bluuebunny/crossref_metadata_2025_split huggingface dataset:
1144. Evaluation of Procalcitnonin Usage in Neonates Presenting with Fever or Suspected Sepsis
Authors: Bhagat Hita , Burns Beech , Lewis James , Yu Diana 
Published: December 2021

Abstract

Background
Clinical evaluation alone is not effective in identifying serious bacterial infections (SBI) in neonates presenting with suspected sepsis and fever. A clinical decision making tool to aide in evaluating neonates presenting to the pediatric emergency department (PED) uses urinalysis, absolute neutrophil count (ANC), and procalcitonin (PCT) and together has high negative predictive value (NPV) for SBI. Use may decrease invasive testing, antibiotic exposure, and rates of admission. The tool was incorporated into hospital guidelines in October 2020. The purpose is to assess implementation and prediction of SBIs.

Methods
This is a single-center quality improvement study at an academic medical center. Neonates less than 60 days presenting with fever or suspected sepsis were included in the baseline group from October 2019- March 2020 or the post-implementation group from October 2020- March 2021. Exclusion criteria were receiving antibiotics 48 hours before PED visit, pre-existing medical conditions, indwelling devices, soft-tissue infections, and ≤ 36 weeks gestation. Implementation and guideline compliance was assessed in neonates aged 29-60 days as the primary outcome. Secondary endpoints include initiation of empiric antibiotics, rates of admission, rates of re-presentation within 30 days, and rates of lumbar punctures in all included patients.

Results
The baseline group had 29 patients and the post-implementation group had 35 patients who met inclusion/exclusion criteria. Baseline characteristics were similar with higher SBI rates in the post-implementation group having 8 SBIs while the baseline group had 4. There were 16 patients aged 29-60 days in the baseline (55%) and 17 in the post-implementation groups (49%). Complete labs were available for 9 patients (53%) and guideline compliance was 89%. NPV in neonates aged 0-60 days with negative urinalysis, ANC, and PCT was 100%. Rates of secondary endpoints were slightly higher in the post-implementation group along with higher rates of infections.

Conclusion
High NPV in this small cohort is an indication for continued use of this tool in neonates presenting to the PED with suspected sepsis or fever. Further education to increase use and expansion to all neonates should be considered based on overall NPV and previous studies.

Disclosures
All Authors: No reported disclosures
1145. The Role of the Plasmid-Mediated Fluoroquinolone-Resistance (PMFQR) Genes As Resistance Mechanisms in Pediatric Infections due to Enterobacterales (Ent)
Authors: Pitstick Claire E , Marshall Steven , Konda Sreenivas , Medernach Rachel L , Domitrovic T Nicholas , Hujer Andrea M , Qureshi Nadia K , Rudin Susan D , Zheng Xiaotian , Weinstein Robert A , Bonomo Robert A , Logan Latania K 
Published: December 2021

Abstract

Background
Fluoroquinolones (FQs) are not commonly prescribed in children, yet the increasing incidence of multidrug resistant (MDR) Ent infections in this population often reveals FQ resistance. We sought to define the role of FQ resistance in the epidemiology of MDR Ent in children, with an overall goal to devise treatment and prevention strategies.

Methods
A case-control study of children (0-18 years) at 3 Chicago hospitals was performed. Cases had infections by FQ susceptible, 3rd generation cephalosporin-resistant (3GCR) and/or carbapenem-resistant (CR) Ent harboring a non or low level expressed PMFQR gene (PMFQS Ent). Controls had FQR infections due to 3GCR and/or CR Ent with expressed PMFQR genes (PMFQR Ent). We sought bla genes by PCR or DNA (BD Max Check-Points assay®) and PMFQR genes by PCR. We performed Rep-PCR, MLST, and E. coli phylogenetic grouping. Demographics; comorbidities; and device, antibiotic, and healthcare exposures were evaluated. Predictors of infection were assessed.

Results
Of 170 G3CR and/or CR Ent isolates, 85 (50%) were FQS; 23 (27%) had PMFQR genes (PMFQS cases). 85 (50%) were FQR; 53 (62%) had PMFQR genes (PMFQR controls). The median age for children with PMFQS Ent and PMFQR Ent were 4.3 and 6.2 years, respectively (p=NS). Of 23 PMFQS Ent, 53% were Klebsiella and of 53 PMFQR Ent, 76% were E. coli. The most common bla and PMFQR genes in PMFQS Ent were blaSHV ESBL (44%); oqxB (57%) and aac-6’1b-cr (52%) and in PMFQR Ent were blaCTX-M-1 group (76%); aac-6’1b-cr (91%) and oqxA (17%).
Multivariable regression analysis showed children with PMFQS Ent infections were more likely to have hospital onset infection (OR 5.7, 95% CI 1.6-22) and isolates with multiple bla genes (OR 3.8, 95% CI 1.1-14.5). The presence of invasive devices mediated the effects of healthcare setting in the final model. Differences in demographics, comorbidities, or antibiotic use were not found.

Conclusion
Paradoxically, PMFQS Ent infections were often hospital onset and PMFQR Ent infections were community onset. PMFQS Ent commonly co-harbored multiple bla and PMFQR genes, affecting therapeutic options and suggesting need for contact precautions. Control of PMFQS Ent infections in children will require validating sources and risk factors.

Disclosures
Robert A. Bonomo, MD, entasis (Research Grant or Support)Merck (Grant/Research Support)NIH (Grant/Research Support)VA Merit Award (Grant/Research Support)VenatoRx (Grant/Research Support)
1148. Duration of Antibiotic Therapy in the Treatment of Bacterial Meningitis in Young Infants: A Systematic Review and Narrative Synthesis
Authors: Van Hentenryck Maite , Schroeder Alan , McCulloh Russell , Stave Christopher D , Wang Marie E 
Published: December 2021

Abstract

Background
IDSA recommendations of 14-21 days of parenteral therapy for bacterial meningitis are based predominantly on expert consensus. Parenteral durations consistent with these recommendations are sometimes provided even when meningitis is suspected but not confirmed. We aimed to systematically review the literature on duration of parenteral antibiotic therapy and outcomes in bacterial meningitis in infants &lt; 3 months of age.

Methods
We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for publications up until May 11, 2021. Eligible studies were published in English and included infants &lt; 3 months of age with bacterial meningitis for which route and duration of antibiotic therapy and outcomes were reported. We excluded case reports and infants with birth weight &lt; 1500g, major congenital malformations, or neurosurgical conditions. We assessed bias using published tools specific to study type. A meta-analysis was not conducted due to insufficient data on outcomes by duration of therapy. PROSPERO registration: CRD42020201667.

Results
A total of 2195 studies were identified; 280 were selected for full text review and 32 were included for narrative synthesis. There was 1 randomized-controlled trial (RCT), 25 cohort studies, and 6 case series. The RCT found no difference in treatment failure rates between 10 and 14 days of therapy, but only included 2 cerebrospinal fluid (CSF) culture-positive cases. A single cohort study including only CSF culture-negative cases presented outcomes by duration of therapy and concluded that courses &gt;21 days had no impact on prognosis. Twenty-one studies had data on duration of therapy and outcomes by patient, most with small samples (median 4 patients). No conclusions on efficacy of shortened antibiotic courses could be drawn due to small sample sizes and lack of stratification of outcomes by short versus long courses.

Conclusion
Data on parenteral treatment duration in bacterial meningitis in infants &lt; 3 months are primarily observational, and larger studies rarely report outcomes by duration of therapy. Given the associated risks and costs of prolonged parenteral therapy, there is a pressing need for comparative effectiveness research to determine the optimal parenteral treatment duration.

Disclosures
All Authors: No reported disclosures
1149. Application of a Multiplex Polymerase Chain Reaction Test for Diagnosing Bacterial Enteritis in Children in a Real-Life Clinical Setting
Authors: Lee Hyun Woo , Han Seung Beom , Rhim Jung-Woo 
Published: December 2021

Abstract

Background
Although a bacterial multiplex polymerase chain reaction (mPCR) test should be performed selectively in patients with gastrointestinal symptoms consistent with bacterial enteritis, its usefulness has been evaluated upon stool samples as requested by clinicians, without considering the patients’ gastrointestinal symptoms or clinical diagnoses. This study aimed to determine the subjects to bacterial mPCR testing and to interpret the mPCR test results with considering patients’ clinical symptoms and diagnoses.

Methods
Medical records of 710 pediatric patients for whom a bacterial mPCR test was performed were retrospectively reviewed. Clinical characteristics and mPCR test results were compared between patients with positive mPCR test results (n = 199) and those with negative mPCR test results (n = 511) and between patients in whom inflammatory pathogens (Campylobacter spp. and Salmonella spp.) were identified (n = 95) and those in whom toxigenic pathogens (Clostridium spp.) were identified (n = 70).

Results
A positive mPCR test result was significantly associated with an older age (p &lt; 0.001), diagnosis of acute gastroenteritis (p = 0.021), presence of hematochezia (p &lt; 0.001), and absence of cough (p = 0.004). The diagnosis of acute gastroenteritis (p = 0.003), presence of fever (p = 0.027) and diarrhea (p = 0.043), and a higher C-reactive protein level (p = 0.025) were significantly associated with the identification of inflammatory pathogens rather than toxigenic pathogens in patients with positive mPCR test results.

Conclusion
Bacterial mPCR testing should be performed selectively based on patients’ clinical symptoms and diagnoses, and its results should be interpreted with considering identified pathogens.

Disclosures
All Authors: No reported disclosures
1150. Pediatric Osteoarticular Infections Caused by Mycobacteria Tuberculosis Complex: A Twenty-Six Year Review of Cases in San Diego, California
Authors: Drobish Ian , Ramchandar Nanda , Raabe Vanessa , Pong Alice , Bradley John S , Cannavino Christopher R 
Published: December 2021

Abstract

Background
Osteoarticular infections (OAI) account for 10-20% of extrapulmonary Mycobacteria tuberculosis (MTB) complex infections in children. Given the rarity of MTB OAI, the epidemiology, disease manifestations, and treatment are poorly characterized. We describe 21 children treated for MTB complex OAI over a 26-year period at a tertiary pediatric center in southern California.

Methods
We conducted a retrospective review of children diagnosed with MTB complex OAI and cared for between 31 Dec 1992 to 31 Dec 2018 at a single tertiary care pediatric hospital with close proximity to the United States-Mexico border.

Results
We identified 21 children with MTB complex OAI during the study period (Table 1). Concurrent pulmonary disease (4.8%), meningitis (9.5%), and intra-abdominal involvement (14.3%) were all observed. MTB complex was identified by culture from operative samples in 15/21 children (71.4%); 8/15 (51.3%) cultures were positive for Mycobacterium bovis. Of the eight cases of vertebral OAI (the most common site), one was culture-positive for M. bovis. Open bone biopsy was the most common procedure for procurement of a tissue sample and had the highest culture yield (Table 2). The median duration of antimicrobial therapy was 52 weeks (IQR 52-58). Successful completion of therapy was documented in 15 children (71.4%). Seven children (33.3%) experienced long term sequelae related to their infection.
Table 1. Twenty-one children with Mycobacteria tuberculosis complex osteoarticular infections.

Table 2. Surgical sample type and percent positivity.

Conclusion
Among the 21 children with MTB complex OAI assessed, 8 of 15 (53.3%) children with a positive tissue culture had M. bovis (intrinsically resistant to pyrazinamide), representing a higher percentage than in previous reports and potentially reflecting its presence in unpasteurized dairy products in the California-Baja region. Local epidemiological trends in endemic MTB complex species should be considered when evaluating and managing MTB complex OAI. Bone biopsy produced the highest culture yield in this study. Given the rarity of this disease, multicenter collaborative studies are needed to improve our understanding of the presentation and management of pediatric MTB complex OAI.

Disclosures
Vanessa Raabe, MD, MSc, Pfizer (Scientific Research Study Investigator, Other Financial or Material Support, Editorial support)Sanofi (Scientific Research Study Investigator)
1151. Clinical Characteristics of Persistent Staph Aureus Bacteremia in Children
Authors: Venturelli Nicholas , Bhagat Palak , Nelson Allison , Kumar Madan 
Published: December 2021

Abstract

Background
Persistent Staphylococcus aureus bacteremia (pSAB) is a poorly defined entity, but associated with significant morbidity and mortality in children. We aim to better describe the epidemiological features of this clinical entity.

Methods
We performed a retrospective case series analysis of pediatric patients with pSAB at a single center children’s hospital using electronic medical data from 2016 – 2020. Bacterial persistence was defined as culture growth &gt; 72 hours after first blood culture.

Results
Twenty-two patients with pSAB were included in the analysis. Sources of persistent infection were endovascular infection (n=11, 50%), osteoarticular infection (n=6, 27%,), isolated central line associated blood stream (n=4, 18%), isolated skin and soft tissue infection (n=2, 9%), and no known primary infectious site (n=1). Methicillin resistance occurred in 41% (n=9) of cases of pSAB. Total duration of therapy varied, with a median of 4 weeks from negative cultures (range of 2 – 8 weeks). Total days of positive cultures in pSAB were not significantly associated with methicillin susceptibility of the bacterial isolate, use of double gram-positive coverage, nor presence of a central venous catheter. Use of double gram-positive coverage occurred in 50% of cases with a mean duration of therapy of 11 days, most frequently in cases of septic thrombophlebitis (Table 1). Rifampin and gentamicin were the most commonly used agents.
Table 1. Clinical Characteristics of Children Treated with Double Gram-Positive Coverage

Conclusion
Children presenting with persistent S. aureus bacteremia present with a heterogenous group of underlying conditions and epidemiological features. While pediatric recommendations for double gram-positive coverage for synergy have not been established, their use for pSAB is common, especially in endovascular infections where culture persistence is often an expected outcome. Further research should examine risk factors for pSAB and define optimal treatment modalities and duration.

Disclosures
All Authors: No reported disclosures
1152. Microbiology of Pediatric Neck Infections Based on Age and Anatomic Location
Authors: Dimo Joana , Zembles Tracy N , Bushee Glenn , Mitchell Michelle L 
Published: December 2021

Abstract

Background
Studies of pediatric neck infections demonstrate an increase in methicillin resistant Staphylococcus aureus (MRSA), and predominance of Staphylococcus aureus (S. aureus) in infants, and commonly polymicrobial infections. Thus, some providers treat acute neck infections with empiric broad spectrum antibiotics, often with two drugs. Our institution often uses clindamycin plus ampicillin-sulbactam as empiric therapy for hospitalized children with acute neck infection. We aimed to identify the microbiology of acute neck abscesses at our institution to determine if stratifying by age and abscess location would allow for single agent therapy.
Table 1. Causative organism based on anatomic location of neck infection.

Methods
Diagnosis codes identified patients hospitalized with acute neck infections. Cases with underlying malignancy, cervicofacial malformations, or lymphatic malformations were excluded. Patients with surgical cultures were categorized into two groups based on anatomic location of infection: medial (retropharyngeal, parapharyngeal, and peritonsillar), lateral (other locations), or both. Within each group, causative pathogen(s) were explored and further categorized by age (infants: &lt; 1 year old; non-infants: ≥1 year old).

Results
412 patients were hospitalized for acute neck infection of which 132 had surgical cultures. 110 had growth of one or more pathogens (20 infants, 90 non-infants). 53 infections were located medially, 54 laterally, and 3 had both locations involved. S. aureus was most commonly identified, with lateral infections accounting for the majority (Table 1). 40/44 S. aureus isolates were susceptible to clindamycin. Among medial infections, Streptococcus Anginosus and Group A Streptococcus were most common followed by S. aureus (Table 1). 17/20 (85%) positive cultures in infants grew S. aureus with 8/17 (47%) MRSA. No polymicrobial infections were identified in infants. Among non-infants, 0/39 lateral infections had polymicrobial growth but 23/50 (46%) of medial infections did.

Conclusion
Local epidemiology based on anatomic location and patient age suggests a single agent (clindamycin for lateral and penicillin with beta-lactamase inhibitor for medial) may be reasonable for non-infants with uncomplicated neck infections. For infants, coverage of MRSA, regardless of anatomic location, is advisable.

Disclosures
All Authors: No reported disclosures
1153. ESBL Producing E. coli Urinary Tract Infections in Children: Is Carbapenem Always Necessary?
Authors: del Carmen Ruiz Cabrales Diva , Oviedo Gabriel Ivan Narvaez , Londono-Ruiz Juan Pablo , Tobar Ivan Felipe Gutiérrez 
Published: December 2021

Abstract

Background
Urinary tract infections (UTI) are common in children with a prevalence of 5% in infants. UTI are the main reason for beginning antibiotics in children’s hospitals and E. coli is approximate 80% of urinary pathogens. Extended-spectrum beta-lactamases (ESBL) producing E. coli are a common concern in daily practice. Carbapenems, especially ertapenem are the choice for the treatment in some hospitals, but aminoglycosides or trimethoprim and sulfamethoxazole are options for carbapenem saver. The aim of this study was comparing the clinical outputs in ESBL producing E. coli ITU in children treated with ertapenem or amikacin.

Methods
We designed a quasi-experimental study. In 2018 the antimicrobial stewardship program begins the use of amikacin for non-septic UTI for ESBL producing E. coli. Before this recommendation the use of ertapenem was common. We use WHONET 5.6 to identify ESBL producing E. coli UTI between 2016 and 2020. We analyzed the information using R 4.0.3.

Results
We analyzed 162 clinical records. 89 in ertapenem group, 45 in amikacin group, 23 in other treatments (TMP-SMX, meropenem) and 5 patients that received empirical treatment (Cefazolin) with clinical improvement and ambulatory management. The initial clinical and paraclinical variables was similar between two groups, only meropenem was more frequent in amikacin group as empiric treatment (table 1). Amikacin group received for media 7.4 days of antibiotic therapy (IQR 7-7.5) and ertapenem 8.2 days (IQR 7-10) (p value 0.049). The mortality, PICU requirement, mechanical ventilation and inotropic requirement was similar an both groups (Table 2). In amikacin group the median length of stay was 7.2 days (IQR 4-9) and in ertapenem group was 9 days (IQR 6-10). No significant adverse effects were documented in any group.
Table 1. Patient’s characteristics in both groups.

Table 2. Patient’s Clinical outcomes in both groups

Conclusion
The use of amikacin in ESBL producing E. coli UTI in children have similar clinical outputs that ertapenem. The use of amikacin could decrease de hospitalization time.

Disclosures
Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses)
1155. Covering Your Tracts? The Effect of Antibiotic Prophylaxis on Respiratory Tract Infections in Pediatric Acute Lymphoblastic Leukemia
Authors: Strength Rachel , Cross Shane , Pui Ching-Hon , Jeha Sima , Gowen Ashleigh , Wolf Joshua , Wolf Joshua 
Published: December 2021

Abstract

Background
Antibiotic prophylaxis decreases rates of febrile neutropenia and systemic infection in children with acute lymphoblastic leukemia (ALL). However, it is unknown whether prophylaxis prevents or ameliorates the severity of specific types of infections like upper respiratory tract infections (URTI) or lower respiratory tract infections (LRTI).

Methods
This is a retrospective, observational convenience cohort study of children with newly-diagnosed ALL, comparing respiratory tract infections (RTI) in participants receiving no antibiotic prophylaxis, levofloxacin prophylaxis, or non-levofloxacin prophylaxis. Information regarding the presence of URTI or LRTI, identified respiratory viruses, hospitalization, oxygen supplementation, and ICU admission was collected through medical record review. The proportion of participants in each group was estimated and compared between groups using Fisher’s exact test and the Kruskal-Wallis test.

Results
Of 262 evaluable participants, 126 received no antibiotic prophylaxis, 59 received levofloxacin prophylaxis, and 77 received non-levofloxacin prophylaxis, with a total of 136 children getting any antibiotic prophylaxis regimen. In the no-prophylaxis group, 22/126 (17.4%) had RTI, compared to 23/136 (16.9%) in the prophylaxis group. There was no significant difference in the numbers of LRTI and URTI, with or without an identified respiratory virus, regardless of the presence or type of antibiotic prophylaxis. Participants receiving prophylaxis did not have a significantly different risk of hospitalization, oxygen supplementation, or ICU admission.
Participant Characteristics

Comparisons of levofloxacin prophylaxis, other prophylaxis, any prophylaxis, and no prophylaxis

Conclusion
There was no observed difference in RTI, hospitalization, oxygen supplementation, or ICU admission for RTI between participants receiving or not receiving antibiotic prophylaxis in this cohort. Because of the relatively low number and severity of respiratory infections, and the high proportion that are viral in etiology, it would likely take a very large sample size to determine the impact of antibacterial prophylaxis on respiratory infections during induction therapy for pediatric ALL.

Disclosures
Joshua Wolf, MBBS, PhD, FRACP, Karius Inc. (Research Grant or Support) Joshua Wolf, MBBS, PhD, FRACP, Nothing to disclose