bluuebunny/crossref_metadata_2025_split huggingface dataset:
226. Nine-year Survey of Bloodstream Infections (BSIs) across Six Types of Solid-organ Transplant (SOT) at a Large University Medical Center
Authors: Buehrle Deanna , Clancy Cornelius J , Rivosecchi Ryan , Clarke Lloyd , Nguyen Minh-Hong 
Published: October 2019

Abstract

Background
BSIs are common in SOT patients. We surveyed BSIs across 6 types of SOT over 9 years at our center.

Methods
We conducted a retrospective study of BSI among patients transplanted from January 2010 to January 2019. Single blood cultures positive for coagulase-negative staphylococci, Corynebacterium, Bacillus, or Propionibacterium were excluded.

Results
3,358 patients underwent SOT, including kidney (K, 43%, 1432), lung (Lu, 23%, 778), liver (Li, 21%, 700), heart (H, 8%, 256), pancreas (P, 4%, 149), and small bowel/multivisceral (SB/MV 1%, 43). 16% (529) of patients had ≥1 episode of BSI. There were 770 BSIs; 14% (105/770) were recurrent. Median number of BSI was 1/patient (range: 1 to 7). BSI rates were highest among SB/MV patients (53%), followed by Lu (22%), Li (20%), P (15%), H (14%) and K patients (14%) (Figure 1). 20% (156), 24% (187) and 7% (52) of BSI occurred at ≤30 d, 31–180 d, and 181–365 d after SOT, respectively. BSI rates at ≤ and >180 d post-SOT were 3.6 and 0.65/1000 pt-d, respectively (P < 0.0001). Most common bacteria were Enterobacteriaceae (35%) and Enterococcus spp. (22%). Candida spp. accounted for 6% (49/770) of BSIs. Enterobactericeae were most common among intra-abdominal SOT patients, whereas Enterococcus and non-fermenting Gram-negatives were most common in Lu patients (Figure 2). 8% (65) of BSI was polymicrobial. From 2016 to 2018, 15% (14/96) of Enterobacteriaceae BSIs were multi-drug-resistant (MDR); 8% (8/96) were extensively drug resistant (XDR). 23% (3/13) of P. aeruginosa were MDR (all XDR). 70% (14/20) and 5% (1/20) of E. faecium and E. faecalis were vancomycin-resistant, respectively. Thirty-day mortality following BSI diagnosis was highest for H (31%), followed by Lu (15%), Li (10%), P (9%) and SB/MV (4%) patients. Patients with bacteremia had higher mortality than patients with no bacteremia (Figure 3).

Conclusion
BSIs are common after SOT, and associated with significant short- and long-term mortality. Almost half of BSIs occur within the first 6 months of SOT, when BSI rates are significantly higher than at later time points. Predominant BSI pathogens differ between SOT types; as such, empiric antimicrobial therapy decisions should be organ-specific. At our center, MDR and XDR Gram-negative bacteria and VRE are common; centers should use overall SOT and organ-specific antibiograms to drive empiric antimicrobial strategies.

Disclosures
All authors: No reported disclosures.
240. The Clinical Utility of Molecular Testing in the Diagnosis and Management of Infectious Diseases: Plasma-based Next-Generation Sequencing (PNGS)
Authors: Nomura Jim H , Tsai Townson 
Published: October 2019

Abstract

Background
Molecular diagnostic tests can provide microbiologic results rapidly and with greater sensitivity than traditional methods. However, these tests come with considerable costs, so thoughtful diagnostic stewardship is essential to ensure that resources and outcomes are optimized. We sought to evaluate the impact of PNGS testing on patient management.

Methods
From February 2017 to January 2019, physicians in our group ordered 164 PNGS tests (Karius, Redwood City CA) on 125 patients. A retrospective chart review was performed to determine the clinical indication and utility of the test.

Results
The assay failure rate was 4.9% (8/164). Positive (pos) results were noted in 34% (53/156), of which 23 (43.4%) represented false pos results; 28 were true pos (52.8%) but 2 were unnecessary (also had pos blood cultures). The most common reason for testing was to assess for Mycobacterium chimera (Mc) infection, representing 94 of 156 (60.3%) tests. Of the 21 patients with known Mc, only 10/21 had pos initial tests (47.6%); if patients with Mc localized to the sternum were excluded (8 patients), 76.9% with deep organ involvement had pos initial tests. Five patients with deep Mc infection had persistently pos results while on therapy; 4 of these had not had surgery; 1 was 6 months s/p valve replacement for Mc. The next most common indication was to r/o endocarditis in 18/156 (11.5%) and had an impact in 8/18 (44.4%), including 4 patients whose PNGS result identified a likely pathogen in culture negative endocarditis (CNE). Of the 62 tests done for non-Mc patients, 33.9% (21/62) were useful for management decisions. Among patients who eventually had a diagnosis made but had negative PNGS results included patients with Whipple’s (1), CNS infection (2), and fungal infections (5).

Conclusion
Overall, only 17.9% (28/156) of tests yielded true pos results. The most common reason was to evaluate for Mc infection. PNGS did not detect Mc in patients with proven local disease and was pos in >75% with deep/disseminated disease. However, a negative result did not exclude significant Mc infection. Repeat testing can be considered if clinical suspicion is high but should not be done before standard blood cultures are negative. While more than 60% of the non-Mc tests were not clinically useful, there was modest added utility where infection is high on the differential especially patients with CNE.

Disclosures
All authors: No reported disclosures.
241. Molecular patterns of Streptococcus agalactiae (GBS) Strains Associated with Different Clinical Syndromes: Early-Onset Disease in Neonates, Intrauterine Infection, and Vaginal Colonization, an Orthodox Jewish Community (OJC) Residing in Bney Brak
Authors: Shindler Yulia , Rahav Galia , Madar-Shapiro Liora , Abtibol Julia , Ravid Moti , Maor Yasmin 
Published: October 2019

Abstract

Background
Rectovaginal colonization during pregnancy with Group B Streptococcus (GBS) is a risk factor for early neonatal sepsis, and may also cause chorioamnionitis and fetal death. In Israel, the reported colonization rate in pregnant women is low, and therefore routine screening of pregnant women for GBS colonization is not recommended. We noticed higher rates of early-onset disease (EOD) due to GBS in newborns of women hospitalized in Maayaney Hayeshua Medical Center, which serves an Orthodox Jewish Community (OJC) in Israel. Therefore, our aim was to investigate molecular patterns of GBS strains from mothers and neonates hospitalized in Maayaney Hayeshua.

Methods
During 2017, GBS isolates were collected from asymptomatic pregnant women (280/1,074), neonates with EOD (n = 7), and intrauterine fetal death remains (IUFD) (n = 7). We serotyped isolates from vaginal carriage (n = 203), EOD (n = 7), IUFD (n = 7) and EOD isolates obtained from the Ministry of Health (n = 11). Multilocus sequence typing (MLST) was performed on isolates from asymptomatic pregnant women (n = 14), EOD (n = 7) and IUFD (n = 7). Antibiotic susceptibilities were determined.

Results
GBS carriage rate was 26.1%. In asymptomatic pregnant women the dominant serotype was VI [84 women (41.3%)], followed by III, IV and V in 32 (15.7%), 23 (11.3%) and 21 (10.3%) women, respectively. The dominant serotype in EOD was III [15/18 (83.3%)] and in IUFD VI [5 (71.4%)]. ST-17 was expressed mainly by serotype III, and was associated with EOD. ST-1, expressed mainly by serotype VI, was associated with IUFD. See Tables 1 and 2 and Figure 1. Resistance to erythromycin and clindamycin was 19.3% and 18.2% while resistance in invasive isolates was 45.5% to both antibiotics.

Conclusion
GBS vaginal colonization rate in an OJC was significantly higher than the reported carriage rate of 21.6% reported in Israeli pregnant women. Serotypes VI was dominant in carriage and in cases of IUFD while EOD was exclusively associated with serotype III. Resistance rates to erythromycin clindamycin were high, particularly in invasive disease. These results advocate routine GBS screening in this population and caution against empirical treatment with macrolides or clindamycin in penicillin-allergic women.

Disclosures
All authors: No reported disclosures.
256. Optimizing the Clinical Utilization of T2 Rapid Candida Panel at a Large Community Hospital
Authors: Thottacherry Elizabeth , Heard Gladys T , Steuber Taylor D , Hassoun Ali , Sawyer Adam J , Edwards Jonathan 
Published: October 2019

Abstract

Background
Candidemia is the fourth leading hospital-acquired bloodstream infection with an estimated mortality rate of 35%. Fungal blood cultures result in at least five days and fail to identify 40% of Candida infections. The T2 Candida Panel is a diagnostic test which utilizes whole blood to provide rapid detection of five Candida varieties. It has a 91% sensitivity and 99% specificity rate and enables physicians to initiate or de-escalate therapy rapidly, possibly decreasing mortality. However, practical utilization clinically has not been studied. Our aim is to evaluate the appropriate utilization of the T2 Candida Panel in a large community hospital.

Methods
A retrospective chart review of hospitalized with a T2 Candida Panel result from December 2015 to June 2018 was performed. The panel was restricted and could only be ordered by two specialties, Infectious Disease and Oncology. Baseline demographics and patient characteristics were collected. Endpoints assessed included patient outcomes, antifungal medication use, T2 Candida panel results, corresponding blood culture results, time to appropriate therapy and duration of therapy.

Results
A total of 628 T2 Candida panels resulted during the study period with 56.6% involving the intensive care setting. The average age was 59.5 years with 52.5% of the population being male. Of the total, 8.1% (n = 60) were positive. Only three patients had a positive fungal blood culture result with a negative T2 panel collected at the same time (sensitivity 94.3%, 95% CI 80.8–99.3; specificity 94.2%, 95% CI 91.4–96.3). 264 (42%) were ordered with concomitant antifungal therapy and 48.1% underwent de-escalation of therapy based on T2 result. The average time to de-escalation was 137 hours. Of the positive results, 40 (66.7%) had an antifungal ordered when the T2 panel was ordered and 30 (50%) were switched to appropriate therapy after T2 resulted in an average time of 11 hours.

Conclusion
Our data shows that while the T2 Candida Panel demonstrated faster and more sensitive results, there was still a considerable delay in achieving appropriate therapy. The variation in utilization of the T2 Candida Panel indicates that further intervention regarding appropriate use of the panel is required.

Disclosures
All authors: No reported disclosures.
277. Identification and Antifungal Susceptibility of Candida Species Isolated from Bloodstream Infections Over a 14-Year Period
Authors: Kline Ahnika , Andrew Clark , Lionakis Michail S , Zelazny Adrian 
Published: October 2019

Abstract

Background
Invasive infections caused by Candida species are associated with significant morbidity and mortality. Historically, C. albicans has been the predominant species recovered from patients with candidemia. However, the changing epidemiology of invasive candidiasis now includes more non-C. albicans species, which may exhibit intrinsic resistance or reduced susceptibility to antifungal agents used for therapeutic intervention. We sought to evaluate the epidemiology and susceptibility of invasive Candida ssp. isolates causing bloodstream infections at the NIH Clinical Center over a 14 year period.

Methods
Candida spp. isolates causing bloodstream infections between 2004 and 2018 were identified. Retrospective chart review was performed for infected patients in accordance with the IRB. All Candida isolates were recovered from frozen storage by plating onto Sabouraud Dextrose Agar, and isolate identities were confirmed by MALDI-TOF MS. Antifungal susceptibility testing was performed by broth microdilution and MICs were interpreted using current CLSI criteria.

Results
Between 2004–2018, we identified 98 unique clinical isolates from 77 patients with candidemia. Records from 75 of these patients were able to be reviewed, and the 30-day and 90-day mortalities were 24% and 52%, respectively. The average age at the time of culture positivity was 41.3 years (range 6.5 to 76.9 years). Thirty-one of the patients were female and 44 were male. C. albicans only constituted 18% of isolates (N = 18) and was the third-most prevalent Candida species identified behind C. parapsilosis (28%, N = 27) and C. glabrata (23%, N = 23), and followed by C. tropicalis (8%, N = 8) and C. krusei (6%, N = 6). As expected, fluconazole resistance was prevalent among C. glabrata (70%, N = 16) and C. krusei (100%, N = 6); however, a sizable proportion of C. parapsilosis (11%, N = 3), C. tropicalis (63%, N = 5) and C. albicans (22%, N = 4) strains also exhibited fluconazole resistance.

Conclusion
Our findings illustrate a high prevalence of non-C. albicans Candida spp. as the causative agents of bloodstream infections among patients at our institution. The clinical risk factors associated with the development of candidemia and azole resistance, as well as the molecular mechanisms of antifungal resistance are under investigation.

Disclosures
All authors: No reported disclosures.
281. Hypersensitivity Pneumonitis Diagnosed with Broad-Range PCR Testing after Exposure to Battarrea Mushroom Spores
Authors: Selby Laura , Jacobs Justin D , Brady Adam C 
Published: October 2019

Abstract

Background
Battarrea puffball mushrooms are found extensively worldwide and contain spore-containing sacs. Inhalation of the spores of similar mushrooms, such as Lycoperdon, have been implicated in cases of lycoperdonosis—a syndrome of hypersensitivity pneumonitis. We report a case of hypersensitivity pneumonitis confirmed to be secondary to Battarrea spore exposure diagnosed by broad-range PCR.

Methods
A 23-year-old homeless man with a history of methamphetamine use presented to the emergency department with a 2-week history of fevers, chills, productive cough, and malaise. He reported his symptoms began soon after eating a long-stemmed mushroom he found growing next to a building. He reported inhaling particles from the mushroom when he picked it up prior to eating it. He vomited within 1 hour of ingestion, and then had a worsening progression of cough and malaise over the following 2 weeks. In the emergency department, he was noted to have leukocytosis and mild elevation of transaminases. He required supplemental oxygen due to hypoxemia. CT scan of his chest demonstrated extensive bilateral nodular pulmonary infiltrates. He was admitted and started on treatment for community-acquired pneumonia. Over the next several days, he had worsening respiratory failure, and routine work up for infectious etiologies was unrevealing. To further investigate, bronchoscopy and bronchoalveolar lavage (BAL) was performed and routine bacterial, fungal and mycobacterial cultures and cytology with Gomori Methanamine-silver and acid-fast stains were negative. BAL fluid was sent for broad range DNA testing by PCR. Antibiotic therapy was stopped, and he was started on steroids to treat presumed hypersensitivity pneumonitis. He recovered rapidly and was discharged on a course of oral corticosteroids.

Results
After the patient was discharged, molecular testing of BAL fluid resulted with detection of Battarrea species DNA using 28s and ITS primer sets. DNA from no other pathogens was detected.

Conclusion
Identified through broad range DNA PCR testing, exposure to Battarrea mushroom spores may be a previously unreported cause of hypersensitivity pneumonitis. PCR testing should be considered in the workup of hypersensitivity pneumonitis with known or suspected exposure to mushroom spores.

Disclosures
All authors: No reported disclosures.
314. Healthcare Providers’ Views on HCV Testing and Counseling Among Sexual Partners of Hepatitis C-Infected Persons
Authors: Dunham Katherine , McDonald Jessica , Yousaf Anna , Barocas Joshua A , Neill Marguerite A , Noska Amanda J , Flanigan Timothy P 
Published: October 2019

Abstract

Background
Current hepatitis C virus (HCV) counseling guidelines from the Centers for Disease Control and Prevention (CDC) do not recommend that HCV-infected-patients notify their partners or encourage them to get tested. Because there is a small but present risk of HCV acquisition through sex, sexual partners should be encouraged to receive HCV counseling and testing. We aimed to assess healthcare professionals’ knowledge of and attitudes toward current counseling and testing recommendations for HCV-infected patients.

Methods
A 15-question, anonymous survey was designed and distributed to a convenience sample of healthcare providers (MDs, NPs, PAs) who work with Brown University or Boston University-affiliated hospitals. Questionnaires included demographic information as well as questions regarding providers’ current counseling practices and knowledge of current recommendations for HCV counseling. Descriptive statistics were used to analyze the survey data.

Results
Of the 55 respondents (a 20% response rate), 73% believed that current CDC HCV testing guidelines already recommend partners of HCV-infected patients be tested for HCV infection. Furthermore, 80% of respondents believed recommendations should be revisited to explicitly include that HCV-infected patients encourage their partners to get tested. When counseling patients with HCV, 44% of respondents reported they always ask whether the patient’s partners have been tested for HCV and 42% reported they sometimes do. Similarly, 42% reported they always suggest that the HCV-infected patient’s partners be tested for HCV. If sufficient resources were available, 75% of respondents reported that they would support active partner notification for HCV during an HCV outbreak situation and 72% said they would support active partner notification in a non-outbreak situation where there is still high HCV incidence.

Conclusion
Our survey shows that healthcare providers believe that current HCV-counseling and testing recommendations could be revisited, with specific attention given to the promotion of HCV testing for partners of HCV-infected patients.

Disclosures
All authors: No reported disclosures.
335. Antiretroviral Therapy Anchor-based Trends in Body Mass Index following Treatment Initiation among Military Personnel with HIV
Authors: Kline David , Daniels Colton , Xu Xiaohe , Sunil Thankam , Ganesan Anuradha , Agan Brian , Colombo Rhonda , Kronmann Karl , Blaylock Jason M , Okulicz Jason , Markelz Ana E 
Published: October 2019

Abstract

Background
Weight gain and obesity in people living with HIV have been associated with increased risk for non-AIDS-related comorbidities, and integrase strand transfer inhibitor (INSTI)-based regimens may lead to comparatively more weight gain than other regimens. We evaluated body mass index (BMI) following antiretroviral therapy (ART) initiation among participants in the US Military HIV Natural History Study (NHS).

Methods
Of 961 NHS participants started on initial ART between 2006–2017, 496 men who had available baseline BMI data and were virally suppressed (< 200 c/mL) at 1 and 2 years of follow-up were included (Tables 1 and 2). ART was categorized by anchor class to include INSTIs, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Linear growth-curve modeling was used to predict BMI changes from ART initiation through 2 years of follow-up in participants stratified by baseline BMI (< 25 vs. ≥25 kg/m2) at ART start and anchor drug class. Demographic and HIV-related characteristics were analyzed as independent variables.

Results
Overall, the predicted BMI increased over 2 years regardless of baseline BMI (Table 3). There was a trend toward decreased BMI on ART for those with BMI ≥ 25 treated with a non-INSTI regimen (−0.63, P = 0.079). In participants with BMI < 25, all regimens were associated with overall gains in BMI except for those with high viral load (>100,000 c/mL) started on PI regimens (−1.61, P = 0.013). For those with BMI ≥ 25, only INSTI- and PI-based regimens were significantly associated with increased BMI (INSTI 0.54, P = 0.000; NNRTI 0.11, P = 0.174; PI 0.39, P = 0.006). Observed BMI increases for INSTI and PI regimens were also associated with increased time from HIV diagnosis to ART initiation (INSTI 0.35, P = 0.003; PI 0.44, P = 0.037). African Americans with BMI ≥ 25 on INSTIs had the greatest predicted gains in BMI (1.84, P = 0.007).

Conclusion
In our cohort of young military members with HIV infection, those with baseline BMI < 25 experienced BMI gains across all ART classes. Among those with baseline BMI ≥ 25, African Americans on INSTI regimens had the greatest BMI gains. Further studies are needed to determine whether NNRTI regimens should be considered in certain individuals at risk for INSTI-associated weight gain.

Disclosures
All authors: No reported disclosures.
360. Advanced Liver Disease in HIV/Hepatitis B Coinfected Patients: Associated with Race, Age, and Comorbidities
Authors: Go Gabriella , Vigil Karen J , Parisot Paul , Vu Trung , Taylor Barbara , Jain Mamta 
Published: October 2019

Abstract

Background
Hepatitis B virus (HBV) coinfection is common in people with HIV. Compared with HBV mono-infected individuals, those that are HIV/HBV coinfected show evidence of more rapid progression to advanced liver disease (ALD) and increased mortality rate. In this study, we identified characteristics in an HIV/HBV cohort associated with ALD.

Methods
We retrospectively examined an HIV/HBV coinfected cohort to determine the prevalence of ALD and its correlation with selected variables. Data were drawn from HIV and HBsAg+ patients at three HIV clinics in Houston, Dallas, and San Antonio, Texas. Those without chronic HBV were excluded. ALD was defined as cirrhosis, decompensation, and/or hepatocellular carcinoma, as determined by imaging. Variables included demographics, HIV risk factors, comorbidities, HBsAg loss, HepBeAg, CD4+ count, HBV DNA, and HIV RNA viral load. Bivariate analysis was performed using chi-square and student t-test as appropriate; a logistic regression model was used to identify independent associations among significant variables (STATA).

Results
Within those with HIV/HBV coinfection (n = 501), 89 (18%) met the criteria for ALD (92% male, 47% Black, 33% White, 16% Hispanic, 73% >40 years old). Amongst these (n = 89), significant differences were observed with race (P = 0.039), age (P = 0.001), patients identified as MSM/Bisexuals (P = 0.047), diabetes mellitus (DM) (P = 0.01) and hepatitis C virus (HCV) coinfection (P ≤ 0.001). Compared with Whites, Blacks are less likely to have ALD (95% CI 0.27, 0.79, P = 0.004), and those age 40–49 (95% CI 1.28, 10.92, P = 0.016) and >50 (95% CI 1.63, 15.54, P = 0.005) were more likely. The multivariate logistic regression analysis showed patients that are White race, age >50, have DM, and those with HCV coinfection had increased risk for ALD (Table 1). No differences were seen with gender, insurance, alcohol use, HBsAg loss, HepBeAg status or baseline CD4+ count, HBV DNA, HIV RNA, and AIDS.

Conclusion
Increased monitoring for the presence of ADL should be conducted in HIV/HBV coinfection. Particular attention and surveillance should be paid to those with the following risk factors: Whites, elder age (>50), and comorbidities of DM and HCV. These should be taken into consideration when approaching the development and treatment of ADL in HIV/HBV patients.

Disclosures
All authors: No reported disclosures.