bluuebunny/crossref_metadata_2025_split huggingface dataset:
1368. The Clinical Impact of BioFire BCID2 Compared to BCID in a U.S. Pediatric Hospital
Authors: Graff Kelly E , Palmer Claire , Anarestani Toraj , Velasquez Darcy , Hamilton Stacey , Pretty Kristin , Dominguez Samuel 
Published: January 2021

Abstract

Background
Multiplex PCR panels, particularly BioFire FilmArray Blood Culture Identification (BCID), have been shown to decrease time to pathogen identification and time to effective and optimal antimicrobial therapy. BioFire Blood Culture Identification 2 (BCID2) has an additional 17 targets and resistance genes compared to BCID. There is limited data on the impact of these expanded targets in pediatric populations.

Methods
We performed a head-to-head comparison between BioFire BCID2 with BCID when compared to standard culture. From January 2020- May 2020, we ran BCID2 simultaneously as a research use only prototype with the current standard of care on all blood culture specimens at Children’s Hospital Colorado. Percent agreement was calculated with BCID2 compared to standard culture and BCID compared to standard culture. Time to positivity, time to optimal therapy, and time to effective therapy were also calculated.

Results
We performed an interim analysis halfway through the study with 86 unique positive blood cultures. We found equal organism detection rates between BCID and BCID2 when compared to standard culture (88% each). BCID2 correctly identified 100% of target organisms. There were 10 (12%) isolates that only grew in culture that were not BCID or BCID2 targets. Compared to BCID, BCID2 was able to detect to the species level on 23 additional isolates. Most notably, 3 Enterococcus faecalis isolates were detected on BCID2, which would have resulted in a theoretical decrease in time to optimal antimicrobial therapy. Three CTX-M genes were detected on the resistance panels for Enteric bacteria, which could have resulted in a theoretical decrease in time to effective therapy.

Conclusion
BioFire BCID2 had equal rates of detection when compared to BCID in pediatric patients. It has the additional advantage of detecting more organisms at the species level, with clinical significance for Enterococcus faecalis specifically. With the additional resistance genes, it also has the potential to impact care with early identification of ESBL-producing Enteric pathogens.

Disclosures
Kelly E. Graff, MD, BioFire Diagnostics, LLC (Grant/Research Support) Claire Palmer, MS, BioFire Diagnostics, LLC (Grant/Research Support) Toraj Anarestani, MT(ASCP), BioFire Diagnostics, LLC (Grant/Research Support) Darcy Velasquez, MS, MB (ASCP)CM, BioFire Diagnostics, LLC (Grant/Research Support) Stacey Hamilton, MT(ASCP)SM, BioFire Diagnostics, LLC (Grant/Research Support) Kristin Pretty, n/a, BioFire Diagnostics, LLC (Grant/Research Support) Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)
1369. The Spectrum of Chronic Osteomyelitis in Children
Authors: Joseph Marritta , Sommer Lauren , Vallejo Jesus G , McNeil Jonathon C 
Published: January 2021

Abstract

Background
While the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. We sought to describe the epidemiology, clinical features and management of chronic osteomyelitis in children.

Methods
We reviewed hospital admissions with an ICD10 code for chronic osteomyelitis from 2011-2018 at Texas Children’s Hospital. Cases were included if symptoms lasted &gt;28 days on presentation. Patients diagnosed with chronic recurrent multifocal osteomyelitis were excluded. Cases were classified as those 1) associated with a contiguous focus (CoF), 2) penetrating or open trauma, 3) orthopedic hardware (OH), 4) post-acute chronic osteomyelitis (PACO, those occurring after &gt;28 days of therapy for acute osteomyelitis) and 5) primary hematogenous chronic osteomyelitis (PHCO, those with 28 days of symptoms without other clear risk factors).

Results
114 cases met inclusion criteria. The median patient age is 11.8 years and 35.9% patients had underlying comorbidities. 83% of patients underwent a surgical procedure. Cases were diverse in terms of pathogenesis (Figure 1). A microbiologic etiology was identified in 72.8% of cases and was polymicrobial in 20.2% of cases; Staphylococcus aureus was the single most common etiology (Figure 2). CoF infection was more often associated with polymicrobial etiology with or without Pseudomonas (P&lt; 0.001) and disease of the foot. PACO was caused by S. aureus in 95% of cases (p&lt; 0.001, Figure 3). The overall median duration of total therapy was 210 days. 41% were discharged from hospital on OPAT with or without later transition to oral antibiotics. 26.3% of patients had persistent functional limitations at time of last follow-up of which 46% experienced repeat hospital admission/surgery. There was no association between duration of intravenous therapy and persistent functional limitations.
Figure 1. Categories of Chronic Osteomyelitis

Figure 2. Microbiology of Pediatric Chronic Osteomyelitis

Figure 3. Clinical Features of Pediatric Chronic Osteomyelitis

Conclusion
Children with chronic osteomyelitis are diverse both in terms of pathogenesis and microbiology. Pathogenesis and clinical presentation can provide clues to microbiologic etiology. Prolonged intravenous therapy does not appear to improve functional outcomes in chronic osteomyelitis

Disclosures
Jonathon C. McNeil, MD, Allergan (Research Grant or Support, Allergan provided ceftaroline powder for use in studies described in this abstract)
1371. Trends in Antibiotic Resistance Among Uropathogens in the Pediatric Population: A Single Center Experience in the US
Authors: Mithal Leena B , Otero Sebastian , Sun Shan , Arshad Mehreen 
Published: January 2021

Abstract

Background
Urinary tract infections (UTIs) are common infections in children. Overuse of antibiotics has led to an increasing prevalence of antibiotic resistance among uropathogens in adults; however, data on pediatric trends have not been previously reported. Our objective was to characterize antibiotic resistance trends in uropathogens among children at a tertiary care hospital in a diverse urban US city.

Methods
Positive urine culture data (&gt;20,000 CFU/ml) from January 1st, 2010 through December 31st, 2019 were obtained from the electronic medical records (inpatient and outpatient). Yearly antibiotic agent-specific resistance rates were calculated based on culture, patient, and organism level data.

Results
A total of 7,512 patients had ≥1 positive urine culture, with 13,327 positive individual cultures. The average age at sample collection was 6 yrs (IQR 2-11). Overall, 66% of cultures showed resistance to at least 1 antibiotic. Ampicillin resistance (50.1% IQR: 48.2%-52.4%) was the most common and remained stable over the study period. However, resistance against amoxicillin-sulbactam, third and fourth generation cephalosporins, and fluoroquinolones has increased significantly over this period (Figure 1). There was also a corresponding increase in the prevalence of extended spectrum beta-lactamase (ESBL) Enterobacteriaceae (Figure 2). Among infants &lt; 1 year, a similar trend in increasing resistance against beta-lactams was noted (ampicillin-sulbactam 0% to 38%, ceftriaxone 0% to 9% and cefepime 0% to 4%, Figure 3).
Figure 1

Figure 2

Figure 3

Conclusion
There are rising rates of antibiotic resistance to broad spectrum antibiotics, including beta-lactams and quinolones, in a pediatric population over the last 10 years, with a notable increase in resistance starting in 2015-2016. While we were not able to distinguish patients with community acquired UTI, the increase in resistance among infants &lt; 1 year suggests a community reservoir of multi-drug resistant gram-negative bacteria. Colonization by resistant uropathogens has implications for empiric antibiotic choice, limited oral therapy options, and clinical outcomes which necessitate further study.

Disclosures
All Authors: No reported disclosures
1372. Urinary Tract Infections Caused by Gram-Positive Bacteria in Patients Younger than 19 Years: Prediction Analysis in a 13-year Hospital-Based Cohort
Authors: Hsu Yu-Lung , Chang Shih-Ni , Kuo Chin-Chi , Lin Che-Chen , Lin Hsiao-Chuan , Lai Huan-Cheng , Hwang Kao-Pin , Chiang Hsiu-Yin 
Published: January 2021

Abstract

Background
Urinary tract infection (UTI) is one of the common pediatric bacterial infections. Gram positive (GP) pathogens, in contrast to gram negative (GN) bacilli such as E. coli, are less accounted for pediatric UTI. The aim of this study was to identify predictors to enable clinicians to detect GP uropathogens from mostly causative GN bacteria in children with UTI.

Methods
This retrospective cohort study identified 26,066 paired urinalysis and urine culture obtained from the pediatric patients during 2003-2016. Of patients with UTI meeting our criterial, we included children with first-time UTI and classified them into GP-UTI and GN-UTI (Figure 1). Demographic, clinical and laboratory data were collected into analysis. We built a multivariable logistic regression model to predict the GP-UTI. The model performance was examined by using calibration and discrimination plots. We demonstrated a nomogram to predict GP-UTI that could be feasible in the clinical practice.
Figure 1. Flowchart of the Selection Process of the Study Population (N = 3,783 patients).

Results
Of 3,783 children with first-time UTIs, 166 (4.4%) were infected by GP and 3,617 (95.6%) by GN bacteria. The top 3 pathogens for GP uropathogens were vancomycin-resistant (VR) E. faecalis, S. saprophyticus, and coagulase-negative Staphylococcus. Significant risk factors associated with GP-UTI in the multivariable analysis were: age &gt;= 24 months [odds ratio (OR) 3.40, 95% confidence interval (CI) 1.40-8.26], serum white blood cell (WBC) (compared to ≥14.4 x 103/μL) [OR 2.18, 95% CI 1.26-3.77], hemoglobin (compared to &lt; 11.3 g/dL) [OR 1.89, 95% CI 1.04-3.45], negative urine leukocyte esterase [OR 3.12, 95% CI 1.83-5.33], negative urine nitrite [OR 4.14, 95% CI 1.88-9.14] and urine WBC (compared to ≥420/μL) [OR 2.16, 95% CI: 1.09, 4.26] (Table 1). This model had good discrimination (C-statistic 0.874; 95% CI 0.839-0.908) and calibration performance (Figure 2). By using our nomogram, physicians can estimate the probability of UTI that is caused by a GP pathogen, with a probability ranges from 0.04% to 55% (Figure 3).
Table 1. Multivariable Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.

Figure 2. Discrimination Plot (A) and Calibration Plot (B) of the Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.

Figure 3. Nomogram of the Prediction Model for Pediatric Urinary Tract Infections Caused by Gram-Positive Bacteria.

Conclusion
VR E. faecalis is the leading GP uropathogen in the children less than two years of age which need notice of infection control. Our proposed prediction model for GP UTI in children could help clinicians detect potential GP uropathogen and enable them to choose adequate antibiotic regimen early.

Disclosures
All Authors: No reported disclosures
1374. Carbapenem-Resistant Enterobacterales Infection in Children: Clinical and Molecular Data from a Prospective Multicenter Cohort Study
Authors: Fisher Matthew , Dai Weixiao , Doi Yohei , Doi Yohei , Komarow Lauren , Patel Gopi , Revolinski Sara , Huskins W Charles , Fries Bettina C , Banerjee Ritu , Banerjee Ritu 
Published: January 2021

Abstract

Background
Carbapenem Resistant Enterobacterales (CRE) are an urgent public health threat. We describe the clinical and molecular epidemiology of CRE infection in a multicenter pediatric cohort.

Methods
Patients under 18 years of age with CRE positive cultures between April 30 2016 and August 31 2017 were identified from among 49 hospitals participating in the Consortium on Resistance Against Carbapenems in Klebsiella and Other Enterobacteriaceae. Isolates representing colonization or infection were included. Bacterial identification and antimicrobial susceptibility testing were performed in each contributing clinical microbiology laboratory. Carbapenem resistance was defined per CDC criteria as those isolates displaying imipenem, doripenem, or meropenem MIC ≥4 μg/mL or ertapenem MIC ≥2 μg/mL. Clinical and epidemiological data were obtained from the electronic health record. Carbapenemase genes were detected using PCR.

Results
51 pediatric patients with CRE were identified at 17 hospitals. All regions of the United States were represented, with highest prevalence in the South (46%), followed by the Northeast (24%), Midwest (20%) and West (10%). The mean age at time of positive culture was 4 years. 66% of children were under age 2. 53% were male. 40% were white, 38% black, and 18% Hispanic. Mean time from admission to culture was 25 days. 72% of children were in an ICU at the time of culture, including 18% in the neonatal ICU. 42% required mechanical ventilation prior to culture. History of malignancy was present in 14% of children. The most common source was urine (31%), followed by respiratory (25%), and blood (18%). The most common species were Enterobacter cloacae (29%), Klebsiella pneumoniae (24%) and E. coli (20%). Carbapenemase genes were detected in 8 out of 35 (23%) isolates tested. 90-day mortality was 18%. Mortality was highest for K. pneumoniae (42%). The majority of subjects (88%) did not receive effective antibiotic therapy on the day of culture collection.
Table 1

Table 2

Conclusion
CRE infection or colonization in children in the U.S. was geographically widespread, likely hospital-acquired, and associated with high mortality. A significant portion of patients were infants. Ineffective antibiotic therapy was common at illness onset.

Disclosures
W. Charles Huskins, MD, MSc, ADMA Biologics (Consultant)Pfizer, Inc (Consultant)
1375. Characterization of Recurrent Central Line-associated Bloodstream Infections at Texas Children’s Hospital
Authors: Foster Catherine , Marquez Lucila , Koy Tjin , Campbell Judith 
Published: January 2021

Abstract

Background
Recurrent central line-associated bloodstream infections (CLABSI) in children present a unique challenge to infection prevention efforts but guidelines for management are lacking.

Methods
We reviewed CLABSI data at Texas Children’s Hospital (TCH) from fiscal years (FY) 2017-2019. A chart review to characterize clinical features, risk factors, and outcomes of patients with recurrent CLABSIs in FY2019 was performed. Descriptive statistics and Fisher’s exact test were used.

Results
Recurrent CLABSIs increased from FY 2017-2019 [20% (26/126) to 33% (44/131)] (P=0.03). In FY2019, 15 patients accounted for 44 CLABSIs (Figure 1). Underlying conditions included aplastic anemia (4), hemophagocytic lymphohistiocytosis (3), malignancy (4), genetic disease (2), congenital heart disease (1) and biliary atresia (1). Two-thirds of the CLABSIs occurred in the setting of severe neutropenia (ANC &lt; 100 cells/mm3) though only 16 (36%) were classified as mucosal barrier injury. The median time between line insertion and date of infection was 41 days (range 1-105). Line type included central venous catheters (25, 57%), peripherally inserted central catheters (17, 39%) and implantable ports (2, 5%). Most lines (80%) had double lumens. The most common organisms included: Gram-negative bacilli (15), coagulase negative staphylococci (14), viridans group streptococci (6) Candida spp. (5), Enterococcus faecalis (3) and Staphylococcus aureus (3). Four CLABSIs were polymicrobial. Patients with &gt;2 CLABSIs were more likely to have subsequent infections with the same organism as compared to patients with only 2 CLABSIs (P=0.01). Lines were removed promptly (19, 43%), had delayed removal (removal &gt;72 hours from infection date) (10, 23%) or remained in place (15, 34%). Lines were removed for all episodes of fungemia (5/44) and for most Gram-negative infections (10/12). Six of 7 Escherichia coli CLABSIs were breakthrough fluoroquinolone-resistant infections in patients on levofloxacin.
Single Episode and Recurrent CLABSIs at Texas Children’s Hospital for Fiscal Year 2019

Conclusion
Recurrent CLABSI accounted for a third of CLABSIs in FY2019. Line mismanagement was not a key contributor to recurrent CLABSI. Breakthrough CLABSIs in patients on levofloxacin prophylaxis need further investigation. For patients with CLABSIs due to Staphylococci decolonization may be considered.

Disclosures
All Authors: No reported disclosures
111. Impact of Microbiology Laboratory Result Presentation on Antibiotic Stewardship: Process Use Evaluation
Authors: Brummett Christina M , Harding Stephanie , Beadle Kathy , Jones Shelley 
Published: January 2021

Abstract

Background
Advancements in laboratory diagnostics are constantly occurring and accuracy in interpreting results directly affects optimal patient care. The purpose of this process use evaluation was to assess the efficacy of our current presentation of microbiology results in facilitating appropriate clinical decisions and antibiotic stewardship.

Methods
A six question multiple choice survey was sent to prescribers and pharmacists. Each question used our healthcare system’s current presentation of microbiology results. The recipients were asked to make a clinical decision based on patient history and results presented. The topics surveyed included de-escalation of antibiotics based on polymerase chain reaction (PCR) for positive blood cultures (Image 1), evaluation of C. difficile PCR and enzyme immunoassays (Image 2), impact of recent immunization on results of S. pneumoniae urine antigen (Image 3), susceptibilities of Group C Streptococcus and H. influenzae (Images 4 and 5), and understanding of minimum inhibitory concentrations (MIC, Image 6). The anonymous surveys were collected either electronically or by paper.
Image 1

Image 2

Results
Several trends were seen in the 64 responses received (n, %). Questions with lab results containing detailed comments with guidance on how to interpret the results had the highest percentage of correct responses. This included our C. difficile (59, 92%) and S. pneumoniae urine antigen (61, 95%) results. Culture results with presumed susceptibilities and/or lack of guidance (H. influenzae (55, 86%); Group C Streptococcus (46, 72%)) had lower rates of correct interpretation and resulted in provider reluctance to de-escalate antibiotics. A similar trend was seen with the word “presumptive” on blood culture results by PCR (37, 58%). MICs were frequently misinterpreted as being able to compare activity between antibiotics (46, 72%).
Image 3

Image 4

Image 5

Conclusion
This study highlights that stewardship programs should focus on how lab results are reported and interpreted and should work with their microbiology lab to determine the presentation of results. Additions of detailed interpretations to Microbiology results may lead to improved de-escalation and antibiotic selection.
Image 6

Disclosures
All Authors: No reported disclosures
1378. Reservoirs of Transmission of Resistant Gram-negative Pathogens Responsible for Neonatal Sepsis among Hospitalized Neonates in Pune, India
Authors: Johnson Julia , Johnson Julia , Robinson Matthew , Naik Shilpa Nandkumar , Patil Sunil , Kulkarni Rajesh , Kinikar Aarti , Dohe Vaishali , Mudshinkar Swati , Smith Rachel , Westercamp Matthew , Randive Bharat , Kadam Abhay , Kulkarni Vandana , Mave Vidya , Gupta Amita , Milstone Aaron , Milstone Aaron , Manabe Yukari C 
Published: January 2021

Abstract

Background
Neonatal infections with resistant Gram-negative (GN) organisms are associated with high rates of mortality, with limited antibiotic treatment options. The role of maternal colonization and environmental GN organisms as reservoirs for transmission to neonates has not been well described.

Methods
We performed a prospective cohort study from October 12, 2018, until October 31, 2019, to describe the role of maternal and environmental GN colonization in BSI among neonates admitted to the neonatal intensive care unit (NICU) at a tertiary care center in Pune, India. Women admitted to Labor & Delivery with risk factors for neonatal sepsis who provided consent were enrolled and their neonates were followed until hospital discharge. For neonates who developed bloodstream infection (BSI), colonization with resistant GN organisms was assessed in their mothers from frozen vaginal and rectal swabs collected at enrollment and at delivery and in the neonates from frozen skin swabs and peri-rectal swabs collected at day of life (DOL) 0, 3, 7, and weekly until discharge. Environmental colonization was assessed with weekly sampling of unit sinks and the immediate neonatal care environment. Colonization samples were processed to identify organisms that matched neonatal blood culture isolates.

Results
953 women were enrolled, of whom 741 (78%) received antepartum antibiotics. Among 987 live born neonates, 12 (1%) died in the delivery room and 257 (26%) required NICU admission. Among neonates admitted to the NICU, 143 (56%) had at least one blood culture, of which 28 (20%) were positive; 21 (75%) had a GN BSI. The most common cause of neonatal BSI was Klebsiella pneumoniae, and 8 (38%) GN BSI were due to a carbapenem-resistant organism. No organism isolated from maternal samples matched organism and resistance pattern from neonatal blood culture. Matching strains were found in unit sinks and neonatal rectal and skin samples (Figure 1).
Organism recovery from swabs and match to bloodstream isolate by sample source and time of collection from birth

Conclusion
Among neonates born to mothers with risk factors for neonatal sepsis, GN organisms were the most common cause of neonatal BSI. Environmental and neonatal colonization may represent important reservoirs of transmission for these pathogens among neonates hospitalized in a tertiary care NICU in Pune, India.

Disclosures
All Authors: No reported disclosures