bluuebunny/crossref_metadata_2025_split huggingface dataset:
1006. Demographic, Clinical, Microbiological Characteristics and Outcome of Patients Admitted to the Emek Medical Center with Blood Stream Infection Acquired in LTCF: A 5-Year Surveillance
Authors: Almog Moty , Yanovskay Anna , Edelstein Hana , Colodner Raul , Schwartz Naama , Chazan Bibiana 
Published: November 2018

Abstract

Background
Residents from long-term care facilities (LTCF) hospitalized with an acute infectious disease are challenging in terms of diagnosis and treatment, considering atypical clinical presentation are high rate of resistant bacteria,.
This study aimed to Characterize patients with LTCF acquired bacteremia (LTCF-B), epidemiology of blood cultures (BC) and potential risk for mortality.

Methods
A retrospective study of LTCF residents hospitalized with LTCF-B. Demographic, clinical and laboratory data were collected and analyzed using SPSS 22 and SAS.

Results
One hundred seventy-seven LTCF residents hospitalized in internal wards were included, mean age 81.6 years, mostly completely dependent, 54.8% were males. Most frequent diagnoses was urinary tract infection (UTI), second by respiratory tract infections. Half were hospitalized during prior 6 months, one-third had a permanent indwelling urinary catheter. On admission, 70% had WBC blood count &gt;10,000 cells/mL. The following pathogens were isolated from BC: Gram-negative enterobacteriaceae (70%): E. coli were 40% and Gram-positive cocci (21%): S. aureus 5.08% (55.5% of them MRSA). Extended-spectrum-β-lactamase (ESBL) producing enterobacteriaceae were in 47.1% BC, clearly document increase during the years, 26% (2010)–63% (2014). Absolute majority of enterobacteriaceae were sensitive to carbapenems and amikacin, half were resistant to gentamycin, second- and third-generation cephalosporins and quinolones. Inappropriate empiric antimicrobial therapy was given to 46.8% of patients with ESBL-producing enterobacteriaceae (P &lt; 0.001). Mortality rates were 21.5% in-hospital and 46.3% day-90 post discharge. Variables associated with mortality: initial diagnosis of skin and soft-tissue infections (SSTI) (OR = 14.44), inappropriate empiric antibiotic (OR = 5.038), high level of urea (OR = 1.017), and nasogastric tube (OR = 4.966). UTI (OR = 0.316) was a protective factor.

Conclusion
Diagnosis of SSTI, high urea levels, nasogastric tube, and inappropriate empiric antibiotic were associated with in-hospital mortality. The notable increased rate of ESBL-producing enterobacteriaceae should alert physicians to be aware of local microbial resistance profile, especially among LTCFs patients.

Disclosures
All authors: No reported disclosures.
1007. Etiology of Sepsis; A Systematic Review of Emergency Department Sepsis
Authors: Husebye Ashley , Baxter Caitlin , Wesenberg Elizabeth , Hansen Glen 
Published: November 2018

Abstract

Background
Sepsis is a systemic response to an infection involving one or multiple organ failures frequently caused by bacteremia. Over a million cases of sepsis are reported in the United States annually with an estimated 25% mortality. Early recognition, diagnosis, and treatment of sepsis in the Emergency Department (ED) improves patient outcomes. Increased awareness of sepsis has fostered novel opportunities to improve diagnostics. EDs are increasingly targeted as areas of primary care for suspected septic patients. Understanding the etiology of ED sepsis supports empiric approaches and opportunities for targeted diagnostics. However, a systematic analysis of etiology of ED sepsis, spanning multiple years, is lacking.

Methods
A retrospective analysis conducted over 60 months at Hennepin County Medical Center, an inner-city level one trauma center with over 100,000 ED visits annually were examined. Positive blood cultures drawn in the ED were included in data analysis. Charts were reviewed for patient demographics and whether the culture was treated; infections that were not treated were considered contaminants, and relevant susceptibility patterns.

Results
A total of 8,013 blood cultures were drawn in the ED over an initial 12-month period. Of these, 8.4% (n = 674) were culture positive resulting in 731 microorganisms. Of these, 314 were treated as infections with the remaining considered contaminants. Overall contamination rate was 2.9%. Of clinically relevant positive blood cultures, 19.4% were Escherichia coli, 18.5% were Staphylococcus aureus, 27.1% were strep species (group A strep 5.4%, group B strep 4.8%, strep pneumonia 5.1%), 7.0% were Enterococcus faecalis, and 6.4% Klebsiella pneumonia. Among these species, they accounted for 78.4% of pertinent positive cultures. Gram-negative bacteremias accounted for 41% of infections compared with 59% for Gram-positive organisms.

Conclusion
A comprehensive understanding of the etiology of ED sepsis facilitates appropriate empiric antimicrobial prescribing for patients who present with sepsis in the ED. Data collected to date identifies five key bacterial species associated with over 78% of confirmed ED sepsis.

Disclosures
All authors: No reported disclosures.
1010. Effectiveness of Oral Antibiotics for Definitive Therapy of Gram-Positive Bloodstream Infections
Authors: Roshdy Danya , Quinn Nick , Sebaaly Jamie , Templin Megan , Weinrib David 
Published: November 2018

Abstract

Background
Transition from intravenous (IV) to oral (PO) antibiotics is common practice in patients with Gram-positive bloodstream infections (GP-BSI); however, clinical data evaluating IV to PO switch options are lacking. The objective of this study was to examine effectiveness of PO antibiotics for definitive treatment GP-BSI, with a focus on bioavailability (BA).

Methods
This was a single-center, retrospective cohort study of adult inpatients admitted to an 874-bed academic medical center in Charlotte, NC between September 1, 2014 and August 31, 2017. Patients with a GP-BSI who received appropriate antibiotic therapy with at least one third of their total course administered PO were included. Patients with GP-BSI caused by staphylococcal species were excluded. The primary endpoint was clinical failure in patients receiving high (≥90%) vs. low (&lt;90%) BA agents. Secondary endpoints included clinical failure stratified by antibiotic group, bactericidal vs. bacteriostatic agents, and organism. Chi-square and Fisher’s exact tests were used to examine clinical failure.

Results
One hundred three patients were included, 26 in the high BA group, and 77 in the low BA group. The median age was 58, 51% were women, 74.8% of patients had streptococcal bacteremia (26.2% S. pneumoniae), with pulmonary being the most common source (30.1%). There were no major differences in baseline demographic and clinical characteristics between groups. The median treatment duration with IV antibiotics was 4 and 5 days in the high and low BA groups, respectively (P = 0.12). There was no statistically significant difference in clinical failure in the high vs. low BA groups (19% vs. 23%, P = 0.66, respectively). Clinical failure stratified by antibiotic group, bacteriostatic vs. bactericidal agent (OR 1.43, CI 0.26–7.90), and organism also did not yield statistically significant differences.

Conclusion
These data demonstrate similar rates of clinical failure among patients definitively treated with high or low BA agents for GP-BSI. High BA agents such as fluoroquinolones may not be needed for all patients with GP-BSI, where more targeted β-lactam therapies may be appropriate. Additional prospective studies with larger sample sizes are needed to further validate these conclusions.

Disclosures
All authors: No reported disclosures.
1013. If Blood Cultures Were Not Done Before Starting Antibiotics, Is It of Any Value to Obtain Them Later?
Authors: Rand Kenneth , Beal Stacy , Allen Brandon , Payton Thomas , Lipori Gloria , Rivera Kimberly 
Published: November 2018

Abstract

Background
Obtaining blood cultures before starting antibiotics is one of the pillars of the Surviving Sepsis Campaign (SSC), and delay in obtaining blood cultures (BC) after starting antibiotics is associated with increased mortality (Levy M 2015, Pruinelli L 2018), but we were unable to find data on the relationship between such a delay and a reduction in percentage of positive cultures.

Methods
All adult patients (&gt;18) admitted from the UFHealth Shands Emergency Department (ED) between August 2012 and December 2016 were included in the study (N = 30,743), excluding hospital-hospital transfers. BC were done with BacTec aerobic, anaerobic, and pediatric resin bottles, incubated for 5 days. We calculated the hourly rate of positive BC obtained before and after the start of IV antibiotics by subtracting the time stamp in the electronic medical record (Epic) between the first BC collection time and the start of the first IV antibiotic dose. We considered S. aureus, all Gram-negative rods, β-hemolytic Streptococci and Enterococci as significant pathogens and coagulase negative Staphylococci, S. viridans, Propionibacterium sp., Micrococcus sp. and Bacillus sp. as contaminants hospital ransfers.

Results
The percentage of BC with significant growth was unchanged during the first hour after starting IV antibiotics, but declined significantly in the period 1–12 hours after IV antibiotics were started. The overall positivity rate before starting IV antibiotics was 1,646/20,867 (7.9%) of patients and declined to 112/3,490 (3.2%), P &lt; 0.0001, in the 1–12 hour period afterwards, but did not decline to 0. Septic patients averaged 1,143/4,923 (23.2%) positive and declined to 65/728 (8.9%), P &lt; 0.0001, while nonseptic patients averaged 503/15,944 (3.15%) positive before antibiotics and declined to 47/2,762 (1.7%) P &lt; 0.0001, 1–12 hours after. It should be pointed out that these are group averages from different patient groups at each hourly time, rather than individual patients with blood cultures drawn serially.

Conclusion
We conclude that IV antibiotics dramatically reduce the likelihood of getting a positive blood culture, but not during the first hour of administration; however, the residual positivity rate remains high enough that blood cultures are still clinically worthwhile.

Disclosures
All authors: No reported disclosures.
1015. Enhanced Detection of Bloodstream Pathogens From Positive Blood Culture Specimens With an Improved Multiplex PCR Molecular Diagnostic System
Authors: Green Jeremy , Carter Caitlin , Chandler Craig , Clark Angela , Thatcher Stephanie 
Published: November 2018

Abstract

Background
Timely bloodstream infection (BSI) pathogen identification requires robust sample purification and testing methods that can accommodate the wide variety of blood culture media used for growing positive blood culture (PBC) specimens. Sensitive molecular methods are needed for identification of all organisms present in PBD, especially polymicrobial cultures which can be difficult to identify with standard methods. Multiple types of BD and BioMérieux blood culture media commonly used in hospital laboratories were used to evaluate the performance of a prototype BioFire® FilmArray® Blood Culture Identification 2 (BCID2) Panel with PBCs.

Methods
Fungi (seven) and bacteria (19) were independently seeded in blood samples, inoculated into as many as eight different types of blood culture bottles, and incubated on the recommended instrument. Time to positivity (TTP) was recorded for all PBCs. Subsets of PBCs were enumerated and tested on the BioFire BCID2 Panel and BioFire® FilmArray® Blood Culture Identification (BCID) panel. Polymicrobial testing was performed by seeding fast and slow growing organisms into the same bottles.

Results
Over 750 PBCs were enumerated; ~500 PBCs were tested on the BioFire BCID2, and over 200 were also tested on the BioFire BCID. 100% of seeded PBCs tested on the BioFire Panels resulted in correct pathogen identification. Across all bottle types, fungi grew to levels ranging from 8E+05 to 5E+07 CFU/mL, Gram-positive bacteria titers ranged from 7E+06 to 2E+09, and Gram-negative bacteria titers ranged from 9E+07 to 3E+09. Polymicrobial PBCs (30) had reduced titers of slow growing organisms when seeded with fast growing organisms but were detected by both BioFire BCID Panels at a rate of 99%.

Conclusion
This study demonstrates that a prototype BioFire BCID2 Panel, and the BioFire BCID Panel, robustly detect and identify (100%) BSI pathogens over a multitude of common blood culture media and systems. Results confirm PBC (single and polymicrobial) titers are above the levels of sensitivity for both BioFire panels. An expanded menu of targets (organism and resistance) and faster run time with the BioFire BCID2 Panel will offer a flexible and comprehensive aid in the diagnosis of BSIs. The BioFire® BCID2 Panel has not yet been evaluated by the FDA or other regulatory agencies for in vitro diagnostic use.

Disclosures
J. Green, BioFire Diagnostics, LLC: Employee, Salary. C. Carter, BioFire Diagnostics, LLC: Employee, Salary. C. Chandler, BioFire Diagnostics, LLC: Employee, Salary. A. Clark, BioFire Diagnostics, LLC: Employee, Salary. S. Thatcher, BioFire Diagnostics, LLC: Employee, Salary.
1017. Impact of Enterococcal Bloodstream Infection on Mortality in Patients With Acute Myelogenous Leukemia
Authors: Messina Julia , Miller Marion Hemmersbach , Sung Anthony , Alexander Barbara D , Chao Nelson 
Published: November 2018

Abstract

Background
Though enterococcal bloodstream infection (EBSI) is common in patients with acute myelogenous leukemia (AML), its impact on mortality requires further elucidation. Our objectives were to: (1) determine attributable mortality to EBSI and (2) compare overall, 1-year, relapse-related mortality (RRM), and treatment-related mortality (TRM) between AML patients with and without EBSI.

Methods
This was a retrospective cohort receiving intensive chemotherapy for AML from 2010 to 2015. EBSI was defined by _1 positive blood culture for E. faecium or faecalis and fever, hypotension, or chills. Attributable mortality to EBSI was defined by failure to achieve BSI Clearance (_1 negative culture _24 hr after last positive culture and defervescence) by the date of death. Student’s t-test was used to compare continuous variables, and C2 test was used for categorical variables. Kaplan–Meier was used for survival analyses (unadjusted), and P-values were computed by log-rank.

Results
Three hundred eight patients were identified during the study period: 80 with EBSI and 228 without EBSI. 5/80 patients died with EBSI (6%) although 4/5 patients had concurrent infections at the time of death (Clostridium difficile colitis, candidemia, proven invasive aspergillosis, and probable invasive fungal disease, respectively). There were no significant differences between overall and 1-year mortality (Table 1). In the survival analyses, EBSI did not significantly impact overall survival, 1-year mortality, RRM, and TRM (Figure 1). However, patients with vancomycin-resistant EBSI (VRE) trended toward increased overall mortality.

Conclusion
Attributable mortality to EBSI is uncommon (6%) in AML. Additionally, EBSI does not significantly impact mortality in this vulnerable patient population that already has very high rates of RRM and TRM. However, as EBSI inflicted 26% of patients over the course of this study period, further investigation is needed to elucidate the morbidity suffered from this common infection and identify potentially modifiable risk factors.
Table 1.

Disclosures
A. Sung, Merck: Grant Investigator, Grant recipient. Enterome: Grant Investigator, Grant recipient.
1018. Prevalence of Bacteremia/Fungemia and Pneumonia in Remission Induction Chemotherapy for Adult Acute Myeloid Leukemia From 1987 to 2005: Japan Adult Leukemia Study Group (JALSG)
Authors: Kato Hideaki , Fujita Hiroyuki , Akiyama Nobu , Kimura Shun-Ichi , Hiramoto Nobuhiro , Hosono Naoko , Takahashi Tsutomu , Shigeno Kazuyuki , Minamiguchi Hitoshi , Miyatake Junichi , Handa Hiroshi , Kanda Yoshinobu , Yoshida Minoru , Miyawaki Shuichi , Ohtake Shigeki , Naoe Tomoki , Kiyoi Hitoshi , Matsumura Itaru , Miyazaki Yasushi 
Published: November 2018

Abstract

Background
Remission induction (RI) chemotherapy for acute myeloid leukemia (AML) is one of the most intensive chemotherapy available. Antibiotic prophylaxis and prompt treatment for infectious complications during RI chemotherapy play a major role in supportive care.

Methods
We retrospectively analyzed the infectious complications associated with RI chemotherapy listed in the Japan Adult Leukemia Study Group AML201 protocol, a nationwide study of de novo AMLs, conducted between 2001 and 2005 in Japan. Of the 1,057 cases initially included in the AML201 study, 980 cases with data on infectious complications during RI chemotherapy were analyzed. The incidences of infectious complications and the causative pathogens were compared with previous studies [(period A) 1987–1991, 577 cases; (B) 1992–1995, 669 cases; (C) 1995–1997, 531 cases; (D) 1997–2001, 808 cases; (E) 2001–2005, 980 cases].

Results
In study period E, the causative pathogens of bacteremia/fungemia were Staphylococcus epidermidis (20.9%), S. aureus (11.6%), Streptococcus sp. (14.0%), and other Gram-positive bacteria (18.6%); P. aeruginosa (12.8%) and other Gram-negative bacteria (10.5%); and fungi (9.3%). Pathogens causing pulmonary infections were Aspergillus sp.(15.8%), P. aeruginosa (7.9%), and other Gram-negative bacteria (6.9%) and Gram-positive bacteria (3.0%). Pulmonary aspergillosis was diagnosed mainly using serological test. The prevalence of bacteremia/fungemia was reported in 11.8%, 9.4%, 8.7%, 9.2%, and 8.3% of cases and pulmonary infections were reported in 24.6%, 16.9%, 13.9%, 12.9%, and 10.3% of cases in the study periods A, B, C, D, and E, respectively. The incidence of Gram-negative bacteremia was significantly lower in period E compared with the periods A, B, and C (2.0% vs. 4.9%, 3.7%, and 3.4%, respectively).

Conclusion
The prevalence of Gram-positive bacteremia and pulmonary aspergillosis was higher in period E than in the periods A–D. This trend was possibly due to the wide use of fluoroquinolone prophylaxis in neutropenic patients and high performance of the serological test for aspergillosis. Sufficient monitoring for Gram-positive bacterial infection and mold infection is therefore essential during RI chemotherapy for AML.

Disclosures
All authors: No reported disclosures.
1019. Treatment Outcomes for Enterococcus faecium Bacteremia in Solid-Organ Transplant Patients: Implications for Daptomycin
Authors: Mercuro Nicholas J , Kenney Rachel M , Alangaden George , Davis Susan L 
Published: November 2018

Abstract

Background
Optimal antimicrobial therapy for Enterococcus faecium (EFM) bacteremia in the solid-organ transplant (SOT) population is not well defined. Antimicrobial resistance, immunosuppression, and high mortality associated with EFM infections all pose serious threats. The purpose of this study was to describe the pharmacotherapy and outcomes of EFM bacteremia in SOT patients.

Methods
This was a single-center retrospective cohort of SOT patients with EFM bloodstream infection from 2013 to 2018. Susceptibility of ampicillin (AMP), vancomycin (VAN), linezolid (LZD), and daptomycin (DAP) against EFM were reported as MIC90 when available. The primary outcome, 30-day all-cause mortality, was assessed in bivariate analysis to identify potential risk factors. Secondary outcomes included inpatient mortality and development of DAP nonsusceptibility (DNS).

Results
Forty-four unique cases representing 40 patients were included in the analysis. The median age was 62.5 years and liver (65.9%), intestine (20.5%), and kidney (11.4%) were the most common organs transplanted. The MIC90 of VAN, DAP, and LZD of initial isolates collected were &gt;32 mg/L, 4 mg/L, and 2 mg/L, respectively; all were AMP resistant. The median durations of hospitalization and intensive care stay were 29 days and 17.5 days, respectively. Most patients had indwelling central lines (81.8%) at the time of bacteremia; intra-abdominal abscesses/fluid collections were present in 45.5% of patients and 9.1% had endocarditis. The most common definitive antimicrobial regimens were DAP plus β-lactam (45.5%), DAP monotherapy (18.2%), and LZD 600 mg Q12H (25.0%). The mean initial and definitive DAP doses were 8.1 ± 1.6 and 8.9 ± 1.7 mg/kg actual body weight, respectively. Among subjects that received DAP, 21.9% developed DNS. Inpatient mortality was 39.5% and 30-day mortality was 27.3%. Mortality at 30-days was greater in patients with high-grade bacteremia (40.7 vs. 5.9%, P = 0.01) and receipt of DAP &lt;10 mg/kg as the first active antibiotic (42.9 vs. 13.0%, P = 0.03).

Conclusion
Inadequate DAP dosing for EFM bacteremia may be associated with mortality in the SOT population. Larger, matched analyses are necessary to determine the impact of optimized pharmacodynamics.

Disclosures
S. L. Davis, Achaogen: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. Nabriva: Scientific Advisor, Consulting fee. Zavante: Scientific Advisor, Consulting fee.
1020. Injection Drug Use-Associated Staphylococcus aureus Bacteremia in a Large Urban Hospital in Atlanta, Georgia
Authors: Serota David P , Kelley Colleen , Jacob Jesse T , Ray Susan M , Schechter Marcos C , Kempker Russell 
Published: November 2018

Abstract

Background
Infectious complications of injection drug use (IDU) have increased with the expanding opioid epidemic in the southeast. We assessed the incidence, clinical presentation, and treatment outcomes of IDU-associated Staphylococcus aureus (SA) bacteremia (SAB).

Methods
We created a retrospective cohort of all adults with community acquired (CA) SAB over 5 years presenting to Grady Memorial Hospital, a 1,000-bed urban county hospital in Atlanta, GA. Charts were reviewed by infectious diseases physicians to obtain clinical and laboratory characteristics, including substance use disorder (SUD), and determine if SAB was IDU-associated. The study period was divided into three periods (P1 = March 2012–January 2014, P2 = January 2014–December 2015, P3 = December 2015–November 2017) to evaluate changes in the incidence of IDU-SAB over time using Poisson regression.

Results
Among 321 patients with a first episode of CA-SAB, 24 (7%) were IDU-SAB. The number of IDU-SAB cases in each period increased (P1 = 4, P2 = 7, and P3 = 13 [P = 0.07 for trend]). The median age of IDU-SAB patients was 38 (IQR 31–57), 11 (46%) were black, and 15 (63%) had chronic hepatitis C virus infection. Heroin was the most common injected drug (92%) followed by cocaine (25%); multiple drugs were injected in 29%. All but two patients (92%) had a complication of SAB, most commonly endocarditis (50%) and septic pulmonary emboli (38%). The median hospitalization was 23 days (IQR 19.5–37.5) and 5 patients (12%) left the hospital against medical advice (AMA). Readmission for persistent or recurrent SA infection during the study period was common (42%), and three (13%) died ≤6 months from initial presentation, including two with prior discharge AMA. Half of the discharge summaries did not mention SUD as a hospital problem. Outpatient SUD treatment was recommended to eight (33%) patients and a recommendation of abstinence was the intervention for 12 (50%).

Conclusion
Increasing IDU-SAB was observed over 5 years in our urban Atlanta hospital, primarily due to heroin use. Most cases were associated with complications of SAB with a long length of stay and frequent readmission, but few patients received treatment or harm reduction interventions for their SUD. These data will raise awareness and direct resources to expanding evidence-based opioid use disorder treatment for patients with infectious complications of IDU.

Disclosures
All authors: No reported disclosures.