bluuebunny/crossref_metadata_2025_split huggingface dataset:
1468. Determination of Antibiotic Susceptibilities in Aerococcus urinae Urinary Isolates
Authors: Krishnan Anish , Nadeau Lynn 
Published: October 2019

Abstract

Background
Aerococcus urinae is a Gram-positive organism, initially identified in 1992. It is known to cause urinary tract infections (UTIs), bacteremia, and endocarditis in humans. There is limited data regarding the susceptibility of A. urinae to first-line antimicrobials indicated for the treatment of UTIs. In 2016, A. urinae was isolated in 125 urine samples processed by the Integrated Hospital Laboratories Service, which services four hospitals in Southwestern Ontario, Canada. The unfamiliarity with this organism and the lack of local antimicrobial susceptibility rates presents a challenge for clinicians and often results in the unnecessary use of broad-spectrum antibiotics. The primary objective of this study was to establish the susceptibility rate of A. urinae urinary isolates to cefazolin, ampicillin, nitrofurantoin, fosfomycin, and ciprofloxacin. The secondary objective was to identify demographic characteristics associated with A. urinae bacteriuria in our patient population.

Methods
Urinary samples received by the laboratory from October 2017 to June 2018 underwent routine identification as per physician orders. Samples that grew A. urinae were included in this study and subjected to susceptibility testing. Susceptibility testing was conducted via disk diffusion and results were interpreted based on published breakpoints for zone diameters.

Results
A total of 72 isolates were included. Susceptibility rates for cefazolin, ampicillin, nitrofurantoin, fosfomycin, and ciprofloxacin were 100%, 99%, 99%, 96%, and 65%, respectively. The average age of patients was 79 years, 63.9% were female, 31.9% were recently hospitalized, and 44.4% were residents of a long-term care facility.

Conclusion
Cefazolin, ampicillin, nitrofurantoin, and fosfomycin demonstrated good in vitro activity against A. urinae. In contrast, ciprofloxacin demonstrated decreased activity against this organism. Currently recommended first-line agents for the management of uncomplicated UTIs could be utilized to treat this organism. Characteristics of patients with A. urinae bacteriuria are consistent with risk factors predisposing to UTIs.

Disclosures
All authors: No reported disclosures.
1472. Non-Carbapenems for Treating Community-Associated Urinary Tract Infection Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Children
Authors: Joo Jung Hyun , Young Lee Shin 
Published: October 2019

Abstract

Background
Childhood urinary tract infection (UTI) may cause increased major morbidity and long-term clinical consequences. Extended-spectrum β-lactamase (ESBL) is produced by the members of the Enterobacteriaceae family, which are the primary infectious agents that cause UTI in children. Isolation of ESBL-producing Enterobacteriaceae (ESBL-E) typically occurred in healthcare facilities; however, the incidence of community-associated (CA) UTIs due to ESBL-E has increased worldwide. It has led to an increase in the use of carbapenems. In this study, we determine the characteristics of community-onset UTIs caused by ESBL-E in children to suggest non-carbapenem options for the treatment of childhood UTIs due to ESBL-E in order to preserve carbapenems.

Methods
A total of 2,157 isolates of ESBL-E were collected from children below 18 years old who were clinically certified UTI or urosepsis between January 2008 and August 2018 at tertiary university hospital in Korea. Their electronic medical records were retrospectively reviewed. Long-term healthcare facility stay within the preceding month and isolates recovered more than 72 hours after hospitalization were the criteria of healthcare-associated (HA) infection.

Results
The most common isolates were E. coli 1815 (84.2%) followed by K. pneumoniae 342 (15.8%). CA infection was detected in 1,513 of the 2157 ESBL-E (70.1%). The prevalence of CA ESBL-E infection increased significantly from 68 cases in 2008 to 325 cased in 2017. Antibiotic susceptibility test showed highest sensitivity to ertapenem, meropenem, and amikacin (>90%) followed by cefoxitin (82%), and piperacillin–tazobactam (TZP) (80.5%). CA E. coli showed higher sensitivity to amikacin and TZP compared with HA E coli. CA K. pneumoniae showed much higher sensitivity to TZP compared with HA K. pneumoniae. Of total ESBL-E, the antimicrobial resistance rate to aminoglycoside such as amikacin and gentamicin showed full sensitivity during the study period; furthermore, a rate of resistance to TZP has been decreasing over the years.

Conclusion
Identifying antibiotic susceptibility patterns of ESBL-E is a useful guide for treatment strategy of UTI. This study showed that there are non-carbapenem options for the treatment of CA ESBL UTI in children.

Disclosures
All authors: No reported disclosures.
1482. Microbiological Analysis from a Phase II Study Evaluating Gepotidacin (GSK2140944) in the Treatment of Uncomplicated Urinary Tract Infections
Authors: Scangarella-Oman Nicole , Hossain Mohammad , Tiemeyer Jr. Timothy , Perry Caroline R , Tiffany Courtney , Raychaudhuri Aparna , Dumont Etienne 
Published: October 2019

Abstract

Background
Gepotidacin (GEP), a first in class novel triazaacenaphthylene bacterial topoisomerase inhibitor, inhibits bacterial replication and has in vitro activity against key pathogens, including drug-resistant strains, associated with a range of infections.

Methods
This phase IIa single-center study evaluated the safety, tolerability, pharmacokinetics, and efficacy of oral GEP 1,500 mg BID for 5 days in female subjects with acute cystitis. Clean catch mid-stream urine specimens were obtained for quantitative culture by standard methods. Susceptibility testing by CLSI broth microdilution and gradient diffusion (fosfomycin only) was conducted. Inclusion in the microbiological intent-to-treat population (micro-ITT) required growth of a qualifying baseline uropathogen (≥ 105 CFU/mL). Microbiological success was defined as culture-confirmed eradication (no growth, <103 CFU/mL) of the qualifying baseline uropathogen.

Results
Of 22 participants, 8 (36%) had a baseline qualifying uropathogen (5 E. coli, 1 S. saprophyticus, 1 K. pneumoniae, and 1 C. koseri) and were included in the micro-ITT. GEP MICs against the 8 qualifying uropathogens ranged from 0.06 to 4 µg/mL. Two E. coli isolates were multidrug-resistant (defined as resistance to ≥3 antibiotic classes) due to resistance to ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin/levofloxacin or cefazolin. One additional E. coli isolate was ampicillin-resistant. Of the 8 participants in the micro-ITT, 7 (88%), and 6 (75%) were microbiological successes at the Test of Cure (TOC) and Follow-up Visits, respectively. The one microbiological failure at TOC (E. coli) was due to an unreportable (out of stability) urine specimen. For the 4 participants with available steady-state PK, qualifying Enterobacteriaceae uropathogens and who were microbiological successes at TOC, plasma fAUC24h/MICs ranged from 7 to 90.5 and urine AUC24h/MICs from 1292 to 121,698. The participant with the lowest plasma fAUC/MIC (7) and urine AUC24h/MIC (1292) had a K. pneumoniae with a gepotidacin MIC of 4 µg/mL.

Conclusion
This first report of microbiological efficacy in the treatment of acute cystitis supports further clinical study of GEP as a first-in-class, novel mechanism of action antibacterial.

Disclosures
All authors: No reported disclosures.
1485. Trends in Important-Resistant Gram-Negative (GN) and Gram-Positive (GP) Urine Bacterial Pathogens in Hospitalized Patients in the United States: A Multicenter Evaluation from 2013 to 2018
Authors: Lodise Thomas , Gelone Steven P , Yu Kalvin , Gupta Kalpana , Early Maureen , Ye Gang , Schranz Jennifer , Gupta Vikas 
Published: October 2019

Abstract

Background
The US CDC has identified a number of antibiotic-resistant (AR) bacteria as urgent or serious public health threats. This study sought to quantify the prevalence and incidence of extended-spectrum β-lactamase (ESBL) Enterobacteriaceae (ENT), Carbapenem-resistant ENT (CRE), P. aeruginosa (Carb NS-PsA), vancomycin-resistant enterococci (VRE), and methicillin-resistant S. aureus (MRSA) in the urine of adult hospitalized patients.

Methods
All hospitalized adult patients with a positive urine culture (first urine isolate of a species per 30-day period) were evaluated from over 400 US hospitals (2013–2018; BD Insights Research Database, Becton, Dickinson and Company). The following five groups of AR bacteria were examined: (1) ESBL ENT if ESBL-positive per commercial panels or intermediate/resistant (non-susceptible [NS]) to a third-generation cephalosporin; (2) CRE ENT if NS to imipenem (IPM), meropenem (MEM), doripenem (DOR) or ertapenem; (3) Carb-NS PsA if NS to IPM, MEM or DOR; (4) VRE if resistant to vancomycin; and (5) MRSA as resistant to methicillin/oxacillin. For each AR grouping, % NS and rates of NS per 100 admissions were calculated and trends were examined using Logistic regression and Poisson models.

Results
Across the 6-year study period, there were 24,558,856 admissions, accounting for 2,285,971 non-duplicate urine isolates; 1,016,642 were ENT, 87,450 were PSA, 203,231 were enterococci, and 41,979 were S. aureus. The % of NS for ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA were 12%, 0.9%, 13%, 19%, and 55%, respectively. The % of NS for ESBL increased from 2013 to 2018 (P < 0.001) whereas % NS for PsA and % MRSA decreased during the same time period (P < 0.001) (Figure 1). The rates of NS per 100 admissions for ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA were 0.44, 0.04, 0.05, 0.16, and 0.09, respectively. The annual NS rates per 100 admission trends for ESBL and CRE ENT were increasing (all P < 0.0001) while the trends for Carb-NS PsA, VRE, and MRSA were decreasing (all P < 0.0001).

Conclusion
While the percent of ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA have remained relatively constant over the past 6 years, there has been a notable increase in the rates of ESBL and CRE ENT per 100 admissions among adult hospitalized patients with positive urine cultures.

Disclosures
All authors: No reported disclosures.
1502. Risk Factors Associated to Aeromonas spp. Infection and Outcome at a Third-level Care Hospital in Mexico
Authors: López-Iñiguez Alvaro , Morado-Aramburo Oscar , Pérez-Gutiérrez Teresa , Peña-Puga Cecilia F , Aranza Marañon-Solorio Karen , Zamora-Tapia Irwin , Lambraño-Castillo Darwin , Maravilla-Franco Ernesto , Sifuentes-Osornio José , Ponce de Leon Alfredo 
Published: October 2019

Abstract

Background
Information regarding infections caused by Aeromonas spp. is limited. The aim of this study was to describe the clinical and epidemiologic characteristics of infections by Aeromonas spp. during a 7-year period at a tertiary care hospital in Mexico.

Methods
We analyzed a retrospective cohort of adults with Aeromonas spp. clinical isolates, between January 1, 2010 and August 31, 2017 from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. We analyzed demographic, clinical, microbial characteristics and antimicrobial susceptibility test. Risk factors for bacteremia and mortality were identified with logistic regression; adjustment for possible confounder factors was carried out. Data were analyzed with IBM SPSS Statistics version 21. Statistical significance was defined as the value for P < 0.05.

Results
We identified 387 patients with an infection by Aeromonas spp.; the median age was 55 years and 52% were women. 94 (24.3%) patients had an autoimmune disease; 74 (19.1%) had a solid tumor (ST); 51 (13.2%) had chronic kidney disease (CKD); 43 (11.1%) had chronic liver disease (CLD); 37 (9.6%) had a hematologic malignancy (HM); 23 (5.9%) were solid-organ recipients and 20 (5.2%) HIV infected. 41.6% (n = 161) of the infections were healthcare related. Stools were the most frequent isolation site (n = 299, 77%), followed by blood cultures (n = 29, 7.4%) and abscess (n = 19, 4.9%). The most common species was A. veronii. Aminoglycosides, quinolones, carbapenems, and trimethoprim/sulfamethoxazole were the most active antibiotics in vitro. The variables associated with bacteremia were CLD OR 5.647; diabetes OR 2.376 and nosocomial acquisition OR 4.08. 30-day mortality was 5.7%, while global mortality was 10.3%. Mortality was associated with sex (male) OR 1.753; HM OR 2.741; ST OR 2.576; polymicrobial infection OR 2.445; ICU admission OR 5.175 and bacteremia OR 3.881.

Conclusion
Infections by Aeromonas spp. have increased and have a greater incidence among individuals with chronic diseases and immunosuppressive states in this setting. Mortality described in this cohort was minor than previously stated by other series.

Disclosures
All authors: No reported disclosures.
1524. Presentation of Acute Focal Bacterial Nephritis in Children
Authors: Ha Park Geun , Lee Bongjin , Rhim Jung-Woo , Lee Kyung-Yil , Mi Kang Hyun 
Published: October 2019

Abstract

Background
Ascending infections are thought as the main route of infection in acute pyelonephritis (APN). However, among patients diagnosed with APN, a subset has atypical presentation unexplainable by ascending routes of infections. This study aimed to review 8 cases initially diagnosed as APN, however presenting with no or minimal pyuria and presenting as acute focal bacterial nephritis (AFBN).

Methods
This was a retrospective cohort study of children <18 years old without underlying diseases, treated for their first episode of APN during 2006 and 2016. Those that fit the following inclusion criteria were diagnosed as AFBN: (1) characteristic CT findings compatible AFBS, (2) atypical presentation of APN including lack of urinary symptoms, and (3) no antibiotic administration prior to urine culture. Electronic medical records were analyzed, and radiologic images re-evaluated.

Results
During the 11-year period, of the total of 359 patients were diagnosed with the first episode of APN. Of these, 8 were re-diagnosed as AFBN. The mean age was 9.8 years old (1.9–17.4). Abdominal pain with nausea and vomiting were chief complaints (62.5%), and none had urinary symptoms including dysuria, incontinence, or increased frequency. Initial urinalysis in all the patients showed WBC <10–19 hpf, and were negative for nitrite. High initial WBC and CRP levels were observed (median 17.892 × 103/mm3 and 13.1 mg/dL, respectively). Cultures were positive for E. coli in 3 cases. CT findings showed nephromegaly with multifocal wedge-shaped heterogeneous enhancement defects corresponding to blood supply patterns of renal segmental arteries, no hydronephrosis, and no inflammation in the pelviureteric calyceal system. A mean duration of fever was 6.6 days, and time to defervescence after initiation of antibiotics was an average of 3 days.

Conclusion
Lack of urinary symptoms, insignificant pyuria, and CT findings of AFBN support the possibility of an alternative route of infection, other than the ascending route.

Disclosures
All authors: No reported disclosures.
1525. Epidemiology, Management, and Outcomes of Skin and Soft-Tissue Infections in Well-Appearing Infants Less Than 60 Days of Age
Authors: Neese Jeremy , Harik Nada 
Published: October 2019

Abstract

Background
Skin and soft-tissue infections (SSTIs) in children are increasingly common. The IDSA has published guidelines for SSTI treatment in children, adolescents, and adults but data in infants less than 2 months is sparse despite their higher risk of concomitant serious bacterial infection (SBI). Clinical work-up and management of these patients varies widely with little evidence to guide providers.

Methods
We retrospectively identified 536 patients, from 2007 to 2017, seen at our EDs or hospital-associated clinic and diagnosed with SSTI by ICD9/10 code. We excluded those with ill-appearance, prematurity, known immunodeficiency, skin disorder, previous SSTI, or previous procedure at infection site. Remaining patient’s medical records were reviewed to confirm a SSTI. The total included study population was 182 (Figure 1). Data collected included demographics, type/location of infection, laboratory/imaging studies obtained, procedures performed, disposition, treatment, and treatment failure.

Results
Demographics are reported in Table 1. Mean age was 24.2 days (range 2–57 days). Of 182 patients, 13% had fever. 34% had a superficial infection (impetigo or pustulosis), 24% had cellulitis/scalded skin, 35% had an abscess/paronychia, and 7% had periorbital cellulitis. The most common SSTI locations were perineal/genital (30%) and head/scalp/face (23%). 63% of infants had a blood culture obtained and 4/114 grew a pathogenic bacteria. 52% had a wound culture and 72/95 grew a pathogenic bacteria. No infants had bacterial meningitis or a UTI (Table 2). 25% underwent incision/drainage and 93% received any antibiotic. The most commonly prescribed antibiotics were clindamycin and mupirocin. Of 80 non-admitted infants, 21% had an unscheduled return visit within 2 weeks (Table 3): 9% for treatment failure, 6% unrelated to SSTI, and 1% for missed SBI (1 patient with GAS bacteremia).

Conclusion
Most well-appearing infants with SSTI were afebrile. The majority of studied infants had blood cultures obtained but rates of clinically significant bacteremia were low. Management varied considerably and antibiotics were commonly administered. However, overall rates of SBI were low and there was only 1 case of missed SBI. Extensive evaluation of well-appearing infants with SSTI may be unnecessary.

Disclosures
All authors: No reported disclosures.
1527. Clinical Variables Associated with Vancomycin Resistance in Children with Bacteremia Due to Enterococcus spp.
Authors: Jimena Carla , Mussini Soledad , Taicz Moira , Paula Arias Ana , Perez Guadalupe , Reijtman Vanesa , Mastroianni Alejandra , Ines Sormani Maria , Garcia Eva , Teresa Rosanova Maria , Bologna Rosa 
Published: October 2019

Abstract

Background
Enterococcus spp. (E) is an important cause of nosocomial bacteremia. The emergence of vancomycin-resistant E in the nosocomial setting conditions the empirical treatment and limits therapeutic options.

Methods
A retrospective cohort study of children ≥1 month with E bacteremia in a reference pediatric hospital was performed. Study period January 1, 2016–December 31, 2018. Outcome: to describe clinical and epidemiological characteristics of children with bacteremia due to Enterococcus spp. resistant to vancomycin (VRE) vs. sensitive (VSE). Identify variables associated with VRE. STATA 13 was used.

Results
N = 82 patients. Median age was 37.6 months (IQR 2–48), 45 patients (54.9%) were male; 76 patients (92.7%) had underlying disease (intestinal failure (21.9%), heart disease (17.1%), preterm births (12.2%), hematological disease (10.9%), and liver failure (7.3%); 16 patients (19.5%) received immunosuppressive therapy. Sixty bacteremia (73.2%) were by E. faecalis and 22 (26, 8%) by E. faecium. Vancomycin resistance was documented in 13 patients (15.8%), all of which were E. faecium. In the bivariate analysis, patients with VRE bacteremia were significantly older in months than those with VSE bacteremia [75.4 (IQR 6–151) vs. 30.5 (IQR 2–33), P <0.02]; had more frequency of previous colonization with VRE [n: 8 (61.5%) vs. n: 4 (5.8%) P < 0.001], hematological disease [n: 5 (38.5%) vs. n: 5 (5.8%), P = 0.01], liver failure [n: 3 (23.1%) vs. n: 3 (4.4%), P = 0.02] and immunosuppressive therapy [n: 6 (46.2%) vs. n: 10 (14.5%) P = 0.008]. Patients with VRE bacteremia had a lower median white blood cell count [7040 (IQR 2150–10250) vs. 14474 (IQR 6160–17090), P <0.03]. Mortality in P with VRE was 15.4% (n: 2) and 4.3% in P with VSE (n: 3), P = 0.1. No statistically significant differences were found according to history of surgery, previous hospitalization, antibiotic therapy in the last 3 months or clinical presentation. In the multivariate model, predictors of VRE bacteremia adjusted for the rest of the significant variables were hematological disease OR 11.1 (95% CI 2.3–53.8) P = 0.003, and liver failure OR 7.7 (95% CI 1.2–50.4), P = 0.03.

Conclusion
In this cohort of children with enterococcal bacteremia, hematological disease and liver failure were predictive variables of VRE bacteremia.

Disclosures
All authors: No reported disclosures.
1531. A Twenty 3-Year Retrospective Study of Secondary Hemophagocytic Syndrome in a Pediatric Third-Level Referral Center in Mexico City
Authors: Gonzalez Saldaña Napoleon , Mendoza Francisco Javier Otero , Carmona Vargas Ana Jocelyn , Zuyino Mondragon Salinas Izveidy 
Published: October 2019

Abstract

Background
Secondary hemophagocytic syndrome (SHS) may develop as a result of excessive immune activation, with proliferation of T cells and macrophages. It is often fatal and remains ill-recognized in children, leading to false or delayed diagnosis and suboptimal management. This condition has been described more often in association with virus, but it can be secondary to bacteria, fungi, and parasites.

Methods
Retrospective, descriptive, and observational study. We systematically reviewed the clinical files of patients diagnosed with SHS at the Instituto Nacional de Pediatría between January 1995 and December 2018; age, gender, clinical features, laboratory results, management, and final outcome were registered.

Results
49 cases of SHS were diagnosed, 26 (53%) were male, mean age at diagnosis was 67.5 months (newborn–15.5 years), 47 (96%) presented with fever, 46 (94%) hepatomegaly, 37 (76%) splenomegaly, 28 (57%) lymphadenopathy, 18 (37%) jaundice, and 4 (8%) bleeding. The most common laboratory findings were anemia in 29 (59%) patients, thrombocytopenia in 39 (80%), hypertriglyceridemia in 39 (80%), with isolation of Epstein Barr Virus in 18 (35%), followed by Cytomegalovirus in 2 (4%), Escherichia coli in 2 (4%), Salmonella enterica in 2 (4%), and Leptospira, Brucella abortus, Shigella sonnei, Enterococcus faecium, Enterovirus and congenital Rubella in 1 case each (2%). Intravenous Gamma-globulin therapy was administered to 38 (78%) patients, antimicrobials to 26 (53%), systemic steroids to 46 (94%) and VP16 to 32 (65%). 22 (45%) had full recovery, 6 (12%) patients presented with a recurrent episode of SHS, and 21 (43%) died.

Conclusion
Due to the rarity of this syndrome, variable clinical presentation, and lack of specificity of the clinical and laboratory findings, the diagnosis of SHS is often delayed. EBV remains an important etiologic agent of this syndrome, identified in 35% of our cases. The mortality rate around the world is reported approximately around 45%, confirmed in our study in 43% of the cases, remarking the importance of prompt diagnosis and treatment to increase the survival in our population.

Disclosures
All authors: No reported disclosures.