bluuebunny/crossref_metadata_2025_split huggingface dataset:
1115. Use of a Fluoroquinolone (FQ) vs. a Non-Fluoroquinolone (Non-FQ)-Based Antibiotic Regimen in the Treatment of Acute, Uncomplicated Diverticulitis
Authors: Mourani Jessyca , Postelnick Michael , Martin David 
Published: November 2018

Abstract

Background
The management of acute, uncomplicated diverticulitis (DVT) remains based on expert consensus rather than on evidence from randomized clinical trials. The most common antibiotic (AB) regimen used in this patient population is metronidazole plus a fluoroquinolone (FQ). Non-FQ options, including B-lactam and non B-lactam regimens are available. Since there is a lack of clinical data comparing outcomes between these regimens, it remains uncertain whether patients presenting with acute, uncomplicated DVT require a FQ-based regimen. Increasing rates of FQ resistance and awareness of collateral damage have raised concern about whether this class should remain a first-line option.

Methods
This retrospective cohort study was conducted utilizing electronic health records to identify patients 18 years of age or older with acute, uncomplicated DVT, defined by ICD 10 codes. Patients included had CT confirmed DVT and were started on a guideline recommended AB regimen. Data points collected included length of stay, 30-day readmission due to DVT, time to conversion from IV to PO AB, progression to surgery, and discharge AB regimen. The primary objective is to evaluate differences in length of stay and 30 day re-admission rates. The secondary objectives are to evaluate time from intravenous (IV) to oral (PO) AB, progression to surgery, and discharge AB between the two groups.

Results
136 patients were evaluated, 71 FQ and 65 non-FQ. Length of stay was 4 days (1–18) in the FQ group vs. 5 days (1–19) in the non-FQ group (P = 0.236). 11% of patients in the FQ group vs. 9% of patients in the non-FQ group had a DVT related 30 day readmission (P = 0.451). 22% of patients in the FQ group vs. 23% of patients in the non-FQ group progressed to GI surgery during the admission. Time from IV to PO conversion of AB was 34.2 hours (0–63) in the FQ group vs. 48.4 hours (0–81) hours in the non-FQ group. Lastly, 63 of the 71 patients who were started on a FQ were discharged on an oral FQ vs. Forty patients of the 65 patients started on a non-FQ were discharged on an oral FQ

Conclusion
In the treatment of acute, uncomplicated DVT outcomes including length of stay, 30-day readmission, time from IV to PO AB, and progression to surgery were comparable in patients receiving treatment with a FQ based AB regimen vs. a non-FQ based regimen.

Disclosures
D. Martin, GlaxoSmithKline: Independent Contractor, Salary
Syneos Health: Employee, Salary.
1120. Clostridium difficile Infection Risk Factors, Severity, and Outcomes in Patients Infected with NAP1/027 Strain in a Non-Epidemic Setting
Authors: Nahar Julie 
Published: November 2018

Abstract

Background
Evidence surrounding outcomes with the North American pulsed-field gel electrophoresis type 1 (NAP1) Clostridium difficile (CDI) strain remains conflicting. We compared risk factors, severity of illness, and mortality of patients infected with NAP1 strain compared with patients with non-NAP1 strains in our multihospital health system.

Methods
This is a retrospective case–control analysis of patients admitted to one of five hospitals (one academic and four community hospitals) and diagnosed with CDI from April 2014 through July 2017. CDI definition included three or more stools per day with positive stool sample polymerase chain reaction (PCR) testing for C. difficile.

Results
A total of 490 patients met inclusion, of which 155 had the NAP1 strain and 335 patients were infected with non-NAP1 strains. More patients with NAP1 were older, female, had CHF, and presented from a healthcare facility as opposed to from the community (all P &lt; 0.05). No difference in 90-day antibiotic class use was found. NAP1 patients had increased ICU admission (12.3 vs. 6.0%, P = 0.016), a shorter length of stay (10.8 vs. 13.4 days, P = 0.037), abnormal CT findings (P &lt; 0.023), and trend toward more ID consults (P = 0.067). Per IDSA classification, 61.9% in the NAP1 CDI group had severe CDI as opposed to 49.6% in the non-NAP1 study group. (P ≤ 0.038). There was no observed difference in inpatient mortality (7.7 vs. 5.7%, P = 0.381).

Conclusion
CDI caused by NAP1 strain did result in increased severity but did not result in increased mortality compared with CDI caused by non-NAP1 strains. Evidence continues to mount that while the NAP1 strain may affect severity, its effect on mortality remains in question.

Disclosures
All authors: No reported disclosures.
1126. Three Cases of Neutropenic Enterocolitis Following Midostaurin Administration
Authors: Carroll Ryan , Nichols Courtney , Awadh Hesham , Visweshwar Haresh , Evans Derek , Willenburg Kara 
Published: November 2018

Abstract

Background
Neutropenic enterocolitis is a life-threatening inflammation of the colon with a mortality rate above 50% primarily seen in neutropenic patients on cytotoxic chemotherapy. The following cases illustrate three patients with this condition following midostaurin administration after standard induction chemotherapy with daunorubicin/idrarubicin and cytarabine for acute myeloid leukemia (AML). Midostaurin is a multitargeted FMS-Like Tyrosine kinase 3 (FLT3) receptor inhibitor used in AML treatment after induction chemotherapy.

Methods
Review of records of three patients seen by the infectious disease service.

Results
In these cases, patients were diagnosed with AML with FLT3 mutation. All three were admitted and started on standard induction chemotherapy. Midostaurin was started on chemotherapy day 8 at which time all patients were neutropenic. The patients developed fevers, abdominal pain, and diarrhea within 36 hours of starting midostaurin and had abdominal CT findings consistent with neutropenic enterocolitis. For two patients, midostaurin was discontinued and symptoms improved upon discontinuation. One patient completed the course of midostaurin with symptom resolution after its completion. Of note, all were started on appropriate prophylactic antibiotics at chemotherapy initiation and were started on broad-spectrum antibiotics at onset of fevers and abdominal symptoms. Appropriate evaluation was also done for each patient to rule out other causes of abdominal symptoms, including testing for Clostridium difficile colitis.

Conclusion
These cases are significant because they illustrate individuals treated with standard induction chemotherapy for AML and started on midostaurin while neutropenic who began reporting symptoms of neutropenic enterocolitis within 36 hours of receiving midostaurin. This shows a possible increased toxicity when midostaurin is given after induction chemotherapy in the setting of neutropenia. Stone et al. showed increased intestinal symptoms with midostaurin, but no cases of neutropenic enterocolitis have been reported. With increased midostaurin use in the past year, further studies are warranted to establish and raise awareness of a possible direct association between midostaurin and gastrointestinal toxicity.

Disclosures
All authors: No reported disclosures.
1130. Low Risk of Pneumocystis jiroveci Pneumonia in Patients With Waldenstrom’s Macroglobulinemia on Ibrutinib
Authors: Kusztos Amanda E , Cheng Matthew P , Gustine Joshua N , Dubeau Toni E , Woolley Ann E , Hammond Sarah P , Baden Lindsey R , Castillo Jorge J , Issa Nicolas C 
Published: November 2018

Abstract

Background
Ibrutinib is a Bruton’s tyrosine kinase inhibitor that is FDA approved for the treatment of chronic lymphocytic leukemia (CLL), mantle cell lymphoma, marginal zone lymphoma, and Waldenstrom’s macroglobulinemia (WM). Fungal infections including Pneumocystis jiroveci pneumonia (PCP) are increasingly reported in patients with CLL and lymphoma on ibrutinib possibly due to the off-target effect of ibrutinib on the adaptive immune system. Whether this increased risk is due to the effect of ibrutinib alone or in combination with immune dysregulation due to underlying malignancy is unknown. The purpose of this study was to assess the incidence of PCP in patients with WM on ibrutinib therapy.

Methods
A retrospective cohort study was performed of all patients with WM who initiated ibrutinib monotherapy at Dana-Farber Cancer Institute between July 1, 2015 and January 30, 2018. Baseline characteristics, laboratory parameters, previous and concomitant malignancy treatment regimens, and antimicrobial medications were collected by chart review. Patients were followed until April 1, 2018 for the development of PCP.

Results
There were a total of 106 patients with WM on ibrutinib during the study period. Sixty-one (58%) were male, and the median age at initiation of ibrutinib was 69 years (range 43 – 89). Forty-six patients (43%) received prior therapy for WM, with a median of two previous treatment courses (range 1–6). Fourteen patients (13%) were on PCP prophylaxis for a combined duration of 8 person-years. No cohort patient developed PCP during the study period, which included 146 person-years of ibrutinib exposure. Three patients (3%) died due to disease progression (n = 2) and E. coli sepsis (n = 1).

Conclusion
Patients with WM on ibrutinib monotherapy appear to have a different infectious risk profile than patients with CLL or lymphoma and do not have a high risk of developing PCP. These data suggest that PCP prophylaxis is likely not beneficial for patients with WM on ibrutinib.

Disclosures
M. P. Cheng, Royal College of Physicians and Surgeons of Canada: Member, Salary. S. P. Hammond, Merck: Investigator, Research support. J. J. Castillo, Pharmacyclics: Consultant and Grant Investigator, Consulting fee and Research grant. N. C. Issa, GSK: Investigator, Research grant. Merck: Investigator, Research grant. Akros Pharma: Consultant, Consulting fee.
1131. Characteristics and Risk Factors for Mortality in Hematologic Patients with Invasive Non-Aspergillus Mold Infections: A Single-Center 7-Year Cohort Study
Authors: Lee Hyeon-Jeong , Lee Dong-Gun , Cho Sung-Yeon 
Published: November 2018

Abstract

Background
Since anti-mold active azole prophylaxis has become a standard approach for patients with high-risk hematologic diseases, the epidemiology of invasive fungal infections (IFIs) has shifted toward non-Aspergillus molds in recent years. The aim of this study was to identify the epidemiology and characteristics of non-Aspergillus invasive mold infections (NAIMIs) in the real-world.

Methods
Proven/probable NAIMIs developed in patients with hematologic diseases were reviewed from January 2011 to January 2018 at the Catholic Blood and Marrow Transplantation Center.

Results
There were 662 patients with proven/probable IMIs, of which 40 patients (41 isolates) were diagnosed with NAIMIs. The incidence of NAIMIs showed an increasing trend since 2013 when posaconazole prophylaxis was approved in Korea [correlation coefficient (r) = 0.735, P = 0.265]. Mucormycosis (n = 24, 58.5%) was the most common, followed by Fusarium (n = 7, 17.1%), Alternaria (n = 2), Scopulariopsis (n = 2), Scedosporium (n = 2), Paecilomyces (n = 1), Coprinus (n = 1), Chaetomium (n = 1), and Schizophyllum (n = 1). Twenty-eight patients were under neutropenia upon diagnosis of NAIMI and 35.0% were allogeneic stem cell transplantation recipients. The most common sites of NAIMI were the lungs (60.0%), followed by the paranasal sinus (17.5%) and disseminated infections (12.5%). There were 35.5% breakthrough IMI cases. In addition, there were 42.5% mixed or concurrent IFIs and 77.5% had coexisting bacterial or viral infections. The overall mortality at 6 and 12 weeks was 32.5% and 42.5%, respectively. The mortality rates for mucormycosis and nonmucormycosis at 6 weeks were 21.7% and 47.1%, respectively. Breakthrough IFIs [adjusted hazards ratio (HR) = 4.83, P = 0.018] and surgical treatment [HR = 0.09, P = 0.003] were independently associated with 6-week mortality.

Conclusion
NAIMIs showed an increasing trend, mixed/concurrent IFIs were substantial, and coexisting bacterial or viral infections were found in more than two-thirds of patients. Breakthrough IFIs and surgical treatment have significant impact on mortality. More meticulous approaches to diagnosis and treatment strategies of NAIMIs are needed.

Disclosures
All authors: No reported disclosures.
1132. Pneumocystis Infection in Children: National Trends and Characteristics in the United States, 1997–2012
Authors: Inagaki Kengo , Blackshear Chad , Hobbs Charlotte V 
Published: November 2018

Abstract

Background
Although epidemiology of immunocompromising condition in children has evolved over time, updated epidemiology of pediatric pneumocystis infection in the United States is not available.

Methods
We performed a retrospective analysis using the Kids’ Inpatient Database, a nationally representative sample of US pediatric hospital discharges collected in 1997, 2000, 2003, 2006, 2009, and 2012. Pneumocystis cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code 136.3 among children aged 0–18 years. Demographic data of cases with and without mortality were compared.

Results
We identified 1,902 (standard error, SE: 95) pneumocystis cases during the study period. The pneumocystis hospitalization rate decreased from 7.5 (SE: 0.91) to 2.7 (SE: 0.31) per a million US children from 1997 to 2012 (63.2% decrease). Cases with human immunodeficiency virus (HIV) infection decreased from 285 (SE: 56) cases in 1997 to 29 (SE: 7) cases in 2012, although non-HIV-associated cases remained relatively stable. After 2009, HIV was the third common underlying disorder after hematologic malignancy and primary immunodeficiency. All-cause in-hospital mortality was 11.7% (SE: 1.3%) and was particularly high among cases with hematopoietic stem cell transplant (HSCT) (32.4% [SE: 7.1%]) (P &lt; 0.001).

Conclusion
Pneumocystis infection in children showed a marked decrease from 1997 to 2012 in the United States, largely driven by the reduction in HIV-associated cases. Non-HIV illnesses including hematologic malignancy and primary immunodeficiency became prominent underlying conditions over time. HSCT-associated cases had particularly high mortality. Non-HIV conditions should be the target for primary and secondary prevention in reducing the disease burden.

Disclosures
All authors: No reported disclosures.
1135. Strongyloides Stercolaris Serology in Transplant Patients: To Test or Not?
Authors: Rivera Karla Rivera , Shah Tulsi , Garcia-Diaz Julia , Hand Jonathan 
Published: November 2018

Abstract

Background
Strongyloides stercoralis is an intestinal nematode endemic to the tropics, subtropics, and to a limited extent the United States and Europe. The global estimates of strongyloidiasis are reported to range from 3 to 100 million infected worldwide; however, the true US prevalence is unclear. The seroprevalence of infection in solid-organ transplant candidates and recipients in the New Orleans, Louisiana region is also unknown. The purpose of this study was to identify the prevalence of Strongyloides seropositivity within transplant candidates at Ochsner Medical Center (OMC).

Methods
Patients were identified using EPIC-CLARITY with ICD-9 and ICD-10 codes for any solid-organ transplant at OMC from July 2012 to December 2016. Inclusion criteria were age 18 or older, patients evaluated for solid-organ transplant, and Strongyloides IgG testing. Patients were excluded if they had other immunocompromising conditions or exposures including but not limited to steroids, TNF-alpha, or biologic agent use. The primary outcome was the overall prevalence rate of strongyloidiasis at OMC. Secondary outcome was the comparison of prevalence between January 1, 2012 to July 31, 2016 (when testing was ordered based on risk stratification) vs. August 1, 2016 to December 31, 2016 (when routine testing was implemented).

Results
We analyzed a total of 1,047 patients which had 1,128 tests ordered for Strongyloides. Of those, 985 were unique patients (62 patients had multiple serological tests resulting in 81 repeat tests). During July 1, 2012 to July 31, 2016 testing yielded a total of 822 tests. From August 1, 2016 to December 31, 2016 testing yielded 306 tests.
Overall, 43/1,128 (3.8%) tests were positive for Strongyloides. The remaining 1,085/1,128 (96.2%) tested negative. For our secondary outcome, we found that testing based on risk stratification yielded 22/822 (2.7%) positives while testing for all patients we had 21/306 (6.9%) positives.

Conclusion
Our data suggest that testing based on risk stratification yielded a lower prevalence rate as compared with generalized testing, underestimating the true incidence of disease (2.7% vs. 6.9%). Testing all patients being evaluated for transplantation will capture a greater number of patients with positive serology.

Disclosures
J. Garcia-Diaz, Astellas Pharma: Speaker’s Bureau, Speaker honorarium.
1137. Implementation of Universal Screening for Strongyloidiasis Among Solid-Organ and Hematopoietic Stem Cell Transplantation Candidates in a Non-endemic Area
Authors: Kottkamp Angelica , Mehta Sapna 
Published: November 2018

Abstract

Background
Strongyloidiasis can lead to hyperinfection and dissemination after transplantation with significant morbidity and mortality. Treatment for Strongyloidiasis prior to transplantation can reduce the risk of disseminated infection. Targeted screening based on travel history and country of origin incompletely identifies at-risk patients. Data on universal screening prior to solid-organ (SOT) or hematopoietic stem cell transplantation (HSCT) are limited. We implemented universal serology-based screening for strongyloides at our transplant center, located in a metropolitan non-ndemic area.

Methods
We identified patients screened with serum Strongyloides IgG by ELISA during pre-transplant evaluation for SOT or HSCT from August 1, 2017 to April 25, 2018. We reviewed adherence to the screening recommendation by program type and the medical record of seropositive patients for country of origin, history of eosinophilia (&gt;500 cell/μL), Gram-negative bacteremia, ova and parasite (O&P) examination and treatment.

Results
A total of 812 patients were evaluated for transplant during the study period: 484 for kidney, 152 for liver, 12 for liver/kidney transplant, 40 for heart, 24 for lung, and 100 for HSCT. 201 (24.7%) of the 812 patients were screened for Strongyloides; 107 (17%) evaluated for abdominal transplant, 32 (50%) for thoracic transplant, and 62 (60%) for HSCT. Seventeen (8.4%) of 201 patients screened tested positive: nine evaluated for kidney transplant, four for heart, one for liver, and three for HSCT. Nine of 17 patients (53%) were treated with Ivermectin or referred to Infectious Diseases clinic prior to our review. Ten (59%) seropositive patients were from the United States and 70% had no documented travel to endemic areas; six patients were from countries other than the United States; and one from Puerto Rico. Two patients with Strongyloidiasis had eosinophilia, one had history of Klebsiella pneumoniae bacteremia and one had stool O&P examination. Screening was higher when using an electronic order set (57% vs. 17%).

Conclusion
Universal screening for Strongyloidiasis identified individuals with latent infection who did not have epidemiological or clinical findings suggestive of Strongyloidiasis. Screening for Strongyloidiasis was higher in transplant programs that incorporated the recommendation into an electronic order set.

Disclosures
All authors: No reported disclosures.
1139. Novel Formulation SUBA-Itraconazole Prophylaxis in Patients With Hematological Malignancy or Undergoing Allogeneic Stem Cell Transplantation: Follow-up Survival Data
Authors: Lindsay Julian , Sandaradura Indy , Wong Kelly , Arthur Chris , Stevenson William , Kerridge Ian , Fay Keith , Coyle Luke , Greenwood Matthew 
Published: November 2018

Abstract

Background
Despite the advantageous spectrum of activity of itraconazole, it is rarely used as a prophylactic agent due to limited bioavailability and intolerance of the conventional formulation. After the development of a novel formulation SUBA-itraconazole® (SUper BioAvailability), we undertook a study to assess therapeutic levels, safety, tolerability, and IFI rates of this novel formulation when compared with the conventional itraconazole liquid in patients undergoing allogeneic hematopoietic stem cell transplantation or in hematological malignancy patients.

Methods
Following a single-centre, prospective study of SUBA–itraconazole 200 mg BID vs. conventional liquid itraconazole 200 mg BID, the SUBA–itraconazole group was assessed 1-year postallogeneic stem cell transplant for incidence of IFI and survival.

Results
A total of 57 patients (29 SUBA–itraconazole and 30 liquid-itraconazole) were assessed. Therapeutic concentrations were achieved significantly more quickly in the SUBA–itraconazole group; median of 6 days vs. 14 (P &lt; 0.0001). At day 10, therapeutic concentrations were achieved in 69% of the SUBA–itraconazole group vs. 21% (P &lt; 0.0001). The mean trough serum concentrations at steady state of SUBA–itraconazole were significantly higher, with less interpatient variability (1,577 ng/mL, CV 35%) vs. (1,218 ng/mL, CV 60%) (P &lt; 0.001). There were 2 (7.5%) treatment failures in the SUBA–itraconazole group, both due to cessation of therapy for mucositis, compared with 7 (23.3%) treatment failures in the liquid-itraconazole group, due to subtherapeutic levels (five), mucositis (one), and gastrointestinal intolerance (one) (P = 0.096). There was one confirmed IFI in the SUBA–itraconazole treatment failure group defined by a blood culture that yielded yeast; however, this was after the cessation of SUBA–itraconazole for mucositis. No other probable/possible IFIs were observed. After 1 year postallogeneic stem cell transplant in the SUBA–itraconazole group, there were two deaths (10%) due to disease progression and no further IFIs were reported.

Conclusion
The use of the SUBA–itraconazole formulation was a safe and effective prophylactic agent. It was associated with more rapid attainment of therapeutic levels with less interpatient variability when compared with conventional liquid itraconazole.

Disclosures
J. Lindsay, Mayne Pharma: Consultant, Consulting fee.