bluuebunny/crossref_metadata_2025_split huggingface dataset:
675. Crimean-Congo Hemorrhagic Fever Beyond Ribavirin: A Systematic Review
Authors: Fabara Stephanie P , Tirupathi Raghavendra , Ortiz Juan Fernando , Patel Urvish , Srikanth Sashwath , Al-Tawfiq Jaffar A , Rabaan Ali A 
Published: December 2021

Abstract

Background
The Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne virus infection that has been reported in about 30 countries worldwide. Clinical presentation is divided into three phases: pre-hemorrhagic, hemorrhagic, and convalescence. Ribavirin is standard of care treatment for acute infection and prophylaxis. However, the use of other treatments beyond ribavirin is largely unknown.

Methods
We conducted a systematic review using MOOSE protocol. The inclusion and exclusion criteria are seen in the Prisma diagram. For Bias Analysis we use a Robin-1 tool.
Literature review algorithm

Results
We gathered a total of 10 studies, which included 4 therapeutic plasma exchange (TPE), 2 corticosteroids, 2 IVIG, and 1 with convalescent plasma (CP).
TPE in one study showed decreased mortality rate and increased efficacy in patients with severe CCHF. While the other study reported pulmonary embolism related to the use of TPE. Nevertheless, the patients had good outcome in the end. Two case reports used TPE plus ribavirin and supportive measures. Both were discharged home and recovered without sequela. Corticosteroids were found to be beneficial in one study were the case fatality rate was lower with the addition of corticosteroids to ribavirin in severely ill patients (p=0.0014). In a case series of six patients, who received the combination in early stages of the disease had good clinical outcomes with improved survival. IVIG was shown to increase platelet counts in two studies. In the first study, platelet count increased above 150,000/mL in 8.5 +/- 2.5 days. While in the other study the normalization of platelets was seen in 4 - 4.8 days, with no significant difference (P = 0.49). In addition, there was a decrease in the duration of symptoms but there was no statistically significant difference in mortality rates (P = 0.171). CP treatment showed a survival rate of 86% in treated patients. CP was more useful in high-risk patients, defined as having a viral load of 108 copies/mL or more. The main limitations of the studies were the sample size and heterogenicity among the outcomes of the studies.

Conclusion
TPE, CP, IVIG, and corticosteroids were effective in improving the clinical outcomes of the patients. The use of these treatments beyond ribavirin should be explored in future studies.

Disclosures
All Authors: No reported disclosures
677. Compliance and Performance Characteristics of Subject Collected Versus Health-care Worker Collected Nasal Swabs for Respiratory Viral Surveillance
Authors: Kautz Michelle , Epsi Nusrat J , Richard Stephanie A , Colombo Rhonda E , Ganesan Anuradha , Collins Limone , Burgess Timothy , Maves Ryan C , Maves Ryan C , Markelz Ana E , Geaney Casey , Seshadri Srihari , Utz Gregory , Mende Katrin , Hrncir David , Modi Jitu , Fries Anthony C , McClenathan Bruce , Schofield Christina , Montgomery Jay R , Skerrett Catherine , Spooner Christina , Coles Christian L , Lalani Tahaniyat 
Published: December 2021

Abstract

Background
Self-collection of mid-nasal swabs (SCNS) at home is a convenient alternative to health-care worker-collected nasal swabs (HCWC) for determining the pathogen-specific epidemiology of influenza-like illness (ILI). We evaluated the compliance and performance characteristics of SCNS vs. HCWC for respiratory pathogens during 2019-2020 flu season.

Methods
Adult Military Health System (MHS) beneficiaries were enrolled in an influenza vaccine effectiveness trial (PAIVED). Following vaccination, subjects were instructed on SCNS and completion of a symptom diary and were contacted weekly to ascertain ILI symptoms (fever, sore throat, and/or cough). In the event of an ILI, subjects completed the symptom diary and SCNS and were scheduled a clinic visit for HCWC. Swabs were tested with the Luminex NxTAG® Respiratory Pathogen Panel. We evaluated compliance with swab collection, positive percent agreement (PPA) of SCNS using PCR detection from either HCWC or SCNS as the reference standard, and agreement between paired swabs using the Cohen Kappa coefficient (Κ).

Results
1808 ILI were reported by 972 participants enrolled during the study period. Compliance with HCWC was higher than SCNS (58% [1042] vs. 42% [766]; p&lt; 0.001). SCNS were associated with a shorter interval from symptom onset (median: 4 days [IQR:2-6 days] vs. clinic collect: 7 days [IQR:4-9 days]; p &lt; 0.001). 663 paired swabs were available for 609 participants (Table 1). The overall detection rate was higher in SCNS (36%) than HCWC (26%; p&lt; 0.001) (Figure 1). The overall PPA was 85.7% and a PPA of approximately 80% of greater was observed for influenza, rhino/enterovirus, parainfluenza and respiratory syncytial virus. Agreement between paired swabs was poor due to the lower detection rates in HCWC.
Table 1. Demographics and swab collection data for 609 participants who provided 663 paired swabs

Figure 1. Detection by pathogen in 663 paired swabs

Conclusion
SCNS were associated with higher detection rates compared to HCWC, likely due to the shorter interval between symptom onset and swab collection. Strategies to improve compliance with SCNS and minimize the interval between symptom onset and swab collection are needed to optimize detection of respiratory pathogens in this MHS cohort.

Disclosures
Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker's Bureau)
679. Infective Endocarditis and Septic Emboli-Related Complications; Epidemiology and Impacts on Hospital Outcomes
Authors: Park Hansang , Majmundar Monil , Roy Soumyajit , Velasquez-Espiritu Maria Rosa , Ghosh Kuldeep , Kadeishvili Khatuna , Chaudhari Shobhana , Lopez Eliana A 
Published: December 2021

Abstract

Background
Infectious endocarditis (IE) remains a disease of high mortality, complications and a severe burden to the healthcare system despite advances in diagnostic techniques and treatments. There are several investigations of IE using a nation-based population cohort, however, with limited focus on septic emboli-related complications.
Figure 1. Flowchart of the study cohort. IE=Infective Endocarditis

Methods
We used the 2016 to 2018 National Readmission Database (NRD) to identify a primary diagnosis of admissions among adults (Age≥18) with IE. International Statistical Classification (ICD-10) codes were used to identify patients with a primary diagnosis of IE who experienced in-hospital septic emboli-related complications. Primary outcomes were mortality, length of stay, total cost and 30-day all-cause readmission. Uni- and Multivariate Linear, Logistic and Cox regression were used to assess statistical significance and a two-sided p-value less than 0.05 was considered significant.

Results
A total of 30,870 patients were admitted with a primary diagnosis of IE from 2016 to 2018 (December admissions were omitted). After excluding the patients with omitted information, 30,289 patients went into analysis. Baseline characteristics are shown in Table 1. Septic emboli-related complications were seen in 42.6% of the patients; about 10% had central nervous system (CNS) complications, 7% had cardiac complications and 20.2% had respiratory complications. Embolic complications of any kind were associated with higher mortality (Odds Ratio = 2.11 [1.74 – 2.54]), a longer length of stay (5.72 days [5.17 – 6.27]) and higher total costs (21,812 dollars [19,856 – 23,769]) while adjusted for baseline characteristics. Multivariate Cox regression to assess the risk of 30-day readmission was not statistically significant. Predictors of 30-day all-cause readmission among baseline characteristics and subgroups of embolic complications are shown in table 4 and table 5, respectively.

Conclusion
The prevalence of septic emboli-related complications was up to 42.6% of patients admitted with the primary diagnosis of IE. These complications significantly impact hospital outcomes; including mortality, length of stay and total cost. Further studies are required to clarify the relationship between 30-day all-cause readmissions and embolic complications.

Disclosures
All Authors: No reported disclosures
680. Month Long Fungemia due to Candida auris Endocarditis
Authors: khan Haseeba , Varughese Christy , Gonzalez Hemil 
Published: December 2021

Abstract

Background
Candida auris (C. auris) is a multidrug resistant Candida species, reported to cause persistent fungemia along with a multitude of invasive fungal infections. We report the first case of C. auris fungemia due to endocarditis.

Methods
61 year old man with a history of diverticulitis that required sigmoid resection and was complicated by abdominal abscesses due to multi drug resistant organisms warranting heavy antibiosis. Prolonged hospitalisation for that surgery was followed by a stay at a long term acute care hospital. He was readmitted at an outside hospital with sepsis where blood cultures grew C.auris. Upon evaluation, was found to have aortic valve endocarditis. Per patient’s preference, surgery was initially deferred. Despite escalation of therapy with a combination of antifungals, he remained fungemic for five weeks with repeat blood cultures showing changing antifungal susceptibility patterns. Patient eventually underwent surgical intervention at our facility, with valve cultures being positive for C.auris. After the surgery he was treated with 6 weeks of intravenous combination antifungal therapy.

Results
C.auris’s pathogenicity stems from multiple mechanisms with multi drug resistance being most pertinent. What adds to the complexity of the management is the absence of C.auris specific minimum inhibitory concentration breakpoints. Therefore treatment is based on Center for Disease Control’s (CDC) proposed breakpoints that have been extrapolated from other Candida spp. It is further complicated by lack of C.auris specific data showing essential agreement among different commercially available antifungal susceptibility testing (AFST). Heteroresistance of the microbial population is an issue that must be considered in such protracted fungemia.

Conclusion
Invasive infections due to Candida auris presents as a diagnostic and therapeutic challenge to clinicians.

Disclosures
All Authors: No reported disclosures
681. Penicillin Plus Ceftriaxone Against Enterococcus faecalis In Vitro Time-Kill Studies
Authors: Khan Ruhmazia , Shah Zeel , Huang Vanthida , Cusumano Jaclyn 
Published: December 2021

Abstract

Background
Synergistic ampicillin plus ceftriaxone (AC) for Enterococcus faecalis infective endocarditis outpatient use is precluded by ampicillin’s poor room temperature stability. Penicillin has superior stability and has been combined with ceftriaxone (PC), however there is a lack of studies to demonstrate synergy.

Methods
AC and PC were evaluated, in duplicate, for synergy utilizing 24-hour in vitro time-kill assays with a starting inoculum of 106 colony forming units (CFU)/mL. Six clinical E. faecalis blood isolates and one wild-type E. faecalis isolate (JH2-2) were included. All isolates were susceptible to ampicillin and penicillin, with minimum inhibitory concentrations (MICs) ranging from 0.5-1 µg/mL and 2-4 µg/mL, respectively. Ampicillin and penicillin were tested at subinhibitory concentrations (0.25x and 0.5xMIC) as monotherapy and in combination with ceftriaxone average steady state concentrations for a dose of 2g IV q12hr (CPss 17.2 µg/mL), as all ceftriaxone MICs were high due to intrinsic resistance (MICs 128-2048 µg/mL). Synergy was defined as a ≥ 2 log10 decrease in CFU/mL at 24 hours from the most active single agent.

Results
An average increase in bacterial density from the starting inoculum was observed for all isolates against ampicillin 0.25xMIC alone, penicillin 0.25x and 0.5xMIC alone, and ceftriaxone alone (+1.60 ± 0.62, +1.91 ± 0.37, +1.48 ± 0.42, and +1.84 ± 0.46 log10 CFU/mL, respectively) [Table 1]. Ampicillin 0.5xMIC alone average increase in bacterial density from starting inoculum for all but two isolates (e2008 and e2009) was +1.21 ± 0.59 log10 CFU/mL. Isolates e2008 and e2009 were the only isolates with a higher penicillin MIC of 4 µg/mL, and did not display synergy for all AC and all PC combinations. AC synergy was observed for all other isolates, with only one isolate (e2012) displaying synergy at 0.5xMIC. PC synergy was observed for four isolates at 0.5xMIC (-3.47 ± 0.94 log10 CFU/mL) and for only one isolate (e2014) at 0.25xMIC but the change in bacterial density was -0.38 ± 0.24 log10 CFU/mL.

Conclusion
PC synergy against E. faecalis was observed with higher penicillin concentrations. AC and PC did not demonstrate synergy against isolates with a higher penicillin MIC of 4 µg/mL. Further research is warranted to better understand PC synergy against E. faecalis.

Disclosures
All Authors: No reported disclosures
682. Implantable Cardioverter-Defibrillator Lead Vegetation with Long-Standing Actinomyces neuii Bacteremia
Authors: Irwin Mark , Tilem Steven , Ervin Charlie , de la Serna Fernando , Sampath Rahul 
Published: December 2021

Abstract

Background
Endocarditis caused by Actinomyces species is uncommon with only 30 cases reported in contemporary literature.

Methods
We present a novel case of cardiovascular implantable electronic device (CIED) endocarditis secondary to infection by Actinomyces neuii – a unique non-branching member of the species that grows in both anaerobic and aerobic media.

Results
Our patient, a 51-year-old female, with a history of implantable cardioverter-defibrillator (ICD) placement 17 years prior for heart failure, presented with six weeks of fevers and rigors. She was referred to the infectious disease clinic for evaluation of pyrexia of unknown origin. Her examination was unremarkable, and the ICD pocket was uninflamed. Her initial labs revealed mildly elevated inflammatory markers and renal insufficiency. Blood cultures were positive for slow-growing non-branching gram-positive rods in both aerobic and anaerobic media. These were identified as Actinomyces neuii by mass spectrometry. Review of outside records showed positive blood cultures with Actinomyces neuii at another facility two weeks prior to our evaluation which were not acted upon and thought to be bacterial contamination. The patient was further evaluated with a transesophageal echocardiogram that demonstrated a 3.3 x 2.2cm mobile vegetation attached to the ICD lead. She subsequently underwent removal of her Saint Jude cardiac resynchronization therapy defibrillator and leads using laser and snaring techniques, but the tail end of the ventricular lead fractured and could not be retrieved. The ICD pocket was also found to be infected. A planned 6-week course of IV ampicillin was interrupted by 2 weeks of ceftriaxone for treatment of an intercurrent lower respiratory tract infection. The patient regained her baseline health and was discharged 2 weeks after ICD removal with a LifeVest. She is to complete 12 months of oral amoxicillin therapy after completion of IV antibiotics in view of retained lead fragment, and long standing Actinomyces bacteremia - consistent with published management strategies.

Figure 1. Transesophageal echocardiogram demonstrating size of vegetation.

Figure 2. Three-dimensional view demonstrating vegetation on the ICD lead.

Conclusion
Here we describe the first known case of Actinomyces neuii CIED endocarditis with a large lead vegetation and long-standing bacteremia, presenting as pyrexia of unknown origin.

Disclosures
All Authors: No reported disclosures
684. Diagnostic Yield of Echocardiography in Coagulase Negative Staphylococcus Bacteremia
Authors: Nagarakanti Sandhya , Bishburg Eliahu , Okoh Alexis , Grinberg Sagy , Suryadevara Madhu 
Published: December 2021

Abstract

Background
Coagulase negative Staphylococcus (CoNS) bacteremia is a common clinical finding, but is less commonly associated with infective endocarditis (IE). Echocardiography (Echo) is utilized when clinicians suspect the diagnosis of IE. We sought to evaluate the utilization and yield of Echo in patients who had 1 or ≥ 2 (+) blood cultures (BC) for CoNS, and correlate Echo results with a diagnosis of IE.

Methods
A retrospective review in a tertiary care hospital between 2013-2020. Patients with or without cardiac device, who had either 1 or ≥ 2 BC positive for CoNS and who underwent Echo were included. Modified Duke’s (MDC) criteria was used for the diagnosis of IE. Logistic regression was used to examine the association between BC positivity, device existence and the presence of a vegetation on Echo.

Results
We included 116 patients, median age 58 (41-70) years, 64 (55%) women. Cardiac device was present in 69 (59%): Automated implantable cardioverter defibrillator in 49 (71%), pacemaker in 11(16%), ventricular assist device in four (6%), intra-aortic balloon pump in five (7%). CoNS isolated from 1 BC in 53(46%) patients and from ≥ 2 in 63(54%) patients. Trans- thoracic Echo (TTE) was performed in 42(36%), trans- esophageal Echo (TEE) in 39 patients (33.6%). Sequential Echo (TEE after TTE) was performed in 34 patients (29%). “Definite” IE was diagnosed in none, “possible” IE in 30 (26%), the diagnosis was “rejected” in 86 (74%). Vegetations were noted on device lead in 13(43%) and on valves in 17(57%). Overall yield in patients classified as “possible” IE (n=30) was similar in patients with device (n=26) to those without a device (n=4) (22% vs. 3%; p=0.149). For patients with 1 BC positive for CONS, the presence of a device was not associated with a positive Echo yield (OR, 95% C.I: 1.8 (0.3, 12.9); p=0.474). Patients who had ≥ 2 BC for CoNS had the same Echo yield with or without a cardiac device (15% vs. 24% p=0.243).

Conclusion
In our medical center, patients with CoNS bacteremia, no patients had a “definite” diagnosis of IE. Yield of Echo was similar in patients with either one or ≥ 2 positive BC and there was no significant association with the presence of a device.

Disclosures
All Authors: No reported disclosures
685. Evaluating the Role of Medication-assisted Treatment (MAT) in the Management of Infectious Endocarditis in People Who Inject Drugs (PWID)
Authors: Gorseth Allison , Nolan William , Cluff Monica , O'Sullivan David , Dempsey Casey J 
Published: December 2021

Abstract

Background
An estimated 1.29-2.59 million people practice intravenous drug use (IVDU) in the United States making it a growing risk factor for infective endocarditis (IE). In people who inject drugs (PWID), IE accounts for 5-10% of total yearly deaths. IE often requires weeks of intravenous therapy with extensive medical follow-up. The purpose of this study was to evaluate if medication-assisted treatment (MAT) increased treatment retention and survival to optimize addiction assistance and IE treatment efforts.

Methods
A single-center, retrospective chart review was approved for patients admitted with an ICD-10 code of IE. A multidisciplinary group was created in April, 2019 aimed to improve endocarditis patient outcomes, formed of complex case coordination, infectious disease, cardiology, and pharmacy pain management service members. The historical period was January 1, 2018-March 31, 2019 and the IE pathway (IEP) group was April 1, 2019-June 30, 2020. Patients were excluded if there was no documentation of IVDU (Figure 1). The primary outcome was successful endocarditis therapy, defined per study protocol. Secondary outcomes include: against medical advice (AMA) departures, discharge naloxone prescriptions, clinical opioid withdrawal score (COWS) and patient reported pain.
Figure 1. Study Population

Methods for study population inclusion and exclusion

Results
A total of 419 IE patients were evaluated with 166 patients meeting inclusion criteria. The primary outcome was achieved in 51.2% of historical group and 48.8% of the IEP group (p=0.302). AMA departures and inpatient mortality were similar between the two groups. There was increased presence of the pharmacy pain management service with decreased time to consult in the IEP group (Figure 2). Last documented COWS were increased in the IEP group (p=0.002), while last reported patient pain scores decreased (p=0.030). More patients were started on MAT and discharged with naloxone in the IEP group (Table 3). Readmission was found to be higher in the IEP group (p=0.046). Post hoc analysis evaluating outcomes for patients seen by the endocarditis pathway team were similar between the two groups (Table 4).
Figure 2. Secondary Outcome (Consult Services)

The secondary outcomes of the study population are described comparing the presence and time to various consult services. **P-value indicates statistical significance. Abbreviations: n, number; ID, infectious disease; CT, cardiothoracic
Table 3. Secondary Outcomes

Table 4. Post Hoc Analysis

Conclusion
The multidisciplinary group was effective helping to guide the inpatient care of PWID and improve symptom management, but this did not translate to increased successful IE therapy or fewer readmissions.

Disclosures
All Authors: No reported disclosures
686. Comparing Treatments of Methicillin-Resistant Staphylococcus aureus Infective Endocarditis by People Who Inject Drugs
Authors: Rebold Nicholas , Alosaimy Sara , Lagnf Abdalhamid M , Holger Dana , Rybak Michael J 
Published: December 2021

Abstract

Background
People who inject drugs (PWID) are at high risk for infective endocarditis (IE) with high-mortality pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). Stigma against PWID may cause differences in treatment and outcomes between these patients infected with MRSA IE.

Methods
Single center retrospective cohort study from August 2006 to February 2021 that includes adult patients diagnosed with IE. Primary outcomes included 90-day all-cause mortality, 60-day MRSA recurrence, 60-day readmission, and hospital length of stay (LOS). Statistical analysis was performed by chi-square, t-test, and Mann-Whitney-U as appropriate.

Results
A total of 214 patients were diagnosed with MRSA IE; 89 PWID and 125 non-PWID. The mean (SD) age was 47.4±12.4 years (PWID) vs 59.3 ±16.0 years (non-PWID) (p&lt; 0.001). Patients were primarily male (56%), but differed in terms of race 34% African-American (AA) (PWID) vs 66% AA (non-PWID) (p&lt; 0001). Mean APACHE II scores differed between groups: 16(±9.9) (PWID) vs 19(±8.1) (non-PWID) (p&lt; 0.008). Among patients who cleared bacteremia, mean (SD) duration was 5.7(±3.9) days and was not significant between groups (p&lt; 0.64). Valve-type was 93% native and 7% prosthetic and not different between groups (p&lt; 0.16). Infectious Diseases consult did not differ at 96% overall (p&lt; 0.31), but pursuit of source control nearly reached significance at 27% for PWID vs 41% non-PWID (p&lt; 0.06). Similarly, use of combination therapy daptomycin and ceftaroline was nearly significant: 21% (PWID) vs 12% (non-PWID) (p&lt; 0.09). Odds ratio of PWID and combination therapy remained non-significant after regression: 0.39(0.14-1.1,p&lt; 0.07). Primary 90-day mortality was lower in PWID vs non-PWID (15% vs 30%) respectively (p&lt; 0.01), but did not differ in 60-day MRSA recurrence (p&lt; 1.0) at 9%, 60-day readmission (p&lt; 1.0) at 33%, or median LOS (IQR) (p&lt; 0.46) at 15 (10-24) days overall.

Conclusion
While PWID are significantly younger, less critically ill, and have lower mortality compared to non-PWID, they have similar LOS, MRSA recurrence, and readmission rates. Analyses suggest a potential difference in the pursuit of source control and combination therapy among PWID, however more studies may be needed to achieve significance.

Disclosures
Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support)