bluuebunny/crossref_metadata_2025_split huggingface dataset:
699. Case-Case Comparison of Exposures among Fluoroquinolone-Resistant and Pan-Susceptible Campylobacter Cases, Tennessee, 2016-2018
Authors: Hanna Samir , Garman Katie , Dunn John R 
Published: December 2021

Abstract

Background
Campylobacter causes an estimated 1.5 million infections each year in the United States. Of those, approximately 448,400 infections are caused by antimicrobial resistant strains, including strains resistant to fluoroquinolones (e.g., nalidixic acid and ciprofloxacin), which are commonly used to treat campylobacteriosis. Campylobacter infection is commonly attributed to consuming poultry products. We compared exposure data between fluoroquinolone-resistant and pan-susceptible Campylobacter cases reported in 2016-2018 to assess attribution.

Methods
Broth microdilution was performed on Campylobacter isolates at CDC to determine the minimum inhibitory concentration for nine antimicrobial drugs. Whole genome sequencing (WGS) was performed at the Tennessee (TN) State Public Health Laboratory and the sequence data were analyzed at CDC to determine the genetic resistance determinants. Exposure data was collected through routine case interviews. Exposures among cases with fluoroquinolone-resistant infection and cases with no resistance to antimicrobials were compared.

Results
A total of 606 Campylobacter isolates from TN were submitted to CDC NARMS. Of those, 123 (20%) isolates were resistant to fluoroquinolones and 304 (50%) isolates were pan-susceptible. The gyr A (86) resistance gene was detected in 46/54 (85%) of resistant isolates. Exposure data were available for 59 (48%) fluoroquinolone-resistant cases and 186 (61%) pan-susceptible cases. Consumption of chicken (OR 2.1, p-value 0.03) and handling raw seafood (OR 3.1, p-value 0.03) were significantly associated with fluoroquinolone-resistance. More fluoroquinolone-resistant cases reported international travel compared to pan-susceptible cases (15% versus 4%) with OR 4.6, and p-value 0.004.

Conclusion
Fluoroquinolone-resistant Campylobacter infections were acquired domestically and internationally. Exposure to chicken products and handling raw seafood were reported more often among fluoroquinolone-resistant cases. Whole genome sequencing of Campylobacter isolates provides predicted resistance data. Coupling predicted resistance data with exposure data facilitates better understanding of source attribution of different strains.

Disclosures
All Authors: No reported disclosures
700. Risk Factors and Molecular Epidemiology of Acute and Chronic Norovirus Infection at a Large Tertiary Care Cancer Center
Authors: Kondapi Divya S , Ramani Sasirekha , Olvera Adilene , Atmar Robert L , Estes Mary , Okhuysen Pablo C 
Published: December 2021

Abstract

Background
Norovirus (NoV) is the leading cause of viral diarrhea in patients with cancer. In this study, we describe risk factors associated with acute and chronic NoV infection in this patient population.

Methods
We identified 132 patients with NoV diarrhea (using stool RT PCR) between 2016-2020 at University of Texas MD Anderson Cancer Center (MDACC). Patient data, including demographics, clinical characteristics, NoV treatments, and complications were retrospectively extracted from charts. Stool samples were analyzed for NoV genogroups and genotypes. We compared characteristics and outcomes of patients with acute diarrhea (&lt; 14day; AD) versus chronic diarrhea ( &gt;14day or recurrences within 12 weeks; CD) and analyzed the data using Pearson Chi square or Fisher’s exact for categorical variables and Wilcoxon rank-sum test for continuous variables.

Results
Of 132 patients identified, 124 had an underlying cancer (39 solid tumor, 85 hematological malignancies, Table 1). On univariate analysis, CD patients were more likely to have a hematological malignancy (p=0.002), be a hematopoietic stem cell recipient (p= 0.013), have a history of gastrointestinal graft versus host disease (p= 0.011), or have received immunosuppressants or steroids in the 90 days before diarrhea onset (p=0.001, Table 2). CD patients had significantly lower white blood cell counts (p=0.038), absolute neutrophil counts (p=0.049), IgG levels (p= 0.001), and serum albumin levels (p=0.002) at the time of NoV diagnosis (Table 3). Patients with CD more often received symptomatic or NoV targeting treatment, including anti-diarrheal (p=0.005), nitazoxanide (p&lt; 0.001), intravenous immune globulin (p=0.017), and oral IgG (p=0.042). CD patients more often had diarrheal recurrence in the first 4 weeks (p=0.001) or the second month (p&lt; 0.001) after initial diagnosis and needed enteral or parenteral nutrition (p=0.004). We genotyped NoV in 67 patients (Figure 1), resulting in identification of the following genogroups: GI (n=9, 13%), GII.4 (n=23, 34%), and other types of GII (n=35, 52%). Genotype diversity was higher in patients with CD than AD (Figure 1).

Conclusion
In patients with cancer, CD from NoV is associated with severe immunosuppression, is refractory to therapy and can be caused by a variety of NoV genotypes/genogroups.

Disclosures
Robert L. Atmar, MD, Takeda Vaccines, Inc. (Grant/Research Support) Mary Estes, PhD, Takeda Vaccines (Consultant, Grant/Research Support) Pablo C. Okhuysen, MD, FACP, FIDSA, Deinove Pharmaceuticals (Grant/Research Support)Ferring Pharmaceuticals (Consultant)Melinta Therapeutics (Grant/Research Support)Merck & Co. (Grant/Research Support)Napo Pharmaceuticals (Consultant, Scientific Research Study Investigator, Research Grant or Support)Singulex (Consultant)Summit Therapeutics (Grant/Research Support)
701. An Open-label Phase 2a Study of Ibezapolstat, a Unique Gram-positive Selective Spectrum (GPSS) Antibiotic, for Patients with Clostridioides difficile Infection
Authors: Garey Kevin W , Begum Khurshida , Hu Chenlin , Wang Weiqun , Lancaster Chris , Gonzales-Luna Anne J , Loveall Caroline , Jahangir Alam M , Silverman Michael 
Published: December 2021

Abstract

Background
Ibezapolstat, a DNA polymerase IIIC inhibitor, currently in Phase 2 clinical development for treatment of C. difficile infection (CDI). Its unique mechanism of action targets low G+C content Gram-positive bacteria primarily Firmicutes including C. difficile. Phase I healthy volunteer results demonstrated a favorable microbiome profile suggestive of an anti-recurrence effect. The purpose of this study was to report clinical outcomes, pharmacokinetics, and microbiome changes from this Phase 2a clinical study and to continue to test for anti-recurrence microbiome properties.

Methods
Ibezapolstat 450 mg was given twice daily for 10 days to patients with mild-moderate CDI defined as diarrhea plus a positive C. difficile toxin test. Test of cure was evaluated at day 12 and sustained clinical cure at day 38. Stool samples were evaluated for C. difficile cultures and microbiome changes.

Results
Ten subjects (female: 50%) aged 50 ±15 years were enrolled. All ten subjects experienced a clinical cure by the test of cure visit at day 12 and all 10 subjects experienced a sustained clinical cure at the day 38 visit. Ibezapolstat was well tolerated with 1 adverse event (nausea) probably related to drug. Ibezapolstat systemic exposure was minimal with no plasma level reaching 1 ug/mL any time during therapy. Ibezapolstat colonic concentrations averaged 400 ug/g stool at day 3 and greater than 1,000 ug/g by day 10 of dosing. Six of the seven available baseline stool samples grew toxigenic C. difficile of various ribotypes including RT078-226 and RT014-020 (Ibezapolstat MIC range: 0.25-1 ug/mL). Follow-up cultures were no growth starting from day 3 stool cultures. Microbiome changes included overgrowth of Actinobacteria and/or Firmicute phylum species while on therapy.

Conclusion
Favorable clinical efficacy and safety results were observed in ibezapolstat patients with CDI including 100% clinical cure and sustained clinical cure. These results begin to validate our approach to ibezapolstat development in that the favorable microbiome effects seen in healthy Phase 1 volunteers may be predictive of beneficial patient outcomes, including low rates of recurrence. These results support the continued clinical development of ibezapolstat.

Disclosures
Kevin W. Garey, Pharm.D., M.S., FASHP, Summit Therapeutics (Research Grant or Support) Michael Silverman, MD, Acurx Pharmaceuticals (Consultant)
703. Peritoneal Coccidioidomycosis in a Pediatric Patient: An Extremely Rare Presentation and Literature Review
Authors: Braz Barbara Ximenes , Soobhanath Chantal , Thompson Amelia B 
Published: December 2021

Abstract

Background
Chronic peritonitis is an unusual manifestation of coccidiomycosis (CM) that is challenging to diagnose and manage due to its propensity for relapse. It is even more unusual to diagnose peritoneal CM in the pediatric population, with only two other cases reported in the literature.

Methods
We present the case of a previously healthy 5-year-old Filipino female in Florida who was diagnosed with peritoneal CM. After months of unintentional weight loss and worsening abdominal distention, she presented to medical care. Imaging revealed significant abdominal ascites and nodularities throughout the peritoneum. The peritoneal fluid demonstrated a lymphocytic pleocytosis and infectious workup was benign. CA125 levels were elevated, but peritoneal adenosine deaminase was within normal limits. A biopsy of the affected tissue revealed diffuse granulomas surrounding spherules that were positive on GMS and PAS staining, concerning for CM. Exposure history revealed that she was raised in California and moved to Florida one year prior to presentation. Complement fixation titers were significantly elevated at ≥ 1:512 and immunodiffusion titers were positive. A Coccidioides PCR was sent from the tissue to the Mayo clinic and was positive, and fungal cultures from the tissue grew C. immitis/posadasii. Immunologic workup was reassuring. She was started on oral Fluconazole with rapid resolution of her symptoms.

Results
Involvement of the peritoneum in CM is extremely rare. Abdominal distention due to ascites is the most common presentation, and the peritoneal fluid is typically exudative. Imaging may reveal peritoneal deposits which can mimic other infections and malignancy. Diagnosis can be based on histopathological demonstration of fungal structures, cultures, antibody testing, antigen detection and/or PCR. Treatment guidelines suggest azole therapy for nonmeningeal disseminated CM with at least 6–12 months of treatment for extrapulmonary coccidioidal soft tissue infection.

Conclusion
Peritoneal CM is an extremely uncommon condition and it is even more rare in the pediatric population, but should be considered in those in the appropriate clinical settings, particularly if they have history to suggest exposure to regions where this fungus is endemic.

Disclosures
All Authors: No reported disclosures
704. Contemporary Salmonella spp. Infections in Houston, TX (2019 and 2020) and Emergence of Cephalosporin Resistance
Authors: tabarani christy , Flores Anthony R , Flores Anthony R , Arias Cesar A , Wanger Audrey 
Published: December 2021

Abstract

Background
Salmonella spp. Infections are a significant cause of morbidity in children in the United States. Contemporary clinical and microbiological characteristics of pediatric Salmonella infections in urban cities are not well described.

Methods
We used a retrospective chart review of records (0-18 years of age) from a network of hospitals (n=11) in Houston, TX. Only patients with Salmonella spp. isolated from clinical samples in 2019 and 2020 were included. Demographic, clinical, and microbiological data were extracted from the medical record.

Results
A total of 35 pediatric cases of Salmonella spp infection were identified over the two-year period. Median age was 1.6 years with over one-third (13/35, 37.1%) under one year (Table 1). Nearly half (15/35, 42.9%) of patients required hospitalization with a median length of stay of 2 days. From cases with available clinical data (n=31), most common symptoms were fever (22/31, 71%) and bloody diarrhea (21/31, 67.7%) (Table 2). Bacteremia was detected in 17.1% (6/35) of cases (Table 3). Exposure history was elicited in 29% (9/31) of cases with foreign travel being most common risk factor (Table 2). All speciated isolates were Salmonella enterica with the majority (24/29, 82.8%) subspecies enterica. Of 24 samples with serotype information, the most common was infantis (Table 3). A single isolate was resistant to all antibiotics tested except meropenem (Table 3) and was recovered from a patient after travel to Pakistan. Nearly half of patients (15/31, 48.4%) received definitive therapy with a third generation cephalosporin antibiotic. Complications were rare and included septic arthritis/osteomyelitis (n=1), UTI (n=3), coagulopathy (n=1), and hepatitis (n=1).

Conclusion
Salmonella spp. Infections were common in the Houston metropolitan area over the 2-year period and occurred primarily in young children. Foreign travel seems to be a major risk factor for acquisition of this infection in children. For the first time, the identification of a multi-drug resistant Salmonella isolate suggests that this phenotype is likely to increase and highlights the importance of ongoing 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)
705. Community Acquired Gastrointestinal Infections among Transplant Recipients
Authors: Al-Obaidi Mohanad , Zangeneh Tirdad T 
Published: December 2021

Abstract

Background
Community-acquired gastrointestinal (cGI) infections carry a significant risk of mortality and morbidity. Transplant patients are at increased risk of infectious complications. We aimed to study the risks and outcomes of cGI infections in this population.

Methods
After the institutional review board’s approval, a multi-center retrospective study was conducted. Data was collected from inpatient admission for patients with a history of hematopoietic stem transplantation or solid organ transplantation. Data regarding patient demographics, gastrointestinal polymerase chain reaction (GIPCR), clinical presentation, medications, discharge, and length of stay were collected. Chi-square test was performed to compare categorical data, and student’s t-test and Wilcoxon test were used to compare parametric and non-parametric variables accordingly.

Results
From 10/01/2017 to 07/14/2020, there were 445 encounters with GIPCR tests ordered. 48% were female, 53% were non-Hispanic White, and the mean age was 58 (SD ±14.6). Of the 445 encounters, 66 had a positive test. 40/66 had kidney transplants. The most common detected organisms were Norovirus (36%), Enteropathogenic E. coli (26%), Campylobacter species (9%), and Enteroaggregative E. coli (9%). The most common symptoms were abdominal pain and diarrhea, with 26% reported an exposure or a recent travel. There was no difference in the mortality rates between positive and negative GIPCR (3% versus 2.4%, p=0.7), during the study period. There was a significant difference in the mean length of stay between positive GIPCR with 7.5 (SD ±10.5) days versus 12.4 (SD ±18.3) days in negative GI PCR, p=0.036.

Conclusion
The majority of GIPCR tests were negative. Patients with positive GIPCR had shorter length of stay compared to negative GIPCR transplant recipients. There was no difference in mortality between positive and negative GIPCR among transplant patients. Future studies are required to evaluate the impact of cGI infections on transplant patients.

Disclosures
All Authors: No reported disclosures
707. Hospital-Onset Clostridioides difficile Infection Rates During COVID-19 Pandemic in the ICU Patients
Authors: Gavrielatou Evdokia , Temperikidis prodromos , Tsimaras Michalis , magira eleni 
Published: December 2021

Abstract

Background
Due to COVID-19 gastrointestinal microbiome alterations, COVID-19 can be complicated by Clostridioides difficile infection (CDI). This retrospective cohort study aimed to evaluate the prevalence of Clostridium difficile infection in patients with COVID-19pneumonia

Methods
A retrospective cohort study was conducted on PCR Covid-19 positive patients admitted in the ICU from September,2020 to 30th April 2021. All patients in the cohort study were on mechanical ventilation, or at some point during their ICU admission required mechanical ventilation. Hospital-onset (HO-CDI), defined as a positive C. difficile test over 3 days after admission.

Results
Overall, during the study period, a total of 240 PCR Covid-19 patients were admitted to the ICU; of these, 11 (4.5%) were COVID-19 CDI positive. Nine were males (81%). The mean hospital stay for these COVID-19 patients was 12 days (range 1–59 days). HO-CDI median day of identification was 12 days. All patients received ≥2 antibiotics and dexamethasone at admission. Compared to historical controls, COVID-19 patients did not have a higher overall CDI positive rate. However, mortality among COVID-19 HO-CDI patients was increased 7/11 (63%).

Conclusion
Whether COVID-19 itself increases an individual’s risk for CDI remains unclear. Multiple contributing factors drive CDI incidence, severity, and recurrence. Although protective measures such as gowns and gloves during COVID-19 increased, CDI cases in the hospital setting should continue to emphasize the importance of antimicrobial stewardship.

Disclosures
All Authors: No reported disclosures
708. Evaluation of Fungal Culture versus Bacterial Culture for the Identification of Various Mold Species
Authors: Su Erin , She Rosemary 
Published: December 2021

Abstract

Background
Invasive mold infections are challenging to diagnose and in part relies on fungal cultures. A large proportion of mold isolates are recovered on routine bacterial cultures in our medical center, thus we sought to define the utility of bacterial versus fungal cultures for isolation of mold from clinical specimens.

Methods
Routine bacterial and fungal culture results from wound, tissue, body fluid, and respiratory specimens from Jan 2019-Dec 2020 from Keck Medical Center of USC (Los Angeles, CA) were retrospectively reviewed. Cases were excluded if specimens were collected specifically for dermatophyte recovery or for blood culture. Cultures in which mold, including dimorphic fungi, were isolated were included in the evaluation.

Results
Mold was isolated from 612 specimens from 408 patients, with recovery from 329 bacterial and 450 fungal cultures. Among the 329 bacterial cultures, fungal cultures were not requested in 119 (36.2%) while the remaining 210 had concurrent fungal cultures which recovered mold in 167 cases (79.5%). Of 450 fungal cultures recovering mold, a corresponding bacterial culture was performed in 445, isolating mold in 181 (38.8%) of these cases. Two or more molds were found in 28 fungal cultures and in 5 bacterial cultures. Of positive specimens with both fungal and bacterial cultures performed (n=488), mold was isolated in fungal cultures in 446 (91.4%) and in bacterial cultures in 209 (42.9%) (Table).
Yield of molds in 488 specimens with concomitant bacterial and fungal cultures

Conclusion
Although a significant number of molds are recovered in routine bacterial cultures, over half would be missed without concomitant fungal cultures. Conversely, recovery of clinically relevant mold species was optimal when both bacterial and fungal cultures were requested on a specimen. This may be related to increased specimen sampling and incubation conditions allowing for broader organism recovery.

Disclosures
All Authors: No reported disclosures
709. Risk Factors for Candida auris Candidemia: Results from a Multicenter Case-Control Study
Authors: Simon Samuel , Li Rosanna , Andrade Justin A , Tharian Biju , Silver Michael , Cox Diana Villanueva , Gonzalez Daniel , Mayer Ariel M , Fu Lung H , Truong James , Figueroa Nilka , Ghitan Monica , Chapnick Edward , Lin Yu Shia 
Published: December 2021

Abstract

Background
The emergence of Candida auris as a global pathogen has been described as a serious global threat by the CDC. It has caused outbreaks in healthcare settings as it is transmissible between patients. The risk factors for candidemia caused by C. auris may be different than candidemia caused by other Candida spp.

Methods
We performed a multicenter, retrospective case-control study at three hospitals in Brooklyn, New York between 2016 and 2020. Patients with at least one positive blood culture for Candida spp who were started empirically on an antifungal within 24 hours of blood culture positivity were included in the study. Subsequent cases in the same patient were excluded unless separated by at least 90 days from the initial case. Similar variables such as antibiotics and antifungals within the same drug class were compressed into one variable. Variables with a p-value ≤ 0.05 on univariate analysis were entered into a multivariable analysis with a p-value ≤ 0.05 considered to be statistically significant.

Results
84 cases of C. auris candidemia and 105 cases of candidemia caused by other Candida spp were included in the analysis. The most common species of other Candida spp was C. glabrata (N=33, 31.7%) followed by C. albicans (N=32, 30.4%). In the multivariable model, the strongest risk factor for C. auris candidemia was prior infection or colonization with C. auris (aOR 17.5; 95% CI, 1.60-192.93; P = 0.019) followed by prior infection or colonization with multidrug-resistant bacteria (aOR 6.97; 95% CI 1.49-32.74, P = 0.014). A history of peripheral vascular disease (PVD) (aOR 7.78; 95% CI 1.34-45.34, P = 0.023), cerebrovascular disease (CVA) (aOR 4.24; 95% CI 1.18-15.20, P = 0.027) and hemiplegia (aOR 6.43; 95% CI 1.19-34.85, P = 0.031) were also statistically significant. These risk factors remained significant analyzing only patients without any history of C. auris.

Conclusion
These data suggest that in hospitalized patients with candidemia, a history of colonization or infection with C. auris, prior infection or colonization with multidrug-resistant bacteria, as well as a history of PVD, CVA, and hemiplegia are associated with C. auris candidemia.

Disclosures
Samuel Simon, PharmD, Accelerate Diagnostics (Employee)