bluuebunny/crossref_metadata_2025_split huggingface dataset:
1201. A Prolonged Multispecies Outbreak of Carbapenemase-Producing Enterobacteriaceae Due to Transmissible Plasmid With Carbapenemase Gene
Authors: Yamagishi Takuya , Matsui Mari , Sekizuka Tsuyoshi , Ito Hiroaki , Fukusumi Munehisa , Uehira Tomoko , Tsubokura Miyuki , Tawa Akio , Nakamori Shoji , Miyamoto Atsushi , Yoshida Hideki , Suzuki Satowa , Shibayama Keigo , Kuroda Makoto , Matsui Tamano , Oishi Kazunori 
Published: November 2018

Abstract

Background
In 2010, a multispecies outbreak of IMP type carbapenemase-producing Enterobacteriaceae (IMP-CPE) occurred at a large acute care hospital in Japan. The outbreak continued for years involving more than 100 patients mainly in surgical wards.

Methods
Because of the long period of the outbreak, investigation were focused on hospitalized patients whose clinical samples were positive for IMP-CPE between July 2013 and March 2014. A case–control study was conducted for cases who underwent abdominal surgery with controls from whom meropenem-susceptible Enterobacteriaceae were isolated. Pulsed-field gel electrophoresis (PFGE) was used for molecular typing. To evaluate genetic relationship among IMP-CPE isolates of different species, plasmid analysis using S1 nuclease to separate plasmid and chromosomal DNA followed by plasmid DNA extraction and whole-genome sequencing (WGS) was conducted.

Results
During the study period, 22 cases were identified and 22 IMP-CPE isolates which consisted of eight Escherichia coli, five Klebsiella oxytoca, five Enterobacter cloacae, three Klebsiella pneumoniae and one Enterobacter aerogenes were obtained. All five isolates of K. oxytoca had similar PFGE profiles which suggested clonal transmission. However, PFGE profiles of E. coli, E. cloacae and K. pneumoniae isolates were diverse. Plasmid analysis revealed that all 22 isolates shared ca. 50 kb IncN plasmid with blaIMP-6 which implies interspecies transmission of it The case–control study which adjusted by days of hospitalization with 11 cases and 24 controls revealed that pancreato-duodenectomy (adjusted odds ratio (aOR) = 6.4, 95% confidence interval (CI) 1.3–32.4) and enteric fistula (aOR = 8.0, 95% CI 1.5–41.9) were associated with IMP-CPE acquisition. Use of endoscopy within the past six months was not associated with IMP-CPE (aOR = 0.8 95% CI 0.2–4.2). With a bundled infection control with Osaka City Public Health Office, the outbreak was contained in July 2016.

Conclusion
Dissemination of carbapenemase gene by transmissible plasmid can play a critical role to complicate epidemiology of CPE outbreak and made it difficult to control. Plasmid analysis using WGS technology is a promising tool to untangle it.

Disclosures
All authors: No reported disclosures.
1202. Multimodal Sequencing of a Clonal Case Cluster of Carbapenem-Resistant Citrobacter Reveals Unexpectedly Rapid Dynamics of KPC3-Containing Plasmids
Authors: Bhattacharyya Roby , Pironti Alejandro , Walker Bruce J , Manson Abigail , Pierce Virginia , Ferraro Mary Jane , Shenoy Erica , Hooper David C , Earl Ashlee 
Published: November 2018

Abstract

Background
Carbapenem-resistant Enterobacteriaceae (CRE) are a major public health threat. We report four clonally related Citrobacter freundii isolates harboring the blaKPC-3 carbapenemase in April–May 2017 that are nearly identical to a strain from 2014 at the same institution. Despite differing by ≤5 single nucleotide polymorphisms (SNPs), these isolates exhibited dramatic differences in carbapenemase plasmid architecture.

Methods
We sequenced four carbapenem-resistant C. freundii isolates from 2017 and compared them with an ongoing CRE surveillance project at our institution. SNPs were identified from Illumina MiSeq data aligned to a reference genome using the variant caller Pilon. Plasmids were assembled from Illumina and Oxford Nanopore sequencing data using Unicycler.

Results
The four 2017 isolates differed from one another by 0–5 chromosomal SNPs; two were identical. With one exception, these isolates differed by &gt;38,000 SNPs from 25 C. freundii isolates sequenced from 2013 to 2017 at the same institution for CRE surveillance. The exception was a 2014 isolate that differed by 13–16 SNPs from each 2017 isolate, with 13 SNPs common to all four. Each C. freundii isolate harbored wild-type blaKPC-3. Despite the close relationship among the 2017 cluster, the plasmids harboring the blaKPC-3 genes differed dramatically: the carbapenemase occurred in one of the two different plasmids, with rearrangements between these plasmids across isolates. The related 2014 isolate harbored both plasmids, each with a separate copy of blaKPC-3. No transmission chains were found between any of the affected patients.

Conclusion
WGS confirmed clonality among four contemporaneous blaKPC-3-containing C. freundii isolates, and marked similarity with a 2014 isolate, within an institution. That only 13–16 SNPs varied between the 2014 and 2017 isolates suggests durable persistence of the blaKPC-3 gene within this lineage in a hospital ecosystem. The plasmids harboring these carbapenemase genes proved remarkably plastic, with plasmid loss and rearrangements occurring on the same time scale as two to three chromosomal point mutations. Combining short and long-read sequencing in a case cluster uniquely revealed unexpectedly rapid dynamics of carbapenemase plasmids, providing critical insight into their manner of spread.

Disclosures
M. J. Ferraro, SeLux Diagnostics: Scientific Advisor and Shareholder, Consulting fee. D. C. Hooper, SeLux Diagnostics: Scientific Advisor, Consulting fee.
1207. Acquisition and Quantification of Antimicrobial Resistance Genes in the Gut Microbiome of Ugandan Women Exposed to Small-Scale Chicken Farming
Authors: Debela Meti D , Muyanja Daniel M , Kakuhikire Bernard , Baguma Charles , Bangsberg David R , Tsai Alexander C , Weil Ana A , Lai Peggy S 
Published: November 2018

Abstract

Background
Antibiotic use in livestock farming is thought to be a major contributor to the spread of antimicrobial resistance (AMR) genes in humans. However, quantitative data in this in this field are rare. To address this gap in the literature, we examined the prevalence of clinically important AMR genes before and after the introduction of chicken farming among women in rural Uganda.

Methods
We recruited a subset of women participating in a waitlist-randomized controlled trial of small-scale hybrid chicken farming in rural Uganda. Tetracycline is routinely administered to chicks during brooding. Stool samples before and one year after chicken introduction were obtained from six women randomized to the control arm, from five women randomized to the intervention arm, and from chickens. Microbial DNA was extracted from chicken and human stool and screened for 87 AMR genes using validated qPCR arrays (Qiagen).

Results
The median age was 35 years. At baseline, 10 of the women reported animal contact, most commonly goats (n = 8), free ranging village chickens (n = 7), cats (n = 4), and dogs (n = 4). During baseline testing of the women’s stool, we detected 18 genes conferring AMR to aminoglycosides, fluoroquinolones, macrolides, lincosamides, streptogramin B, Class A-C β-lactamases and tetracycline efflux pumps. Chickens harbored 23 AMR genes from the same classes as found in humans, and were also found to have vancomycin resistance genes (Van B and C) and Group D β-lactamases (OXA-58 and OXA-10). At one year, six new AMR genes emerged in controls, including one present in chickens; CTX-M-1, a Class A β-lactamase. In contrast, seven new AMR genes emerged in the intervention group, including four present in chickens: SHV, SHV(238G240E), (Class A β lactamases) and QnrS, QnrB-5 (fluoroquinolone resistance genes). Two AMR genes gained by both control and intervention groups were not present in chickens.

Conclusion
Women exposed to small-scale chicken farming acquired more AMR genes compared with unexposed participants. Chickens harbored many of the genes that emerged in humans. Introduction of antibiotic-treated animals may result in the transfer of AMR genes from animals to humans, even among humans exposed to a wide range of animals at baseline.

Disclosures
All authors: No reported disclosures.
1208. Impact of Admission to an Inpatient Infectious Disease Unit on Methicillin-Resistant Staphylococcus aureus Bloodstream Infections
Authors: Mirza Zainab Farooqui , Bardossy Ana C , Misikir Helina , Hadid Hind , Baratz Nathalie , Rizvi Hira , Herc Erica , Chen Anne , Zervos Marcus 
Published: November 2018

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) remains a condition with high mortality. Despite the introduction of new antibiotics, the mortality in the past 10 years at our institution remains unchanged. To evaluate measures that improve outcomes in these patients (patients), we studied the impact of admission to an inpatient infectious disease (ID) unit.

Methods
We identified a retrospective cohort of patients with MRSA BSI at an 800-bed hospital in urban Detroit from January 2013 to February 2017. Patients were assigned to one of the three groups: group 1 was admission to inpatient ID unit where the ID doctors were the attending physicians, group 2 was ID consultation (without admission to ID unit), and group 3 was no ID consultation. Demographics, clinical information, and 30 day mortality from index blood culture were collected. Source of BSI was classified into four categories: primary (endovascular infection); secondary (respiratory, skin, osteomyelitis, abdominal and genitourinary infections); central line associated; unknown. Unpaired t-test and Fisher’s exact test were used to compare groups.

Results
A total of 477 patients were identified with MRSA BSI during the study period. 89 (18.7%) were in group 1, 299 (62%) in group 2 and 89 (18.7%) in group 3. Pt clinical characteristics and outcomes are shown in Table 1. Overall 30-day mortality was 21.4%. Comparison of mortality between groups are shown in Table 2.

Conclusion
While it is well established that ID consultation has improved outcomes in MRSA BSI, this is the first study that shows that admission to an inpatient ID unit decreases mortality even further.

Disclosures
All authors: No reported disclosures.
1215. Geographic Distribution of Staphylococcus aureus With Reduced Sensitivity and Resistance to Vancomycin in the Dominican Republic
Authors: Mena Lora Alfredo J , Gonzalez Patricia , Lluberes Magnolia , Grau Gabriel , Bleasdale Susan C 
Published: November 2018

Abstract

Background
Resistant Staphylococcus aureus (SA) poses a major challenge to clinicians. The prevalence of methicillin-resistant SA (MRSA) has increased over the past decades, while vancomycin resistance remains rare. Only 14 cases of vancomycin-resistant SA (VRSA) have been described in the United States since 2002. VRSA and SA with reduced susceptibility to vancomycin (VISA) cause high morbidity and mortality. There is a paucity of data on VRSA in developing nations. We seek to define the prevalence and resistance profile of SA in the Dominican Republic (DR).

Methods
This is a retrospective review of resistance patterns of SA isolates from a clinical laboratory in the DR (Amadita Laboratories). Amadita provides services nationwide. Data collected from 2016 to 2017 included SA phenotypic sensitivity patterns and geographic location and income level. VISA and VRSA were defined as having minimum inhibitory (MIC) concentrations between 4 and 8 and MIC &gt;16.

Results
Of 5,372 SA samples, 2,735 (51%) were MRSA, 21 were VISA and 39 were VRSA. VRSA samples were more commonly from Santo Domingo (SD) (Figure 1). Communities in SD with mixed and low incomes had greater burden of VRSA (Figure 2). Antimicrobial susceptibilities are shown in Table 1.

Conclusion
In this nationwide sample, we found an alarming number of VISA and VRSA. Most cases were in metropolitan SD, with lower income communities carrying a higher case burden. Linezolid and TMP-SMX retain activity against VISA and VRSA in the DR. The rise of vancomycin resistance in developing countries and the disproportionate burden on communities of low income is concerning and requires further study. Infection control measures and antimicrobial stewardship interventions may help prevent further spread of resistant strains.

Disclosures
All authors: No reported disclosures.
1217. Staphylococcus Protein A (spa) Typing Demonstrates Genetic Heterogeneity of Methicillin-Susceptible Staphyloccus aureus (MSSA) in a Neonatal Intensive Care Unit (NICU)
Authors: Hill-Ricciuti Alexandra , Ferguson Samantha , Geng Wenjing , Stump Stephania , Messina Maria , Zachariah Philip , Sahni Rakesh , Green Daniel , Whittier Susan , Saiman Lisa , Uhlemann Anne-Catrin 
Published: November 2018

Abstract

Background
In the NICU, MSSA is a more prevalent pathogen than MRSA, but optimal infection prevention and control strategies for MSSA are not yet well understood. There are likely multiple routes of MSSA acquisition given its role as normal flora and its detection in the anovaginal tract of pregnant women. We describe the molecular epidemiology of MSSA in our NICU during a yearlong surveillance effort.

Methods
Included infants were hospitalized in a university-affiliated level III-IV NICU from January to December 2017 (1032 admissions) and had positive clinical and/or surveillance cultures for MSSA. Infants admitted at ≥7 days of age were screened for MSSA colonization by culturing the anterior nares and three skin sites. All infants in the NICU were screened twice monthly. Spa typing was performed to genetically characterize isolates.

Results
During the study period, MSSA was identified in 187 infants (18 at admission, 145 by twice monthly surveillance, and 24 from clinical cultures). In all, 269 MSSA isolates (245 surveillance and 24 clinical isolates) from 166 infants were spa typed. Sixty-two MSSA spa types were identified; 31 (50%) were each detected in only one infant. The incidence of the nine most common spa types is shown (Figure 1); t279 (13%), t002 (8%), and t1451 (6%) had the highest incidence. t1451 and t571 belong to ST398, a common MSSA clone in the local community. The epidemiology of spa types varied; e.g., incident cases of t279 was detected in 10 months, t1451 was detected in 6 months and t148 in 3 months. Among the 14 sets of twins and triplets with MSSA isolates, 12 (86%) shared the same spa type as their sibling(s). Of the 58 infants with &gt;1 MSSA isolate, 12 (21%) acquired new spa-types. No spa type(s) predominated in the 19 episodes of invasive infections. In 6 infants with both colonizing and invasive isolates, colonizing and invasive isolates were the same spa type(s) in 5.

Conclusion
Spa typing demonstrated that MSSA isolates in our NICU exhibited substantial genetic heterogeneity. While these data do not elucidate acquisition route(s), they suggest infants are acquiring MSSA from multiple sources, likely including family members and the local community. Ongoing sequencing studies are examining common spa types to further understand transmission dynamics.

Disclosures
A. C. Uhlemann, Merck: Investigator, Grant recipient
1225. High Rate of Linezolid (LZD) Nonsusceptibility (LNS) Among Enteric Vancomycin-Resistant Enterococci (VRE) Recovered From Hospitalized Patients Actively Screened for VRE Rectal Colonization (VREC)
Authors: Dilworth Thomas J , Beck Eric , Pedersen Rachel , Al-Karkokly Waseem , Cook Margaret , Aldag Erika , Kramer David J , Sahajpal Ajay , Nadeem Iram , Buggy Brian , Brummitt Charles F 
Published: November 2018

Abstract

Background
Select hospitalized patients are actively screened for VREC but VRE isolates may not undergo antibiotic susceptibility testing. We sought to identify predictors of daptomycin (DAP) nonsusceptibility (DNS, MIC &gt; 4) and LNS (MIC &gt; 2) among enteric VRE isolates recovered from patients actively screened for VREC for which antibiotic susceptibility testing was not preformed.

Methods
This was a retrospective study of consecutive adults admitted to a surgical intensive care unit (ICU) or associated medical unit between June 1, 2017 and March 1, 2018 who had a VRE isolate from active screening. Only index isolates were included. DAP and LZD MICs were determined by Etest. Patient- and antimicrobial-level data, including ambulatory prescriptions, dating back to January 1, 2016 were collected. Multivariable logistic regression models were used to determine predictors of DNS and LNS VRE.

Results
In total, 64 patients’ VRE rectal isolates were included. Fifty-nine (92.2%) were E. faecium and 50 (78.1%) were from ICU patients. Thirty-seven patients (57.8%) were female and the mean age ± SD was 60 ± 13 years. Five (7.8%) and 20 (31.3%) patients had previous abdominal transplant and VRE infection, respectively. DAP and LZD MIC distributions are shown in the table below. Forty-one (64.1%) VRE isolates were LNS, including five LZD-resistant isolates. Only one (1.6%) isolate was DNS precluding an analysis of DNS predictors; 12 (18.8%) isolates had a DAP MIC &gt; 2 mg/L. Common antimicrobial exposures prior to index VRE isolate included: vancomycin (62.5%), ceftriaxone (64.1%), cefepime (53.1%), metronidazole (50%), and ciprofloxacin (50%). Previous LZD (17.2%) and DAP (15.6%) exposure were less common. In a multivariable model, number of previous cefazolin doses (adjusted odds ratio (aOR) 0.74 95% confidence interval (CI) 0.55–0.95), and previous tobramycin exposure (aOR 0.15, 95% CI 0.02–0.81) were inversely associated with LNS. Previous LZD exposure was not associated with LNS.

Conclusion
LNS was common amongst VRE isolates in this cohort. Previous LZD exposure was infrequent and not associated with LNS. LZD susceptibility testing among VRE isolates recovered from patients actively screened for VREC warrants clinical consideration.

Disclosures
All authors: No reported disclosures.
1226. Can Universal Decolonization Obviate the Need for Screening and Contact Precautions for Carriers of Methicillin-Resistant Staphylococcus aureus in a Medical Intensive Care Unit With MRSA Endemicity? An Interrupted Time Series Study
Authors: Lee Seung Soon , Kim Yong Kyun , Han Junhee , Jung Younghee 
Published: November 2018

Abstract

Background
Universal decolonization of patients in intensive care units (ICUs) has been identified to be an effective infection control strategy of methicillin-resistant Staphylococcus aureus (MRSA). However, it remains uncertain whether universal decolonization can obviate the need for active surveillance testing (AST) and contact precautions (CPs) for MRSA carriers.

Methods
We conducted an interrupted time series study to evaluate whether universal decolonization (daily chlorhexidine bathing plus twice-daily intranasal mupirocin ointment for 5 days) without AST and CPs did affect the incidence of MRSA acquisition on clinical specimen and MRSA bacteremia (the first positive blood culture obtained more than 48 hours after ICU admission) in a medical ICU. There was a 12-month control period of universal decolonization combined with AST and CPs, followed by a 12-month intervention period of universal decolonization without AST and CPs for MRSA carriers. Changes in incidence density (new cases of MRSA acquisition on clinical specimen per 1,000 eligible patient-days) of MRSA were evaluated by segmented Poisson regression, and the cox proportional-hazards regression model was used to compare the differences in incidence of MRSA bacteremia between the two periods.

Results
The median overall prevalence of MRSA did not differ between the two periods (25.3% vs. 23.4%, P = 0.55), and the segmented Poisson regression analysis revealed that there were no significant differences in both level and trend of MRSA prevalence (P = 0.43 and P = 0.27, respectively). The incidence density of MRSA acquisition on clinical specimen was lower during the intervention period (5.7 vs. 4.5, P = 0.039). However, both level and trend of MRSA incidence density did not differ significantly whether to perform active surveillance and contact precaution or not (P = 0.94 and P = 0.81, respectively). No patient developed MRSA bacteremia during the control period and there were only two patients of MRSA bacteremia during the intervention period, which showed no significant difference (Log rank test, P = 0.21).

Conclusion
Universal decolonization without AST and CPs for MRSA carriers do not increase the incidence of MRSA acquisition on clinical specimen and ICU-attributable MRSA bacteremia in ICU with high prevalence rate of MRSA.

Disclosures
All authors: No reported disclosures.
1229. Prevalence and Acquisition of MRSA in Females During Incarceration at a Large Inner-City Jail
Authors: Popovich Kyle J , Zawitz Chad , Aroutcheva Alla , Payne Darjai , Schoeny Michael , Diep Lisa , Hota Bala , Hayden Mary K , Weinstein Robert A 
Published: November 2018

Abstract

Background
USA300 MRSA is endemic in the community, with congregate settings such as urban jails potentially facilitating spread. It has been reported previously that males have a higher risk for MRSA carriage and bacteremia than females. However, it is unclear if there is differential risk for MRSA based on gender in high-risk populations. We determined the prevalence of MRSA colonization at jail entrance in females and defined an acquisition rate during incarceration.

Methods
Females incarcerated at the Cook County Jail, one of the largest US single-site jails, were enrolled within 72 hours of intake. Surveillance cultures (nares, throat, groin) were collected to determine prevalence of MRSA colonization. A survey was administered to identify predictors of colonization. Detainees in jail at Day30 had cultures repeated to determine MRSA acquisition. Univariate and multivariate analyses were performed to identify predictors of MRSA colonization.

Results
250 women were enrolled (70% AA, 15% Hispanic) with 70% previously in jail (21% in the past 6 months). The prevalence of MRSA colonization at intake was 20% (50/250), with 42% of those colonized solely in the throat or groin. This intake prevalence is comparable to the 19% for male detainees in a parallel study. 9% (2/23) of initially negative women who remained in jail for 30 days acquired MRSA; five remained colonized and no one lost colonization. Univariate predictors (table) of MRSA at entrance to the jail were: illicit drug use (including using needles), unstable housing, engaging in anal sex, and recent exchange of sex for drugs/money. Women who exchange sex for drugs/money (vs. not) reported higher rates of needle use (35% vs. 4%, P &lt; 0.001) and unstable housing (80% vs. 20%, P &lt; 0.001). With multivariate adjustment for race/ethnicity, needles for illicit drugs was a significant predictor of MRSA (OR 5.89, 95% CI, 1.66, 20.94, P = 0.006).

Conclusion
We found that a high proportion (20%) of females entered jail colonized with MRSA, comparable to rates in males, suggesting that previously reported gender disparities in MRSA may not exist in high-risk populations. Entrance colonization risk factors suggest high-risk activities or venues in the community, with potential for directing gender-specific interventions.

Disclosures
All authors: No reported disclosures.