bluuebunny/crossref_metadata_2025_split huggingface dataset:
1309. Effects of a Pharmacist-Driven Antiretroviral Stewardship and Transitions of Care Service in Persons Living with HIV/AIDS
Authors: Brizzi Marisa B , Burgos Rodrigo M , Chiampas Thomas D , Michienzi Sarah M , Smith Renata , Badowski Melissa E 
Published: October 2019

Abstract

Background
Historical data demonstrate that PLWHA experience higher rates of medication-related errors when admitted to the inpatient setting. Prior to initiation of this program, rapid-start initiation of antiretroviral therapy (ART) was not implemented prior to discharge. The purpose of this study was to evaluate the impact of a pharmacist-driven antiretroviral stewardship and transitions of care service in persons living with HIV/AIDS (PLWHA).

Methods
This was a retrospective pre- and post-analysis of PLWHA hospitalized at University of Illinois Hospital (UIH). Patients included were adults following at UIH outpatient clinics for HIV care admitted to UIH for acute care. Data were collected between April 19, 2017 and October 19, 2017 for the pre-implementation phase, and between July 1, 2018 and December 31, 2018 for the post-implementation phase. The post-implementation phase included an HIV-trained clinical pharmacist (Figure 1). Primary and secondary endpoints included follow-up rates at UIH outpatient HIV clinics, 30-day readmission rates, and access to medications at hospital discharge. Statistical analysis included descriptive statistics and Fisher’s Exact test.

Results
A total of 119 patients were included in the analysis, 66 in the pre-implementation phase and 53 in the post-implementation phase. Patients included were mostly black males with median age of 48. In the pre-implementation phase 50 out of 65 (77%) patients attended follow-up visits for HIV care at UIH outpatient clinics, vs. 42 out of 47 (89%) patients in the post-implementation phase (P = 0.1329). Thirty-day readmission occurred in 17 of 62 (27%) patients in the pre-implementation phase vs. 5 of 52 (10%) of patients in the post-implementation phase (P = 0.0183). During the post-implementation phase, the HIV pharmacist secured access of ART and opportunistic infection medications prior to discharge for 22 patients (42%), 2 of which were new diagnoses.

Conclusion
A pharmacist-led antiretroviral stewardship and TOC program led to a decrease in 30-day readmission rates in PLWHA. Although not significant, the HIV-pharmacist led to higher rates of clinic follow-up. Finally, the HIV-pharmacist helped secure access to ART and initiate rapid-start therapy in newly diagnosed patients prior to leaving the hospital.

Disclosures
All authors: No reported disclosures.
1334. Performance of C-Reactive Protein and Procalcitonin in Immunocompromised Children with SIRS
Authors: Posch Leila C , Boge Craig L K , Gerber Jeffrey , Fitzgerald Julie , Weiss Scott L , Lautenbach Ebbing , Coffin Susan E , Downes Kevin J , Downes Kevin J 
Published: October 2019

Abstract

Background
Biomarkers (C-reactive protein [CRP], procalcitonin [PCT]) have been used in patients with systemic inflammatory response syndrome (SIRS) to identify those with and without bacterial infection. However, their performance in immunocompromised (IC) children is not well studied.

Methods
Retrospective chart review of episodes of SIRS in IC children <19 years old admitted to the PICU August 2012–June 2016 with: (a) blood culture, PCT, and CRP obtained within 6 hours of SIRS, (b) no recent SIRS episodes (> 30 days), and (c) no positive blood culture in 2 days preceding SIRS. We defined IC as neutropenia (ANC< 500), solid-organ transplant (SOT), hematopoietic cell transplant (HCT), and other (immunosuppressive medications or primary immunodeficiency). To identify a comparator group, we additionally reviewed a previously published cohort of non-IC children with SIRS (Downes, et al, JPIDS 2018), applying the same inclusion criteria. For each episode (first 48 hours after SIRS), we determined the presence of bacterial infection using NHSN definitions and viral infection as symptoms with positive PCR. We compared biomarkers in IC children with and without bacterial infection, and in IC and non-IC children, using Wilcoxon rank-sum tests.

Results
We identified 108 SIRS episodes in 94 IC children (neutropenia = 35, SOT = 18, HCT = 22, other = 33) and 278 episodes in 250 non-IC children. Age (P = 0.15) and gender (P = 0.70) were similar among IC and non-IC groups. 41% of episodes in both IC and non-IC children had bacterial infections (P = 0.96). PCT and CRP were significantly higher in IC children with bacterial infection than those without (Figure 1). Biomarkers did not differ significantly among episodes in IC and non-IC children with bacterial infection; however, among episodes without bacterial infection, biomarkers were higher in IC than non-IC children (Table 1). Detection of a viral infection did not affect biomarker values in IC or non-IC children when bacterial infection was absent (Table 2).

Conclusion
In IC children with SIRS, PCT and CRP were higher when bacterial infection was present. Meanwhile, in the subset of non-bacterial SIRS episodes, biomarkers were higher in IC compared with non-IC children. PCT and CRP may be valuable markers to discriminate bacterial from non-bacterial causes of SIRS in IC children.

Disclosures
Kevin J. Downes, MD, Merck: Grant/Research Support, Research Grant; Pfizer: Grant/Research Support.
1352. The Burden of Active Tuberculosis in an Integrated Healthcare System, 1997–2016: Incidence, Mortality, and Excess Healthcare Utilization
Authors: Wada Paul , Lee-Rodriguez Christian , Hung Yun-Yi , Skarbinski Jacek 
Published: October 2019

Abstract

Background
Active tuberculosis (TB) often results from reactivation of latent tuberculosis infection (LTBI). This can be prevented through LTBI screening and treatment, yet only 12% of Californians have undergone LTBI therapy. Updated estimates on the complete burden of active TB are needed to rationally allocate resources for LTBI program implementation.

Methods
We identified all patients with microbiologically confirmed active TB in a large, integrated health system (Kaiser Permanente Northern California, or KPNC) from 1997 to 2016. We calculated active TB incidence in KPNC and measured this against California’s reported cases. Within KPNC, we compared mortality, hospital, emergency department, and ambulatory care use among persons with active TB to age-, sex-, and year-of-diagnosis-matched cohort of persons without active TB.

Results
Active TB incidence was lower in KPNC (3.4/100,000 person-years) than in California (7.2/100,000 person-years). Among 2,522 active TB cases, early and delayed mortality was high with 7.0% dying within 1 year of diagnosis and 6.2% dying 1–5 years post-diagnosis. Of the 1,957 active TB patients who continued to receive care through KPNC for at least one year post-diagnosis, 603 (30.8%) had at least one hospitalization. In KPNC, active TB patients had higher healthcare utilization than the matched cohort in the one year following diagnosis: 0.6 vs. 0.1 hospitalizations, 9.5 vs. 4.6 days mean length-of-stay, 0.8 vs. 0.3 emergency department visits, and 14.6 vs. 5.9 ambulatory visits.

Conclusion
Patients with active TB disease have substantial mortality and high inpatient and outpatient healthcare utilization. By improving LTBI screening and treatment, large healthcare systems may be able to reduce the burden and costs associated with active TB.

Disclosures
All authors: No reported disclosures.
1365. Profiling Extrapulmonary Nontuberculous Mycobacteria Infections and Predictors for rapid-growing Species: A Multi-Center Retrospective Study
Authors: Ho Kim Jung , Ji Lee Woon , Seong Hye , Young Jung In , Jin Kim Eun , Eun Song Je , young Ahn Jin , Jin Jeong Su , su Ku Nam , yong Choi Jun , Yeom Joon-Sup , Goo Song Young 
Published: October 2019

Abstract

Background
Nontuberculous mycobacteria (NTM) disease is increasing worldwide and is an important cause of morbidity and mortality. It is found that 20 to 30% of NTM isolates are of extrapulmonary origin. However, Studies about extrapulmonary NTM infections have been limited. Thus, we aim to describe the diversity of NTM infections and correlate these observations with clinical data.

Methods
We analyzed all symptomatic patients with positive NTM cultures in sterile extrapulmonary sites at three tertiary care centers in South Korea between January 2006 and June 2018. We collected patient information including predisposing factors, diversity of NTM isolates, antimicrobial susceptibility testing, treatment regimens, and outcomes.

Results
A total of 117 patients (46 males vs. 71 females) were included. The median age of the patients was 54 years. There are a lot of infections associated with medical procedures like surgery, but about half of cases (54.7%) are unknown origin. Skin and soft-tissue infections predominated (34.2%), followed by bone and joint infections (28.2%). Of 117 NTM isolates, 66 NTM subspecies were identified. Mycobacterium intracellulare (34.8%) was the most common species identified, followed rapid-growing NTM (RGM) species such as M. fortuitum complex (21.2%), M. abscessus (15.2%), M. massiliense (10.6%), and M. chelonae (9.1%). In skin and soft-tissue infections, RGM species were predominantly identified (26/28, 92.9%), whereas slow-growing NTM (SGM) species were mainly identified in bone and joint infections (18/26, 69.2%). The difference of isolated sites was verified by post hoc test and female sex (OR 4.72; P < 0.001) and skin and soft-tissue infections (OR 25.33; P < 0.001) were identified as predictors of RGM by logistic regression analysis. Based on antimicrobial susceptibility testing, fluoroquinolone and macrolide were mainly used for RGM treatment, and rifamycin-ethambutol-macrolide-based regimen was predominantly used for SGM treatment.

Conclusion
Skin and soft-tissue infection were predominantly caused by RGM, whereas bone and joint infection is mainly caused by SGM. Species-specific and region-specific data that integrate clinical and microbiologic information is crucial in determining treatment direction.

Disclosures
All authors: No reported disclosures.
1374. Diagnostic Utility of Whole Body Positron Emission Tomography-Computerized Tomography (PET-CT) in Patients with Suspected Central Nervous System Tuberculosis: A Retrospective, Descriptive Study
Authors: Ramesh Venkat , Narreddy Suneetha , Barigala Ravikiran , Kumar Chennamchetty Vijay , Kumar Sudhir , Rao Jyotsna , Nanda Sagarika , Varahala Sneha 
Published: October 2019

Abstract

Background
There is difficulty in diagnosing central nervous system (CNS) tuberculosis (TB) in the early stages because features mimic viral and pyogenic meningitis. There is a need to determine alternate methods to diagnose CNS TB. Whole-body PET-CT, used mainly in oncology, has shown promise in the detection of tuberculosis and monitoring response to anti-tuberculous therapy. Utility in CNS TB is unexplored.

Methods
Retrospective, cohort, single-center study. Patients were included if they fulfilled the following criteria: (1) Probable/possible tuberculous meningitis as per the Lancet Consensus Score; (2) undergone whole-body PET-CT with 18-fluorodeoxyglucose and intravenous contrast; (3) less than one week of anti-tuberculous therapy at the time of PET-CT; (4) clinical response to antituberculous treatment and steroids; (5) no other etiological agent identified.

Results
We identified 9 patients that fulfilled the above criteria. 5 of these patients were immunosuppressed (4 had advanced AIDS, one patient was on immunosuppressive therapy). We found that 86.4% of patients (7 out of 9) had radiological features suggestive of probable active TB outside the CNS (Figure 1). Of these 7 patients, 5 patients had definite TB (defined as positive Ziehl–Neelsen stain or Gene Xpert MTB/RIF assay or culture for tubercle bacilli) outside the CNS while 2 had histopathological evidence of TB (granulomatous inflammation) (Figure 2). All strains of TB were rifampin sensitive. The sites of isolation of tuberculosis were (Figure 3). (a) Abdominal lymph node in 2 patients (40%); (b) cervical lymph node in 2 patients (40%); (c) sputum in 1 patient (20%). In patients with evidence of disease outside the CNS, the average maximum standardized uptake value (SUV Max) in diverse anatomical locations was 5.75 (range 1.9–11.2). The most frequent manifestation PET-CT manifestation suggestive of TB outside the CNS in decreasing order of frequency was cervical lymphadenopathy (in 55.5% of patients), pleural and pulmonary parenchymal involvement (44.4% in each), followed by mediastinal nodes and abdominal lymph nodes in 33.3% (Figure 4).

Conclusion
PET-CT is a valuable tool in treatment-naive (less than 1 week of anti-tuberculous therapy) patients with suspected CNS tuberculosis. A large proportion of patients have evidence of TB outside the CNS.

Disclosures
All authors: No reported disclosures.
1409. Next-Generation Sequencing-based Detection of Angiostrongylus cantonensis (AC) Using Microbial Cell-free DNA Sequencing of Plasma in Atypical Cases of Rat Lungworm Meningitis Presenting with Ascending Paralysis
Authors: Melish Marian , Casamina Chanel , Merrifield Rachael , Abe Keisuke , Ahmed Asim A , Hong David K , Blair Lily , Ching Natascha 
Published: October 2019

Abstract

Background
AC or Rat Lungworm meningitis usually presents as a self-limited illness with headache and sensory changes, rarely progressing to coma, death, or permanent brain damage. It is usually diagnosed by eosinophils in the CSF. Once limited to Asia and the tropical Pacific AC transmission via slugs and snails documented on US mainland in 2018. We describe 2 unusual, severe examples of AC infection in infants presenting with ascending paralysis and initial CSF without eosinophilia suggesting Guillain–Barre syndrome (GBS).

Methods
Conventional lab testing of serum and CSF, brain and spine MRI, AC PCR by Hawaii Department of Health, and mcfDNA next-generation sequencing (NGS) of plasma (Karius).

Results
Two infants, aged 8 and 11 months, presented with fever, lower extremity weakness, and ascending paralysis. An initial evaluation in both included normal brain/spine imaging and CSF with modest lymphocytic pleocytosis without eosinophils. Paralysis progressed despite IVIG. Case 1: 11-month male: Admitted on fever day 5. Paralysis progressed to respiratory failure requiring ventilation for 20 days. Illness day 16: MRI showed spinal cord swelling C3-C7, Brain normal. CSF#3: WBC 269 28% eos, ↑ protein. Visible 8 mm long young adult worms, PCR positive for AC. Rx high-dose corticosteroids, albendazole for >4 weeks. Day 29 illness MRI: Cerebral infarct L frontal lobe, worm tracks medulla, inflammation cauda equina. Slow improvement over 5 months. Case 2: 8-month-old female: Admitted fever day 8. Weakness progressed to arms and trunk. Day 10 illness: CSF #2: Visible worms present, WBC 84, 26% eos. PCR positive for AC. Rx: High-dose steroids and albendazole x4 weeks. MRI spine illness day 30: inflammation cauda equina. Weakness improved by illness day 37. McfDNA sequencing of plasma detected AC in acute stage peaks of 123 and 12 molecules/microliter in cases 1 and 2. Serial mcfDNA testing showed a decline in the AC DNA level in plasma which correlated with treatment and clinical response.

Conclusion
AC infection may mimic GBS or transverse myelitis. AC diagnosis may require repeat CSF testing. NGS detection of AC in plasma holds promise as rapid, noninvasive diagnosis and assessment of response to therapy. High-dose steroids with albendazole may be effective even in severe AC.

Disclosures
All authors: No reported disclosures.
1427. Treatment of Children with Acute Hematogenous Osteomyelitis and Staphylococcus aureus Bacteremia: Impact of Severity of Illness on Antimicrobial Therapy
Authors: Copley Lawson Ashley , Sanchez Maria J , Sue Paul K , Patel Karisma , Lindsay Eduardo A , Tareen Naureen G , Jo Chanhee 
Published: October 2019

Abstract

Background
There is limited evidence-based guidance for the treatment of children with acute hematogenous osteomyelitis (AHO) and concurrent Staphylococcus aureus bacteremia (SAB). Current guidelines emphasize the need for parenteral antibiotics in the setting of SAB, but optimal duration of parenteral therapy in this setting remains unclear. We examined the utility of a Severity of Illness (SOI) score to provide guidance for antimicrobial use in this setting.

Methods
We retrospectively studied children with AHO from 2009–2017, employing a clinical practice algorithm and previously validated SOI to assess the incidence and treatment implications of SAB in AHO. Data collected included demographics, antimicrobial therapy, and response to treatment. Cohorts were categorized according to SOI as follows: mild (0–3); moderate (4–7); and severe (8–10), and compared utilizing one-way ANOVA and Kruskal–Wallis tests for continuous variables, and chi-square test for categorical data.

Results
Among 466 children diagnosed with AHO, 274 (58.5%) were culture positive for Staphylococcus aureus, with SAB noted in 209 (44.8%) individuals. Among children with SAB, 72, 81, and 56 children had SOI scores classified as mild, moderate, and severe, respectively. There were 41 of 72 (57.7%) children with mild illness who were managed with clindamycin alone, clindamycin followed by β-lactam, or β-lactam alone, compared with 36 of 81 (44.4%) with moderate illness, and 3 of 56 (5.4%) with severe illness. Median parenteral antibiotic durations per SOI cohort were 4.7 days, 10.4 days, and 24.7 days, respectively. Greater SOI was associated with longer hospitalization, prolonged bacteremia, more surgeries, increased vancomycin use, greater number of antibiotic combinations, and longer total duration of antibiotics.

Conclusion
Treatment of AHO with SAB should be tailored to the severity of illness in the affected child. A “one size fits all” approach may expose children to unnecessarily prolonged parenteral antibiotic courses, as well as suboptimal and potentially toxic regimens. Our study demonstrates the utility of an SOI to help guide antibiotic decisions in the setting of AHO with SAB. Additional studies are needed to further delineate optimal parenteral antibiotic durations in AHO with SAB.

Disclosures
All authors: No reported disclosures.
1469. Effect of Treatment Duration on Outcomes in Septic Patients Admitted for Urinary Tract Infections from Extended Care Facilities
Authors: Jongekrijg Annelise , George Jamie , Kale-Pradhan Pramodini , Johnson Leonard B 
Published: October 2019

Abstract

Background
Adults in extended care facilities (ECFs) are at an increased risk of urinary tract infections (UTIs) with sepsis and there are little data on effective antibiotic duration. The purpose of this project was to assess the impact of inpatient antibiotic duration on clinical outcomes in these patients.

Methods
A single-center, retrospective study of adult, ECF, septic UTI patients from 5/1/16 to 4/30/18 were included. In-hospital mortality, 30-day readmission rate, and length-of-stay (LOS) were compared based on the effective antibiotic duration of short- and long-term therapies (≤ 5 and > 5 days, respectively). Pregnant and asymptomatic bacteriuria patients were excluded. Demographics, Charlson Weighted Index of Comorbidity (CWIC), presence of indwelling catheter, SIRS criteria, microbiologic results and antibiotic regimen were collected. Continuous variables were analyzed using Student’s t-test and categorical variables with Chi-square test.

Results
105 of 1,158 ECF patients met the inclusion criteria. 38 patients received ≤ 5 days of effective antibiotic therapy, and 67 received > 5 days. Baseline demographics were similar, except the ≤ 5 days group were older and less likely to have fever (see table). In-hospital mortality was 18.4% in the short-term antibiotic group and 6.0% in the long-term group. Overall 30-day readmission was not significantly different. LOS was significantly greater in the > 5 day overall and non-bacteremia group.

Conclusion
Duration of antibiotics (≤ 5 and > 5 days) did not significantly affect 30-day readmission and in-hospital mortality; however, LOS was significantly longer in the > 5 days group. Further studies are needed to confirm these findings.

Disclosures
All authors: No reported disclosures.
1478. Efficacy and Safety of a Booster Dose of the MenACWY-TT Vaccine Administered 10 Years After Primary Vaccination with MenACWY-TT or MenACWY-PS
Authors: Quiambao Beatriz , Peyrani Paula , Webber Chris , Van Der Wielen Marie , Bianco Veronique , Perez John L , Cutler Mark W , Li Ping 
Published: October 2019

Abstract

Background
The quadrivalent meningococcal ACWY polysaccharide tetanus toxoid conjugate vaccine (MenACWY-TT; Nimenrix) is licensed in various countries to prevent disease caused by meningococcal serogroups A, C, W, and Y. In a previous study (NCT00464815), subjects aged 11‒17 years received a primary dose of MenACWY-TT or a quadrivalent polysaccharide vaccine (MenACWY-PS). Here, we report the long-term antibody persistence of the primary dose and the immunogenicity and safety of a booster dose given 10 years after primary vaccination of subjects.

Methods
Participants were enrolled from the Philippines and received a booster dose of MenACWY-TT at 10 years postvaccination. Antibody persistence 10 years postprimary vaccination and immunogenicity 1 month after the booster dose were evaluated by serum bactericidal activity assays using rabbit complement (rSBA) to assess the percentages of subjects with titers ≥1:8 and ≥1:128 and geometric mean titers (GMTs) for each serogroup. Safety was assessed for the booster dose.

Results
Of 229 subjects enrolled in this extension study, 169 and 58 subjects in the MenACWY-TT and MenACWY-PS groups, respectively, completed the booster phase. The percentages of primary MenACWY-TT recipients with prebooster rSBA titers ≥ 1:8 and ≥ 1:128 at year 10 ranged from 71.6%‒90.7% and 64.8%‒85.2% for all serogroups, respectively, compared with 43.1%‒82.4% and 25.5%‒76.5% of primary MenACWY-PS recipients; rSBA GMTs for all serogroups were higher in the MenACWY-TT group than in the MenACWY-PS group at year 10. For the MenACWY-TT and MenACWY-PS groups, respectively, the MenACWY-TT booster dose elicited rSBA titers ≥1:8 in 100% and ≥98.0% of subjects (figure); 100% and ≥96.1% of all subjects had titers ≥1:128. For all serogroups, rSBA GMTs at 1 month after the booster dose were higher than before the booster dose. No new safety signals were observed during the booster phase.

Conclusion
Functional antibody responses elicited by MenACWY-TT persisted 10 years after primary vaccination; the booster dose was well tolerated and elicited robust immune responses.
ClinicalTrials.gov: NCT03189745, EudraCT # 2013-001512-29. Funded by Pfizer.

Disclosures
All authors: No reported disclosures.