bluuebunny/crossref_metadata_2025_split huggingface dataset:
2769. The Clinical and Economic Impact of MMR Vaccinations to Prevent Measles Importations from US Pediatric Travelers Returning from Abroad
Authors: Hyle Emily P , Bangs Audrey C , Fiebelkorn Amy P , Walker Alison T , Gastanaduy Paul , Neilan Anne M , Rao Sowmya R , Ryan Edward T , LaRocque Regina C , Walensky Rochelle P 
Published: October 2019

Abstract

Background
Although pediatric travelers comprise < 10% of US international travelers, they account for almost half of all measles importations among returning travelers. For travelers 1–18 years with no other evidence of measles immunity, the Advisory Committee on Immunization Practices (ACIP) recommends 2 MMR vaccine doses before departure; 1 dose is recommended for infant travelers (6 to <12 months) and does not count toward their primary immunization series. All US travelers (6 months to < 6 years) are at risk for being undervaccinated for measles because MMR is routinely given at 1 years and 4–6 years.

Methods
We developed a decision tree model to evaluate the clinical impact and cost per case averted of pretravel health encounters (PHE) that vaccinate MMR-eligible pediatric international travelers. We compared 2 strategies for infant (6 to < 12 months) and preschool-aged (1 to <6 years) travelers: (1) no PHE: travelers departed with baseline MMR vaccination status vs. (2) PHE: MMR-eligible travelers were offered vaccination. All simulated travelers experienced a destination-specific risk of measles exposure during travel (mean, 237exposures/10M travelers; range, 19–6,750 exposures/10M travelers); if exposed to measles, travelers were at risk of illness stratified by age and MMR vaccination status (range, 0.03–0.90). Costs include direct medical costs and lost work wages for guardians. Model outcomes included measles cases, costs, and cost per case averted. We varied inputs in sensitivity analyses.

Results
Compared with no PHE, PHE averted 451 measles cases at $985,000/case averted for infant travelers and 54 measles cases at $1.5 million/case averted for preschool-aged travelers (table, bottom). PHE can be cost-saving for travelers to regions with higher risk of measles exposure and if more MMR-eligible travelers are vaccinated at PHE (Figure 1). At a risk of exposure associated with European travel, PHE had better value when a measles importation led to a higher number of contacts or more US-acquired cases per importation (Figure 2).

Conclusion
PHE for pediatric travelers (6 months to <6 years) decreased the number of imported measles cases and saved costs, especially if targeted to travelers with higher-risk destinations, if more MMR-eligible travelers are vaccinated at PHE, or if outbreaks are larger.

Disclosures
All authors: No reported disclosures.
2776. Post-marketing Safety Surveillance for the Adjuvanted Recombinant Zoster Vaccine: Review of Spontaneous Reports Since Introduction
Authors: Tavares-Da-Silva Fernanda , Miranda Co Maribel , Dessart Cristophe , Hervé Caroline , López-Fauqued Marta , Mahaux Olivia , Van Holle Lionel , Stegmann Jens-Ulrich 
Published: October 2019

Abstract

Background
The adjuvanted recombinant zoster vaccine (RZV, GSK), indicated for the prevention of herpes zoster (HZ) in adults ≥ 50 years of age, received its first marketing authorization in October 2017. We reviewed the post-marketing spontaneous adverse event (AE) reports submitted to GSK’s worldwide safety database since RZV introduction.

Methods
Descriptive analyses were conducted on all spontaneous reports involving RZV from October 13, 2017 to February 10, 2019. Observed-to-expected analyses were performed for the outcomes of interest: all-cause mortality and the 2 most commonly reported potential immune-mediated diseases, Guillain–Barré syndrome (GBS) and Bell’s palsy. Data mining was done to detect quantitative signals by identifying RZV-AE pairings with disproportionate reporting or evidence of an unexpected time-to-onset distribution.

Results
Most of the15,638 spontaneous reports received were medically verified (75.2%), originated from the United States (81.7%) and were non-serious (95.3%). Reports were mainly from individuals 50–69 years old (62.1%) and females (66.7%), when documented (Figure 1). Of all reports, 12,059 (77.1%) described signs/symptoms and 3,579 (22.9%) described vaccination errors, majority of which were without associated signs/symptoms (2,961; 82.7%). Overall, the most commonly reported signs/symptoms were consistent with vaccine reactogenicity (such as injection-site reactions, pyrexia, pain, chills, headache, fatigue), which were previously reported after RZV (Table 1). The observed reporting rates of outcomes of interest likely represent temporary associated events that are occurring as background incidence in the general population. No unexpected reporting patterns were detected overall. The proportion of RZV vaccination errors over time, by country, is shown in Figure 2. Overall, most reports described errors in vaccine preparation and reconstitution (29.7%) (Table 2).

Conclusion
Overall, the safety profile of RZV, following the first year of post-marketing use, is reassuring and consistent with that observed in clinical trials. Ongoing surveillance will continue to monitor RZV safety, as it is an early stage in the implementation, when real-life data are limited.
Funding: GlaxoSmithKline Biologicals SA.

Disclosures
All authors: No reported disclosures.
2785. Respiratory Viral Panel Testing in Intensive Care Units: Effects on Outcomes
Authors: Harris Gavin H , Hughes Kailey L , Middleton Donald , Zimmerman Richard , Silveira Fernanda P 
Published: October 2019

Abstract

Background
Acute respiratory viral illnesses cause significant morbidity and mortality leading to high healthcare costs. Delayed viral pathogen diagnosis likely contributes to increases in morbidity and mortality. We aimed to analyze: (1) the use of respiratory viral panel (RVP) testing in adults hospitalized to intensive care units (ICUs) with acute respiratory illness (ARI) during flu season; and (2) if RVP testing is associated with improved outcomes.

Methods
Data from adults hospitalized to the ICU with ARI during the 2015–2016, 2016–2017, and 2017–2018 influenza seasons at 3 hospitals participating in the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) study was analyzed. Details of disease severity, underlying health status, and vaccination status were obtained through enrollment interviews and medical records. Clinical RVP results were recorded. Research swabs for influenza (CDC PCR) were performed in all patients who did not have a clinical sample. Multivariate regression was used to estimate the associations between RVP and in-hospital complications.

Results
397 patients were enrolled; 263 (66%) had a clinical RVP done. 25% of patients with ≥ 1 CDC-defined high-risk condition for influenza complications did not have an RVP. 36 (9%) of patients had a positive RVP for flu (1 H1N1, 28 H3, 1 A no subtype, and 6 B). Mean time from onset of symptoms to RVP was 2.25 ± 2.24 days and mean time from ICU admission to RVP was 0.85 ± 1.27 days. 11 (8%) of patients who had only a research swab were positive for flu (1 A no subtype, others H3). 4 (36%) of these patients received oseltamivir. Use of antivirals was significantly more common in patients who had RVPs (68 vs 1%, p

Conclusion
One-third of patients admitted to the ICU with ARI during the flu season did not have an RVP, including 25% of patients with ≥ 1 high-risk condition for influenza complications. Influenza was present in 8% of patients who did not undergo clinical testing and 64% of these patients did not receive antivirals. There is room for improvement in ordering of RVPs in ICUs.

Disclosures
All authors: No reported disclosures.
490. High Prevalence of Rectal Carriage of blaKPC –Mediated Carbapenem-Resistant Enterobacteriaceae Among Community Food Handlers in Kuwait
Authors: Al-Sweih Noura , Moghnai Ola , Rotimi Vincent O 
Published: October 2019

Abstract

Background
Carbapenemases are diverse enzymes which inactivate the carbapenems. KPC-producing carbapenemase-producing Enterobacteriaceae have disseminated to many regions in the world, however, anecdotal reports of KPC-producing CPE in some GCC countries excluding Kuwait. In this study we report the first emergence of the KPC producing CPE isolated from healthy food handlers in our community.

Methods
Rectal swabs were collected from 405 food handlers. Isolates were identified by VITEK 2 and their susceptibility to 21 antibiotics performed by MIC determination using Etest. Genes encoding carbapenemase production were characterized by PCR and clonality of isolates was determined by MLST.

Results
A total of 36 CPE were isolated from 31 participants, of which 15 (41.7%) were Escherichia coli and 8 (22.2%) Klebsiella pneumoniae. All isolates were susceptible to amikacin and tigecycline but an alarmingly high percentage (38.9%) were non-susceptible to colistin. A very high proportion of the CPE harbored blaKPC (58.3%), followed by blaOXA-48 (25%), blaNDM (5.6%) and blaVIM (2.8%). Carbapenemases were co-produced with ESBLs in 30.6% of the isolates. Sequencing of the KPC revealed that KPC-18 represented 45%, KPC-2 36% and KPC-29 18%. Considerable genetic diversity among the isolates was identified by MLST assays demonstrating the emergence of new clones. Five diverse new CPE clones were detected from three Bangladeshi citizens and 2 Indians.

Conclusion
Our finding demonstrates a relatively high colonization rate (8.9%) of healthy food handlers by CPE of which KPC-producing CPE were predominant; this is an unusual finding in Kuwait representing the first of such findings in our country and GCC.

Disclosures
All authors: No reported disclosures.
1152. Implementation of Enhanced Data Surveillance Methods to Reduce Catheter-Associated Urinary Tract Infections
Authors: Ehni Jordan , Moss Marie , Koll Brian , Mazo Dana , Javaid Waleed , Latrace Maria , Mahoney Christine D , Barnett Barbara 
Published: October 2019

Abstract

Background
Urinary tract infections (UTIs) continue to be one of the most common types of healthcare-associated infections (HAIs). Instrumentation of the urinary tract using devices such as indwelling urinary catheters (IUCs) is the leading cause of healthcare-associated UTIs. Every day that a patient has an IUC increases their risk of acquiring a UTI. After an increase in the number of catheter-associated urinary tract infections (CAUTIs), a mid-sized acute care hospital in the Northeast United States used an electronic surveillance system to monitor IUC order compliance and appropriateness in order to reduce IUC utilization and prevent CAUTIs.

Methods
Using an Infection Prevention (IP) electronic surveillance system, a line list was generated of patients who had an IUC documented in the urinary flow sheet of their electronic medical record. This list contained variables such as: catheter insert date, catheter order status, and catheter indication. IP staff sent this list in a daily e-mail to clinical leadership and front line staff over a 14 month period. The e-mail notified providers when their patients had an IUC without an order. Clinical staff was directed to discontinue the IUC if it was no longer indicated or to place a new IUC order if still indicated. The National Healthcare Safety Network (NHSN) CAUTI definition and data functions were used for the purposes of this study.

Results
A statistically significant (P = 0.017) reduction in the hospital CAUTI rate was found when a comparison was made between the 14-month pre-intervention baseline period (1.12 CAUTI per 1,000 catheter days) and the 14 month post-intervention period (0.29 CAUTI per 1,000 catheter days). A statistically significant decrease (P = 0.0004) in IUC utilization was also noted for the same time period, decreasing from 8.2 catheters per 100 patient-days to 7.8 catheters per 100 patient-days.

Conclusion
A significant reduction in CAUTIs and IUC utilization was seen over the 14-month IP-driven e-mail intervention. This study suggests that regular electronic communication of surveillance system information to providers may reduce CAUTIs.

Disclosures
All authors: No reported disclosures.
188. Which patients with gram-negative bacteremia need follow-up blood cultures?
Authors: Jung Jongtak , Mi Moon Song , Suk Kim Eu , Bin Kim Hong , Hwan Bang Ji , Won Park Sang , Beom Park Wan , Kim Nam-Joong , Oh Myoung-don , Song Kyoung-Ho 
Published: October 2019

Abstract

Background
Universal follow-up blood culture (FUBC) in gram-negative bacteremia (GNB) is not recommended, but it has been routinely conducted in many acute-care hospitals. In contrast with Staphylococcus aureus bacteremia, risk factors for positive FUBC in GNB have not been well investigated. Therefore, we tried to identify the risk factors for and develop predictive scores of positive FUBC.

Methods
All adults (≥18 years-old) with GNB were identified in a tertiary-care hospital during the 2-year period, retrospectively. Death within 2 days of GNB and polymicrobial infection with gram-positive bacteria or fungus were excluded. GNB were classified into eradicable and non-eradicable source of infection groups, according to the possibility of source removal. We performed multivariate analyses for identifying risk factors for positive FUBC and built prediction scores using the coefficients of the multivariate logistic regression models.

Results
Of total 1,473 GNB, FUBC was drawn in 1,268 (86%) patients and 122 (9.6%) had positive results. In patients with eradicable source of infection, ESBL-producing microorganism, catheter-related bloodstream infection, unfavorable treatment response, and quick sequential organ failure assessment (qSOFA) score (≥2) were associated. On the other hand, administration of effective antibiotics and adequate source control were negatively associated with positive FUBC. In non-eradicable source of infection, end-stage renal disease on hemodialysis, and unfavorable treatment response were related to positive FUBC and administration of effective antibiotics was negatively associated (Table 1). When we built prediction scores according to the coefficients, the areas under the curves were 0.864 (95% confidence interval [CI95] 0.816–0.912) and 0.792 (CI95, 0.721–0.861), respectively. When we applied a cutoff of 0, specificities/negative predictive values in eradicable and non-eradicable source of infection groups were 84.7%/95.6% and 95.5%/95.0%, respectively (Table 2).

Conclusion
Our prediction scores based on adequate source control and use of effective antibiotics showed high specificities and negative predictive values. Therefore, we could expect these score systems to contribute to reducing unnecessary FUBC in GNB.

Disclosures
All authors: No reported disclosures.
199. Infections in VADers: A True Villain of the Force
Authors: Seidelman Jessica , Barac Yaron , Junpaparp Parichart , Jawitz Oliver K , Blue Laura J , Milano Carmelo , Wolfe Cameron R 
Published: October 2019

Abstract

Background
Ventricular assist devices (VADs) are increasingly used for the management of end-stage heart failure, but infection is a complication that has not been thoroughly studied. The purpose of our study was to compare patients who had surgical debridement vs. medical therapy alone for VAD-related/specific infections.

Methods
We performed a retrospective chart review on patients at Duke University Hospital (DUH) from 2015 to 2017. Patients with VAD-related/specific infections were included, per 2011 ISHLT definitions. We reviewed electronic medical records for demographics, VAD implantation data, infectious episodes, surgical debridements and mortality. Descriptive statistics compared patients with and without debridement and compared with and without relapse.

Results
We found 94 infections in 72 patients. Descriptive statistics of the cohort and comparisons with and without debridement can be seen in Table 1. Sixty-one cases (65%) included debridement and 5 (5%) required pump exchange. Notably, patients with fever or bacteremia were more likely to undergo debridement. Of the patients that had a preoperative CT, sensitivity for deep infection (pump, pocket, or deep to the muscle) was 38%, yet specificity was 95%. For superficial infections (involving the driveline or superficial to the muscle), preoperative CT sensitivity was 95%; specificity 65%. Table 2 shows intraoperative culture data. When the preoperative driveline culture grew Staphylococcus species or Pseudomonas aeruginosa there was strong correlation with intraoperative organism (matched in >75% of cases). Table 3 compares treatments among patients with and without infective relapse. Relapse rate appeared the same if patients received 2, 4, or ≥6 weeks of intravenous antibiotics.

Conclusion
We present a large single-center cohort [DCWM1] examining VAD-related/-specific infections. While patients chosen for debridement may be sicker, these patients had a longer hospital stay and relapsed more often. Preoperative CT should be used with caution as it underestimates the extent of disease. However, preoperative driveline cultures correlated strongly with intraoperative cultures for most common pathogens. There was no association between initial intravenous therapy duration and infection relapse.
Table 1. demographic characteristics of total cohort and comparisons among patients who underwent debridement for treatment of infection and patients who did not undergo debridement for treatment of infection

Table 2. Organisms found intraoperatively and the number of organisms found preoperatively that are the same as the intraoperative cultures

Table 3. Comparing treatment and cultures in patients who suffered an infection relapse

Disclosures
All authors: No reported disclosures.
200. Real-World Experience with Dalbavancin for Complicated Gram-Positive Infections: A Multicenter Evaluation
Authors: Alosaimy Sara , Pearson Jeffrey , Veve Michael , Dionne Brandon , Aleissa Muneerah , Jorgensen Sarah C J , Rybak Michael J 
Published: October 2019

Abstract

Background
Dalbavancin (DAL) received Food and Drug Administration (FDA) approval for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by Gram-positive organisms including Methicillin-resistant Staphylococcus aureus (MRSA). Due to its unique activity and dosing schedule, use in non-FDA approved indications has been increasing. We evaluated the clinical and safety outcomes of patients treated with DAL for various infections.

Methods
A multicenter, retrospective observational study was conducted from April 2017 to February 2019. We included adult patients who received 1 dose of DAL for any indication. The primary outcome was clinical success defined as 30-day survival from DAL initiation, resolution of signs and symptoms of infection, and absence of therapy escalation/change. Reasons for DAL therapy selection were also investigated.

Results
A total of 30 patients were included. The median age was 49 (35–58) years, 50% were female and 93.3% were Caucasian. Median APACHE II score was 9 (5–12). Persons who inject drugs (PWID) comprised 50%. Common DAL indications were bacteremia (53.3%), bone and joint infections (33.3%) and ABSSSI (26.7%). Pathogens were MRSA (43.3%), coagulase-negative Staphylococci (23.3%) and methicillin-susceptible S. aureus (MSSA) (13.3%). Previous antibiotics were administered in 93.3% of patients for a median of 9 (7–15) days and (13.3%) received combination antibiotic therapy with DAL. In a subgroup of patients with confirmed microbiological eradication (73.3%), DAL was initiated at a median of 8 days (4–14) after clearance. Clinical success was achieved in 80% of patients and 10% were de-escalated to oral therapy. Rash/pruritus and hypotension occurred in two and one patient, respectively. DAL was selected because of ease of administration (60%), inability to be discharged with a line (43.3%), poor candidacy for outpatient therapy (36.7%), and/or inadequate adherence (30%).

Conclusion
DAL appears to be well tolerated and results in high clinical success. Larger studies with longer follow would be valuable to more precisely define the role of DAL in complicated Gram-positive infections, particularly in comparison to other long-acting lipoglycopeptides.

Disclosures
All authors: No reported disclosures.
202. The effectiveness of combination therapy of anti-methicillin-resistant Staphylococcus aureus agents and β-lactam agents in patients complicated with febrile neutropenia after bone marrow transplantation
Authors: Sugiyama Soichiro , Shimizu Hiroyuki , Hashimoto Shinya , Tsukiji Jun 
Published: October 2019

Abstract

Background
Febrile neutropenia (FN) is one of the most frequent and serious complications of hematopoietic stem cell transplantation such as bone marrow transplantation (BMT). Anti-Pseudomonas agents should be initiated in all patients complicated with FN without delay, while anti–methicillin-resistant Staphylococcus aureus (MRSA) agents are exclusively recommended in the case of central venous (CV) line infection. Most BMT patients have the potential risk of catheter-related blood stream infection because of long-lasting catheterization including indwelling CV line. Therefore, the patients may also be received anti-MRSA agents empirically in addition to anti-Pseudomonas agents. So far, there are little reports that verify the effectiveness of the combination therapy under FN condition after BMT. The purpose of this study was to address the effectiveness.

Methods
BMT was performed at Yokohama City University Medical Center between April 2012 and March 2018, and 44 patients who developed FN after BMT were enrolled. We analyzed patient information retrospectively. We used the duration of fever to evaluate the additive effect of anti-MRSA agents to β-lactam anti-Pseudomonas agents. We classified the patients during FN period into two groups whether anti-MRSA agents were administered (Ad group; 34 patients) or not (non-Ad group; 10 patients). Fever is defined as a single axillary temperature measurement of over 37.5 Celsius degrees. The study design and protocol were approved by the ethics committee at the Review Board of our hospital (ID：D1602011).

Results
Baseline characteristics were similar between the two groups. Blood cultures were performed onset of FN in all cases, in which five showed positive (11.4%). Bacteria requiring administration of anti-MRSA drugs were detected in the four cases. Nonetheless, duration of fever was not significantly shorten (6.8 ± 4.0 vs. 5.2 ± 2.5, P = 0.171) and there was no difference in the hospitalization period. The renal dysfunction was significantly higher in Ad group and the cost of anti-MRSA agents totaled about $ 36,000.

Conclusion
Our study indicates that no use of empirical combination therapy of anti-MRSA agents in addition to anti-Pseudomonas agents under FN condition after BMT, even if CV line is inserted.

Disclosures
All authors: No reported disclosures.