bluuebunny/crossref_metadata_2025_split huggingface dataset:
738. Role of Respiratory Syncytial Virus and Mycoplasma pneumoniae in Pediatric Community-Acquired Lower Respiratory Tract Infections
Authors: Kumar Sanchit , Chakravarti Anita , Kumar Surinder , Kapoor Seema 
Published: November 2018

Abstract

Background
Respiratory syncytial virus (RSV) infection is a major cause of serious lower respiratory disease in infancy and early childhood and Mycoplasma pneumoniae (M. pneumoniae) is a common cause of respiratory tract infections in all age groups. This study was conducted to determine the role of RSV and M. pneumoniae and in pediatric lower respiratory tract infections employing serological tests, polymerase chain reaction (PCR) and reverse transcriptase PCR analysis.

Methods
In this prospective study, 75 children aged 1 month to 5 years with acute lower respiratory tract infections (LRTIs) were investigated. Paired serum samples were obtained on admission and after 4–6 weeks to assay for M. pneumonia antibodies. Nasopharyngeal aspirates were obtained for the detection of RSV antigen by using the immunochromatographic test, reverse transcriptase-polymerase chain reaction (RT-PCR) for RSV and M. pneumoniae by PCR.

Results
RSV infection was positive in 20(60.60%) children aged &lt;1 year and 13 (39.40%) aged 2–5 years, the difference being statistically insignificant (P = 0.360). M. pneumoniae infection was documented in a 15(57.6%) children aged &lt;1 year age and 11(42.4%) in age 2–5 years which was statistically significant(P = 0.026). Clinical and radiological features among RSV and M. pnemoniae positive and negative cases were comparable. Thirty (40%) children were positive for RSV antigen and by RT-PCR and 3(12%) only by RT-PCR. Serological evidence of M pneumoniae infection was documented in 24(32%) children. M. pnemoniae PCR was positive in 8 (10.66%) patients. Together, serology and PCR detected M. pneumoniae in 26(34.66%) children. Considering RT-PCR as a diagnostic standard, the sensitivity of RSV antigen by immunochromatography was 90.90%, specificity 100%, positive predictive value 100% and a negative predictive value of 93.3%.The sensitivity of M. pneumoniae serology was 75%, specificity 73.3%, positive predictive value 25% and a negative predictive value of 96% considering PCR as a diagnostic standard,.

Conclusion
Our data underline the role of RSV and M. pneumoniae as the major cause of community-acquired lower respiratory tract infections in children aged &lt;5 years.

Disclosures
All authors: No reported disclosures.
740. Impact of the 2014 American Academy of Pediatrics Guidance on Respiratory Syncytial Virus Hospitalization Rates for Preterm Infants &lt;29 Weeks Gestational Age at Birth: 2012–2016
Authors: Goldstein Mitchell , Krilov Leonard R , Fergie Jaime , Brannman Lance , Ambrose Christopher S , Wade Sally , Kong Amanda 
Published: November 2018

Abstract

Background
In 2014, the American Academy of Pediatrics stopped recommending RSV immunoprophylaxis (RSV IP) for otherwise healthy infants 29–34 weeks gestational age (wGA), while continuing to recommend RSV IP for infants born at &lt;29 wGA. The decline in RSV IP and associated increase in RSV hospitalizations (RSVH) among infants 29–34 wGA have been described previously, but potential effects of the 2014 guidance change on preterm infants &lt;29 wGA are unknown. This study compared 2012–2014 and 2014–2016 outpatient RSV IP use as well as RSVH rates relative to term infants among otherwise healthy &lt;29 wGA infants.

Methods
Infants born from July 1, 2011 to June 30, 2016 were followed from birth hospitalization discharge through their ﬁrst year of life in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. DRG and ICD codes identified term and &lt;29 wGA infants at birth. RSV IP receipt was derived from pharmacy and outpatient medical claims (inpatient RSV IP data were unavailable). RSVH were derived from inpatient medical claims. RSVH IP use and RSVH were assessed across three chronologic age (CA) groups: &lt;3 months, 3–&lt;6 months, and 6–&lt;12 months. RSVH rate ratios for 2012–2014 and 2014–2016 were calculated for &lt;29 wGA infants using healthy term infants 0–&lt;12 months of age as a reference category.

Results
Outpatient RSV IP receipt fell after 2014 for &lt;29 wGA infants across all CA categories, with the greatest decline observed among infants &lt;3 months CA (Table 1). Greater RSVH rates for &lt;29 wGA infants relative to term infants were observed after 2014 (Figures 1 and 2), with infants &lt;3 months CA experiencing the greatest percentage increases in relative RSVH risks.

Conclusion
Outpatient RSV IP decreased and RSVH relative to term infants increased among otherwise healthy &lt;29 wGA infants following the 2014 policy change, even though RSV IP continued to be recommended. The effects were greatest for infants &lt;3 months CA and those insured by Medicaid.
Funded by AstraZeneca

Disclosures
M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. L. Brannman, AstraZeneca: Employee, Salary and Stocks. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting contracted by Truven: Consultant, Consulting fee. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary.
748. The Impact of a Positive Respiratory Viral Panel Among Hospitalized Adult Patients with Negative Rapid Influenza Testing at an Academic Tertiary Care Facility: A-matched Cohort Study
Authors: Ciccone Emily , Kinlaw Alan , Chundi Vahini , Miller Melissa , Weber David , Juliano Jonathan , Jhaveri Ravi , Willis Zachary ,   The UNC Antimicrobial Stewardship Team
Published: November 2018

Abstract

Background
Multiplex nucleic acid amplification assays (NAATs) are increasingly used to evaluate respiratory illnesses. Viral diagnosis has the potential to change clinical management and, specifically, decrease antibiotic use. However, the assays are expensive, and their effect on clinical management is unknown. This study evaluated the incremental impact of a multiplex respiratory viral panel after negative rapid influenza testing.

Methods
We completed a retrospective review of all adult patients with respiratory viral panel (RVP; GenMark) and/or rapid influenza or RSV/influenza PCR tests (PCR; Cepheid Xpert) collected within 48 hours of admission to non-ICU, inpatient units from September 1, 2015 to April 15, 2016. We matched hospitalizations with a positive RVP simultaneously with or following negative PCR testing (PCR−RVP+) 1:1 with patient encounters with negative rapid PCR testing only (PCR−). Matching of the referent PCR-group occurred without replacement based on age (±10 years), sex, race, season of testing (±50 days), and any respiratory viral test in the prior 30 days. The primary outcome was a change in management, defined as antimicrobial de-escalation (discontinuation, switch from intravenous to oral administration, and/or narrowing of spectrum), antiviral initiation, and/or change in isolation precautions.

Results
During the study period, there were 153 PCR−RVP+ patient encounters and 524 with PCR− testing only from which we identified 134 matched pairs. In the matched cohort, the median age was 60 years (IQR: 41–71), 47.8% were female, and 34.3% were non-White. Respiratory viral testing was associated with management change in 3.7% of PCR− and 23.9% of PCR−RVP+ patients (risk difference 20.1%; 95% CI 12.2–28.0%). Antimicrobial de-escalation did not occur after testing for any PCR- patients but did occur for 15.7% of PCR−RVP+ patients (95% CI 9.5–21.8%).

Conclusion
Among patients with negative rapid influenza testing, a subsequent or simultaneous positive RVP was associated with a higher frequency of antibiotic de-escalation. This suggests multiplex NAATs could play a role in improving antimicrobial stewardship in the setting of respiratory illness.

Disclosures
M. Miller, GenMark: Investigator, Research support. R. Jhaveri, GenMark: Investigator, Research support.
752. Geographic Analysis of Latent Tuberculosis Screening: A Health System Approach
Authors: Bonnewell John , Farrow Laura , Dicks Kristen , Cox Gary , Stout Jason E 
Published: November 2018

Abstract

Background
Targeted testing and treatment of latent tuberculosis infection is a key element of tuberculosis (TB) elimination in the United States. In particular, foreign-born persons from TB-endemic countries are high priority for latent TB screening.

Methods
We used the DEDUCE interface to query the electronic medical records of all patients presenting to Duke University Health System from January 1, 2010 to November 1, 2017. Latent tuberculosis screening was identified using CPT codes for the tuberculin skin test (TST) and/or interferon gamma release assays (IGRA). Patients’ home addresses were mapped to census tracts; demographic data for these tracts were obtained from the American Community Survey. Higher-risk foreign born persons were defined as persons born in Africa, Asia, or Latin America.

Results
Thirty-six thousand eight hundred and twenty-five patients received 48,419 TSTs and 5,366 received 5,746 IGRAs during the study period. Excluding census tracts with fewer than 20 Health System patients (to reduce referral bias), census tracts with a higher proportion of higher risk residents had a greater proportion of Health System patients screened for latent TB (P &lt; 0.001, figure). Health system patients residing in census tracts with greater proportions of higher risk foreign born residents were more likely to be screened with TST than with an IGRA (P &lt; 0.001).

Conclusion
Latent TB screening was significantly but weakly associated with a greater proportion of higher risk foreign born persons in a given census tract, and persons residing in such tracts were more likely to be screened with TST, which is not preferred due to cross-reaction with the BCG vaccine. Focusing latent TB screening on higher risk areas and using more IGRAs will be necessary to optimize TB prevention efforts.

Disclosures
All authors: No reported disclosures.
755. Clinical Adherence to Latent Tuberculosis Screening Recommendations in Adults with Inflammatory Bowel Disease (IBD) Prior to Biologic Therapy
Authors: Mponponsuo Kwadwo , Fisher Dina 
Published: November 2018

Abstract

Background
Biological agents have become increasingly common in the treatment of immune-mediated illnesses. Their use, however, is associated with an increased risk of progression from latent to active tuberculosis (TB) infection. The American Thoracic Society (ATS) recommends both a tuberculin skin test (TST) and an interferon gamma release assay (IGRA) be conducted to screen for latent TB prior to initiation of biologic therapy. We examined the adherence to these recommendations for adults with inflammatory bowel disease (IBD) in the Calgary region of Alberta.

Methods
In this retrospective cross-sectional study, we used the Alberta Health Services’ Sunrise Clinical Manager and Netcare databases to identify IBD patients initiated on biologic therapy (age &gt;18 years) in Calgary, Alberta between 2008 and 2018. Socio-demographic and clinical characteristics of patients were described. Linear and logistic regression models were constructed to identify factors associated with screening. All analyses were conducted using Stata 15.0 (University of London, UK).

Results
There was a total of 247 identified cases (48.18% female). Of these 96 were Ulcerative Colitis and 151 Crohn’s Disease. The mean age was 39.5 (14.8 SD). There was a total of 210 (85%) who had documented screening with the TST and nine (3.4%) with the IGRA. In a multivariable analysis, factors associated with latent TB screening were age and outpatient setting at the time of screen. Six patients (2.43%) had positive screens and four of those six were treated for latent TB infection.

Conclusion
TST remains the predominant screening method for latent TB infection although the ATS recommends both IGRA and TST prior to biologic therapy. Screening varied with age and higher rates were noted in those evaluated as outpatients compared with inpatients. Further work is needed to evaluate the barriers to screening and to improve access to latent TB screening particularly in the inpatient setting.

Disclosures
All authors: No reported disclosures.
767. A 7-Year Retrospective Study of Pediatric Tuberculosis in a Third-Level Hospital in Mexico City
Authors: Saldaña Napoleón González , Parra Mercedes Macías , De La Garza Eduardo Arias , Trujillo Diego Galvis , Ayala Salim Kuri , Macías Ernesto Rivera , Bejarano José Iván Castillo 
Published: November 2018

Abstract

Background
According to WHO data, in 2016 10.4 million people were infected with tuberculosis (TB), from which one million were patients ≤18 years, and 250,000 deaths. The diagnosis of TB in pediatric patients is a challenge given the clinical behavior.

Methods
This is a retrospective, descriptive, and observational study of patients under 18 years treated at the TB Clinic at Department of Pediatric Infectious Diseases in the National Institute of Pediatrics (INP) in Mexico City during the period 2011–2018.

Results
A total of 118 cases were included; 64 (54.5%) were male, and the average age at diagnosis was 79.45 ± 63.7 months. The most frequent presentations were; lymph node in 50 (42.4%) cases, followed by skeletal 20 (16.9%), pulmonary 16 (13.6%), meningeal 11 (9.3%), abdominal 6 (5.1%), cutaneous 6 (5.1%), and miliary 4 (3.1%). The most common symptoms were fever (52%) and lymphadenopathy (49%). TST was applied in 42 cases (55% positive). A positive COMBE was reported in 47.5% of patients. We performed: GeneXpertâ in 33 (28%) cases with 36% positive results; biopsy in 74 (62%) cases with 92% positive cases; and Ziehl-Neelsen stain in 30 (25.4%) cases with 26% positive results. Positive cultures (41%) isolated: M. bovis 25 (52.4%), followed by MTB complex in 9 (19%), M. tuberculosis 7 (14.3%) and atypical Mycobacteria with 7 (14.3%) cases. The most frequent treatment was: INH (98.2%), RIF (95.5%), E (85.6%) and PZA (77.5%) with an average of 6.3 months during intensive phase and 10.1 months of maintenance. Primary immunodeficiency (PID) was detected in 33 (20.3%) cases, mainly: chronic granulomatous disease in 15 (45.5%), Mendelian susceptibility to Mycobacterial diseases was found in 8 (24.2%) and severe combined immunodeficiency in 7 (21.2%). Overall mortality was 2.5%.

Conclusion
Tuberculosis in Mexico is still a major public health problem and thus is important to remain suspicious of it. This is the first report in Mexico where immunodeficiency is investigated in pediatric patients with tuberculosis, detected in one out of five cases, which stresses the need of its search, given this can modify the outcome.

Disclosures
All authors: No reported disclosures.
779. Mycobacterium tuberculosis Prosthetic Joint Infections: A Case Series and Literature Review
Authors: Uhel Fabrice , Corvaisier Grégory , Poinsignon Yves , Chirouze Catherine , Béraud Guillaume , Grossi Olivier , Varache Nicolas , Arvieux Cédric , Berre Rozenn Le , Tattevin Pierre ,   Groupe d’Epidémiologie et Recherche en Infectiologie Clinique Centre-Ouest (GERICCO)
Published: November 2018

Abstract

Background
Mycobacterium tuberculosis is a rare cause of prosthetic joint infection (PJI), as most countries with high prevalence of tuberculosis have limited access to arthroplasty. We aimed to characterize the diagnosis, the management, and the outcome of M. tuberculosis PJI.

Methods
All cases of M. tuberculosis PJI documented in a network of 7 referral centers in France were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire, including diagnosis, management, and outcome. In addition, we performed a systematic literature review using the keywords”prosthetic joint,” and”tuberculosis.”

Results
During years 1997–2016, we managed 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) with documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to PJI diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), definitive resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. One patient died of disseminated tuberculosis. The literature review identified 70 additional cases of documented M. tuberculosis PJI, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement and prosthesis retention, 86% (19/22) with revision arthroplasty, and 81% (17/21) with definitive prosthesis resection (NS).

Conclusion
M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.This case series and literature review suggest that the paradigms for the management of M. tuberculosis PJI may differ from PJI related to other pathogens, for which surgery is required.

Disclosures
All authors: No reported disclosures.
781. Non-Tuberculous Mycobacterium: Often a Missed Entity
Authors: B Sairam , Gogia Atul , Kakar Atul , Byotra S P 
Published: November 2018

Abstract

Background
Initially referred to as Lady Windermere syndrome, the prevalence of Non-Tuberculous Mycobacterium (NTM) is on the rise globally. In India, the TB capital of the world, these infections still go unrecognized, as the clinical presentation of all mycobacterial diseases are similar. This is of clinical relevance as misdiagnosis may lead to unwarranted or inappropriate therapy.

Methods
We conducted a retrospective study of adults suspected of having mycobacterial infection. Records of patients admitted with suspected TB from January 2015 to December 2017 were reviewed; clinicoradiological features were correlated with the organism isolated; treatment given and outcomes were recorded.

Results
Out of 877 suspected patients, 245 patients had microbiologically proven Mycobacterium tuberculosis and 34 had NTM (3.8%). Pulmonary infection was seen in 19 cases (56%), rest were extra pulmonary (34%).
Fever was the commonest symptom (62%) others being cough (50%), breathlessness (41%), hemoptysis (15%), weight loss (3%), chest pain (3%), and back ache (12%). Symptoms were prolonged (&gt;1 month) in 65% of cases. Radiologically, cavitations (42%), lung nodules (32%), and infiltrates (32%) were commonly seen. Upper zone predilection was noted in 68% of cases. Past tuberculosis was the major risk factor seen in 42% of cases while 26% were immunocompromised. Macrolide resistance was noted in none of our patients. Twenty-four out of 34 cases were AFB smear positive (71%), but MTB gene Xpert was negative. Our series includes four patients who did not respond to first-line anti-tubercular therapy (ATT) and were suspected to have multi-drug-resistant (MDR) tuberculosis. Cultures later grew NTM and the patients improved with macrolide regime.

Conclusion
NTM is an underreported infection in a developing country like India with a high TB prevalence. Similar clinical features and morphology create a greater diagnostic dilemma. Usage of molecular techniques and AFB culture should be made mandatory in all suspected cases of tuberculosis. NTM should always be considered in ATT nonresponders before starting them on MDR regime.

Disclosures
All authors: No reported disclosures.
784. The Changing Epidemiology of Disseminated Mycobacterium avium complex in the United States
Authors: Dousa Khalid M , Ponce-Terashima Rafael , Van Aartsen Daniel , De La Hoz Alejandro , Johnson John L 
Published: November 2018

Abstract

Background
The epidemiology of disseminated Mycobacterium avium complex (DMAC) infection in the United States is changing. Previously most DMAC occurred in adults with advanced AIDS. Since the development of effective antiretroviral therapy, the incidence of DMAC in AIDS has fallen more than 10-fold. Malignancy, immunosuppression, and tumor necrosis factor inhibitors are known risk factors for DMAC. We sought to describe the epidemiology of DMAC disease in HIV seronegative patients in the United States.

Methods
We performed a retrospective analysis of a commercial database (Explorys Inc., Cleveland, OH). This database contains an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the United States from 1999 to present. Explorys contains de-identified information from over 50 million patients, 360 hospitals, and over 317,000 providers. We identified a total of 571 persons diagnosed with DMAC, based on Systemized Nomenclature of Medicine-Clinical Terms. We excluded 80 HIV-infected and identified association of the infection with known risk factors.

Results
Of 570 patients, 491 HIV-uninfected patients with DMAC were studied. Underlying structural pulmonary diseases were COPD and bronchiectasis (51% and 47%, respectively). Two hundred ten patients had concomitant malignancy of which lung cancer was the most frequent (43%). Seventy-nine percent were receiving corticosteroids and 10 patients (2%) were on TNF inhibitors (2%).

Conclusion
In this study, majority of patients with DMAC are HIV-uninfected. Larger studies should focus on identifying the prevalence and risk factors of DMAC in the post-AIDS era.

Disclosures
All authors: No reported disclosures.
789. Comparison of Interferon-γ Release Assays (IGRAs) for Diagnosis of Latent or Active Tuberculosis in Cancer Patients
Authors: Kulkarni Prathit , Kmeid Joumana , Batista Marjorie , El Chaer Firas , Ariza-Heredia Ella , Graviss Edward A , Mulanovich Victor E , Chemaly Roy F 
Published: November 2018

Abstract

Background
Patients with certain types of cancer are at increased risk for progression from latent tuberculosis infection (LTBI) to active tuberculosis (ATB) because of immunosuppression. The purpose of this study was to compare the utility of the two commonly used IGRAs, QuantiFERON-TB Gold® (QFT) and T-spot.TB® (T-spot.TB), for diagnosis of LTBI or ATB in cancer patients.

Methods
We identified patients who had an initial IGRA during 2013 and 2014 at our institution. Along with demographic information, collected clinical data included type of underlying cancer or other condition, reason for testing, diagnosis of ATB following testing, and absolute lymphocyte count (ALC) at the time of testing. IGRA results (positive, negative, borderline, or indeterminate/invalid) were compared between patients who underwent testing with either QFT or T-spot.TB.

Results
A total of 356 patients had 411 QFT tests done, while 737 patients had 853 T-spot.TB tests performed. The most common underlying malignancies in the QFT and T-spot.TB groups were acute myeloid leukemia (30% and 25%, respectively) and solid tumors (28% vs. 30%, respectively). The most common reasons for testing were pre-hematopoietic-cell transplantation (HCT) screening (42% with QFT and 31% with T spot.TB) or suspected pulmonary ATB (34% with QFT and 42% with T spot.TB). In the QFT group, 145/411 (35%) tests were indeterminate, while only 96/853 (11%) tests in the T-spot.TB group were invalid (P &lt;0.001). The median ALC was 650 cells/µL in patients with an indeterminate result in the QFT group and 90 cells/µL in patients with an invalid test in the T-spot.TB group. A total of four patients were diagnosed with ATB at 1 year after testing. Figure 1 provides a flowchart describing IGRA testing results and development of ATB.

Conclusion
The frequency of an inconclusive test result is significantly higher with QFT as compared with T-spot.TB for diagnosis of LTBI or ATB in cancer patients. A low ALC is likely a contributing factor in indeterminate QFT and invalid T spot.TBresults.

Disclosures
E. Ariza-Heredia, Oxford Immunotec: Grant Investigator, Research grant. R. F. Chemaly, Oxford Immunotec: Consultant and Grant Investigator, Research grant.