bluuebunny/crossref_metadata_2025_split huggingface dataset:
1838. Bare Below the Elbows vs. Sleeved Attire: A Pilot Study Comparing Microbial Flora of Healthcare Workers
Authors: Assi Mariam , Major Yvette , Hess Olivia , Styslinger Emily , Srivastava Tara , Doern Christopher , Cooper Kaila , Godbout Emily , Stevens Michael , Bearman Gonzalo , Doll Michelle 
Published: October 2019

Abstract

Background
Bare Below the Elbows (BBE) is an approach to healthcare worker (HCW) attire that limits patient contact with contaminated HCW clothing. While supported by biological plausibility, the practice is controversial. Critics cite limited evidence that bare skin is less contaminated in comparison to sleeved garments such as white coats. This study is a comparison of the flora and bioburden between BBE and sleeved HCW.

Methods
HCW on 2 progressive care units were asked to allow swab sampling of their dominant wrist/forearm (Figure 1). Non-clinicians were excluded. Hand hygiene was not performed prior to sampling. HCW agreeing to participate completed informed consent, and a survey regarding bathing and laundering. Swabs were inoculated into TSA broths, and incubated for 24 hours at 37°C. Bioburden was estimated using McFarland standard optical densities by 2 independent blinded evaluators. The broth was streaked on blood agar and MacConkey plates. Colonies consistent with possible Staphylococcus spp. were tested with latex agglutination, and positive isolates were plated on CHROMagar™ MSSA/MRSA. Fisher’s exact/Wilcoxon rank-sum tests were used to compare the categorical/numerical data between BBE and sleeved providers using SAS version 9.4.

Results
Sixty-three HCW participated; 30 were BBE and 33 sleeved. A comparison of the 2 groups is shown in Table 1. The majority of bacterial growth was morphologically consistent with skin flora; no Gram-negative rods grew. The bioburden estimates and presence of Staphylococcus aureus were not different between the groups (P = 0.099 and 0.325, respectively). Surveys indicated that BBE providers were more likely to be working in freshly laundered garments (P < 0.0001); this was true for all BBE providers except 2 HCW on shift >24 hours. Three sleeved individuals could not remember when they last laundered the garment in which they were providing clinical care.

Conclusion
HCW laundering practices remain suboptimal, particularly among sleeved HCW. The potential impact of hand hygiene on comparative bioburden between sleeved and BBE HCWs remains unknown and is the focus of future investigations.

Disclosures
All Authors: No reported Disclosures.
1874. Comparison of the Risk of Birth Defects in Live Births From Pregnant Women Infected and Not Infected by Zika Virus in Guadeloupe, 2016–2017
Authors: Louise Funk Anna , Hoen Bruno , Tressières Benoit , Vingadassalom Ingrid , Janky Eustase , Kadhel Philippe , Ryan Catherine , Gaete Stanie , Fontanet Arnaud 
Published: October 2019

Abstract

Background
In the French Territories in the Americas (FTA), the risk of birth defects possibly associated with Zika virus (ZIKV) infection was estimated at 7% among fetuses/infants in a cohort of 546 women who developed a symptomatic RT-PCR confirmed ZIKV infection during pregnancy (NEJM 2018;378:985–94). There was no concomitant prospective cohort of pregnant women without ZIKV infection to use as a control group.

Methods
In Guadeloupe, one of the 3 FTAs that participated in the FTA cohort study, pregnant women were recruited at the time of delivery and tested for ZIKV infection. Women who had a confirmed negative IgG serology test for ZIKV at delivery and no other positive ZIKV test during pregnancy were considered to be ZIKV noninfected. Information on the course of the pregnancy was collected retrospectively and outcomes of live born infants of ZIKV noninfected women were analyzed, using the same definition criteria as those used for the FTA cohort study. Pregnancy outcomes were compared with those of the 241 ZIKV-exposed live born infants in Guadeloupe, extracted from the FTA cohort.

Results
Of the 490 live born infants without in-utero exposure to ZIKV, 42 infants (8.6%) had neurological abnormalities that were described as “potentially linked to ZIKV infection”; all but one of these were microcephaly without any other brain or clinical abnormalities. The proportion of such abnormalities was not statistically different from that observed in the 241 live born infants with ZIKV exposure (6.6%, P = 0.36). When re-considering the combined 8 fetuses and 241 infants of women with confirmed ZIKV infection in Guadeloupe from the FTA cohort, only two (0.8%) live born infants and three (1.2%) medically aborted fetuses had birth defects that could still be linked to ZIKV infection.

Conclusion
Isolated anthropometric and other mild neurological abnormalities had the same prevalence among live born infants with and without in utero ZIKV exposure. The high prevalence of isolated microcephaly among ZIKV noninfected women in our study population suggests that the sensitive definition for microcephaly, using a −2 SD cut-off with international growth curves, may lead to an overestimate of the rate of neurological complications of ZIKV infection during pregnancy.

Disclosures
All Authors: No reported Disclosures.
1876. A Hepacivirus-Like Protein Is Targeted by the Antibody Response to Kawasaki Disease (KD)
Authors: Rowley Anne , Baker Susan , Arrollo David , Gruen Leah , Tetyana Bodnar , Innocentini Nancy , Shulman Stanford 
Published: October 2019

Abstract

Background
Clinical and epidemiologic data support a viral cause of KD, but the etiology has eluded 50 years of study. We previously identified virus-like intracytoplasmic inclusion bodies (ICI) in ciliated bronchial epithelium of KD children but not infant controls, but the antigens within the ICI were unknown. At 1–2 weeks following infection, 75% of peripheral blood plasmablasts (PB) specifically target the infectious agent. We cloned the PB response to KD to identify KD-specific antibodies and their target antigens.

Methods
We isolated single PB from children with KD 1–3 weeks after fever onset by flow cytometry, and amplified immunoglobulin VDJ and VJ genes from each PB by RT-PCR. We sequenced the products and made monoclonal antibodies (Mab) from clonally expanded PB in individual patients. Mab were tested for binding to KD tissues and to a viral peptide array containing 29,939 peptides from known B cell epitopes of animal viruses (www.iedb.org).

Results
We sequenced 1156 PB from 11 KD patients, and identified 44 clonally expanded sets of PB. We prepared 61 Mab from clonally expanded and highly mutated IgA PB, and found that 33/61 bind to KD ICI, 10 strongly and 23 weakly. Of 10 Mab that strongly bind, 2 were VH3-33 (single patient), 2 VH3-23 (single patient), 1 VH3-15, 1 VH3-74, 3 VH1-46 (2 patients), and 1 VH4-59. These Mab CDR3s varied from 11 to 20 aacids, with 4–28 aacid mutations. Mab KD4-2H4 recognized multiple similar peptides from nonstructural protein 4A of hepacivirus C; pt KD4 sera was negative for hepatitis C by fourth-generation ELISA. Amino acid substitution analysis yielded an optimized peptide, and 6 KD Mab recognized this peptide by ELISA. These 6 Mab derived from 3 KD patients, all of whom had coronary aneurysms, and were VH3-74 (n = 1), VH3-33 (n = 2, single patient), VH1-45 (n = 1), and VH3-72 (n = 2, single patient). Strong binding of KD Mab KD4-2H4 and KD6-2B2 to ICI was totally blocked by pre-incubation with optimized peptide. KD but not control sera react with optimized peptide expressed as a glutathione S-transferase fusion protein by western blot.

Conclusion
Children with KD make antibodies to a hepacivirus-like protein, and KD ICI contain this protein. These results strongly suggest that a previously unidentified hepacivirus with a respiratory portal of entry is etiologically related to KD.

Disclosures
All Authors: No reported Disclosures.
1877. Evaluation of Antibiotic Utilization After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units
Authors: Trachuk Polina , Hemmige Vagish , Chen Victor , Weston Gregory , Cowman Kelsie , Berger Jay , Sarwar Uzma N 
Published: October 2019

Abstract

Background
Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving a high volume of empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely implemented. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a large tertiary hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide an ID consult on select patients. We sought to evaluate the impact of this dedicated ID consultation and stewardship program on antibiotic utilization in the ICU.

Methods
This is an IRB-approved single-site retrospective study. We analyzed antibiotic utilization in the ICU during the post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICU during the pre-intervention period from January 1, 2015 to December 31, 2015. Using Poisson regression analysis, we evaluated antibiotic utilization of each agent, expressed as days of therapy (DOT) per 1,000 patient-days, between the two groups.

Results
The six most commonly used broad-spectrum antibiotic agents were included in the final analysis. During the intervention period, statistically significant reductions were seen in cefepime (131 vs. 101 DOT per 1,000 patient-days, P = 0.01), piperacillin-tazobactam (268 vs. 251 DOT per 1,000 patient-days, P = 0.02) and vancomycin (265 vs. 228 DOT per 1,000 patient-days, P = 0.01). The utilization of other antibiotics including daptomycin, linezolid, and meropenem did not differ significantly (Figure 1).

Conclusion
With this multidisciplinary intervention, we saw a decrease in the use of the most frequently administered broad-spectrum antibiotics. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.

Disclosures
All Authors: No reported Disclosures.
1880. Reducing Antibiotic Prescribing for Acute Bronchitis in Outpatient Settings Using a Multifaceted Approach
Authors: Chung Philip , Nailon Regina , Salman Ashraf M , Bergman Scott , Micheels Teresa , Rupp Mark E , Schwedhelm Michelle , Tierney Maureen , Tyner Kate , Van Schooneveld Trevor C , Marcelin Jasmine R , Marcelin Jasmine R 
Published: October 2019

Abstract

Background
Nebraska (NE) ranks among the highest states for per capita antibiotic (AB) use in outpatient (OP) settings. Nebraska Medicine (NM) partnered with NE Antimicrobial Stewardship Assessment and Promotion Program (ASAP), a program funded by NE DHHS via a CDC grant, to reduce AB prescribing for acute bronchitis in OP settings.

Methods
The antimicrobial stewardship (AS) pilot program targeted NM OP clinics during winter 2018. All OP facility clinicians were notified of the availability of online AS educational videos. In addition, 5 primary care clinics (PCC) received clinician-directed interventions that included acute respiratory infection management pocket guides and posters for display in workrooms. Another 5 PCC received both clinician- and patient-directed interventions (examination room patient empowerment posters, Be Antibiotic Aware pledge cards and brochures). We compared AB prescribing rates for acute bronchitis between January and April 2017 and January and April 2018 among the 2 PCC groups and a control group of 5 immediate care clinics/emergency departments (ICC/ED). Clinicians in all 10 PCC were surveyed to assess usefulness of the AS campaign.

Results
A total of 593 acute bronchitis diagnosis encounters were included. AB prescribing rates for acute bronchitis for the 15 sites decreased from 53.7% to 43.6% (P = 0.02). Prescribing rates were unchanged in ICC/ED that received only notification of online educational videos (40.8% vs. 41.5%, P = 1.00) but were reduced in clinics that received clinician-directed (74.5% vs. 33.3%, P < 0.01) and patient-directed (61.1% vs. 48.8%, P = 0.07) interventions. Azithromycin was the most commonly prescribed AB (31.5% in 2017 and 29.8% in 2018). After the AS campaign, only the clinician-directed intervention group saw a reduction in azithromycin prescribing (33.3% vs. 13.9%, P < 0.05). Out of 51 clinicians who completed the survey, 45.1% felt campaign tools facilitated meaningful discussion with patients. Workroom posters and pocket guides were reported by 47.1% and 39.2% to be somewhat or extremely helpful, respectively.

Conclusion
This OP AS campaign led to a significant reduction in AB prescribing. Successful OP AS campaigns need multifaceted approaches but targeted clinician interventions appear most beneficial.

Disclosures
All Authors: No reported Disclosures.
1883. Factors Associated with Stigma Toward Isoniazid-Preventative Therapy in a Rural Community of South Africa
Authors: Foppiano Palacios Carlo F , Kompala Tejaswi , Moll Anthony , Andrews Laurie J , Shenoi Sheela 
Published: October 2019

Abstract

Background
Patients living with HIV should receive isoniazid-preventative therapy (IPT) in order to prevent tuberculosis (TB). In South Africa, IPT implementation has decelerated. Stigma is frequently found to be a barrier to treatment. We sought to understand community members’ perceptions of TB and HIV stigma in order to inform future IPT implementation efforts.

Methods
The study was conducted in the rural KwaZulu Natal province of South Africa. Community members were interviewed anonymously and answers to interview questions were scored to represent stigma. Three different domains of TB knowledge were evaluated: causes, transmission, and treatment and prevention of TB. All three knowledge scores were added to create a total knowledge of TB score. A 7-item scale was used to assess stigma; presence of stigma was defined as 1 or more positive responses on the scale. Descriptive statistics, chi-square tests, linear regression, and Kruskal–Wallis tests were performed.

Results
Among 104 participants, the mean age was 35 ± 9.3 years, 65% were female, and 26% completed secondary school. Overall, respondents had poor knowledge about the causes (mean = 61, SD = 27) and transmission (mean = 46, SD = 21), and good knowledge of the treatment and prevention (mean = 88, SD = 18) of TB. The vast majority of participants identified the presence of stigma (72%), with a mean score of 1.7, SD = 1.4. Participants were less likely to report stigma with excellent TB knowledge, characterized by accurate responses to at least 95% of the knowledge items (P = 0.025). Factors associated with higher levels of stigma included marital status (P = 0.01), being previously screened for TB (P = 0.008), considering mosquitos as a vector for TB transmission (P = 0.005), worrying about being infected with TB (P = 0.0117), and reporting travel to the clinic to be expensive (P = 0.03). Interest in taking IPT exhibited a trend toward significance with lower levels of stigma (P = 0.057). On multivariable linear regression of stigma, marital status (P = 0.0304) and prior TB screening (P = 0.0149) were significant.

Conclusion
HIV-related stigma was prevalent among rural South African community members considering IPT. Stigma decreased with higher knowledge levels. Global expansion and implementation of IPT will require interventions to reduce stigma.

Disclosures
All Authors: No reported Disclosures.
1955. Novel Compound Reverses Vancomycin Resistance in Vancomycin-resistant Enterococci (VRE)
Authors: Onyedibe Kenneth , Dayal Neetu , Sintim Herman 
Published: October 2019

Abstract

Background
Enterococcus causes 14% of all hospital-associated infections (HAIs) according to Centers for Disease Control and Prevention (CDC) data. 35.5% of these HAIs are caused by Vancomycin-resistant Enterococci (VRE) including highly fatal bacteremia, surgical site infections, and urinary tract infections. We present a novel synthetic compound, HSD 03-21 that could make VRE completely susceptible to vancomycin in-vitro.

Methods
HSD 03-21 was synthesized de novo from a hydroxybenzylidene – indolinone backbone in our laboratory. The minimum inhibitory concentration (MIC) of HSD 03-21 and vancomycin against VRE were determined according to clinical laboratory standards institute (CLSI) guidelines. The standard checkerboard assay was used to determine vancomycin-HSD 03-21 interactions against VRE. Briefly, HSD 03-21 and vancomycin at 10 mg/mL were prepared and diluted serially along the ordinate and abscissa of 96-well microtiter plates, respectively. Bacteria was standardized using the 0.5 McFarland standard, diluted (1:100), aliquoted into respective wells and incubated at 37oC for 18–20 hours. All assays were run in triplicates. The fractional inhibitory concentration (FIC) index was calculated for each combination. The FIC of either agent was calculated as: FIC (vancomycin) = MIC of vancomycin in combination/MIC of vancomycin alone and FIC (HSD 03-21) = MIC of HSD 03-21 in combination/MIC of HSD 03-21 alone. The cumulative FIC index ∑FICI was then calculated as: ∑FIC = FIC(vancomycin) + FIC(HSD 03-21). The calculated ∑FIC indices were interpreted as synergistic if ∑FIC: ≤ 0.5.

Results
The MIC of vancomycin for VRE faecalis was 256 μg mL−1 while that of HSD 03-21 was 128 μg mL−1. When vancomycin was combined with HSD 03-21 at 8 μg mL−1 (1/16 MIC), there was a reduction in MIC of vancomycin to 0.5 μg mL−1. The combination showed excellent synergy with ∑FIC of 0.06.

Conclusion
HSD 03-21 reduced the MIC of vancomycin from 256 to 0.5 μg mL−1. This has an immense potential of changing the way we use vancomycin and in the treatment of VRE infections. Translation of this novel compound could save thousands of lives from VRE and the failures and inherent toxicities of current doses of vancomycin.

Disclosures
All Authors: No reported Disclosures.
1957. Impact of β-Lactam Antibiotic Allergy on Antimicrobial Use, Clinical Outcomes, and Costs for Hospitalized Children
Authors: Jones Trahern Wallace , Fino Nora , Olson Jared , Hicks Lauri , Fleming-Dutra Katherine E , Hersh Adam 
Published: October 2019

Abstract

Background
Most β-lactam antibiotic allergies (BLA) are incorrectly diagnosed and could be de-labeled. Adult patients with BLA are more likely to receive broader-spectrum antimicrobials and experience worse health outcomes than nonallergic patients. Similar studies on the impact of BLA on antimicrobial use and clinical outcomes are limited in pediatrics. Our objective was to compare antimicrobial use, and clinical and economic outcomes between hospitalized children with and without BLA.

Methods
This was a retrospective cohort of pediatric patients hospitalized at an Intermountain Healthcare (IH) hospital from 2007 to 2017. IH has 22 hospitals including one children’s hospital. Patients aged 30 days-17 years who received ≥1 dose of an antimicrobial during hospitalization were included. The exposure variable was the presence of BLA (penicillins or cephalosporins) in the allergy field of the medical record. Patients with BLA were matched to nonallergic controls on age, sex, race, clinical service line, admission date, children’s hospital or other hospital, and co-morbid conditions. We used multivariable log-transformed-linear and logistic regression models to compare patients with BLA to controls in terms of antibiotic selection and total antimicrobial days, antimicrobial cost, length-of-stay (LOS) and 30-day readmission. For antibiotic selection we examined the odds of receiving the following broader-spectrum agents individually and in composite: vancomycin, fluoroquinolones, clindamycin, carbapenems, and macrolides.

Results
39,785 patients were identified including 2897 (7%) with BLA. The prevalence of BLA increased with age (Figure 1). 2459 (85%) patients with BLA were matched to a control. Patients with BLA had higher odds of receiving broader-spectrum antibiotics (OR 2.35, 95% CI: 2.07–2.67) and had greater antimicrobial costs (1.21-fold increase, 95% CI: 1.08–1.35) than nonallergic patients (Figure 2). There were no differences in LOS, total antimicrobial days, or 30-day readmission (Figure 2).

Conclusion
Pediatric patients with BLA are more likely to receive broader-spectrum antibiotics and incur higher antimicrobial costs than matched controls. De-labeling interventions could reduce unnecessary exposure to these agents and lower costs.

Disclosures
All Authors: No reported Disclosures.
1962. Renal Outcomes for Participants Taking F/TAF vs. F/TDF for HIV PrEP in the DISCOVER Trial
Authors: Mills Anthony , Workowski Kimberly , Campbell Thomas , Benson Paul , Crofoot Gordon , Salazar Laura , Ogbuagu Onyema , Shalit Peter , Trottier Benoit , Carter Christoph C , Wong Pamela , Brainard Diana M , McCallister Scott , Das Moupali , Doblecki-Lewis Susanne 
Published: October 2019

Abstract

Background
In the DISCOVER PrEP trial, emtricitabine/tenofovir alafenamide (F/TAF) was noninferior to emtricitabine/tenofovir disoproxil fumarate (F/TDF) for HIV prevention. Here, we report on the renal outcomes of F/TAF and F/TDF among all DISCOVER participants and in those on baseline F/TDF PrEP who were randomized to F/TAF.

Methods
In total, 5387 men who have sex with men (MSM) and transgender women (TGW) at risk for HIV were randomized 1:1 to receive blinded F/TDF or F/TAF taken once daily (full cohort). Of these, 905 were on F/TDF PrEP at enrollment; of whom, 465 were randomized to F/TAF. Renal function and safety assessments included urinalysis (UA), estimated glomerular filtration rate (eGFRCG), urine protein:creatinine (Cr) ratio (UPCR), markers of proximal tubular function (β2-microglobulin:Cr ratio [β2M:Cr] and retinol-binding protein:Cr ratio [RBP:Cr]) and investigator-reported renal adverse events (AEs). Week 48 data are presented.

Results
In the full cohort, F/TAF was associated with more favorable changes in eGFRCG, β2M:Cr, and RBP:Cr compared with F/TDF (Table 1). Treatment-emergent proteinuria by UA was more common with F/TDF than F/TAF (24.3% vs. 21.3% P = 0.009), as were treatment-emergent elevations in UPCR >200 mg/g (35 [1.5%] vs. 16 [0.7%], P = 0.005). Compared with F/TDF, participants taking F/TAF had numerically fewer study drug-related renal AEs, severe study drug-related renal AEs, and discontinuations due to renal AEs (Table 2). Proximal renal tubulopathy (Fanconi syndrome) was reported in one participant in the F/TDF arm and none in the F/TAF arm. In participants on F/TDF PrEP at enrollment who were randomized to F/TAF, statistically significant increases in eGFRCG were apparent as early as week 4 (Table 1 and Figure 1), as were decreases in tubular proteinuria (Table 1). Renal biomarker changes in PrEP-naïve participants mirrored those in the full cohort.

Conclusion
Through 48 weeks, MSM and TGW taking F/TAF for PrEP had significantly better measures of renal function and fewer study-drug-related renal AEs compared with those taking F/TDF; switching from F/TDF to F/TAF was associated with improvements in eGFRCG and tubular function biomarkers. F/TAF for PrEP is effective and has a superior renal safety profile compared with F/TDF.

Disclosures
All Authors: No reported Disclosures.