bluuebunny/crossref_metadata_2025_split huggingface dataset:
1399. A Prospective Cohort Study Regarding the Impact of Biofire® FilmArray® Meningitis/Encephalitis (FA) Panel in Children with Suspected Central Nervous System Infection
Authors: Posnakoglou Lamprini , Syriopoulou Vasiliki , Siahanidou Tania , Atmatzidou Eleni , Syriopoulos Triantafyllos , Michos Athanasios 
Published: October 2019

Abstract

Background
Rapid detection of pathogens involved in central nervous system (CNS) infections could be important for the optimal patient management and overall hospitalization cost. The aim of the study was to evaluate the possible benefits with the use of BioFire® FilmArray® meningitis/encephalitis (FA) panel in children with suspected CNS infection.

Methods
A prospective cohort study, was performed on children admitted to a tertiary pediatric hospital, over a period of 1 year (April 2018–April 2019), with possible CNS infection and cerebrospinal fluid (CSF) pleocytosis (>15 cells/mm3). For each child that FA was used for the diagnosis, an age-matched control was selected, and separate molecular CSF microbiological tests were sent according to pediatrician’s discretion. Conventional microbiological procedures were performed in all children. Length of hospital stay, duration of antimicrobials, and total cost of hospitalization were compared between groups. FA enables rapid automated cerebrospinal fluid testing for 14 common viral, bacterial and yeast pathogens that cause CNS infections. The cost was estimated according to ICD-10 diagnosis standard cost, adding additional daily hospitalization cost, FA or other molecular microbiological tests costs.

Results
A total of 142 children were included in the study (71 cases). The median age of cases and controls was 2.5 months (IQR: 1–72) and 2 months (IQR: 0.7–36) respectively (P = 0.157). A pathogen was detected in 38/71 (53.5%) children with the use of FA and in 16/71 (22.5%) in the control group (P < 0.001). In aseptic meningitis cases a virus was detected in 27/60 (45%) and in 11/64 (16.4%) controls (P < 0.001). Length of stay in cases and controls with aseptic meningitis was 5 days (IQR: 4–8) and 8 (IQR: 6–10) respectively (P < 0.001). The median duration of antimicrobials in cases was 4 days (IQR: 2–5.7) and 7 (IQR: 5–10) respectively (P < 0.001). The hospitalization cost was calculated in cases and controls 1,042 (IQR: 932–1372€) and 1,522 (IQR: 1,302–1,742€) respectively (P < 0.001).

Conclusion
The use of FA was able to reduce significantly the hospitalization days and the total cost comparing to the control group in children with suspected CNS infection.

Disclosures
All authors: No reported disclosures.
1400. Impact of a Multiplex Polymerase Chain Reaction Meningitis/Encephalitis Panel and Antimicrobial Stewardship Bundle on Antimicrobial Use in Patients with Suspected Meningitis or Encephalitis
Authors: Woodbury Katelyn , Seddon Megan , McMahon Andre , Kisgen Jamie 
Published: October 2019

Abstract

Background
Optimal treatment of meningitis relies on prompt diagnostic evaluation and initiation of appropriate antimicrobials. The meningitis/encephalitis panel (MEP) is a multiplex rapid polymerase chain reaction, with the ability to detect 14 community-acquired pathogens in 1 hour. The purpose of this study was to evaluate impact of the MEP on de-escalation of antimicrobials in adult inpatients with suspected meningitis at a large community teaching hospital.

Methods
This single-center retrospective quasi-experimental pre/post study included adults admitted for ≥48 hours and initiated on antimicrobial therapy for suspected meningitis. Those with healthcare-associated meningitis, immunosuppression, initiation of antimicrobials >8 hours prior to lumbar puncture (LP), and use of antimicrobials for another indication were excluded. The pre-group included patients admitted prior to MEP introduction. The post-group included patients with the MEP performed. An antimicrobial stewardship bundle consisting of a meningitis order set, provider education, and use of a real-time meningitis alert in clinical decision support software was also implemented in the post-group. The primary outcome was percentage of patients experiencing antimicrobial de-escalation ≤48 hours after LP. Secondary outcomes included time to de-escalation, total duration of antimicrobial therapy (DOT), and hospital length of stay (LOS).

Results
A total of 45 patients were included in the study (23 pre-group and 22 post-group). Baseline characteristics were similar between groups. The percentage of patients experiencing de-escalation of antimicrobials ≤ 48 hours after LP increased by 44% in the post-group (82% vs. 38%, P = 0.005). The overall median time to de-escalation of antimicrobials decreased by 35 hours [11.1 (IQR 5.6, 17.6) vs. 46.1 (IQR 18.4, 66.5); P = 0.002] and the median time to de-escalation after LP decreased by 38 hours [13.6 (IQR 8.3, 20.3) vs. 51.6 (IQR 44.2, 69.8); P < 0.001]. No statistically significant difference in hospital LOS or total DOT was seen.

Conclusion
Implementation of the MEP and antimicrobial stewardship bundle increased the percentage of patients de-escalated in 48 hours and decreased the time to de-escalation. However, this did not impact the total DOT or hospital LOS.

Disclosures
All authors: No reported disclosures.
1406. Steroid-Sparing Agents to Control Inflammation in Complicated Neurocysticercosis: Three Cases
Authors: Anand Pria , Mukerji Shibani , Gunaratne Shauna , Thon Jesse , Cho Tracey , Venna Nagagopal 
Published: October 2019

Abstract

Background
Clinical manifestations of neurocysticercosis (NCC) are primarily due to the inflammatory response against degenerating cysts of the Taenia solium tapeworm. Inflammation can occur when cysts lose their ability to evade the host immune response during their natural life cycle or result from antihelminthic therapy. A subset can develop chronic perilesional edema requiring immunosuppressive therapy. Although guidelines recommend methotrexate (MTX) as an alternative to long-term steroids, limited information is available regarding when to start a steroid-sparing agent (SSA) and alternative SSAs in case of MTX failure or intolerance.

Methods
Retrospective chart review.

Results
Three patients with complicated NCC followed at a single tertiary care center are described in this study: Patient 1 with subarachnoid NCC (age 64, female), patient 2 with subarachnoid and intraventricular NCC (age 48, male) and patient 3 with parenchymal NCC (age 43, male). Patients 1–3 were followed clinically and radiographically for 8, 1.5 and 3 years, respectively. Patient 1 was treated with antihelminthic therapy and steroids for 24 months. She was transitioned to MTX for 1 month, but developed ulcerative stomatitis, leukopenia and transaminitis. She completed a treatment course of steroids, complicated by osteoporosis. Patient 2 was treated with 12 months of antihelminthic therapy and steroids with resolution of a previously positive cysticercal antigen in spinal fluid. Imaging revealed persistent inflammation in spite of adequate antihelminthic therapy. He was started on MTX and has remained on this medication for 5 months. Patient 3 was treated with two courses of antihelminthic therapy. He developed perilesional edema despite treatment with steroids and MTX uptitrated to 20 mg weekly. Adalimumab was added to his regimen and he had a rapid radiographic resolution of edema and clinical improvement in seizures. His seizures returned during an interruption in his adalimumab treatment and again resolved with re-initiation of this medication.

Conclusion
SSAs are beneficial in the long-term treatment of patients with subarachnoid NCC or chronic perilesional edema. The formulation of guidelines that include multiple options for SSAs will be essential in guiding management of complicated NCC.

Disclosures
All authors: No reported disclosures.
1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial
Authors: Larsen Travis M , Campen Natalie , Larsen Robert 
Published: October 2019

Abstract

Background
The therapeutic challenges of neurosyphilis are rooted in its diagnosis and management, with potential for complications arising from asymptomatic, unrecognized, or under-treated disease. Currently, the non-treponemal VDRL testing of cerebrospinal fluid (CSF) samples is used to predict those with CNS invasion by T. pallidum. However, more extensive evaluation of those at any stage of infection demonstrates both that the incidence of CNS invasion is much greater than predicted, and there exists a large proportion of false positives from VDRL testing alone.

Methods
Subjects with suspected neurosyphilis were recruited from the infectious disease clinic after referral to LAC+USC Hospital. Informed consent was obtained and subjects underwent clinical examination, including a standardized neurological and neurocognitive evaluation and CSF sampling. A CSF-specific VDRL, FTAabs, and a T. pallidum particle agglutination index were calculated:
A TPPA Index >2.0 was defined as positive and definitive evidence of neurosyphilis

Results
40 subjects were recruited, 8 were HIV-negative and 32 HIV positive, of which, 1 declined to continue after CSF sampling (Table 1). Employing the CSF TPPA index, 7/31 HIV positive (22.6%) and 1/8 HIV-negative individuals (12.5%) had neurosyphilis (Table 2). Discordant results with the CSF VDRL were common; 4/31 subjects (12.9%) with a positive CSF VDRL had a TPPA Index < 2.0 (0.227, 0.227, 0.315, and 0.400) and 4/31 subjects (12.9%) with a negative CSF VDRL had a positive TPPA index (2.234, 3.333, 3.797, and 4.548, Table 3). Neurocognitive and neurologic abnormalities were commonly encountered in this population both with and without documented neurosyphilis.

Conclusion
Our investigations demonstrate the value of CSF sampling in persons with any stage of syphilis and establish the utility of T. pallidum-specific antibody testing to greatly facilitate clinical decision-making. The diagnostic tools to evaluate the T. pallidum-specific immunological response of the CNS to syphilis are currently widely available, inexpensive, but woefully underutilized

Disclosures
All authors: No reported disclosures.
1416. Nocardia beijingensis: A Rare and Unusual Cause of Intracranial Abscess
Authors: Chauhan Lakshpaul , Vassa Nirali , Henderson Elizabeth , Mubarik Ateeq , Siddiq Danish , Eddib Abdulmagid 
Published: October 2019

Abstract

Background
Nocardia species are thin, aerobic, filamentous, gram-positive bacilli that are ubiquitous in soil worldwide. Nocardia infections are divided into three main categories: pulmonary nocardiosis, disseminated nocardiosis, and cutaneous nocardiosis.

Methods
We present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB).

Results
A 60-year-old Caucasian lady from Florida with type 2 diabetes mellitus, hypertension, hyperlipidemia, presented to the emergency room with complaints of altered mentation. Per husband, she was having episodes of emesis and diarrhea 3 days prior to admission that resolved however, her mentation significantly deteriorated to where she was unable to perform simple chores around the house. Pertinently she had resection of lung mass 2 months prior to admission which found to be benign. Vital sign at admission was stable and on examination, the patient was alert and oriented, however, lethargic appearing. Neurological examination was pertinent for expressive aphasia; however, cranial nerves II-XII were grossly intact. The patient was also found to have a 3 cm by 4 cm, tender, cystic lesion on the left-sided occipital scalp. The remainder of the physical examination was unremarkable. Admission laboratories were remarkable for leukocytosis and hyperglycemia. MRI of the brain was completed that showed multiple areas of vasogenic edema and multiple nodules with the largest being 1.8 cm suggestive of abscesses. She was started empirically on vancomycin, ceftriaxone, metronidazole, and ampicillin. Cerebral spinal fluid showed neutrophilic pleocytosis, low glucose, and high protein. Initial cultures including CSF were negative. Left-sided occipital scalp lesion was excised and sent for pathology and culture. Initial cultures showed gram-positive bacilli, so antibiotics were de-escalated to sulfamethoxazole/trimethoprim and ceftriaxone. Repeat imaging showed improving abscess, and final cultures resulted in NB.

Conclusion
NB is believed to have originated in Southeast Asia. NB has been associated mainly with infections in immunocompromised. In the United States, the two only other cases of NB described in immunocompetent hosts were interestingly from Florida as well.

Disclosures
All authors: No reported disclosures.
1417. Detection of Human Herpesviruses DNA in Cerebrospinal Fluids of Patients Suspected with Central Nervous System Infection
Authors: Higashimoto Yuki , Ishimaru Soichiro , Miura Hiroki , Kozawa Kei , Ihira Masaru , Kawamura Yoshiki , Yoshikawa Tetushi 
Published: October 2019

Abstract

Background
Of the nine human herpesviruses (HHVs), most viruses have neurovirulence. Clinical manifestations of central nervous system (CNS) complications caused by some of the HHVs are well examined in children and immunocompromised adults; however, information of EBV and β-herpesviruses in an immunocompetent adult is limited.

Methods
Between April 2013 and March 2018, 322 patients (median age; 51.6 years old, male/female; 196/126) suspected to CNS infection were enrolled in this study. Patients with unconsciousness or characteristic change lasting more than 24 hours and abnormal brain MRI or EEG were defined as encephalitis. Real-time PCRs for detection of the 7 HHVs DNA including HSV-1, HSV-2, VZV, CMV, EBV, HHV-6, and HHV-7 were carried out in DNA extracted from 200 μL CSF. HHV-6 was discriminated between HHV-6A and HHV-6B using RFLP analysis.

Results
Herpesviruses DNA was detected in 33 (10.2%) of the 322 patients. The most frequently detected HHVs was VZV (19 cases) and followed by HHV-6B (4 cases), HSV-1 (3 cases), HSV-2 (3 cases), and EBV (2 cases). Multiple HHVs DNAs were detected from the 2 patients (case A; HSV-2, HHV-6, and EBV, case B; EBV and HHV-6B). No CMV and HHV-7 DNAs were detected in any of the samples. Eleven cases were assigned as encephalitis, and other 22 cases were non-encephalitis. Although all 3 patients with positive HSV-1 DNA were encephalitis, all 3 patients with positive HSV-2 DNA were meningitis. Fourteen (13 patients had zoster) of the 19 patients with positive VZV DNA were meningitis, and the remaining 5 patients (4 patients had zoster) were encephalitis. Two of the 4 HHV-6B-positive patients were non-encephalitis, one patient was diagnosed Orbital apex syndrome and another patient was myelitis. One of the 2 encephalitis patient was chromosomally integrated (ci) HHV-6. Additionally, case B was also ciHHV-6.

Conclusion
Approximately 10% of the samples were positive of HHVs DNA. VZV was the most frequently detected viral DNA in this cohort. Thirty-three percent of the patients were encephalitis, remaining patients were non-encephalitis such as meningitis and myelitis. As suggested, ciHHV-6 can cause miss-diagnosis of patients suspected with CNS infection.

Disclosures
All authors: No reported disclosures.
1428. Comparing Outcomes of Diabetic Foot Infections Requiring Amputation, Negative vs. Positive Margins
Authors: Dixon Michael K , Cadena Jose , Walter Elizabeth 
Published: October 2019

Abstract

Background
This was a retrospective, observational cohort study of patients with diabetes and lower extremity osteomyelitis requiring amputation. Patients were categorized as having negative margins (without residual osteomyelitis or with joint disarticulation), or positive margins (with residual osteomyelitis). Health outcomes were compared between groups. The primary outcomes were relapse of infection at one year and reintervention at one year. Secondary outcomes include mortality at 30 days, 90 days, and 1 year; treatment failure at one year; and a composite of relapse of infection at one year, reintervention at 1 year, and death at 1 year.

Methods
CPRS ICD-10 codes were reviewed from patients at Audie L. Murphy VA with amputation for osteomyelitis between July 2, 2015 and July 13, 2017. Pathology reports were reviewed for the presence or absence of residual osteomyelitis, and outcomes were determined by chart review. Patient characteristics were recorded, such as age, serum albumin, presence of diabetes, hemoglobin A1c, organism on culture, peripheral vascular disease, and occurrence of a peripheral vascular intervention.

Results
The ALMVA is a 500-bed medical center with an active BMT program. Clinical data from 146 patients were obtained and analyzed. There were no significant differences in primary or secondary outcomes relative to patients with positive margins or negative margins. A lack of consistency in margin reporting by Pathology was seen. Albumin level and number of patients with residual osteomyelitis were significantly different between the two groups (table).

Conclusion
There were no significant differences in outcomes between amputations with positive margins and those with negative margins. Based on current IDSA guidelines, treatment varies significantly for patients with positive or negative margins, with the former requiring 6 weeks of parenteral antibiotic therapy. Extended courses of parenteral antibiotics increase risk for treatment-associated morbidity, and more evidence is needed to support these recommended durations. A quality improvement project is underway with the ID, Podiatry and Pathology departments to resolve issues related to obtaining and processing surgical samples, as well as interpreting and reporting margin results.

Disclosures
All authors: No reported disclosures.
1434. Risk Factors for Community-Acquired Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase (ESBL) Producing Escherichia coli in Children: A Case–Control Study
Authors: Zhu Frank , Maria Rodado , Asmar Basim , Salimnia Hossein , Thomas Ronald , Abdel-Haq Nahed M 
Published: October 2019

Abstract

Background
In recent years, there has been an increasing incidence of community-acquired urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli. However, the risk factors of ESBL-producing bacteria in community-acquired (CA)-UTI in children in the USA remain unclear.

Methods
A retrospective case–control study of UTI due to CA-ESBL-producing E. coli during a 5-year period (2011–2016) was performed. Control cases of non-ESBL-producing E. coli UTI were matched by age, gender, and year of infection. Medical records were manually reviewed to collect data for potential risk factors for ESBL-positive infection.

Results
A total of 111 patients with ESBL-producing E coli UTI and 103 control patients were included. The proportion of ESBL-producing E coli UTI ranged from 7% to 15% per year. The median age was 4 years with female predominance (84%). The ESBL group was predominantly African American (32%) followed by patients of Middle Eastern (ME) ethnic background (31%). Risk factors by univariate analysis were vesicoureteral reflux (VUR): (20.9 ESBL group vs. 6% controls; P = 0.002), prior antibiotic usage in the previous 3 months (including β-lactams), prior UTI (last 3 months), recent hospitalization (last 3 months) and ME ethnic background. However, multivariate analysis showed that only prior antibiotic usage (P = 0.001) and ME ethnic background (P < 0.001) remained statistically significant. 18% (11/60) of patients exposed to prior antibiotic use in the ESBL group were on long-term antibiotic prophylaxis for VUR.

Conclusion
Risk factors for CA-ESBL-producing E coli UTI in children were: (1) antibiotic usage within the previous 3 months and (2) ME background. Prior antibiotic usage as a risk factor reinforces the need for judicious use of antibiotics. The high percentage of patients in this group (18%) receiving long-term antibiotic prophylaxis for VUR warrants further study as this practice may increase the prevalence of ESBL-producing infections in a population at high risk for UTI. The increased risk among children of ME ethnic background warrants further study to evaluate possible additional associated risk factors such as recent international travel or contact with international travelers.

Disclosures
All authors: No reported disclosures.
1448. Prostate Abscess: Clinical Features, Management, and Outcomes of a “Stealth” Infection: A Case Series
Authors: Wooster Margaux E , Huang Glen , Sanders John W , Peacock James E 
Published: October 2019

Abstract

Background
Prostate abscess (PA) is uncommon and the diagnosis is often delayed or missed. Traditionally, PA has resulted from acute prostatitis or ascending genitourinary (GU) infection due to gram-negative bacilli but S. aureus is an emerging cause.

Methods
A retrospective review of all adult patients admitted with an ICD-9 or -10 diagnosis of PA between January 2013 and July 2018 was conducted. Inclusion criteria included age ≥18 years, a compatible GU infection syndrome, and imaging consistent with PA.

Results
Twenty-two patients with PA were identified. The median age was 57 years. Five patients (22.7%) were immunosuppressed and 11 (50%) had diabetes. The median Charlson Comorbidity Index was 2. No patient had a prior history of PA but 3 patients had a past diagnosis of prostatitis. Only 1 patient had GU instrumentation in the preceding 6 weeks and no patient had an indwelling urethral catheter. Fever (59%), dysuria (49%), and urinary retention (32%) were the most common presenting symptoms. Only 7/18 (39%) patients had a tender prostate on examination; fluctuance was not described. Pelvic CT revealed PAs in all patients; 14 (64%) were solitary and 16 (73%) were >2 cm in greatest diameter. The median abscess size was 3.2 cm. Urine cultures were positive in 11/18 (61%) patients with 6/11 (55%) growing S. aureus (MRSA 3); 9/16 (56%) patients had positive blood cultures (S. aureus 7 with MRSA 3) and 5/5 had positive PA cultures (S. aureus 1). Nine patients (41%) were managed with antibiotics alone whereas 13 (59%) underwent abscess drainage. The median duration of antibiotic therapy was 34.5 days. All-cause mortality at 4 weeks was 9.1%. No relapses were documented at 6 months. When comparing patients with S. aureus PA to those with other causes, S. aureus patients more often had diabetes (86% vs. 33%, P = 0.06) and a longer median duration of antibiotic therapy (35 days vs. 31 days, P = 0.04) but age, abscess size, and mortality did not differ between groups.

Conclusion
PA is relatively uncommon and may be difficult to distinguish clinically from acute prostatitis. CT is critical to an accurate diagnosis. Optimal management usually requires both antibiotics and drainage. Given the frequent occurrence of S. aureus as a cause, coverage for MRSA should be a component of empiric treatment for PA.

Disclosures
All authors: No reported disclosures.