bluuebunny/crossref_metadata_2025_split huggingface dataset:
2673. Risk Factors for Clostridium difficile Infection in Lung Transplant Patients
Authors: DeRose Joseph L , Axelrod Peter , Samuel Rafik , Clauss Heather 
Published: October 2019

Abstract

Background
Clostridium difficile infection is a serious and common illness affecting almost 500,000 people in the United States each year. Solid-organ transplant recipients are at increased risk for this infection, with lung transplant patients being at the highest risk. Temple University Hospital (TUH) in Philadelphia has performed the most lung transplants in the United States over the last 2 years.

Methods
A retrospective case–control study was performed to identify patients diagnosed with C. difficile following lung transplantation at our institution between January 1, 2014 and April 30, 2018 (N = 35). We randomly selected control patients (N = 35) who had lung transplantation performed during this time but did not develop C. difficile infection. The study objectives were to characterize risk factors that are associated with C. difficile infection in lung transplant recipients and compare clinical outcomes in recipients with and without C. difficile. Statistical analysis was performed using Epi Info (CDC, Atlanta GA).

Results
The average age was 62.4 years, 64.7% were male, 75% were white and 69.1% of transplants were performed for underlying idiopathic pulmonary fibrosis. 52.9% of patients had “non-severe” C. difficile infection as defined by the 2018 Infectious Disease Society of America guidelines. Patients with C. difficile infection were more likely to have been treated for cytomegalovirus (CMV) viremia (OR 8.2, 95% CI 2.4–28.2, P = 0.0006) and were more likely to have received third- to fifth-generation cephalosporins (OR 4.0, 95% CI 1.4–11.2, P = 0.01) and/or carbapenems (OR 3.7, 95% CI 1.4–9.9, P = 0.02). Patients with C. difficile infection were more likely to experience multiple hospitalizations when compared with C. difficile-negative patients (3.6 vs. 8.4, P = 0.003). 22 of the 68 evaluable patients died during the study period, 9 of whom had C. difficile infection (P = NS).

Conclusion
Patients who received lung transplants and developed C. difficile infection were more likely to be treated for CMV viremia, receive antibiotics including cephalosporins and/or carbapenems and require repeat hospitalizations when compared with control patients who did not develop C. difficile infection following transplant.

Disclosures
All authors: No reported disclosures.
2683. Evaluation of the Negative Predictive Value (NPV) of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Swab Screening in Acute Myeloid Leukemia Patients
Authors: Binks Bailee , McManus Dayna , Perreault Sarah , Topal Jeffrey E 
Published: October 2019

Abstract

Background
Methicillin-Resistant Staphylococcus aureus (MRSA) nasal swabs are utilized to guide discontinuation of empiric MRSA therapy. In multiple studies, MRSA nasal swabs has been shown to have a negative predictive value (NPV) of ~99% in non-oncology patients with pneumonia and other infections. At Yale New Haven Hospital (YNHH), a negative MRSA nasal swab is utilized in acute myeloid leukemia (AML) patients to de-escalate empiric MRSA antibiotic therapy. The primary endpoint was to assess the percentage of patients with a negative MRSA nasal swab who developed a culture documented (CD) MRSA infection during their admission. Secondary endpoints included the number of MRSA nasal swabs that were initially negative but converted to positive, and the types of MRSA infections.

Methods
This was a retrospective chart review of AML patients with a suspected infection and a MRSA nasal swab collected at YNHH between 2013 and 2018. Patients were excluded if < 18 years old, prior confirmed MRSA infection or positive MRSA nasal swab within the past year.

Results
194 patients were identified with 484 discrete encounters analyzed. Hematopoietic stem cell transplantation occurred in 83 (43%) patients. A total of 468 (97%) encounters had a negative MRSA nasal swab upon admission with no CD MRSA infection during their hospitalization. Three encounters (0.6%) had a negative MRSA nasal swab with a subsequent CD MRSA infection during their admission. Identified infections were bacteremia (2) and pneumonia (1). Median duration from the negative MRSA nasal swab to CD infection was 16 days. Thirteen encounters (3%) had a positive MRSA nasal swab, 5 of which had a CD MRSA infection. Infections included bacteremia (3), pneumonia (2), and sputum with negative chest X-ray (1). MRSA nasal swab had a sensitivity of 57% (CI 0.56–0.58), specificity of 98% (CI 0.98–0.98) positive predictive value of 31% (CI 0.3–0.32), and NPV of 99% (CI 0.99–0.99).

Conclusion
The results of this retrospective study demonstrate that a negative MRSA nasal swab has a 99% NPV for subsequent MRSA infections in AML patients with no prior history of MRSA colonization or infection. Based on these findings, a negative MRSA nasal swab can help guide de-escalation of empiric MRSA antibiotic therapy in this immunosuppressed population.

Disclosures
All authors: No reported disclosures.
2700. Evaluation of 10- and 13-Valent Protein Conjugate Pneumococcal Vaccine Effectiveness for Children in Korea
Authors: Sohn Sangho , Hong Kwan , Hwang Hari , Chun Byung Chul 
Published: October 2019

Abstract

Background
Pneumococcal vaccination for infants was introduced to the mandatory National Immunization Program (NIP) of Korea in May 2014. Both 10- and 13-valent protein conjugated vaccines (PCV) have been in use with 3 + 1 dose schedule. We assessed the vaccine effectiveness in protecting children from all-cause pneumonia (ACP), pneumococcal pneumonia (PP), invasive pneumococcal diseases (IPD), and acute otitis media (AOM).

Methods
The birth cohort of children born between 2013 and 2015 was identified from the national population registry for retrospective observation. Vaccination status was confirmed through NIP registry by Korean Centers for Disease Control and Prevention, and disease occurrence was detected through the National Health Insurance System. Children who finished at least 3-doses of PCV were classified vaccinated while who did not receive any type of pneumococcal vaccine until study end were classified unvaccinated. The outcome of interest was hospital admission from any of pneumococcal infections among ACP, PP, IPD or AOM. After adjusting for high risk and underlying conditions, the vaccine effectiveness (VE) was calculated with Cox regression. VE of different valent PCV was also compared within fully vaccinated (4-doses) children.

Results
A total of 1,243,432 children were included. Fifty-one percent of children were boys and median age was 30-months. Ninety-eight percent were vaccinated and 89% of them were fully vaccinated. The incidence (per 100,000 person-years) of ACP was 10,982 in vaccinated and 9,276 in unvaccinated, and that of IPD and AOM were 1.0 vs 1.5 and 45.7 vs 31.3, respectively. The vaccine had protective effect for ACP (VE 20.2% [95% CI 19.5–20.9]), PP (VE 25.5% [95% CI 21.1–29.6]), IPD meningitis (VE 93.6% [95% CI 27.1–99.4]) and AOM (VE 4.6% [95% CI 4.1–5.1]). When fully vaccinated with PCV10, compared with PCV13, it was statistically more protective against ACP (VE 22.7% vs. 19.6%, P = 0.033) and PP (VE 50.8% vs. 21.3%, P < 0.001) but not different against AOM (VE 4.2% vs. 6.0%, P = 0.53).

Conclusion
Four-doses of PCV strategy for children in current mandatory NIP is effective for protecting the vaccinated from ACP, PP, IPD, and AOM.

Disclosures
All authors: No reported disclosures.
2713. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine in Korean National Population Cohort over 65 Years Old
Authors: Sohn Sangho , Hong Kwan , Hwang Hari , Chun Byung Chul 
Published: October 2019

Abstract

Background
Twenty-three valent pneumococcal polysaccharide vaccine (PPSV) has been introduced to the National Immunization Program (NIP) for adults aged 65 years and older in Korea since 2013. We describe the effectiveness evaluation of PPSV among adults against pneumococcal infections including all-cause pneumonia (ACP), pneumococcal pneumonia (PP), and invasive pneumococcal diseases (IPD) using national population cohort.

Methods
Vaccination records of the national population, aged 65 years and older, from NIP registry by Korea Centers for Disease Control and Prevention (KCDC) were matched to their corresponding medical records by National Health Insurance Service (NHIS) for retrospective cohort analysis. Adults vaccinated with 1-dose PPSV between 2013 and 2016 were compared with those non-vaccinated. Primary outcomes were hospitalization due to ACP, PP, and IPD. Vaccine effectiveness (VE) adjusted for high risk and underlying conditions was calculated as one minus hazard rate ratio (HR) using Cox regression.

Results
Records of 6,743,002 cohort members were included. Forty-three percent were male, and median age was 75-years. Among the cohort, 3,425,949 (51%) were vaccinated during the study period. Incidence (per 100,000 person-years) of each disease in vaccinated and unvaccinated, respectively, was 2,184 and 1,584 for ACP, 8.9 and 5.4 for PP, and 1.6 and 1.9 for IPD. VE against IPD was 41.7% (95% CI 28.8–52.3) and against IPD sepsis was 53.5% (95% CI 39.8–64.0). PPSV was also protective against ACP with VE 7.2% (95% CI 6.6–7.8). When stratified by age-group, adults aged 65–74 years were better protected from ACP (VE 16.5% [95% CI 15.6–17.3]) compared with older adults aged 75 years or older (VE –0.4% [95% CI –1.2 to 0.4]), while VE was higher in older adults against IPD (VE 47.6% [95% CI 32.4–59.4]) and IPD sepsis (VE 54.9 [95% CI 38.4–66.9]) than in 65–74 years group (IPD VE 30.4% [95% CI 3.4–49.9]; sepsis VE 49.0% [95% CI 19.7–67.6]).

Conclusion
Single-dose PPSV strategy for adults in general population is protective against PCV, IPD, and IPD sepsis.

Disclosures
All authors: No reported disclosures.
2742. The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017
Authors: Klein Eili , Schueller Emily , Tseng Katie K , Nandi Arindam 
Published: October 2019

Abstract

Background
Antibiotic resistance is a cause of morbidity and mortality driven by inappropriate prescribing. In the United States, a third of all outpatient antibiotic prescriptions may be inappropriate. Seasonal influenza rates are significantly associated with antibiotic prescribing rates. The impact of influenza vaccination coverage on antibiotic prescribing is unknown.

Methods
We conducted a retrospective analysis of state-level vaccination coverage and antibiotic prescribing rates from 2010 to 2017. We used fixed effects regression to analyze the relationship between cumulative vaccine coverage rates for a season and the per capita number of prescriptions for systemic antibiotics for the corresponding season (January–March) controlling for temperature, poverty, healthcare infrastructure, population structure, and vaccine effectiveness.

Results
Rates of vaccination coverage ranged from 33% in Nevada to 52% in Rhode Island for the 2016–2017 season, while antibiotic use rates ranged from 25 prescriptions per 1,000 inhabitants in Alaska to 377 prescriptions per 1,000 inhabitants in West Virginia (Figure 1). Vaccination coverage rates were highly correlated with reduced prescribing rates, and controlling for other factors, we found that a one percent increase in the influenza vaccination rate was associated with 1.40 (95% CI: 2.22–0.57, P < 0.01) fewer antibiotic prescriptions per 1,000 inhabitants (Table 1). Increases in the vaccination coverage rate in the pediatric population (aged 0–18) had the strongest effect, followed by the elderly (aged 65+).

Conclusion
Vaccination can reduce morbidity and mortality from seasonal influenza. Though coverage rates are far below levels necessary to generate herd immunity, we found that higher coverage rates in a state were associated with lower antibiotic prescribing rates. While the effectiveness of the vaccine varies from year to year and the factors that drive antibiotic prescribing rates are multi-factorial, these results suggest that increased vaccination coverage for influenza would have significant benefit in terms of reducing antibiotic overuse and correspondingly antibiotic resistance.

Disclosures
All authors: No reported disclosures.
2773. Safety and Immunogenicity Study of Eastern Equine Encephalitis Vaccine
Authors: Maryam Keshtkar-Jahromi , Reisler Ronald B , Purcell Bret K , Rivard Robert G , Cardile Anthony P , Liggett Dani , Norris Sarah , Pitttman Phillip R 
Published: October 2019

Abstract

Background
Eastern equine encephalitis virus (EEEV) is an alphavirus with a high mortality rate and serious neurological sequelae in infected persons making this virus an important human pathogen.

Methods
Following written informed consent, eligible subjects received two priming doses of EEEV vaccine, inactivated, TSI-GSD 104, 0.5 mL subcutaneously on days 0 and 28 days followed by a mandatory booster, 0.1 mL intradermal, at 6 months. Serum samples were collected pre-vaccination, days 21–35 following dose 2, as well as before and 21–35 days after dose 3. Sera with a Plaque Reduction Neutralization Test80 titer (PRNT80) ≥ 1:40 were considered responders with adequate titers for the purpose of biocontainment suite entry.

Results
Sixty-seven (67) subjects were enrolled in this study to receive the primary vaccination series. All 67 subjects received at least 1 primary vaccination; 66 completed the 2 primary doses; 58 completed the 2 primary doses and the 6-month dose. Of these, 38 (56.7%) reported one or more adverse events. Fatigue was reported in 13 (19.4%), headache in 9 (13.4%), upper respiratory tract infection in 6 (9.0%), nausea in 5 (7.5%), pyrexia in 5 (7.5%), oropharyngeal pain in 4 (6.0%), myalgia in 4 (6.0%), injection site pain in 7 (10.4%), injection site hematoma in 4 (6.0%) and injection site erythema in 3 (4.5%) subjects. Adverse events were mostly mild or moderate and transient. PRNT80 titers ≥ 1:40 was observed in 39/65 (60%) subjects who received both primary doses of EEEV vaccine compared with 48/57 (84%) subjects who completed the 2-dose primary series and the 6-month dose and also had blood drawn for titer. Females had a higher response rate (61.5%) at the pre 6-month boost titer than did males (34.3%) (p = 0.0231). Similarly, the pre 6-month boost geometric mean titer (GMT) for females was 35.5 vs. 21.9 for males (p = 0.0231). The post 6-month boost GMT for females was 146.7 and 181.5 for males (P = 0.13).

Conclusion
Inactivated Eastern Equine Encephalitis Virus vaccine, TSI-GSD 104, Lot 2-1-89 appears to be safe and immunogenic. This Phase 2 vaccine study supports a priming dose schedule of Days 0 and 28 and 6-month. The 6 month dose is anamnestic improving the overall response rate and level of antibody for this primary dosing schedule.

Disclosures
All authors: No reported disclosures.
2780. Reactogenicity Profile of Adjuvanted Recombinant Zoster Vaccine after Dose 2 According to the Intensity of the Same Event Experienced after Dose 1
Authors: Colindres Romulo , Wascotte Valentine , Brecx Alain , Clarke Christopher , Hervé Caroline , Hyung Kim Joon , Levin Myron J , Oostvogels Lidia , Zahaf Toufik , Schuind Anne , Cunningham Anthony L 
Published: October 2019

Abstract

Background
In the pivotal clinical trials, ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229), the adjuvanted recombinant zoster vaccine (RZV) showed high efficacy against herpes zoster and postherpetic neuralgia. The incidence of reported solicited events was higher in RZV compared with placebo recipients.

Methods
In these phase III, observer-blind, placebo-controlled trials conducted in 18 countries, adults ≥50 years of age (YOA, ZOE-50) and ≥70 YOA (ZOE-70), randomized 1:1, received 2 doses of RZV or placebo 2 months apart. Injection-site and general events were solicited for 7 days after each dose via diary cards in a participant subset. For this post-hoc analysis, ZOE-50 and ZOE-70 data from participants having completed the diary cards for both RZV doses were pooled. The intensity of each solicited event after dose 2 was stratified by the intensity of the same event after dose 1.

Results
Solicited injection-site and general events were recorded for both RZV doses by 4,676 and 4,668 vaccinees, respectively (Figure 1). Of 1,235 vaccinees with no injection-site event at dose 1, 881 (71.3%) reported no injection-site event and 20 (1.6%) reported a grade 3 event after dose 2. A total of 433 (9.3%) vaccinees reported a grade 3 injection-site event, either after dose 1 or dose 2. Of 244 vaccinees with grade 3 injection-site events at dose 1, 79 (32.4%) also reported a grade 3 event after dose 2. Of 2,312 vaccinees with no general event at dose 1, 1,617 (69.9%) reported no general event and 67 (2.9%) reported a grade 3 event after dose 2. A total of 499 (10.7%) vaccinees reported a grade 3 general event, either after dose 1 or dose 2. Of 222 vaccinees with grade 3 general events at dose 1, 81 (36.5%) also reported a grade 3 general event after dose 2. In general, vaccinees who did not experience a certain event after dose 1, did not experience this event after dose 2 either. Most vaccinees reporting a specific event at high intensity after dose 1, reported the same event at a lower intensity (or not at all) after dose 2 (Figures 2 and 3).

Conclusion
While not powered to predict event intensity of the second RZV dose, our data provides an overview of event intensity after RZV dose 2 according to the intensity of the same event experienced after dose 1.
Funding: GlaxoSmithKline Biologicals SA.

Disclosures
All authors: No reported disclosures.
171. Rising Rates of Gram-Negative Bacilli Blood Stream (GNB-BSI) Infection in Adults
Authors: Johnson Leonard B , Khatib Riad , Youssef Dima , Hooshmand Babak , Fakih Mohamad G , Riederer Kathleen M 
Published: October 2019

Abstract

Background
Monitoring bloodstream infections provides updates of the microbiology and antibiotic susceptibility trends. We elected to examine GNB-BSI.

Methods
We retrospectively studied adults (≥18 years old) inpatients with gram-negative bacilli (GNB) bloodstream infection (BSI; January 1, 2010–December 31, 2017), determined the demographics, onset place, microbiology and source. The results were stratified to study year and evaluated by the extended Mantel–Haenszel chi square for linear trends.

Results
GNB were encountered in 4520/14314 (31.6%) positive blood culture (BC) accounting for 2811 BSI episodes (2291 patients) with a steadily increasing rate (table). The 3 most common organisms were Escherichia coli (EC; 44.4%), Klebsiella pneumoniae (KP; 19.2%) and Pseudomonas aeruginosa (PA; 9.6%). GNB-BSI rate increase was mainly in EC-BSI (P = 0.01). The rate of other GNB-BSI did not change. Source distribution of EC-BSI did not change and antibiotic resistance did not change.

Conclusion
GNB-BSI is rising, primarily due to EC, without changes in source distribution or antibiotic susceptibility. Prospective studies to look at EC lineage and virulence factors are needed to determine the reason for EC-BSI rise.

Disclosures
All authors: No reported disclosures.
2789. Respiratory Syncytial Disease in Hospitalized Adults: A Retrospective Cohort Study
Authors: Nam Hannah , Ison Michael G 
Published: October 2019

Abstract

Background
Respiratory syncytial virus (RSV) is associated with significant mortality rates amongst hematopoietic stem cell transplant (HSCT) and lung transplant recipients. Although RSV is responsible for ~177,000 hospitalizations and 14,000 deaths annually, few epidemiologic studies including all adults including those with immunocompromise have been conducted over multiple seasons.

Methods
A retrospective cohort study of adults admitted to a large academic medical center in Chicago, IL from 2009 to 2018 was conducted in patients with positive RSV PCR. Specific data on clinical presentation, management, and outcomes were collected by manual chart review. Descriptive statistics were calculated, and Pearson’s Chi-Squared test was utilized to assess association between severe disease status and comorbidities.

Results
A total of 140 patients* were admitted during part of the study period (2016–2018) with positive PCR for RSV. Most patients had otherwise underlying comorbidities prior to admission (lung 44.2%, heart 40.0%, diabetes 20.7%), history of immunocompromise (36.4%, 51) or history of smoking (39.2%, 55). Cough was the most common symptom among all hospitalized adults (90.7%, 127). However, patients with a history of transplant (both HSCT and SOT) more commonly displayed symptoms of fevers at presentation (50%, 10) when compared with non-immunocompromised patients (36.6%, 36). ICU admission occurred in one-third of the hospitalized patients, with no significant difference amongst transplant patients, immunocompromised patients, and non-immunocompromised patients. Need for mechanical ventilation was highest in patients with co-infections. None of the co-morbidities measured were independent risk factors for severe disease. Most patients (78.5%, 110) were discharged home. Among the 12 fatal cases, all were admitted to the ICU with seven (58.3%) requiring mechanical ventilation. Three (25.0%) were immunocompromised while two (16.7%) were HSCT patients, but none were solid-organ transplant patients.
*Ongoing data collection.

Conclusion
RSV patients were diverse in their demographics, treatment, and outcomes. Large percentages of patients had underlying comorbidities such as immunocompromise due to HSCT, lung and heart disease.

Disclosures
All authors: No reported disclosures.
2795. Clinical and Economic Impact of a Ribavirin Intervention Program in Hematopoietic Cell and Solid-organ Transplant Recipients with Respiratory Syncytial Virus Infection
Authors: Leonard Emily , Wrenn Rebekah , Saullo Jennifer , Drew Richard H , Drew Richard H , Sarubbi Christina 
Published: October 2019

Abstract

Background
While data are limited, oral ribavirin (RBV) has been shown to be a cost-effective alternative to aerosolized RBV for the treatment of respiratory syncytial virus (RSV) in immunocompromised patients with significant reductions in acquisition and administration costs. We evaluated the clinical and economic impact of an RBV intervention program at a large, academic medical center.

Methods
This single-center, retrospective cohort study evaluated hematopoietic cell and solid-organ transplant patients admitted to Duke University Hospital (DUH) with documented or suspected RSV receiving aerosolized and/or oral RBV from July 2013 to April 2018. The ID consult service approval requirement was initiated for aerosolized RBV beginning in October 2015. Education was done at this time to promote oral RBV as the preferred therapy for immunocompromised, RSV-infected adults and children. No restrictions or treatment protocols were in place prior to that time for either formulation. Clinical outcomes, adverse effects, and drug acquisition cost were collected. A cost-avoidance analysis was performed using DUH acquisition cost for actual and alternate RBV therapy.

Results
A total of 118 treatments (115 unique adult and pediatric patients) were included. Demographics were comparable between groups with and median age was 52 years in the Oral RBV and 61 years in the Aerosol RBV group. The predominant transplant type was lung (62.5% in Oral RBV and 55.6% in Aerosol RBV) followed by hematopoietic (16.7% in Oral RBV and 27% in Aerosol RBV). The median (range) duration of therapy was 4 (1–16) days for oral RBV and 5 (1–23) days for aerosolized RBV. The total cost avoidance was $2,522,915 with oral RBV. Clinical outcomes are summarized in Table 1.

Conclusion
In our large tertiary care center, the use of oral RBV led to substantial cost avoidance with clinical outcomes comparable to aerosolized RBV in immunocompromised patients. Larger prospective trials evaluating oral RBV for RSV treatment are warranted.

Disclosures
All authors: No reported disclosures.