bluuebunny/crossref_metadata_2025_split huggingface dataset:
1105. Vibriocidal Titer Variation and Likelihood of Protection in Children Compared With Adults in a Cholera Endemic Area
Authors: Ritter Alaina , Chowdhury Fahima , Becker Rachel , Bhuiyan Taufiq , Khan Ashraful , Ryan Edward T , Calderwood Stephen B , LaRocque Regina , Harris Jason , Qadri Firdausi , Weil Ana 
Published: November 2018

Abstract

Background
Vibrio cholerae, the causative agent of cholera, is responsible for significant morbidity and mortality worldwide. Children less than 5 years old have the highest disease burden of cholera in endemic areas. While children develop serum vibriocidal antibody responses to cholera vaccines, they derive less protection from vaccination compared with adults. The aim of our study was to determine whether the vibriocidal immune responses to V. cholerae infection are equally accurate as markers of protection in all age groups.

Methods
Cholera patients and their household contacts, who are known to be at high risk of V. cholerae infection, were enrolled between 2001 and 2017 in Dhaka, Bangladesh. Baseline vibriocidal titers were measured at the time of enrollment of household contacts, and participants were followed prospectively for development of V. cholerae infection.

Results
We studied 50 contacts &lt; 5 years old (“young children”), 228 contacts 5–16 years old (“older children”), and 548 contacts &gt; 16 years old (“adults”). The baseline serum vibriocidal titer was higher in contacts who remained uninfected from all age groups than in contacts who developed cholera during the follow-up period (young children: P = 0.0092; older children: P = 0.0003, adults: P = 0.0012).

Conclusion
We found that higher vibriocidal antibody titers were associated with protection against V. cholerae infection across all three age categories. These findings may help increase our understanding of the protective immune response against V. cholerae infection and have importance for future vaccine development strategies.
Acknowledgments: This research was supported by Massachusetts General Hospital training grant T32AI007061.

Disclosures
All authors: No reported disclosures.
1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant
Authors: Schuster Jennifer , Johnston Samantha , Piya Bhinnata , Dulek Daniel , Wikswo Mary E , Browne Hannah , Vinje Jan , Payne Daniel C , Azimi Parvin H , Selvarangan Rangaraj , Halasa Natasha B , Englund Janet 
Published: November 2018

Abstract

Background
Acute gastroenteritis (AGE) is a frequent sequela in children undergoing hematopoietic cell transplant (HCT). Although rotavirus and norovirus have been implicated as important causes of AGE, the frequency of other pathogens is unknown. Little data exist on longitudinal prevalence of infectious AGE in HCT.

Methods
From February 2015 to May 2016, subjects &lt;18 years undergoing allogeneic HCT were enrolled at four CDC-NVSN sites: Oakland, Kansas City, Seattle, and Nashville. Stool samples were collected at enrollment, weekly until discharge or day 100 (whichever occurred earliest), during re-admissions within the first 100 days, and day 100. AGE was defined as unexplained ≥3 episodes diarrhea and/or ≥1 episode vomiting/24 hours. Specimens were tested using Luminex xTAG Gastrointestinal Pathogen Panel (Austin, TX) and real-time PCR for adenovirus, astrovirus, norovirus, and sapovirus.

Results
Thirty-one patients were enrolled at four sites (Seattle: 13, Kansas City: 8, Oakland: 6, Nashville: (4) with median age 5 (IQR 3–10) years. Two hundred sixteen samples were obtained with median 7 samples/subject. During the first 100 days, 29 (94%) subjects met the AGE definition. Thirty-six single pathogen detections occurred in 16 (52%) subjects. Clostridium difficile was the most frequent pathogen (Figure 1), with 14 detections in nine patients, all ≥3 years; 50% of detections were asymptomatic. Seven (50%) detections occurred at HCT onset and none received targeted C. difficile therapy. Sapovirus was detected nine times in four patients, with seven (78%) detections associated with AGE symptoms. Rotavirus was detected nine times, during five symptomatic episodes, in three patients. Adenovirus was detected four times in three patients and all were symptomatic.

Conclusion
We longitudinally characterized the etiology of infectious AGE in children undergoing HCT. Despite the majority of patients meeting the definition for AGE, only half had a pathogen detected, suggesting that differentiating infectious vs. noninfectious AGE (e.g., medication induced) in this population is difficult. Although all subjects with adenovirus and most with sapovirus were symptomatic, asymptomatic C. difficile detection was common. Interestingly, norovirus was not detected. Further investigation of AGE is warranted in this population.

Disclosures
All authors: No reported disclosures.
1110. A multicenter Evaluation of Outcomes Associated With Oral Vancomycin Dose in Patients With Clostridium difficile Infection
Authors: Bidell Monique , Novak Gregory , Singh Gurkirat , Bratek Benjamin , Duru Odirichukwu , Mitchell Colby , O’Donnell J Nicholas 
Published: November 2018

Abstract

Background
Clostridium difficile infection (CDI) is a significant cause of morbidity and mortality. IDSA guidelines recommend oral vancomycin (VAN) for the treatment of CDI, although doses used in practice vary substantially. The purpose of this study was to determine differences in outcomes between patients treated with high dose (HD; ≥250 mg four times daily [QID]) vs. standard dose (SD; 125 mg QID) VAN for CDI.

Methods
This multicenter study evaluated patients at two hospitals in Albany, NY diagnosed with CDI and treated with oral VAN between January 2013 and August 2017. Hospitalized patients were included if: age ≥18 years, positive C. difficile toxin polymerase chain reaction (PCR), symptomatic infection (e.g., new onset or increased frequency of loose stools), and received ≥48 hours of VAN QID. Patients were excluded if: received ≥48 hours of metronidazole prior to VAN initiation, VAN per rectum, required surgical intervention ≤48 hours from PCR, had a history of fecal microbiota transplant, received ≥1 dose of fidaxomicin or tigecycline prior to or within 48 hours from PCR, or died ≤48 hours from PCR. The primary outcome was 90-day CDI recurrence; secondary outcomes included 30-day all-cause mortality and 90-day readmission. Variables with a P-value &lt;0.2 in univariate analysis were evaluated in multivariate (MV) analyses.

Results
Four hundred fifty-eight patients were included (site 1: 270; site 2: 188). Two hundred twenty-four patients received SD VAN (48.9%); 234 received HD VAN [250 mg QID: 199 (43.5%); 500 mg QID: 35 (7.6%)]. Baseline demographics were similar between groups. Patients treated with HD were more likely to present with colitis (19.2 vs. 29.5%, P = 0.01) and have higher infection severity based on IDSA (P &lt; 0.01), Zar (P &lt; 0.01), and American College of Gastroenterology (P &lt; 0.02) criteria. Modified APACHE II scores were similar between SD and HD groups (median: 12.2 vs. 12.9, P = 0.17). MV analysis identified no difference in 90-day recurrence with HD (OR 1.65, P = 0.13) after controlling for solid tumor cancers, immunosuppression, and IDSA severity. Similarly, no significant differences between SD and HD were observed for 30-day mortality and 90-day readmission.

Conclusion
No differences in recurrence, mortality, or readmission were identified between SD and HD oral VAN for the treatment of CDI, though HD VAN patients primarily received 250 mg QID.

Disclosures
All authors: No reported disclosures.
1127. Genomic Analysis of Biofilm-Forming Enteroinvasive E. coli Emergent Pathogen
Authors: Gomez-Duarte Oscar , Guerra Julio , Ko Ricky 
Published: November 2018

Abstract

Background
Enteroinvasive Escherichia coli (EIEC) are involved in dysenteric diarrhea among children in low- and middle-income countries. EIEC strains isolated in Colombia, South America were shown to form biofilms and to be invasive in vitro. The O96:H19 serotypes and biofilm formation (BF) are not common phenotypes among EIEC, and the role they may play in diarrhea is at present unknown. The main goal of this study was to identify virulence and BF genes from EIEC genomic data. We hypothesize that EIEC O96:H19 strain 52.1 originated from horizontal transfer of a Shigella-like virulence plasmid into a non-EIEC pathogenic E coli strain.

Methods
WGS was performed on the BF-EIEC 52.1 strain using NextGen Illumina and Pacific Biosciences (PacBio) platforms. Publically available genomes from other EIEC O96H19 and Shigella genomes previously published were analyzed using online available software and databases including NCBI, BLAST, Mauve, among others. This analysis was tailored to identify virulence factors from the virulence factor database (VFDB). BLASTn was used to determine identity and query coverage of genes encoding the Shigella virulence factors. EIEC and Shigella genomes were analyzed on a multiple genome alignment software (Mauve) to verify results from BLASTn and to determine pseudogenes.

Results
The genome of EIEC O96:H19 strain 52.1 was 5,193,449 bp in size, containing 5,050 coding DNA sequences (CDSs). O96:H19 strain 52.1 carries three plasmids, the invasion plasmid (pINV) contains all type 3 secretion system (TTSS) and TTSS effectors genes previously described for Shigella and EIEC O96:H19 CFSAN029787 Italian strain. Non-TTSS virulence genes were also identified, including: long polar fimbrial gene (IpfA), enterotoxin (senB), and antibiotic resistance genes.

Conclusion
The EIEC O96:H19 strain 52.1 genome carries TTSS genes within a virulence plasmid, protein effector genes, and enterotoxin genes known to be associated with EIEC virulence. The EIEC O96:H19 stain 52.1 is an emergent diarrheagenic pathogen likely derived from an E. coli O96:H19 strain that acquired a Shigella-like virulence plasmid by horizontal transfer.

Disclosures
All authors: No reported disclosures.
1136. Universal Prophylaxis for Prevention of Invasive Aspergillus in Lung Transplant Recipients
Authors: Guenette Alexis , Gonzalez A Adrian , Emtiazjoo Amir 
Published: November 2018

Abstract

Background
Invasive aspergillosis (IA) is a significant complication status post lung transplantation with an incidence of 6% to 16%. Because early diagnosis of IA in lung transplant is hampered by the lack of specific clinical signs and by the low sensitivity of culture-based diagnostic methods, the efficacy of bronchoalveolar lavage galactomannan (BAL GM) for early diagnosis is explored in this study.

Methods
A retrospective analysis was performed on 45 consecutive lung transplant recipients between January 2015 and February 2016 at UF Health Shands Hospital. All patients were placed on prophylactic itraconazole post-transplant. Surveillance bronchoscopies were performed at 2 weeks, 1 month, 3 months, 6 months, 9 months, and 12 months post-transplant. During each bronchoscopy, bacterial, fungal, and acid-fast bacterial cultures along with BAL GM [an optical density (OD) index of ≥0.5 considered positive] were obtained. If BAL GM ≥1.0, the patient was switched to voriconazole for further treatment. CT Chest was also evaluated. If BAL GM remained ≤1.0 at the 6 month interval, then prophylaxis was complete. IA was defined using the EORTC/MSG criteria for invasive fungal disease (i.e., patient classified as either having proven, probable or possible IA).

Results
There was a total of 225 observations from the 45 patients. Two patients (4.4%) had proven IA with a mean GM of 4.153 (SE, 0.629) and seven patients (15%) had probable IA with a mean of 2.169 (SE, 0.409). There was no correlation of cold ischemic time (P = 0.88), primary graft dysfunction (PGD, P = 0.38), presence of Candida species (P =0.048) or non-tuberculous mycobacteria (NTM) in bronchoalveolar lavage (P = 0.044), and viral pneumonitis (P = 0.047) with a positive BAL GM. All nine patients with GM &gt;1 were switched to voriconazole from itraconazole which resulted in negative GM levels on follow-up bronchoscopy.

Conclusion
Our data suggest that the implementation of universal antifungal prophylaxis with itraconazole may not be efficacious in preventing IA in lung transplant recipients. On the other hand, surveillance with BAL GM is a strategy that can lead to early detection of IA in patients during the first year after lung transplantation.

Disclosures
All authors: No reported disclosures.
1146. Effectiveness of Ultraviolet Irradiation on Candida auris: A Laboratory Study
Authors: Garmon Gennifer , Navarathna Dhammika , Coppin John , Williams Marjory , Jinadatha Chetan 
Published: November 2018

Abstract

Background
Candida auris is a multidrug-resistant yeast which persists on healthcare surfaces for prolonged periods of time and is an emerging pathogen in hospitals. It has been linked to healthcare-associated infection (HAI) through surface transmission. Mobile ultraviolet (UV) light emitting devices from mercury sources have been shown to be effective in reducing C. auris bioburden but require prolonged exposure. In this study, we demonstrate the efficacy of an UV emitting device used in our hospital for terminal disinfection on C. auris.

Methods
Two C. auris strains (AR-381-CAU-01 and CAU-02) isolates obtained from Centers for Disease Prevention and Control (CDC) were used along with a Candida albicans (C. albicans) strain. An organism load of 10 μL containing 106 colony forming unit (CFU) was spread on a 20-mm diameter stainless steel coupon and exposed to the UV source from a pulsed xenon device at 5 feet distance and 4 feet height for 5, 10, and 30 minutes. Killing efficacy in terms of log reduction was calculated in comparison to untreated control coupons.

Results
Mean CFU log10 reduction for C. albicans, CAU-01, and CAU-02 was 0.547, 1.051, and 0.952 at 5 minutes; 1.412, 1.975, and 1.879 at 10 minutes; and 2.639, 3.971, and 4.145 at 30 minutes, respectively. Figure 1 describes the mean log10 reduction as well as the minimum and maximum log reduction by isolates.

Conclusion
Our study demonstrates the UV from a pulsed xenon device is effective in reducing the C. auris on stainless steel coupons. Similar to previously published data on reduction of C. auris by other UV sources, extended exposure is required to achieve a higher log reduction of C. auris. We did not have any C. auris clinical infections to assess efficacy of UV on HAI reduction.

Disclosures
C. Jinadatha, Xenex Healthcare Service: Grant Investigator, Research grant.
1148. Reduction of Blood Culture Contamination Rates by an Altered Sampling Protocol: Single-Center, Prospective, Randomized, Controlled, Open-Label Trial
Authors: Strahilevitz Jacob , Svinik Or , Lalezari Alon , Tel-Zur Odaya , Sinvani Shlomo , Al-Dayem Yasmin Sa’id Abed , Moses Allon , Cohen Matan , Oster Yonatan 
Published: November 2018

Abstract

Background
Contaminated blood cultures remain a challenge for patients, physicians, and microbiology laboratories, often leading to unnecessary antibiotic treatment. One approach to reduce contamination is to avoid culturing the initial blood sample that can contain a contaminated plug of skin from the needle stick. Initial specimen diversion technique (ISDT) was associated with decreased rate of blood culture contamination, when applied by trained phlebotomists, using either sterile vacuum blood collection tubes or a designated device. The aim of this study was to test ISDT in real-life, using externally nonsterile regular vacuum sample tubes for the diversion, by any medical personnel taking blood cultures.

Methods
Adults from whom the treating physician planned to take blood cultures and additional blood chemistry tests, in the same venous puncture, were eligible and were randomly assigned to intervention or control arms. The hospital’s standard procedure for blood drawing was maintained, except that in the intervention arm, blood was aspirated to a green-capped tube, which was used for regular biochemistry tests, prior to the blood culture.

Results
Four hundred twenty-three blood cultures were obtained from 404 patients. Of 404 (11.1%) of the blood cultures, 45 yielded microbial growth, with 31 (7.7%) regarded as true pathogens and 14 (3.5%) as contaminants. Detection of true bloodstream infection was similar by the two methods, 16/181 (8.83%) with the ISDT, and 15/223 (6.72%) using the standard method. The ISDT was associated with a significantly less isolation of presumed contaminants compared with the standard method, 2/165 (1.2%) vs. 12/208 (5.76%), P = 0.02.

Conclusion
ISDT, by any medical personnel, through altered order of test tube vs. blood culture sampling significantly reduced contamination of blood cultures without loss of diverted blood.

Disclosures
All authors: No reported disclosures.
1157. Optimal Isolation Periods Based on Time Interval to Elimination of Scabies After Topical Agent in the Real Clinical Practice
Authors: Park Jebyung , Park Se Yoon , Han Jaijun , Lee So Young , Kim Gil Eun , Jeong Yeon Su , Kim Jin Hwa , Lee Eunyoung , Lee Eun Jung , Yu Shi Nae , Kim Tark , Jeon Min Hyok , Choo Eun Ju , Kim Tae Hyong 
Published: November 2018

Abstract

Background
Scabies reemerged globally as the ninth of most highly prevalent skin diseases from 1990 to 2010. Existing topical agents, like permethrine and lindane are highly effective showing 95% or more therapeutic response. Patient isolation is only recommended for one day after treating with topical agents. However, there is little evidence-based recommendation on optimal isolation period after treatment in healthcare settings to prevent secondary infection.

Methods
All patients who were diagnosed from 2008 to 2017 with scabies at a referral university hospital in Seoul, Republic of Korea were analyzed. We investigated the time interval between symptom onset and diagnosis of scabies. The period from the application of topical agents and clinical resolution was also analyzed.

Results
A total of 23 patients were diagnosed with scabies. There was no crusted scabies such as Norwegian scabies. Seventy percent of these patients were referred from long-term care facilities. Median number of treatment was three times per patient (Interquartile range [IQR], 2–3). Time interval between the onset of symptoms and the diagnosis of scabies was median 4 days (IQR, 2–14). Median isolation period was 13 days (IQR, 8–15). Dermatologist confirmed successful treatment of 16 patients, the median time until confirmation was 15 days (IQR, 8–17). Three patients discontinued isolation before dermatologist’s confirmation. After re-evaluation by a dermatologist, one of the three was re-isolated due to persistent scabies infestation.

Conclusion
Scabicides are highly efficacious, but repeated microscopic examination for confirming elimination is strongly recommended. Optimal isolation period should be individualized based on the repeated dermatologic examination.

Disclosures
All authors: No reported disclosures.
1162. Epidemiology of Carbapenem-Resistant Pseudomonas aeruginosa Identified Through the Emerging Infections Program (EIP), United States, 2016–2017
Authors: Grass Julian , Bulens Sandra , Bamberg Wendy , Janelle Sarah J , Stendel Patrick , Jacob Jesse T , Bower Chris , Sukumaran Stephen , Wilson Lucy E , Vaeth Elisabeth , Li Linda , Lynfield Ruth , Vagnone Paula Snippes , Dobbins Ginette , Phipps Erin C , Hancock Emily B , Dumyati Ghinwa , Tsay Rebecca , Pierce Rebecca , Cassidy P Maureen , West Nicole , Kainer Marion A , Muleta Daniel , Mounsey Jacquelyn , Campbell Davina , Stanton Richard , Karlsson Maria S , Walters Maroya Spalding 
Published: November 2018

Abstract

Background
Pseudomonas aeruginosa is intrinsically resistant to many commonly used antimicrobials and carbapenems are often required to treat infections. We describe the epidemiology and crude incidence of carbapenem-resistant P. aeruginosa(CRPA) in the EIP catchment area.

Methods
From August 1, 2016 through July 31, 2017, we conducted laboratory- and population-based surveillance for CRPA in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. We defined an incident case as the first isolate of P. aeruginosa-resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period. Patient charts were reviewed. A random sample of isolates was screened at CDC for carbapenemases using the modified carbapenem inactivation method (mCIM) and real-time PCR.

Results
During the 12-month period, we identified 3,042 incident cases among 2,154 patients. The crude incidence rate was 21.2 (95% CI, 20.4–21.9) per 100,000 persons and varied by site (range: 7.7 in Oregon to 31.1 in Maryland). The median age of patients was 64 years (range: &lt;1–101) and 41.2% were female. Nearly all (97.1%) had at least one underlying condition and 10.2% had cystic fibrosis (CF); 17.8% of cases were from CF patients. For most cases, isolates were from the lower respiratory tract (49.2%) or urine (35.3%) and occurred in patients with recent hospitalization (87.2%) or indwelling devices (70.3%); 8.7% died. At the clinical laboratory, 84.7% of isolates were susceptible to an aminoglycoside and 66.4% to ceftazidime or cefepime. Among the 391 isolates tested, nine (2.3%) were mCIM-positive; one had a carbapenemase detected by PCR (blaVIM-4).

Conclusion
The burden of CRPA varied by EIP site. Most cases occurred in persons with healthcare exposures and underlying conditions. The majority of isolates were susceptible to at least one first-line antimicrobial. Carbapenemase producers were rare; a more specific phenotypic definition would greatly facilitate surveillance for these isolates.

Disclosures
All authors: No reported disclosures.