bluuebunny/crossref_metadata_2025_split huggingface dataset:
2561. Doxycycline Saves Lives! Educating Healthcare Providers on Tickborne Rickettsial Diseases in the United States Using an Online Toolkit
Authors: Binder Alison M , Armstrong Paige 
Published: October 2019

Abstract

Background
Tickborne rickettsial diseases (TBRDs), including Rocky Mountain spotted fever (RMSF), are major causes of illness in the United States. Doxycycline is the first-line treatment for patients of all ages; delay in treatment is the single most important predictor of fatal outcome. Recent assessments have identified a lack of knowledge in recognition and treatment of RMSF among providers. CDC developed an online toolkit to address the need for increased awareness in the medical and public health communities.

Methods
In August 2018, CDC released the Rocky Mountain Spotted Fever (and other tickborne diseases) Toolkit for Healthcare Providers, an online platform including: (1) Narrated video discussing RMSF clinical presentation, diagnosis, and treatment, (2) Physician pocket card, (3) Clinical timeline with images to aid diagnosis, and (4) Tickborne Diseases of the United States Manual. Participants receive free continuing education (CE) by scoring ≥75% on a posttest and providing an evaluation. We summarized post-test scores and evaluations to assess impact on participant knowledge and satisfaction with the format.

Results
As of April 30, 2019, there have been 14,103 visits to the toolkit website. In total, 247 participants registered for CE and completed the posttest; 245 (99%) passed. The majority of participants self-reported as nurses (121, 49%), followed by other professionals (32, 13%) and physicians (31, 13%). All posttest questions except one indicated correct responses were selected by ≥80%. In all, 245 provided a course evaluation; 94% agreed the content and materials addressed a gap in their knowledge, and 84% agreed the knowledge gained from the activity could be applied to practice. Nearly all (96%) agreed the delivery methods used was appropriate and aided in learning the content. Suggested improvements included integration of case-based scenarios, Spanish-language materials, and more information on epidemiology and information on TBRDs in vulnerable populations.

Conclusion
Participation in this online toolkit led to improved knowledge and confidence among providers regarding timely diagnosis and treatment of TBRDs, highlighting the utility of online education in addressing gaps in provider awareness of TBRDs in the United States.

Disclosures
All authors: No reported disclosures.
2574. Temporal Changes in the Vaginal Microbiome During Treatment for Bacterial Vaginosis: Is Lactobacillus Iners an Important Player?
Authors: Shay Elizabeth O , Goje Oluwatosin , Padmanabhan Roshan , Eng Charis 
Published: October 2019

Abstract

Background
Bacterial vaginosis (BV) is the most common vaginal condition affecting women of reproductive age and yet it remains poorly understood. Recurrent BV causes significant emotional and psychological distress and can prove difficult to resolve with currently available treatments. We aimed to investigate the microbiome of recurrent BV patients at various time points in relation to oral Metronidazole treatment.

Methods
Women aged 18–40 years, with recurrent BV, were prospectively enrolled. Vaginal samples (lavage) were collected at baseline (D0), at 7–10 days (D7) and 30–40 days (D30) after initiation of oral metronidazole treatment (500 mg BID, 7 days). DNA was extracted, amplified using primers targeting the V3-V4 region of the 16 srRNA, and then sequenced and processed through a hybrid Qiime MICCA bioinformatics pipeline.

Results
Seventeen recurrent BV patients were enrolled. Alpha diversity decreased (P = 0.0049) after the first week of treatment with oral metronidazole, but increased (P = 0.0062) to near baseline by D30. Lactobacillus iners, was the dominant Lactobacillus, with transient increase in this species corresponding with metronidazole treatment. There was also a decrease in Gardnerella vaginalis that re-normalized to baseline at 30 days. Of the 10 recurrent BV patients with data for all three time points, 4 relapsed by D30. Β diversity differed significantly between patients that relapsed and those that did not (p = 0.044). Alpha diversity did not differ between the groups (p = 0.07).

Conclusion
The dominant Lactobacillus pretreatment in this cohort was L.iners. Oral metronidazole was associated with a decrease in alpha diversity, decrease in G. vaginalis and increase in L. iners. Although L. iners increased after metronidazole treatment, this increase was not sustained by D30. Treatment with metronidazole, only temporarily altered the microbiome. Further studies are needed to clarify the role of L. iners in recurrent BV.

Disclosures
All authors: No reported disclosures.
2589. Two Cases of Congenital Babesiosis
Authors: Hachey Kevin , Lewis Deirdre , Rodriguez Julieta L , Richardson Matthew W , Johnston Alicia M 
Published: October 2019

Abstract

Background
Babesiosis is caused by Babesia microti and often transmitted via Ixodes scapularis. To the best of our knowledge, only 9 cases of vertical transmission have been reported. The spectrum of clinical presentation and optimal therapy for this population remains unknown.

Methods
Case 1 is a 4 week old female admitted with fever and irritability for 2 days. She was pancytopenic, with Hgb of 9.2 g/dL, Plt of 57 K/mm3, and absolute neutrophil count (ANC) of 500/mm3. Thin smear revealed 2.5% parasitemia. Mother was diagnosed with acute Lyme disease in the seventh month of pregnancy. Maternal serologies were positive for B. microti (IgM 1:100 and IgG >1:320). The infant received 1 PRBC transfusion and was treated with 10 days of atovoquone and azithromycin. Case 2 is a 5 week old female twin A admitted with 2 days of pallor, fatigue and poor feeding. Initial Hgb was 3.4 Gm/dL. Peripheral blood smear revealed many intraerythrocytic parasites consistent with B. microti. Thin smear obtained 24 hours after initiation of therapy showed 2% parasitemia. During hospitalization, the patient developed neutropenia with ANC nadir of 800/mm3. The patient required 4 PRBC transfusions and was treated with azithromycin and atovoquone for 10 days. The mother had an acute, self-limited febrile illness at 23 weeks gestation. At infant’s presentation, maternal serologies revealed negative B. microti IgM and positive IgG (1:160). Placental tissue from both twins was positive for B. microti DNA by PCR. Twin B was asymptomatic, had negative B. microti blood PCR, a negative B. microti IgM, positive IgG of 1:30 felt to represent transplacental maternal antibody, and did not require treatment.

Results
Both infants were successfully treated without relapse.

Conclusion
Congenital babesiosis is rare and may cause profound hematologic disturbances. We report 2 cases exhibiting neutropenia in addition to anemia and thrombocytopenia, supporting recent assertions by Wormser et al. that this is a common finding. In addition, Case 2 presented with a severe hemolytic anemia significantly worse than previously reported. Finally, we demonstrated successful treatment in neonates without exchange transfusion, even with severe anemia.

Disclosures
All authors: No reported disclosures.
2600. Mannose-Binding Lectin Polymorphisms are Important Modulating Factors in Community- and Hospital-Acquired Pneumonia Caused by Legionella spp.
Authors: Kavaliauskas Povilas , Prakapaite Ruta , Saab Frederic , Petraitiene Ruta , Jarraud Sophie , Semoskaite Rasa , Baneviciene Rasa , Planciuniene Rita , Walsh Thomas J , Petraitis Vidmantas 
Published: October 2019

Abstract

Background
Community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) are the leading causes of death from infection in developed countries. Mannose-binding lectin (MBL) is a C-type serum lectin that plays a central role in the innate pulmonary host defenses against respiratory pathogens. We hypothesized that MBL polymorphisms may increase the risk of developing Legionella pneumonia. Therefore, the aim of this study was to evaluate the role of MBL polymorphisms in susceptibility to CAP and HAP caused by Legionella spp.

Methods
A total of 96 BAL and blood samples collected for routine microbiological analysis from Lithuanian patients presenting with CAP and HAP, were used for this study. MBL polymorphisms in the 54 codon (54 G/G, 54 G/A, and 54 A/A) were detected by BanIRFLP. Legionella spp. were detected by nested PCR.

Results
Polymorphisms in the 54 codon of MBL were determined in 96 patients. Among 96 patients with CAP and HAP, the most commonly observed 54 codon MBL variant was 54 G/G (69.8%, n = 67), followed by 54 G/A (21.9%, n = 21), and 54 A/A (8.3%, n = 8). By using nested PCR, Legionella pneumonia was detected among 15.6% (n = 15) of patients diagnosed with CAP and HAP. Legionella spp. were detected among 7 patients with MBL 54 codon G/G variant (10.4%), while 3 patients with MBL 54 G/A (14.3%), and 5 patients with MBL 54 codon A/A variant (62.5%). During this study Legionella spp. were detected more frequently (P < 0.05) among patients with the A/A variant of the 54 codon vs. those with other variants of MBL 54 codon. There were no significant differences found among those with Legionella infection and G/A (14.3%) or G/G (10.4%) variants of MBL gene 54 codon.

Conclusion
MBL gene 54 codon variant A/A polymorphisms may play an important role in increased susceptibility to lower respiratory infectionscaused by Legionella spp.

Disclosures
All authors: No reported disclosures.
2602. Genetic Basis of Staphylococcus aureus Virulence
Authors: Adams Edward W , Ward Doyle V , Barton Bruce A , Ellison Richard T , Olaitan Oladapo 
Published: October 2019

Abstract

Background
Although multiple different virulence factors have been identified for Staphylococcus aureus, there is limited information on genetic variation present between different strains of S. aureus in the clinical setting. To better define whether differing virulence factors could contribute to differing clinical manifestations of S. aureus infections we undertook a comparison of the frequency of virulence and antibiotic resistance genes present in S. aureus isolates from different clinical sites.

Methods
Whole-genome sequencing was performed on a convenience sample of S. aureus isolates from clinical or surveillance cultures obtained at an academic medical center over a 27-month period. Genomic assemblies were generated and annotated to define protein-coding regions. The prevalence of 28 genes previously defined as being associated with S. aureus virulence or antimicrobial resistance, including MSCRAMM genes, was then analyzed in relation to nine specific culture sources including only a single isolate from each culture source per patient using a likelihood ratio χ 2 analysis.

Results
There were 1286 S. aureus isolates with draft assemblies and annotations, and there was a statistically significant (P < 0.01) difference in gene frequencies between culture sources for 18 genes that included 13 of 19 virulence factors, 4 of 7 antibiotic resistance genes and 1 of 2 MSCRAMM genes. The most notable variation was seen for the presence of the sec, sep, entB, lukS, lufK, fosB, mecA, and ermA genes (all with P < 0.0001). There were also significant variations in overall gene frequency patterns between isolates from wound, blood, and respiratory isolates (P < 0.0001), as well as significant differences in the frequency of cna and hlY genes between surveillance and clinical isolates (P < 0.0001).

Conclusion
This study demonstrates a difference in the prevalence of virulence and antibiotic resistance genes in S. aureus isolates based on the culture source. As the culture location can be considered a surrogate for different types of infections (such as bacteremia, pneumonia, urinary tract infections) these differences in gene frequency may contribute to variation in the clinical manifestations of infections by differing S. aureus strains.

Disclosures
All authors: No reported disclosures.
2614. Demographic and Clinical Characteristics by Antiviral Prescription in Influenza-Positive Children who Presented to Seven US Emergency Departments
Authors: Hamdan Lubna , Probst Varvara , Rahman Herdi Kurnia , Stewart Laura S , Dantuluri Keerti , Howard Leigh M , Speaker Andrew , Szilagyi Peter G , Ogokeh Constance E , Weinberg Geoffrey A , Klein Eileen J , Sahni Leila C , Englund Janet A , Williams John V , Rha Brian , Boom Julie A , Michaels Marian G , Selvarangan Rangaraj , Harrison Christopher J , Lively Joana Y , McNeal Monica , Campbell Angela P , Halasa Natasha B 
Published: October 2019

Abstract

Background
Antiviral (AV) therapy is recommended for children < 2 years, hospitalized, or with underlying conditions (UC) and suspected influenza (flu). We sought to compare demographic and clinical characteristics by AV prescription in flu-positive children who presented to the emergency department (ED) and determine the percentage of AV prescription in these high-risk children.

Methods
Children < 18 years who presented with respiratory symptoms and/or fever at seven New Vaccine Surveillance Network sites were enrolled. We conducted interviews, obtained mid-turbinate nasal and/or throat swabs for molecular flu testing (results unknown to providers), and reviewed medical charts for AV prescription after presenting to the ED. These are preliminary data.

Results
From December 2016 to June 2018, 9,524 subjects were enrolled and tested for flu; 1,260 (13%) were flu-positive by research testing; 54% were male, median age was 41 months, and 23% were prescribed an AV. The frequency of AV prescription differed by study site (Figure 1). Among research-tested flu-positive patients, AV were prescribed to 25% of children < 2 years, 31% of children with UC, and 51% admitted to the hospital from the ED (Table 1). Of the 388 (31%) clinically-tested flu-positive patients, 52%, 66%, and 77% of the same high-risk groups were prescribed an AV, respectively.

Conclusion
AV prescriptions varied by study site and differences by race, ethnicity, and clinical presentation were noted. Clinical testing was associated with higher use of AV treatment in appropriate target patients. Efforts are needed to understand AV use patterns and improve prescription rates in recommended patients.

Disclosures
All authors: No reported disclosures.
2617. Increased Nasopharyngeal Pneumococcal Density During Asymptomatic Respiratory Virus Infection Is Associated with Subsequent Development of Acute Respiratory Illness
Authors: Howard Leigh M , Zhu Yuwei , Griffin Marie , Edwards Kathryn , Williams John V , Gil Ana , Vidal Jorge E , Klugman Keith , Lanata Claudio , Grijalva Carlos G 
Published: October 2019

Abstract

Background
Increased density of nasopharyngeal (NP) pneumococcal colonization has been associated with invasive pneumococcal disease in children. However, factors that lead to increased pneumococcal density are poorly understood. We sought to determine whether viral detection during asymptomatic periods in young children was associated with increased NP pneumococcal density and the subsequent development of acute respiratory illness (ARI).

Methods
Using NP samples obtained during asymptomatic periods from children less than 3 years of age in the rural Peruvian Andes, we determined NP pneumococcal colonization density by quantitative polymerase chain reaction (qPCR) and identified respiratory viruses by RT–PCR. We examined the association between viral detection and pneumococcal density adjusting for relevant covariates using a multivariable quantile mixed effects regression model. We also assessed the association of pneumococcal density during asymptomatic periods in these children on the time to the next ARI using survival analysis.

Results
During asymptomatic periods, the presence of NP pneumococcal colonization was more common when respiratory viruses were detected. In addition, in the multivariable model, log10-transformed pneumococcal densities were significantly higher during asymptomatic periods when viruses were detected [median 4.52 (4.14, 5.01) P < 0.001], specifically human rhinovirus (HRV) [median 4.58 (4.27, 5.12), P < 0.001] and adenovirus (AdV) [median 4.21 (3.79, 4.91), P = 0.014], compared with when no virus was detected [median 3.16 (2.92, 3.73), Figure 1]. Increased pneumococcal density was also significantly associated with a higher rate of subsequent ARI (p = 0.008, Figure 2).

Conclusion
Among young children, detection of respiratory viruses during asymptomatic periods was associated with increased pneumococcal colonization density, which, in turn, was associated with higher rate of subsequent ARI.

Disclosures
All authors: No reported disclosures.
2635. Outbreak of Enterovirus D68 Among Children in Japan and Simultaneous Circulation of Clade B3 in Europe
Authors: Ikuse Tatsuki , Aizawa Yuta , Yamanaka Takayuki , Habuka Rie , Watanabe Kanako , Otsuka Taketo , Saitoh Akihiko 
Published: October 2019

Abstract

Background
Enterovirus D68 (EV-D68) is a re-emerging, high-morbidity pathogen that causes severe respiratory infection and acute flaccid myelitis in children. EV-D68 is phylogenetically divided into 4 major groups—clade A through D—and each clade has subclades defined by genetic variant. Outbreaks of all strains have been reported in more than 10 countries. However, no study has compared the viral genomic characteristics of EV-D68 in contemporaneous outbreaks in different countries.

Methods
An outbreak of EV-D68 in children younger than 15 years occurred in Niigata, Japan, from October through November 2018. The patients were admitted to hospital with respiratory distress and wheezing episodes. RNA extracted from nasopharyngeal samples was tested by EV-D68-specific PCR. Clade was determined by semi-nested PCR analysis of the VP1 region, and the phylogenetic tree of the VP1 sequence was constructed. To clarify viral genomic characteristics, we compared the clade to those of outbreaks occurring during 2014–2018 in other countries.

Results
EV-D68 testing of 47 patients yielded positive results for 22 (47%) (median age 4.6 years; IQR, 2.9–6.7), and 15 (69%) had a past medical history of allergic disease. No patient developed acute flaccid myelitis. The VP1 sequences from all isolates belonged to clade B3, the same clade detected during the 2015 outbreak in Japan (figure). Interestingly, EV-D68 outbreaks were reported in France and Italy (clades D1/B3 and D1, respectively) during this period. Although the EV-D68 clades responsible for outbreaks in 2014 differed by region, clade B3 is now the dominant clade and has caused concurrent EV-D68 outbreaks in children since 2015 (table).

Conclusion
In 2018, an EV-D68 clade B3 outbreak occurred among children in Niigata, Japan. This clade is now dominant and periodically circulates around the world. Because EV-D68 can cause simultaneous outbreaks worldwide and is associated with high morbidity, detailed real-time epidemiological surveillance of EV-D68 is warranted.

Disclosures
All authors: No reported disclosures.
2636. Distinguishing Pertussis from Viral Mimickers: Development and Validation of a Clinical Prediction Score
Authors: Al-Barwani Lamya , Al-Busaidi Muna , Alhinai Zaid , Al-Shibli Naema 
Published: October 2019

Abstract

Background
Pertussis is often confused with respiratory viral infections, leading to misdiagnosis and overuse of antibiotics. Distinguishing the two entities more accurately can help optimize care.

Methods
We reviewed the charts of children under 18 years of age who presented to Sultan Qaboos University Hospital in Muscat, Oman and were tested for Bordetella pertussis by PCR between 2013 and 2018 (discovery cohort). Clinical and laboratory data were collected from the electronic patient record and analyzed. Backward conditional logistic regression was used to identify independent predictors of laboratory-confirmed pertussis cases. The Muscat Pertussis Index (MPI) score was developed based on the logistic regression model. The MPI score was retrospectively validated on a separate cohort of pediatric patients who presented to the Royal Hospital- Oman’s largest pediatric center- between 2017 and 2018, and were similarly tested for pertussis (validation cohort). Ethical approval of the study was obtained formally for both sites.

Results
354 patients were enrolled in the discovery cohort. 196 (55%) were male, and the median age was 10 weeks (IQR, 6–16). 57 (16%) patients tested positive for B. pertussis by PCR, while 266 (75%) tested positive for respiratory viruses. 32 (9%) patients had both pertussis and a viral co-infection and 63 (18%) were negative for both. 255 (72%) patients received macrolide antibiotics. Younger age, fewer vaccine doses, contact with a sick adult, longer symptom duration, paroxysmal cough, cyanosis, post-tussive emesis, apnea, lymphocytosis and thrombocytosis were significantly associated with pertussis (Table 1). After logistic regression, independent predictors of pertussis were longer symptom duration, lymphocytosis, paroxysmal cough, lack of fever, cyanosis and age under 8 weeks. This formed the basis for creating the MPI score (Table 2). The MPI score was validated on a cohort of 122 patients. Higher MPI scores correlated significantly with confirmed pertussis cases (area under the receiver operating characteristics curve = 0.899, P < 0.001, Figure 1 and Table 3).

Conclusion
The majority of suspected pertussis cases were actually due to viral mimickers. The MPI score can predict likely cases of pertussis before laboratory confirmation. Future validation in more diverse settings would help expand its applicability.

Disclosures
All authors: No reported disclosures.
157. Hospital-Onset Staphylococcus aureus Bacteremia Is Associated with More Than Twice the Mortality Compared with Community-Onset: Evaluation of 58 Hospitals
Authors: Daragjati Florian , Sebastian Danielle , Sturm Lisa K , Saake Karl , Sharma Mamta , Fakih Mohamad G 
Published: October 2019

Abstract

Background
Staphylococcus aureus is a common pathogen that is implicated with both community and healthcare-associated infections. S. aureus infections lead to sepsis and bacteremia, and are associated with considerable morbidity and mortality despite available antimicrobial therapy.

Methods
Utilizing a clinical decision support system, patients with the presence of at least 1 positive blood culture for S. aureus were identified from April 2018 to March 2019, in 58 hospitals from a single health system. Patients were then matched in the outcomes measures database to obtain the following outcome measures: mortality, complications rate, length-of-stay (LOS), and cost. The S. aureus bacteremia (SAB) outcome measures were compared between community-onset (CO), and hospital-onset (HO).

Results
There were 2,700 SAB cases within the system identified during that time period. Baseline characteristics were similar between patients with CO-SAB and HO-SAB. CO-SAB accounted for 89.4% (2,413/2,700) of the overall cases, while 10.6% (287/2,700) of the cases were HO-SAB. For overall SAB, the observed mortality rate was 11.9% (321/2,700), complications rate was 35%, observed LOS was 11.97 days, and mean observed cost per admission was $29,114. There is a statistically significant higher observed absolute mortality rate (14.8%, 95% CI 9.61, 19.93), complications rate (53.3%), LOS (11.06 days), and cost per admission ($33,285) for HO-SAB, compared with CO-SAB.

Conclusion
HO-SAB is associated with more than twice the mortality, complication rate, LOS, and cost compared with CO-SAB. Structured efforts to reduce the risk for HO SAB and optimizing management of SAB are essential to improve patient outcomes.

Disclosures
All authors: No reported disclosures.