bluuebunny/crossref_metadata_2025_split huggingface dataset:
1258. Antibiotic Resistant Nontyphoidal Salmonella Infection Following International Travel — United States, 2018
Authors: Ford Laura , Shah Hazel , Chen Jessica , Eikmeier Dana , Hanna Samir , Langley Gayle , Payne Daniel C , Plumb Ian D 
Published: December 2021

Abstract

Background
Antibiotic resistance in nontyphoidal Salmonella can limit treatment options for patients requiring antibiotic therapy. We assessed the contribution of international travel to resistance among nontyphoidal Salmonella infections.

Methods
We describe characteristics of nontyphoidal Salmonella infections in the Foodborne Diseases Active Surveillance Network during 2018 that were also reported to PulseNet and the National Antimicrobial Resistance Monitoring System. We defined genetic resistance to first-line antibiotics as the presence of genes or mutations known to confer decreased susceptibility or resistance to ciprofloxacin, azithromycin, or ceftriaxone. We used multivariable logistic regression to assess the association between resistance to first-line antibiotics and international travel in the 7 days before symptom onset overall and by United Nations statistical region, and we estimated the contribution of travel to resistance using population attributable fractions.

Results
Among 3,238 nontyphoidal Salmonella infections, 356 (11%) were in patients who traveled internationally in the 7 days before symptom onset. Of these, 109/356 (31%) had isolates with genetic resistance to first-line antibiotics, compared with 308/2882 (11%) non-travelers. Resistance was more likely following travel, after adjusting for age and sex (OR 3.7, 95% CI 2.9–4.8). Nine genes or mutations conferred resistance to first-line antibiotics among travel-associated isolates. The risk of resistance varied by region and was highest after travel to Asia (OR 7.5, 95% CI 4.7–12.0). Overall, 17.1% (95% CI 12.2%–21.7%) of genetic resistance to first-line antibiotics was attributable to international travel.

Conclusion
For patients with nontyphoidal Salmonella infections, international travel is associated with approximately three-fold increased risk that first-line agents could be ineffective. The estimated 17% of resistance to first-line antibiotics attributable to travel is encoded by relatively few genes and mutations. Investigation of the major sources of resistant strains could help target prevention efforts. Travel region should be considered when treating empirically; treatment should be adjusted based on results from antibiotic susceptibility testing.

Disclosures
All Authors: No reported disclosures
1301. Risk Factors for Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in Community Acquired Pneumonia
Authors: Bell Maya , Veltri Courtney , Kolychev Evelina , Hojat Leila S 
Published: December 2021

Abstract

Background
The 2019 American Thoracic Society and Infectious Diseases Society of America Community-Acquired Pneumonia (CAP) guidelines concluded that the major risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) include prior isolation of these organisms and previous hospitalization with IV antibiotic use within 90 days. However, the guidelines recognized that results may vary by region and recommended local validation of risk factors. The primary objective of this study was to determine which potential risk factors are associated with MRSA and Pseudomonas aeruginosa in CAP in our institution. This study also evaluated appropriateness of antibiotics used for empiric CAP therapy.

Methods
This was a single-center, retrospective cohort study performed in an urban academic medical center in Cleveland, OH. Adults hospitalized for CAP who had a respiratory culture performed between January 2016 and September 2020 were included. Patients were randomized in a 1:1:1 ratio into MRSA, PsA, and non-resistant CAP (NR-CAP) groups. Patients with bacterial co-infections or resistant pathogens other than MRSA or PsA were excluded.

Results
The study included 111 patients with 37 patients in each group. The median age was 61 years (IQR 52-70), and 58.6% of patients were male. There were no independent risk factors for MRSA (Table 1). Independent risk factors for PsA included prior isolation and enteral feeding (Table 2). MRSA risk factors as defined by the 2019 CAP guidelines were found in 48.6% of patients with MRSA CAP (Figure 1). Guideline-defined PsA risk factors were found in 56.8% of patients with PsA CAP (Figure 2). In NR-CAP, 62.2% received empiric MRSA coverage while only 27% had a guideline-defined risk factor; PsA coverage was administered in 78.4% of NR-CAP patients, but risk factors were found in only 24.3% of this cohort.
MRSA and P. aeruginosa Risk Factor Analyses

Empiric MRSA and P. aeruginosa Coverage and Guideline-Defined Risk Factors

Conclusion
Our findings were consistent with the risk factors identified in the 2019 CAP guidelines, but additional risk factors may be present in our patient population. Empiric coverage for MRSA and PsA was disproportionately high relative to the rate of recovery. This study encourages local validation of risk factors; however, further analyses are needed to determine the impact on empiric therapy.

Disclosures
All Authors: No reported disclosures
1312. Evaluation of a Multiplexed PCR Pneumonia Panel in a Tertiary Care Medical Center
Authors: Su Erin , She Rosemary 
Published: December 2021

Abstract

Background
Syndromic PCR testing for lower respiratory pathogens may give rapid, actionable results to aid in management decisions for suspected pneumonia cases. We sought to evaluate the performance of a multiplexed PCR pneumonia panel compared to routine microbiologic work-up in a tertiary care patient population.

Methods
Sputum and bronchoalveolar lavage (BAL) samples from Keck Medical Center (Los Angeles, CA) inpatients submitted for clinical microbiology work-up Dec 2019-Jun 2020 were tested by a multiplexed PCR panel (FilmArray Pneumonia Panel, BioFire Diagnostics). We compared panel results for typical bacterial pathogens to those of quantitative culture and susceptibility testing. We retrospectively determined the incidence of non-panel respiratory pathogens as detected by standard of care tests in this patient cohort.

Results
68 of 180 samples yielded 80 positive bacterial PCR results: 34 were detected by both PCR panel and culture and 46 by PCR panel only, yielding a sensitivity of 100% (34/34) for pathogens detected and specificity of 73.1% (114/156) among negative cultures (normal flora or no growth). Concordant results had PCR Bin values ≥10^5 copies/mL whereas all 18 targets detected at 10^4 copies/mL were culture-negative. Among resistance gene targets, the panel detected 12 MRSA specimens, of which MRSA grew in only 4 cultures; E. coli and CTX-M in 1 specimen from which grew normal flora; and multiple gram-negative organisms and KPC in 1 specimen from which culture isolated carbapenem-resistant P. aeruginosa. Quantitation from positive BAL cultures (n=25) correlated weakly with PCR Bin values (R-squared=0.17). Non-PCR panel pathogens were detected in 22 of 180 (12.2%) specimens through routine methods (16 molds, 3 AFB, and 3 non-fermenter gram-negative bacteria).

Conclusion
The pneumonia panel had excellent sensitivity for its target bacterial pathogens, but results were often positive in negative cultures. This could be due to antecedent antibiotic therapy, differences in reporting threshold versus culture, or inability of PCR to discern results from normal flora. Non-panel pathogens were detected in a significant proportion in our population. The pneumonia panel should be implemented and interpreted carefully with consideration of antimicrobial stewardship.

Disclosures
All Authors: No reported disclosures
1353. Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration
Authors: Keddem Shimrit , Maier Marissa , Gardella Carolyn , Borgerding Joleen , Lowy Elliott , Chartier Maggie , Haskell Sally , Hauser Ronald , Beste Lauren 
Published: December 2021

Abstract

Background
United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans have many risk factors associated with STIs, including high rates of childhood sexual assault, military sexual trauma and intimate partner violence. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans.

Methods
We performed a retrospective cohort study of all women Veterans in Veterans Health Administration (VHA) care between January 1, 2018 and December 31, 2019 to examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the VHA in 2019.

Results
Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, predictors of testing in women under age 25 included Black race (aOR: 2.11 CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05 CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (Chlamydia case rate: 265, Gonorrhea case rate: 97/100,000) and those with mental health diagnoses (Chlamydia case rate: 263, Gonorrhea case rate: 72/100,000.) Over a third of chlamydia cases (35.2%) and gonorrhea cases (35.5%) occurred in women who resided in the South Atlantic census division.
Chlamydia cases per 100,000 women Veterans seen in VHA (2019)

Gonorrhea cases per 100,000 women Veterans seen in VHA (2019)

Conclusion
Gonorrhea and chlamydia testing remains underutilized among women in the VHA and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.

Disclosures
All Authors: No reported disclosures
1361. Actinotignum schaalii an Under-recognized Cause of Infections: A Case Series in Calgary from 2012 - 2020
Authors: Lieu Anthony , Mah Jordan , Church Deirdre 
Published: December 2021

Abstract

Background
Actinotignum schaalii is a gram-positive rod that is a fastidious commensal of the urogenital tract. Infections with A. schaalii are underdiagnosed previously because phenotypic methods fail to identify it. Both MALDI-TOF mass spectrometry and 16S rRNA sequencing allow definitive identification of this opportunistic emerging pathogen. A. schaalii is an infrequent but important cause of UTIs in the elderly, particularly with urological abnormalities. The spectrum of invasive disease caused by A. schaalii is not well characterized; however, it has been isolated in severe infections including necrotizing skin and soft tissue infections, bacteremia, osteomyelitis, and endocarditis. We used a population-based approach to characterize and describe the clinical and microbiological features of invasive A. schaalii infections in our region.

Methods
All adult and pediatric cases enrolled had microbiological isolates of Actinotignum schaalii recovered from blood cultures, sterile fluids and tissue cultures from Jan 2012 to Dec 2020 by APL, a regional centralized microbiology laboratory serving the Calgary Zone in Alberta, Canada. Clinical data were retrieved and linked from administrative health databases, chart review and the laboratory information system. Standard descriptive statistics were used.

Results
We identified 84 unique A. schaalii infections, 35 were from bloodstream, 32 soft tissue, 7 post-operative infections. Median age and Charslon comorbidity score was higher in BSI. 54.3% of patient with BSI had a genitourinary pathology, with 51.4% caused by a complicated urinary infection, while soft and skin tissue infections caused 65.3% of non-BSI. Using EUCAST MIC cut-offs, 48% and 100% of the isolates were resistant to clindamycin and metronidazole, respectively. In contrast, all specimens were susceptible to penicillin. Hospitalization and 90-days mortality were higher in the BSI group.

Conclusion
A. schaalii is an anaerobic opportunistic pathogen that can cause life-threatening invasive infections, particularly in older adults with underlying genitourinary pathology. BSI were associated with higher rates of hospitalization and mortality. In contrast, patients with A. schaalii isolated from cutaneous sources were younger and had better clinical outcomes.

Disclosures
All Authors: No reported disclosures
1364. Microbiology of Sepsis in a Combat-Trauma Military Population
Authors: Robinson Sara , Shaikh Faraz , Stewart Laveta , Campbell Wesley R , Decker Catherine F , Yabes Joseph , Blyth Dana M , Blyth Dana M , Tribble David 
Published: December 2021

Abstract

Background
There are limited data on sepsis in combat casualties. We examined characteristics of sepsis, specific infections, and associated microbiology in a complex combat trauma population.

Methods
The Trauma Infectious Disease Outcomes Study collected infection-related data from military personnel wounded during deployment (2009-2014). Medevac patients transferred to participating US military hospitals with sepsis or septic shock based on the Sepsis-1 SIRS criteria were analyzed for associated potential sources and infection-associated clinical microbiology.

Results
Prevalence of sepsis was 24.7% (667 of 2699 patients) with 93 (14%) patients meeting septic shock criteria. There were 1013 sepsis/shock episodes (SSE) among 667 subjects. Infections attributed to SSE were identified in 996 (98.3%) of 1013 episodes, primarily being bloodstream infections (BSI) +/- other infections (29.5%), skin and soft tissue (SSTI)/osteomyelitis (35.3%), pneumonia (12.1%), and multiple concurrent infections (14.2%). At least 1 organism was identified in 96% of SSE and 53% were polymicrobial. Gram-positive organisms (GP) were identified in 54% of SSE: 16% with multiple GP, of monomicrobial infections 4.1% were S. aureus, 15.8% other staphylococci, and 13% Enterococcus spp. Gram-negative bacilli (GN) were identified from 74.5% of SSE: 34% with multiple GN, of monomicrobial infections 11% were Pseudomonas spp., 8% E. coli, 6% Enterobacter spp., and 6% Acinetobacter spp. Mycobacterial species were uncommon (0.9%). Yeast, mold, and anaerobes were identified from 19%, 22%, and 12.5% of SSE, respectively. Compared to sepsis, septic shock infections were more often polymicrobial (p&lt; 0.001), and had more infections with ESKAPEE pathogens, only Mucor spp., and only Bacteroides (p&lt; 0.05). More infections with only Pseudomonas spp. and only non-lugdunensis coagulase-negative Staphylococci were identified among sepsis patients (p&lt; 0.05).

Conclusion
Sepsis rates, using the Sepsis-1 criteria are sensitive but lack specificity supporting reclassification using updated Sepsis-3 criteria. In a complex trauma population, sepsis is common with most frequent infections related to SSTI/osteomyelitis, as well as BSI and multiple concurrent infections with a diverse spectrum of microbiology.

Disclosures
Dana M. Blyth, MD, Nothing to disclose
1365. Clinical and Financial Implication of Dalbavancin Utilization on Length of Stay Avoidance in Acute Bacterial Skin and Skin Structure Infection
Authors: Kim Sonia S , Chen Brandon , Raja Karan , Patel Mitesh , Philips Mona 
Published: December 2021

Abstract

Background
Our institution admits 650 patients annually for acute bacterial skin and skin structure infection (ABSSSI). These patients may require intravenous antibiotics, potentially complicated by social factors and loss to follow up. Dalbavancin is a long-acting lipoglycopeptide given as a single dose regimen for ABSSSI. A previous review conducted at our institution identified 117 potential avoidable hospital days over 4 months with outpatient dalbavancin use. The objective of this prospective study was to evaluate the clinical and financial impact of avoided admissions with outpatient dalbavancin use.

Methods
The Institutional Review Board approved this single-site, prospective study. All patients who presented to the emergency department (ED) with ABSSSI from December 15, 2020 to April 15, 2021 were included in the study. Dalbavancin eligibility criteria were given to providers. Eligible patients were given a single dose of dalbavancin and then discharged. The primary outcome was the difference between percentage of avoidable admissions from the ED with dalbavancin use in the retrospective cohort and prospective cohort. The secondary outcomes were estimated length of stay avoidance, percentage of treatment success without ED re-visit within 30 days, estimated hospital cost avoidance and drug cost reimbursement. The primary outcome was assessed using the Chi-square test. Descriptive statistics were used for the secondary outcomes.

Results
Fourteen patients received dalbavancin and avoided hospital admissions. The percentages of admissions avoided in the retrospective and prospective cohorts were 16.02% and 6.67%, respectively (Figure 1). A difference of 9.35% was found to be statistically significant (p=0.01). The total estimated length of stay avoidance was 50 days. No patients re-visited the ED within 30 days with treatment failure. The total estimated hospital cost avoidance was &148,852 (Table 1). The net reimbursement for dalbavancin over drug cost was &5,100 (Table 2).

Conclusion
Dalbavancin use decreased avoidable admissions. At our institution, annual hospital cost savings can reach &1,015,794 if dalbavancin was utlilized to all eligible patients.

Disclosures
All Authors: No reported disclosures
1402. NTM Infections; A Rising Global Health Problem/Clinical Characteristics and Outcomes of Patients with Non-Tuberculous Mycobacterial Infections at Two Tertiary Academic Medical Centers
Authors: Nawwar Abdelhameed , Madrid-Morales Julieta , Velez-Mejia Carolina , Pizarro Rigoberto De Jesus , Cepeda Victor , Reveles Kelly R , Cadena-Zuluaga Jose , Javeri Heta 
Published: December 2021

Abstract

Background
Non-Tuberculous Mycobacteria (NTM) cause infections in immunocompetent as well as immunocompromised individuals affecting pulmonary and extra pulmonary sites. These pathogens are widely distributed globally and recent reports have shown their rise in many developed countries. Our study aimed to assess the disease magnitude, describe patient characteristics and risk factors, assess diagnostic and therapeutic measures and review outcomes furthering our understanding of the overall disease process.

Methods
We conducted a retrospective, multicenter review of patients with positive NTM cultures treated at University Hospital System and South Texas Veterans Health Care System (STVHCS) from 2011 to 2018. Infections were classified as pulmonary or extrapulmonary, and we recorded demographics, microbiological data, treatment regimens, duration, complications, follow-up and mortality. All categorical variables were described using percentages and compared between groups using the chi-square test.

Results
A total of 176 patients were included for analysis, of which 111 (63.1%) met criteria for NTM disease (2020 ATS/IDSA). The most common cultured mycobacterium was M. Avium Complex (MAC). M. abscessus-chelonae was more commonly associated with clinical disease and isolated from an extra pulmonary site whereas M. simiae complex had similar distribution between the infected and un-infected groups. Over 50% of patients received treatment (80% in the infected group). Cure was seen in 47.2%, all-cause mortality was 27% at last follow-up. Median duration of therapy was 10 months. 47% of patients experienced adverse effects which led to treatment discontinuation in one third of patients. Patients who were able to achieve a cure received a longer duration of therapy (12 vs 7 months; not statistically significant) and treatment was halted more commonly in the group that did not achieve eventual cure (42.6% vs. 16.7%, p=0.007).

Conclusion
NTM infections represent a therapeutic challenge with low cure rates and high mortality. An understanding of the risk factors, treatment options and outcomes is essential to guide appropriate management. Our study highlights high rates of adverse effects and discontinuation which precludes prolonged courses of therapy required to achieve cure.

Disclosures
All Authors: No reported disclosures
1418. Single Center Treatment Patterns for Asymptomatic Bacteriuria and UTIs in Kidney Transplant Recipients: Are We Still Overtreating?
Authors: Azeem Meena , Cowman Kelsie , Pynadath Cindy , Bartash Rachel 
Published: December 2021

Abstract

Background
In February 2019, the American Society of Transplantation (AST) published guidelines on the management of asymptomatic bacteriuria (AB) and urinary tract infections (UTIs) in kidney transplant (KT) recipients. These recommendations include avoiding treatment of AB &gt; 2 months post-transplant and outline the duration of treatment (DT) for uncomplicated and complicated UTIs. We reviewed management of these syndromes and guideline concordance at our institution.

Methods
We conducted a single-center, retrospective cohort study of KT recipients age &gt; 18 years who underwent transplantation between June 2016 - June 2020. Patients were obtained through query of our electronic medical record for documented UTI syndromes and included if a diagnosis was confirmed between March 2019 - December 2020 upon chart review. Definitions of AB, complicated UTI, and uncomplicated UTI were based on AST definitions. Patients with AB &lt; 2 months post-transplant were excluded. Outcomes included treatment of AB, DT, 30-day hospital admission and re-admission, and 30-day mortality. Bivariate analysis was conducted using chi square and t test.

Results
Seventy-four patients (mean age 55.4 years, 62.0% female) were included. Twenty-one patients had AB, 90% of whom received antibiotics. Distribution of diagnoses and median DT among those treated with antibiotics is outlined in Table 1.
Overall DT was similar in patients whose care included infectious disease (ID) input and those who did not (10.0 vs. 10.0 days, p=0.12), although ID involvement was more common in complicated UTIs. There was no difference in 30-day admission rates for those receiving &lt; 7 days vs. &gt; 7 days of antibiotics (p=0.53) (Table 2) including those with complicated UTIs (5/15 in &lt; 7 days (33%) vs. 4/18 in &gt; 7 days (22%) p=0.49). There were no deaths within 30 days of diagnoses.

Conclusion
Despite guidelines, treatment of AB is common and uncomplicated UTIs often receive prolonged courses of antibiotics. There was no increased risk of admission or mortality with shorter DT, though these results should be interpreted cautiously given the small sample size. Greater stewardship efforts are needed in this high-risk population.

Disclosures
Kelsie Cowman, MPH, Merck (Research Grant or Support)