bluuebunny/crossref_metadata_2025_split huggingface dataset:
112. Sick Employee Online Log System for Tracking Employee Illnesses During the 2017–2018 Influenza Season Provided Real-Time Surveillance and Early Detection of Influenza-Like Illnesses Among Employees
Authors: Ramsey Keith M , Cochran M Kathy , Cleve William 
Published: November 2018

Abstract

Background
Vidant Health is an 8-hospital, 1,542-bed system (including the 908-bed teaching hospital for The Brody School of Medicine at East Carolina University) with over 12,000 employees, and uses a sick employee online log (SEOL) to track illnesses among employees. Influenza-like illness (ILI) surveillance is collected from sentinel sites across the state of North Carolina (NC) by the Department of Health. Our goals were to determine the utility of the SEOL to monitor ILI among employees and to compare trends with the NC ILI-system for Influenza surveillance.

Methods
When an employee calls in sick, symptoms for ILI in both the SEOL system and NC ILI-system include fever plus cough and/or sore throat. SEOL is an internet-based system, so information is collected and analyzed in real time. The number of sick hospital employees with influenza-like illness (ILI) per week during the 2017–2018 Influenza season was compared both to those employees reporting “Flu” and to the NC ILI numbers from the sentinel sites using MS Excel.

Results
The data analyzed was from October 2017 to April 2018. First, while lesser actual numbers of sick employees reported “Flu,” there was a correlation value of 0.93 between those reporting “Flu” and those reporting ILI symptoms (see Figure 1). Secondly, the SEOL results are available daily, while the NC ILI data are reported 7–12 days from entry; however, the peaks in ILI paralleled those of the peaks in SEOL data for employees reporting symptoms of ILI (see Figure 2) with a correlation value of 0.79 between the two. Finally, there were no breaks in confidentiality for those employees utilizing the SEOL.

Conclusion
The SEOL provided a real-time tool to monitor employee illnesses due to ILI during influenza season, and without the lag time of the ILI-surveillance by the state. This system maintained confidentiality with a convenient method for data entry. These findings conclude that the SEOL system data correlated positively with the state ILI data and provided an early detection system for the appearance of influenza among our employees.

Disclosures
All authors: No reported disclosures.
115. Results of a Targeted Neonatal Screening Program for Congenital Cytomegalovirus Infection in Montreal, Quebec
Authors: Renaud Christian , Smiljkovic Mina , Boucoiran Isabelle , Valois Silvie , Tapiero Bruce , Lamarre Valérie , Kakkar Fatima 
Published: November 2018

Abstract

Background
There remains considerable debate on the role of symptomatic, targeted vs. universal screening of newborns for congenital cytomegalovirus infection (cCMV). Here we report on a hospital-based targeted screening program for (1) infants who failed their newborn hearing screen and (2) infants of HIV-infected women, and compare this to the prevalence among infants tested for CMV following clinical suspicion of a congenital infection.

Methods
In November 2013, the “Programme québécois de dépistage de la surdité chez les nouveau-nés” (PQDSN), a provincially mandated hearing screening program, was implemented at Centre Hospitalier Universitaire Sainte-Justine, a tertiary maternal-child health center in Montreal, Quebec, along with CMV screening for all infants who failed their hearing test (excluding patients in the neonatal intensive care unit). Concurrently, beginning in April 2013, all infants of HIV-infected women were screened for cCMV infection within 48 hours of birth. The birth prevalence of cCMV infection in these targeted populations was compared with the prevalence among newborns tested for a clinical suspicion of cCMV.

Results
Out of 11 734 newborns screened for hearing through the PQDSN program between April 2014 and March 2018, 536 failed their initial hearing screen and 4 of these newborns tested positive for cCMV infection (0.75%). Out of a total of 130 HIV-exposed newborns born during this period, 116 were screened for cCMV and 3 (2.6%) confirmed positive. An additional 455 newborns were identified by the attending pediatrician as having a risk factor for any congenital infection; of these, 22 (5.3%) tested positive for cCMV. Using these combined methods, a total of 0.24% of newborns enrolled in the PQDSN program tested positive for cCMV infection.

Conclusion
The overall birth prevalence of cCMV was 0.75% among infants who failed their hearing screen, 2.6% among HIV exposed newborns, and 5.3% among infants with a clinical suspicion of a congenital infection. In the absence of a universal screening program for newborns, these results reinforce the importance of maintaining a high index of clinical suspicion for cCMV infection.

Disclosures
All authors: No reported disclosures.
116. Role of Maternal Antibodies in Protection Against Postnatal Cytomegalovirus Acquisition
Authors: Saccoccio Frances , Itell Hannah , Li Skukhang , Jenks Jennifer , Xie Guan , Pollara Justin , Gantt Soren , Permar Sallie 
Published: November 2018

Abstract

Background
Congenital cytomegalovirus (CMV) is the leading infectious cause of birth defects in the United States. Development of an effective CMV vaccine is a public health priority. However, CMV vaccine development is limited by a poor understanding of the immune correlates of protection, including the role of CMV-specific IgG. Defining the role of passively acquired maternal IgG in the protection of half of the CMV-exposed, breastfeeding infants against postnatal CMV acquisition may inform CMV vaccine design

Methods
We analyzed CMV-specific humoral responses in 29 CMV-seropositive Ugandan mother–infant pairs. Seventeen mothers were HIV co-infected. Infants were followed weekly for postnatal CMV acquisition using saliva PCR. Twelve infants acquired CMV and 17 infants did not acquire CMV in the first 6 months of life. We compared CMV-specific IgG responses at delivery of mothers whose infants acquired CMV to mothers whose infants did not acquire CMV by 6 months of life and in the infants at 6 weeks of life. We also compared CMV-specific responses in mothers at delivery and infants at 6 weeks of life based on maternal HIV status.

Results
We found similar CMV-specific total IgG and IgG3 binding, avidity index, neutralization, antibody-dependent cellular phagocytosis, and antibody-dependent cellular cytotoxicity responses in mothers whose infants did or did not acquire CMV by 6 months of life. Moreover, similar CMV-specific IgG binding and neutralization responses were also found between infants who did or did not acquire CMV by 6 months of life. Finally, CMV-specific IgG responses were similar in HIV-infected and uninfected mothers at delivery and in infants at 6 weeks of life regardless of perinatal HIV exposure.

Conclusion
CMV-binding and functional IgG responses do not appear to impact infant susceptibility to postnatal CMV acquisition in the first 6 months of life, and therefore other viral or immunologic factors contribute to the inefficiency of this mode of CMV transmission. Thus, to provide sterilizing protection against mucosal CMV acquisition, an antibody-based CMV vaccine would likely have to induce higher magnitude or qualitatively different responses than that of natural infection.

Disclosures
All authors: No reported disclosures.
118. Nasopharyngeal (NP) Bacterial Detection in Infants With Respiratory Syncytial Virus (RSV) Infection: Impact on Clinical Outcomes
Authors: Diaz Alejandro , Bunsow Eleonora , Garcia-Maurino Cristina , Naples Jeffrey , Juergensen Alexis , Mertz Sara , Wang Huanyu , Salamon Douglas , Leber Amy , Ramilo Octavio , Mejias Asuncion 
Published: November 2018

Abstract

Background
Previous studies suggest that RSV increases NP bacterial colonization and may facilitate infection. However, the role of NP colonization with potentially pathogenic bacteria (PPB) in the pathogenesis of RSV bronchiolitis is not well understood. We sought to determine the frequency, type, and density of NP PPB detection in infants with RSV infection compared with healthy controls (HC), and its association with clinical outcomes.

Methods
Single-center, prospective study of previously healthy infants with RSV infection and age-matched HC. Inpatients (IP) were enrolled within 24 hours of hospitalization, outpatients (OP) at the ED or primary clinics and HC at well-child visits. RSV infection and the following PPB: [S. pneumoniae, M. catarrhalis, H. influenzae, and S. aureus] were detected and quantified by PCR. We compared demographic, clinical characteristics, and outcomes of care according to NP PPB detection.

Results
From 2010 to 2018, we enrolled 815 infants: 664 with RSV infection [IP, 560; OP, 104] and 151 HC. RSV+ OP (6.1 [3.7–10.7] months) and HC (6.9 [3.8–10.8] months) were older than IP (2.5 [1.4–5.4] months; P &lt; 0.001). Identification of ≥1 PPB was 89% in RSV+ infants [IP, 88%; OP, 90%] versus 63% of HC (P &lt; 0.0001). While H. influenzae or &gt;1 PPB detection was higher in RSV infection (P &lt; 0.001), S. aureus detection predominated in HC (P &lt; 0.05; Figure 1). Frequency of S. pneumoniae detection was comparable between groups; however, S. pneumoniae loads were one log higher in RSV+ infants versus HC (P = 0.001) adjusted for antibiotic use. Differences in colonization rates remained different in RSV+ infants versus HC across age ranges (&lt;3, 3–6, &gt;6–12, and &gt;12–24 months; Figure 2). Last, RSV patients (both IP and OP) with S. pneumoniae or H. influenzae detection had fever more frequently (70%–74% vs. 25%–47%; P &lt; 0.0001), higher clinical disease severity scores (P = 0.01), and higher blood neutrophil counts (34%–36% vs. 16%–19%; P &lt; 0.001), versus those with M. catarrhalis, S. aureus detection or PCR negative. In addition, NP detection of H. influenzae in RSV children was associated with higher frequency of atelectasis/consolidation by chest X-ray (P &lt; 0.005).

Conclusion
These data suggest that NP colonization with PPB is high in infants with RSV infection independent of age, and that specific bacteria, namely S. pneumoniae and H. influenzae, are associated with enhanced clinical disease severity.

Disclosures
A. Leber, Nationwide Children’s Hospital: Research Contractor, Research support. O. Ramilo, Janssen Scientific Affairs, LLC: Consultant, Consulting fee. A. Mejias, Janssen: Grant Investigator and Scientific Advisor, Consulting fee and Research grant. Abbvie: CME talks, Speaker honorarium.
119. Prospective Validation of a 3-Gene Signature for Tuberculosis Diagnosis, Predicting Progression and Evaluating Treatment Response
Authors: Warsinske Hayley , Rao Aditya , Moreira Flora Martinez Figueira , Dos Santos Paulo Cesar Pereira , Liu Andrew , Scott Madeleine , Malherbe Stephanus , Ronacher Katharina , Walzl Gerhard , Winter Jill , Sweeney Timothy E , Croda Julio , Andrews Jason R , Khatri Purvesh 
Published: November 2018

Abstract

Background
The World Health Organization (WHO) has identified the need for a nonsputum-based triage test for tuberculosis (TB) that can be used to identify those who need further testing to identify active disease. We investigated whether our previously described 3-gene TB score could identify individuals with active tuberculosis (ATB) prior to seeking care (“active case detection”) and how the 3-gene TB score correlated with the timing of disease onset, disease severity, and response to treatment.

Methods
This study consisted of a prospective nested case–control trial, Brazil Active Screening Study (BASS; 2016), and re-analysis of data from 2 prospective cohort studies, the Adolescent Cohort Study (ACS; 2005–2007), and the Catalysis Treatment Response Cohort (CTRC; 2010–2013). The BASS case–control subcohort contained 81 adults (ages 20–72 years, 33 ATB, 48 controls). The ACS contained 153 adolescents (ages 12–18 years, 46 ATB, 107 LTBI). The CTRC-contained 138 adults (ages 17–67 years, 100 ATB, 17 other lung disease patients, 21 healthy controls).

Results
The 3-gene TB score diagnosed ATB patients with high accuracy: BASS cohort AUC = 0.87 (95% CI = 0.82–0.91, Figure 1A), ACS cohort AUC = 0.86 (95% CI = 0.76–0.97, Figure 1B), and CTRC AUC = 0.93 (95% CI = 0.88–0.97). In the ACS, the 3-gene TB score predicted progression from LTBI to ATB 6 months prior to positive sputum test (AUC = 0.86; 95% CI = 0.79–0.92, Figure 1B). In the CTRC, the 3-gene TB score correlated with glycolytic activity ratio of PET-CT at baseline (correlation = 0.54, P = 3.98 × 10−8, Figure 1C) and at the end of treatment (correlation = −0.408, P = 3.72 × 10−5). In the CTRC, the 3-gene TB score at baseline predicted the likelihood of prolonged sputum positivity following treatment initiation and treatment response at 6 months (P = 3.6 × 10−5). Collectively, across all cohorts, the 3-gene TB score identified ATB patients with 90% sensitivity and 70% specificity, and had 99% negative predictive value (NPV) at 5% prevalence.

Conclusion
Across 3 independent prospective cohorts, the 3-gene TB score closely approaches the WHO target product profile benchmarks for non-sputum–based triage test at high NPV. These performance characteristics make it a potential test for ruling out ATB and for monitoring disease status.

Disclosures
T. E. Sweeney, Inflammatix, Inc.: Employee and Shareholder, Salary. P. Khatri, Inflammatix Inc.: Board Member, Equity
127. Urinary Tract Infection Incidence Is Associated with Recent Environmental Temperatures
Authors: Simmering Jacob , Sewell Daniel , Polgreen Linnea , Polgreen Philip M 
Published: November 2018

Abstract

Background
Urinary tract infections (UTI) are one of the most common infections and the incidence of UTIs is seasonal, peaking in summer months. Relative to other times of the year, incidence of UTIs during the June to September period is approximately 10% greater. Prior work has suggested that a cause of this seasonality may be warmer temperatures during summer months. However, this work focused on inpatients and used average monthly temperatures.

Methods
We identified all UTI cases located in 1 of 397 metropolitan statistical areas (MSA) in the contiguous United States between 2011 and 2016 using the Truven Health MarketScan databases. A total of 192 million person-years of data were included in this dataset and a total of 21,975,244 outpatient claims for UTI were identified by ICD-9 (599.0) and ICD-10 (N39.0) codes. Weather data for each MSA and date were obtained from the National Centers for Environmental Information. We computed the mean temperature during the period 3 to 8 days prior to the service date of the claim. A Poisson generalized linear model was used to estimate the effect of temperature on the count of UTI cases adjusted for MSA size, day-of-week, and week-of-year.

Results
The effect of temperature on UTI risk was significant (likelihood ratio test P &lt; 0.0001). Relative to times when the average temperature 3–8 days prior was 40.1–45°F, UTI incidence exhibited a dose–response relationship as shown in the figure.

Conclusion
Incidence of UTIs exhibits a dose–response pattern with temperature during the period 3–8 days prior to presentation. This pattern persists after adjustment for seasonal factors. These results suggest a causal relationship between warm weather, and UTI risk may exist and warrants further investigation.

Disclosures
All authors: No reported disclosures.
128. Sexually Transmitted Infections Among Adolescent Girls in Thika, Kenya
Authors: Yuh Tiffany , Kiptinness Catherine , Selke Stacy , Oluoch Lynda , Magaret Amalia , Ngure Kenneth , Wald Anna , Mugo Nelly , Roxby Alison C 
Published: November 2018

Abstract

Background
Globally, the rates of sexually transmitted infections (STIs) are highest among 15- to 24-year-old girls, especially in Sub-Saharan African countries where the adolescent sexual health is poor. Recruiting girls presexual debut could identify risk factors for STI acquisition.

Methods
We recruited a prospective cohort of “low-risk” adolescent girls aged 16–20 in Kenya. To be eligible, girls were HIV and HSV-2 seronegative and reported no history of sexual intercourse or reported having sex with only one partner. Demographic data were collected, and girls had nucleic acid testing of vaginal swabs for Neisseria gonorrhea, Chlamydia trachomatis, and Trichomonas vaginalis, and vaginal gram stains for bacterial vaginosis (BV).

Results
We enrolled 400 girls, with a median age of 18.6 years. In this cohort, 322 (80.5%) girls reported never having had sex, while 78 (19.5%) reported prior sex with 1 partner. Of those reporting prior sex, only 20 (25.6%) reported contraception use in the last 3 months, with 60% using only emergency contraceptive pills. The median age of sexual partners was 22 (IQR 19–25). Of the 373 participants with an STI swab result, 49 participants (13.1%) tested positive for STIs at entry into the study, with 41 chlamydia, 5 gonorrhea, and 3 trichomonas cases. Of these 49 participants, 33 (67.3%) had denied prior sexual intercourse. Testing positive for STIs was, however, significantly different among those reporting prior sexual intercourse vs. reporting never having had sex, 21.1% vs. 11.1% (P = 0.02). BV was rare (5.6%) in the cohort, with 90% of participants with a normal Nugent score of 0–3.

Conclusion
In the initial testing of a sexually inexperienced cohort of girls, we found unexpectedly high numbers of prevalent STIs, especially chlamydia which is not routinely screened for in Kenyan settings. Additionally, lack of sexual activity appeared overreported. BV was rare, with much lower prevalence than in adult women in Africa. Our data suggest that prior to initiation of sexual activity, most girls in this Kenyan cohort have vaginal microflora that is dominated by Lactobacillus. Interventions to address STIs, including pre-exposure prophylaxis for HIV, should be targeted at girls at a young age, presexual debut, and in nonmedical settings where girls can be reached who do not selfidentify as at risk for STI.

Disclosures
All authors: No reported disclosures.
158. The Effect of Insurance Coverage on Appropriate Selection of Hospital Discharge Antibiotics for Staphylococcus aureus Bacteremia
Authors: McHale Thomas , Medder Jim , Lyden Elizabeth , Geske Jenenne , Rupp Mark E , Van Schooneveld Trevor 
Published: November 2018

Abstract

Background
Inappropriate or inadequate antimicrobial therapy of Staphylococcus aureus bacteremia (SAB) is associated with worsened outcomes. The impact of insurance coverage on appropriate selection of antibiotics is poorly understood. In patients diagnosed with SAB, we assessed the impact of insurance coverage on appropriate selection and duration of antibiotics at discharge.

Methods
We analyzed 273 patients who were diagnosed with SAB during their hospitalization at Nebraska Medicine and were discharged on antibiotics in 2015 and 2016. Antimicrobial therapy was deemed inappropriate if (i) total treatment duration was less than 14 days, (ii) oral delivery route was used, (iii) vancomycin was used to treat methicillin sensitive S. aureus in non-β-lactam allergic patients, or (iv) any penicillin or cephalosporin was used to treat methicillin-resistant S. aureus. Insurance was categorized broadly into (i) no insurance, (ii) Medicaid, (iii) Medicare, and (iv) Commercial. We collected data on a suite of additional variables that included: type of infectious disease (ID) inpatient consult and location of discharge. Logistic regression was used to determine the odds of being prescribed inappropriate therapy in univariate and multivariate analyses and likelihood ratio tests (LRT) were used to evaluate the strength of evidence.

Results
In unadjusted models, not having insurance was associated with inappropriate antimicrobial therapy (Reference Group: Any insurance; OR No insurance 4.71; LRT P = 0.027). Two additional risk factors for inappropriate therapy were identified in unadjusted models: discharge location (Refrence Group: Nursing assistance; OR Home without assistance 3.37; 95% CI 1.34–8.46; LRT P = 0.008) and lack of an ID consult (Reference Group: Academic team; OR Not consulted 26.8, 95% CI 7.66–93.8; LRT P &lt; 0.001).

Conclusion
We found strong evidence that not having insurance, being discharged to home without assistance, and not having an inpatient ID consult are risk factors for being prescribed inappropriate antimicrobial therapy for SAB upon hospital discharge; however, the sparsity of outcomes prevents us from drawing causal inferences. This study adds to the extensive body of evidence that has shown that uninsured patients tend to have suboptimal therapeutic choices.

Disclosures
All authors: No reported disclosures.
160. Reduction in the Spread of Hospital-Associated Infections Among Pediatric Oncology Patients in an Animal-Assisted Intervention Program from a Canine Decolonization Procedure
Authors: Dalton Kathryn , Ruble Kathy , DeLone Alexandra , Frankenfield Pam , Walker Destiny , Ludwig Shanna , Ross Tracy L , Jaskulski Janice , Carroll Karen C , Rankin Shelley , Morris Daniel , Chen Allen , Davis Meghan 
Published: November 2018

Abstract

Background
Animal-assisted interventions (AAI), the use of animals as a complementary therapy in holistic patient care, has shown many positive outcomes. However, therapy animals can serve as mechanical vectors of hospital-associated infections (HAI), e.g., methicillin-resistant Staphylococcus aureus (MRSA). This pilot study assessed for transmission of HAIs among therapy animals, patients, and the hospital environment. We tested the effectiveness of a novel decolonization protocol for therapy dogs to reduce the risk of transmission of HAIs and enhance AAI program sustainability. Our hypothesis was that HAI transmission occurs from positive child to child, with the dog as an intermediary fomite.

Methods
Before and after child–animal interaction, we sampled patients, dogs, and the environment, and collected vital statistics and survey data from patients. MRSA was detected in samples by culture and molecular testing. Therapy dog handlers performed normal pre-visit practices for 2 control visits, then switched to a decolonization protocol (chlorhexidine-based shampoo prior to the visit, and chlorhexidine wipes on the fur during the visit) for 2 intervention visits.

Results
We evaluated 45 children and 4 therapy dogs over 13 visits. Children had decreased blood pressure and heart rate, and reported improved mental health scores post visit. MRSA conversion was identified from 10.2% of the children and 38.5% of the dogs, while 93% of the environmental samples were MRSA positive both pre and post. Patients that interacted closely with the dog had 8.01 times higher odds (95% CI 1.1–15.2) of MRSA conversion compared with patients who barely interacted with the dog. When stratified by intervention group, the MRSA conversation odds ratio of close interaction was 0.93 (95% CI 0.1–10.8) when the dog was decolonized versus 9.72 (0.9–99) when not decolonized.

Conclusion
This study showed the potential for AAI visits to improve physiological and mental health of pediatric outpatients. A risk of HAI exposure to patients from interaction with the dog was found, but this effect was nullified by the decolonization procedure. Future research is needed to increase the safety of this valuable alternative therapy.

Disclosures
All authors: No reported disclosures.