenem for the treatment of extended-spectrum β-lactamase (ESBL) bacteremia in children with underlying comorbidities is controversial. We aimed to compare clinical and microbiological outcomes between pediatric patients received carbapenem and non-carbapenem as empiric regimens for bacteremia caused by ESBL producing E. coli and K. pneumoniae.

Methods
Pediatric patients aged <19 years who hospitalized between January 2014 to Jun. 2018 at Asan medical center with monomicrobial ESBL producing E. coli and K. pneumoniae bacteremia were included. Patients were excluded if they did not receive a carbapenem after ESBL production was identified. We compared outcomes between patients who had empirical therapy with a carbapenem to those who had empirical therapy with a non-carbapenem.

Results
Among total 161 E. coli and K. pneumoniae bacteremia, 46 (28.6%) fulfilled the criteria, of which 25 (54.3%) were caused by E. coli and 21 (45.7%) by K. pneumoniae. The most common underlying diseases were hemato-oncologic diseases (47.8%) and prematurity (23.9%). The main sources of bacteremia were vascular catheter (37.0%) and necrotizing enterocolitis (10.9%). 25 cases were treated with empiric carbapenem, and the remaining 21 cases with non-carbapenem agents. The all-cause 30-day fatality in the carbapenem group was 32% (8/25) and 5% (1/21) in the non-carbapenem group (P = 0.023). Microbiological cure rate at 3 days after the first culture positive day was 75.3% in the carbapenem group and 89.6% in the non-carbapenem group (P = 0.046). However, adjusting initial presentation with septic shock, the choice of initial empiric antibiotic was not a risk factor for the 30-day fatality and microbiological cure rate at 3 days (aHR 4.82, 95% CI 0.592–39.231; aHR 0.648, 95% CI 0.333- 1.259, respectively).

Conclusion
For the medically fragile pediatric patients with bacteremia caused by ESBL producing E. coli and K. pneumoniae, the impact of empiric antibiotics on clinical and microbiological outcomes was not significant if early transition to definitive carbapenem regimen is possible when susceptibility is proven. A large-scale multicenter study will be needed to select the most appropriate empiric antibiotics and minimize the spread of antibiotics resistance.

Disclosures
All authors: No reported disclosures.
1515. Distinguishing Kawasaki Disease Initially Presenting as Cervical Lymphadenopathy from Bacterial Cervical Lymphadenitis Using the Decision Tree Analysis
Authors: Kim Jihye 
Published: October 2019

Abstract

Background
Kawasaki disease (KD) can present initially with fever and cervical lymphadenopathy before other characteristic clinical signs appear. It is important to recognize KD at an early stage for appropriate treatment to be started and reduce cardiac complications. We sought to identify variables which distinguish early stage of node first presentation of KD from bacterial cervical lymphadenitis (BCL).

Methods
We retrospectively reviewed records of patients presenting with cervical lymphadenopathy and fever as primary diagnosis who discharged from the inpatient ward between January 2010 and December 2017. Only the patients who underwent radiologic studies (CT or US) were included. Patients were divided into 3 groups by their final diagnosis; CL with abscess (Group A), CL without abscess (Group B), and Node first presentation of KD (Group C). Initial clinical, laboratory, and imaging characteristics of the 3 groups were compared. Sequential laboratory data performed on the third hospital day was used to calculate their percentage differences. A clinical prediction model for KD in patients with CL was constructed using the decision tree analysis.

Results
Patients with KD had a longer duration of fever after admission and longer duration of fever prior to final diagnosis compared with BCL patients. Compared with group A or B, group C patients had higher neutrophil counts, neutrophil-lymphocyte ratio, C-reactive protein (CRP), erythrocyte sedimentation rates (ESR), alanine transaminase (ALT), aspartate transaminase (AST). In radiologic studies, no differences were observed in node sizes or palatine tonsil enlargement among the 3 groups. Retropharyngeal edema was more commonly associated with group C than group A and B combined, but was not significantly different between group A and C. By decision tree analysis, factors contributing to classification included presence of abscess, CRP percentage change, and neutrophil percentage change (Figure 1). Strong predictivity of the decision tree was observed in classifying Group C, with an overall accuracy of 87.9% for Group A, 82.6% for Group B, and 91.4% for Group C.

Conclusion
Decision tree analysis showed that the presence of abscess, CRP percentage change, and neutrophil percentage change could classify KD from BCL with an accuracy of 91.4%.

Disclosures
All authors: No reported disclosures.
1519. Identification of Neisseria meningitidis (Nn) Nasopharyngeal Carriage Among Non-Vaccinated Children and Isolations in Invasive Disease (ID) Cases in Argentina 2017
Authors: Gentile Angela , Paula Della Latta Maria , Wisner Barbara , Bloch Mercedes , Martonelli Luisina , Sorohuet Cecilia , Regueira Mabel , del Valle Juárez María , Umido Veronica , Efron Adriana 
Published: October 2019

Abstract

Background
Neisseria meningitides (Nm) cause different types of invasive infections.Nm pharyngeal carriage is a necessary condition for invasive meningococcal disease. In 2017 Argentina introduced a tetravalent meningococcal conjugated vaccine (MenACYW) to the National Immunization Program.Aims To assess the rate of Nm carriage in healthy children and adolescents attending a public hospital in Buenos Aires city, to determine genogroup and clonal complex distribution,to describe genogroup distribution of Nm isolated from ID in Argentina, during the same period.

Methods
Between March and December 2017, a single-center, cross-sectional study was performed among 1,751 children 1–17 years old attending Ricardo Gutiérrez Children Hospital in Buenos Aires, Argentina. From oro-pharyngeal swabs, genogroup and clonal complex (CC) were identified. We analyzed Nm ID genogroups data reported to the Regional Surveillance Program (SIREVA II) in the same year. at the same period were relevated.

Results
114Nm were isolated from the carriage study, with an overall carriage of 6.5%.Genogroups distribution: B 25(21.9%), W 9(7.8%), Y 7(6.1%), Z 6(5.2%), C 4(3.5%), non-groupable 9(7.8%) and non-capsulated (NC)54 (47.3%). 105 Clonal complex (CC) were determined: Genogroup B isolates belonged to ST-41/44, ST-35, ST-32 and ST-865. Genogroup W was associated to ST-11 and ST-35. SIREVA reported 76 strains of Nminvasive infections in 2017, 53.9% meningitis, 11.8% meningitis and sepsis, 22.4% sepsis, and 11.8% others. Genogroupsdistribution: B59.2% (45), W 23.6% (18), C 10.5% (8), Y 6.5% (5).

Conclusion
Genogroup B is the most frequent cause of ID followed by W in our country. In the pharyngeal carriage study we found that NmNC was prevalent and genogroup B was the most frequent among the encapsulated.Genogroup B CCs detected in our carriage study coincided with those found previously in ID in Argentina. Genogroup W carriage was low and hypervirulent CC ST-11 was detected. Although genogroup Z does not cause ID in our country it was found in carriage.

Disclosures
All authors: No reported disclosures.
1528. Rates of Peripheral Blood Culture Contamination in an Urban Children’s Hospital
Authors: Tam Derek , Hengel Kyle , Arun Aparna 
Published: October 2019

Abstract

Background
Positive peripheral blood culture results are essential in guiding antimicrobial therapy in patients with bacteremia. However, false-positive results may frequently pose diagnostic issues in interpreting the test. These results can lead to increased costs and patient harm through the administration of unnecessary antibiotics and prolongation of hospital stay. The maximum acceptable contamination rate for peripheral blood cultures as suggested by the College of American Pathologists is 3%.

Methods
We initiated a longitudinal quality improvement project to monitor peripheral blood contamination rates at our children’s hospital in Brooklyn, NY. We reviewed positive blood culture results on a monthly basis and assessed whether they represented true infections vs. contamination based on review of patient charts. Residents and nurses in the pediatric emergency department (ED), neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), inpatient unit, and newborn nursery were educated on proper skin sterilization techniques using video demonstration; the importance of avoiding palpating the venipuncture site after sterilization and the importance of cleaning the port on the blood culture bottle were reinforced.

Results
The pediatric ED and the PICU had the highest contamination rates in 2018 at 4.38% and 3.82%, respectively. The newborn nursery had the lowest contamination rate, at 0%. The NICU and pediatric inpatient units had contamination rates that met the goal as well, at 1.25% and 0.72%, respectively.

Conclusion
The departments in need of targeted interventions are the pediatric ED and the PICU, both of which had contamination rates greater than the 3% goal rate set for our project. Future interventions currently being considered include re-education of nursing and resident staff as well as the creation of equipment bundles to facilitate adequate skin preparation prior to venipuncture.

Disclosures
All authors: No reported disclosures.