bluuebunny/crossref_metadata_2025_split huggingface dataset:
671. Initial Impression of Explify Respiratory Testing: Is It an Effective Diagnostic Tool?
Authors: Donkin Joshua D , Polega James , Bhugra Mudita , de Sanctis Jorgelina , Hassouna Habiba 
Published: December 2021

Abstract

Background
Respiratory infections are a common cause of hospital admissions resulting in significant morbidity and mortality. Isolating specific pathogens from the respiratory tract is a diagnostic challenge. Traditional testing modalities are prone to contamination, time consuming, and have low sensitivity. Next generation genetic sequencing technology has made possible the development of a number of hypothesis free, fast, and highly accurate genome-based identification tests. In this study, we aim at assessing the initial use and performance of one of these tests, the Explify Respiratory panel, at a large quaternary hospital in west Michigan.

Methods
We performed retrospective analysis on 16 patients with suspected lower respiratory infections. Subjects were chosen for inclusion in the analysis based on the suspicion of pulmonary infection without an identified pathogen. The patient population included 5 immunocompromised patients, 3 with hematologic malignancy, 4 with solid tumor malignancy, and 2 transplant recipients.

Results
The test resulted in: lack of identified organism (5 patients), identification of non-pathogenic organisms (6 patients), and identification of organisms that were either identified by other traditional testing or did not impact provider’s therapeutic plan (5 patients). The results of Explify testing in all 16 patients did not have a clinical impact on patient care or treatment plan.

Conclusion
Explify testing seemed to be an appealing cost-effective tool that could replace other available testing modalities such as culture, other sequencing tests, and serological testing with faster turn-around time and less cost. However, it failed to demonstrate any benefit to clinicians in identifying respiratory pathogens while resulting in added cost burden to the patient. Moreover, it resulted in clinical delays of further investigation while awaiting the results. It remains unclear if the lack of clinical impact results from the extensive interventions and treatments that patients receive prior to Explify testing or from the poor sensitivity and performance of the test.This study emphasizes the importance of continuous evaluation of new diagnostic testing before widespread implementation to improve patient care and minimize cost burden.

Disclosures
All Authors: No reported disclosures
672. Diagnosis of Rocky Mountain Spotted Fever Using Plasma Metagenomic Next-Generation Sequencing
Authors: Chiang Leslie , Ramchandar Nanda , Coufal Nicole , Farnaes Lauge , Foley Jennifer 
Published: December 2021

Abstract

Background
Rocky mountain spotted fever (RMSF), caused by Rickettsia rickettsii, incurs significant morbidity and mortality, especially in children. Early in the course of illness, standard diagnostic tests are of limited sensitivity, and diagnosis is often based on clinical symptoms and local epidemiology. The diagnosis can be missed in areas where RMSF is not endemic, and a delay in initiation of therapy may lead to poor clinical outcomes. Plasma metagenomic next-generation sequencing (mNGS), with turnaround times approaching 48 hours, may be a useful adjunctive tool in the diagnosis of RMSF.

Methods
We describe four children hospitalized with RMSF between January 1, 2017 to May 15, 2021 at a tertiary children’s hospital in southern California. All had plasma mNGS and rickettsial serologic testing as part of clinical care.

Results
mNGS detected Rickettsia rickettsii in all 4 patients. Only 2 subjects had positive serologic testing initially and required repeat testing in the convalescent stage to confirm RMSF. The mean turnaround time for mNGS was 2.75 days, which was comparable to serologic testing. Antibiotic therapy was changed in three subjects as a result of the plasma mNGS result.

Conclusion
Plasma mNGS may be a useful diagnostic modality early in the disease course of RMSF.

Disclosures
Lauge Farnaes, MD, PhD, Cardea Bio (Advisor or Review Panel member)IDbyDNA (Employee)
691. Infective Endocarditis with an Indication for Cardiac Surgery in a Tertiary Care Educational Hospital: Does Cardiac Surgery Improve Outcomes?
Authors: Akyol Deniz , Quliyeva Gunel , özcem Selin Bardak , kayıkçıoğlu Meral , Yamazhan Tansu , Ulusoy Sercan , Sipahi Hilal , Taşbakan Meltem , Sipahi Oğuz Reşat 
Published: December 2021

Abstract

Background
In this retrospective cohort study, it was aimed to compare the clinical characteristics and outcomes of IE cases without and with an indication for cardiac surgery in terms of whether they have been operated or not, in a tertiary-care educational hospital.

Methods
Patients that were followed up for definite IE (diagnosed according to modified Duke criteria between March 2007 and November 2020) with an indication for cardiac surgery according to European Society of Cardiology Guidelines, comprised the study group. Subjects were evaluated in terms of whether these cases have been operated or not, demographic features, underlying diseases, risk factors, clinical and laboratory findings, therapy responses, complications, and mortality. The timing of surgery is defined as emergency; surgery performed within 24 hours, urgent; within a few days, elective; after at least one-two weeks of antibiotic therapy. Statistical analysis was performed via Chi square and Student T tests and a p value &lt; 0.05 was considered significant.

Results
A total of 90 patients with an indication for surgery, 33.3% patients in underwent surgery, 66.6% patients in not underwent surgery group fulfilled the study criteria. The most frequently seen complaints in patients were fever (91.1%), cold-shiver (56.6%), weight-loss (27.7%), dyspnea (25.5%), and tachycardia (20%). Heart murmur was detected during cardiac auscultation of 44 patients. Mean blood leukocyte count, C-reactive protein and erythrocyte sedimentation rate were 12324 ± 6558/mm3 (1408-30330), 11.46 ± 8.38 mg/dl (0.18-34.6) and 61.43 ± 33.4 mm/h (2-130), respectively. There was no significant difference between two groups in terms of cardiac/non-cardiac risk factors, age, gender, etiologic agents, laboratory findings, septic embolisms and complaints (Table 1). In total IE with an indication for surgery mortality was 27.7%. Mortality rate was significantly less and heart murmur was significantly higher in cases who underwent surgery than those did not undergo surgery (p: 0.0447).
Table 1. Comparison of basic characteristics of patients in the two operated / unoperated cohorts.

Conclusion
These data support the importance of the guidelines’ criteria for cardiac surgery in the management of IE. Assuming that only 1/3 of the surgery needing cases received surgery, more interventions are needed to decrease the barriers against surgery.

Disclosures
All Authors: No reported disclosures
698. Contemporary Clinical Epidemiology of Pediatric Shigella and Campylobacter Infections in Houston, TX, 2019 and 2020
Authors: tabarani christy , Flores Anthony R , Flores Anthony R , Arias Cesar A , Wanger Audrey 
Published: December 2021

Abstract

Background
Infections due to Gram-negative, diarrheal pathogens are a significant cause of morbidity in children. Clinical features of pediatric Shigella and Campylobacter infections in urban cities in the United States are not well described.

Methods
We used a retrospective chart review of records (0-18 years of age) from a network of hospitals in Houston, TX. Only patients with Shigella spp. or Campylobacter spp. isolated from clinical samples in 2019 and 2020 were included. Demographic, clinical, and microbiological data were extracted from the medical record.

Results
We identified a total of 59 and 16 pediatric patients with Shigella spp. and Campylobacter spp. infections, respectively. Hospital admission occurred in 27.1% (16/59) of Shigella and 25% (4/16) of Campylobacter. Length of stay ranged between 1 and 2 days for both pathogens (Table 1). Of cases with available clinical data, Shigella infections were more likely to report fever during their illness compared to Campylobacter (80% versus 45.4%) (Table 2). Seizures were observed in 4 Shigella infected patients. No episodes of Shigella or Campylobacter bacteremia were identified. Among patients with an identified exposure, daycare attendance and contact with individuals experiencing similar symptoms were most common (Table 2). The vast majority of Shigella species were S. sonnei (96.6%) and all Campylobacter were C. jejuni (Table 3). Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was common (40/55, 72.7%) among Shigella isolates tested. No resistance to fluoroquinolones or third generation cephalosporins in any of the Shigella spp. isolates was observed. Susceptibility testing was not performed in Campylobacter due to lack of isolates. The most frequent antibiotic used was azithromycin (in 73.3% and 75% of patients with Shigella and Campylobacter, respectively). Major complications included urinary tract infection (n=1), rectal prolapse (n=1) and splenomegaly (n=1).

Conclusion
Infections due to Shigella and Campylobacter were a significant burden among pediatric patients between 2019 and 2020 in Houston, TX. The observed high frequency of resistance to TMP-SMX and emergence of multi-drug resistant Shigella in other countries warrants continued surveillance.

Disclosures
Anthony R. Flores, MD, MPH, PhD, Nothing to disclose Cesar A. Arias, M.D., MSc, Ph.D., FIDSA, Entasis Therapeutics (Grant/Research Support)MeMed Diagnostics (Grant/Research Support)Merk (Grant/Research Support)
713. Coccidioidal Meningitis Among Children: A Case Series and Single Center Experience In Central California
Authors: Naeem Fouzia , Giglio Linda , Sharma Julia , Clerkin Patricia , Laningham Frederick , McCarty James 
Published: December 2021

Abstract

Background
Coccidioidal meningitis is a severe form of coccidioidomycosis associated with significant morbidity and mortality. Published literature in the pediatric population is limited, particularly on coccidioidal meningitis. Here we describe a large case series of pediatric coccidioidal meningitis followed at a tertiary care center in an endemic region.

Methods
We performed a retrospective case review of patients ≤21 years old followed at our facility with a diagnosis of coccidioidal meningitis from January 1, 2000, to December 31, 2018.

Results
Overall, 30 patients were identified during the study period. The median age was 10.8 years (IQR: 4.6-15). The majority of patients were previously healthy (93%) and all required hospitalization. Fever (90%), headache (70%), vomiting (53%), and fatigue (57%) were the most common clinical manifestations. More than one-third (40%) had concurrent pulmonary disease. Only 20 patients (67%) had initial Coccidioides complement fixation (CF) titers &gt;=1:16. The majority had extra-axial brain involvement (60%) and seven (23%) had associated spinal canal disease. Over two-third required shunt placement (70%) and almost half of them (43%) underwent revision. Neurological complications including paresis/paralysis, stroke, neuropathy, seizures, and cognitive delay were observed in 20% of patients. Two-thirds (73%) of patients received fluconazole as the initial drug. However, 37% of those had fluconazole failure, requiring alternative treatment. Due to refractory disease, two patients required a novel triazole, isavuconazole, while adjunctive therapy with steroids and interferon-gamma (IFNγ) was used in 20% of patients. Most cases (83%) stabilized, 13% experienced relapses and/or progressive disease, and 3% were fatal.

Conclusion
Pediatric coccidioidal meningitis is an uncommon and sometimes devastating complication of disseminated coccidioidomycosis. Many patients present with relatively low CF titers, and communicating hydrocephalus and long term neurologic complications are common. Fluconazole treatment failures are common, and management remains difficult despite recent advances in therapy. Most patients do well once the disease is stabilized and require lifelong therapy. Newer therapeutic agents are needed.

Disclosures
All Authors: No reported disclosures
730. Ocular Involvement Associated with Rickettsial Infection
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Rekik Khaoula , Marrakchi Chakib , Smaoui Fatma , Jemaa Mounir Ben 
Published: December 2021

Abstract

Background
Rickettsiosis, a re-emerging disease, is characterized with a myriad clinical symptoms and various manifestations. Ocular involvement is often misdiagnosed since it’s rarely symptomatic. It especially involves the posterior segment. We aimed to study the clinical, laboratory and therapeutic features of ocular involvement associated with rickettsial infection.

Methods
We encountered a retrospective study including all patients hospitalized for rickettsial infection with ocular involvement in the infectious disease department between 2007 and 2020. The diagnosis was confirmed based on serology (seroconversion) and/or positive polymerase chain reaction for Rickettsia in skin biopsy.

Results
A total of 24 patients were included with a mean age of 40±12 years. There were 13 women (54.2%). Sixteen patients sought medical care during the warm months, from June to October (66.6%). The revealing clinical signs were febrile maculopapular skin rash (79.2%), cephalalgia (54.2%) and arthralgia (33.3%). Five patients had visual loss (20.8%). Physical examination revealed conjunctival hyperemia (37.5%) and pathognomonic eschar (29.1%). Laboratory investigations revealed elevated liver enzymes (79.1%), thrombocytopenia (75%) and cholestasis (58.3%). Ocular involvement was unilateral in 14 cases (58.3%). Retinitis was the most common manifestation (70.8%), followed by anterior uveitis (20.8%). Retinal fluorescein angiography, performed in ten cases (41.6%), confirmed retinitis in 8 cases (80%). Both retinal vasculitis and papillary hyperfluorescence were noted in two cases (20%). Patients received doxycycline in 21 cases (87.5%) and fluoroquinolones in three cases (12.5%). The median duration of treatment was 7[6-15] days. The disease evolution was favourable in all cases (100%). No ocular sequelae were noted. Complications were noted in two cases (8.2%) represented by thrombophlebitis (one case) and recurrent seizures (one case).

Conclusion
Systematic fundus examination should be performed in front of suspected rickettsiosis, even in the absence of ocular symptoms and signs. It provides clinical clues to promptly diagnose and treat rickettsiosis.

Disclosures
All Authors: No reported disclosures
749. A Nurse-Driven Protocol for Early Detection of Clostridiodes difficile Infections
Authors: Beckman Shannon , Chia Jonathan , Stibbe Bethany , Rykse Monica , Wang Michael S 
Published: December 2021

Abstract

Background
Clostridiodes difficile infections (CDI) are a significant cause of hospital acquired infections, resulting in significant morbidity and mortality. Early detection of CDI has been shown to reduce the spread of CDI within the hospital. As nurses are frequently at the patient’s bedside, we proposed to empower the nursing staff to assess, collect stool samples, and order C. difficile testing.

Methods
Rates of CDI were measured by our Infection Control Department. Hospital-onset CDI (HO-CDI) was defined as a positive C. difficile PCR assay after 3 days of admission, defined as a stay of at least 3 midnights. Community-onset CDI (CO-CDI) was defined as any case that was diagnosed in the Emergency Department or inpatient ward &lt; 3 days of hospitalization based on stool testing as above. Nursing was instructed and empowered to assess, collect stool specimens, and place an order for C. difficile testing, based on the criteria of ≥3 loose or watery stools over 24 hours. Nursing was also educated to not order a test if patients had received stool softeners, enemas, or laxatives within 24 hours. The protocol was initiated in February 2019.

Results
Rates of HO-CDI increased during the intervention period, rising from 2.6 cases/10000 patient days and peaking at 17.7 cases/10000 patient days (average 6.7 vs. 12.1 monthly cases per 10,000 patient days. Rates of CO-CDI did not significantly change (12.4 vs. 11.5 monthly cases per 10000 patient days). Due to concerns of inappropriate testing, which included testing after laxatives, enemas, or sending specimens despite &lt; 3 stools over 24 hours, the protocol was discontinued in June 2019. Although the HO-CDI rate remained elevated over the next month, the rate subsequently decreased over the next several months (12.1 vs. 8.0 cases per 10000 patient days). Overall testing also increased over the study period (148.3 vs. 169.9 cases/per 10000 patient days).Figure 1 - Clostridiodes difficile rates

Figure 2 - CDI testing rates

Conclusion
A nursing driven protocol resulted in increased HO-CDI and overall CDI rates suggesting that the intervention may have been a factor in increasing the frequency of HO-CDI diagnoses, although the possibility of misdiagnosis of colonization for true CDI cannot be excluded. Further education of nursing staff may be a potential intervention in improving appropriate CDI testing.

Disclosures
All Authors: No reported disclosures
750. Retrospective Evaluation of the Three-Step EIA/PCR Algorithm as a Cost-Effective Method for Detection and Treatment of Clostridium Difficile Infection
Authors: Kulla Bakri , Haggerty patrick 
Published: December 2021

Abstract

Background
Clostridium difficile infection (CDI) is the primary cause of infectious diarrhea in the United States. With an estimated 453,000-500,000 burden cases that are associated with 15,000-30,000 deaths annually in the United States. Because of its prevalence, there is a projected 3.2-4.8 billion dollar annual cost for inpatient care related to CDI. For these reasons, accurate and timely detection of CDI is crucial to reduce the morbidity, mortality, and medical costs.

Methods
This is a retrospective cohort study. Adult patients, aged 18 through 80 years, admitted between 9/1/2016 and 9/30/2017, who presented with diarrhea and received a CDI algorithm test. To assess bivariate associations between true positive and indeterminate positive groups, categorical variables were compared using Chi-Square or Fisher’s exact tests when appropriate, and continuous variables were analyzed using independent samples t-tests.

Results
The study included 1031 stool samples, of which 853 (82.7%) were CDI negative and 178 (17.3%) were CDI positive. Of the full sample, 265 (25.7%) were GDH (+), 94 (9.1%) were toxin (+), and 84 (8.1%) were PCR (+).
In order to examine patient-level variables, the first positive from each patient was included to ensure independence of data points, resulting in 830 unique tests and patients. The true positive rate of this sub-sample was 9.4% (n = 78) and indeterminate positive rate was 8.7% (n = 72).
An important findings of the study is that of the patients who were GDH (+)/toxin (-), 87 (50.9%) were PCR (-) and 84 (49.1%) were PCR (+).Table 1

Conclusion
The study found that of the patients who are GDH (+) and Toxin (-), the PCR test serves as a proxy for the CDI test. In addition, we demonstrated that whether the patient was true positive by the GDH/Toxin test or indeterminate positive, the outcomes were the same. The only difference was the antibiotic selections for treatment. Performing PCR tests as a part of three-step algorithm prevented nearly half of discrepant patients from being unnecessarily treated with antibiotics and placed on enteric precaution, thereby extending their hospital stay. Finally, by preventing unnecessary antibiotic use, isolation and hospital length of stay, it is proposed that the three-step algorithm effectively reduces hospital cost.

Disclosures
All Authors: No reported disclosures
766. Readmissions of Hospitalized Patients with Clostridioides difficile Infection (CDI) for Recurrent CDI Is Common
Authors: Drwiega Emily N , Danziger Larry H , Johnson Stuart , Skinner Andrew M 
Published: December 2021

Abstract

Background
Hospital acquired infections (HAI) and hospital readmissions are of particular focus by Centers for Medicare and Medicaid Services. Clostridioides difficile infection (CDI) is an HAI notorious for causing recurrent illness and potentially resulting in re-hospitalizations. The purpose of our study was to identify the frequency of follow-up appointments in patients with CDI and determine the rate of re-hospitalization for recurrent CDI (rCDI).

Methods
This was a single-center, retrospective, chart review at a tertiary medical center. Through the electronic medical record, we queried all hospitalized patients with a positive stool test for C. difficile (GI panel PCR, FilmArray, Biofire, or C. difficile PCR, Xpert CD assay, Cepheid) with or without an ICD-10 code Enterocolitis due to C. difficile (A04.7, A04.71, A04.72) from January 2018 through April 2018. Demographic and clinical data at the time of diagnosis and up to 90 days after were collected from patient records.

Results
One-hundred and eighty-five patient episodes were evaluated. Of these, 147 (79.5%) were primary CDI, 13 (7.0%) were rCDI, and 25 (13.5%) were determined to be colonization. Twenty-two (11.9%) patients from the total cohort attended a follow-up appointment for CDI within 30 days, most often with a primary care provider or infectious disease physician. Twenty-three (12.4%) patients, 18 of whom were hospitalized for primary CDI episodes, developed a recurrent episode within 90 days of their initial CDI episode. Of these 23 patients with rCDI, 10 (43.5%) patients were re-hospitalized for their rCDI. Only 4 (17.4%) patients with rCDI had a follow-up appointment after their primary episode and among the 10 patients re-hospitalized for rCDI, only 2 (20.0%) patient had been seen for follow up for their previous CDI episode.

Conclusion
In our study, few patients had a follow-up appointment for CDI. Also, more than one third of the patients who had rCDI had to be re-hospitalized for the recurrent episode. Our study highlights a concern that the majority of patients re-hospitalized with rCDI did not have a follow-up appointment within 30 days of their initial diagnosis. Further study is necessary to determine if a dedicated follow-up appointment for CDI would result in decreased re-hospitalizations associated with rCDI.

Disclosures
Stuart Johnson, MD, Acurx Pharmaceuticals (Advisor or Review Panel member)Bio-K+ (Advisor or Review Panel member)Ferring Pharmaceutical (Advisor or Review Panel member)