bluuebunny/crossref_metadata_2025_split huggingface dataset:
1197. Microbiological Surveillance of Duodenoscopes Before and After High-Level Disinfection Following Endoscopic Retrograde Cholangiopancreatography (ERCP)
Authors: Lopansri Bert K , Fernley Tasha , Coombs Jana , Gazdik Michaela A , Smit Lori , Dascomb Kristin K , Burke John 
Published: November 2018

Abstract

Background
Transmission of antibiotic-resistant bacteria during endoscopic retrograde cholangiopancreatography (ERCP) has been linked to the complex design of the duodenoscope (scope) elevator channel and cantilever. We implemented a scope culturing program to monitor the efficacy of disinfection and to identify frequency of pre-disinfection exposure to antibiotic-resistant bacteria.

Methods
Facilities performing ERCPs within the Intermountain Healthcare system voluntarily submit scope cultures to the Infectious Diseases Epidemiology Laboratory. Cultures are collected at designated intervals based on procedure volumes at each site. Samples are submitted by endoscopy techs trained to collect flush and swab samples of the distal end of the scope using a previously described method before (PRE) and after (POST) high-level disinfection. Selective media is used to screen for Gram-negative bacilli-resistant to third-generation cephalosporins (ESBL) and vancomycin-resistant Enterococcus (VRE).

Results
Between March 7, 2016 and April 18, 2018, 1,255 scope samples from 10 facilities were cultured (533 PRE samples and 722 POST samples). 483 (90.6%) PRE samples were positive, with 75 (15.5%) screening positive for an antibiotic-resistant organism (60 ESBL and 15 VRE). 19 (2.6%) POST samples were positive, with 4 (21.1%) screening positive for ESBL. One of the four ESBL positive POST samples had a corresponding PRE sample for comparison; E. coli and Klebsiella variicola were isolated in both indicating residual contamination. Two of the ESBL-positive POST cultures did not have corresponding PRE samples and one had a PRE culture negative for ESBL. No POST samples contained VRE. Endoscopy personnel were contacted for each positive POST culture and endoscopy reprocessing practices were reviewed. Additionally, scopes were quarantined, reprocessed and re-cultured. Scopes were returned to use once POST cultures were negative.

Conclusion
Contamination of scopes with antibiotic-resistant bacteria during ERCP is common. High-level disinfection is effective at reducing bacterial burden but is imperfect. Routine surveillance for post-reprocessing bacterial colonization has been helpful to minimize patient exposure and to maintain focus on the importance of reprocessing.

Disclosures
All authors: No reported disclosures.
1198. Clinical Characteristics and Outcomes of Klebsiella pneumoniae Infections in Service Members Who Sustained Trauma in Iraq and Afghanistan
Authors: Kiley John , Mende Katrin , Kaiser Susan J , Carson Leigh , Lu Dan Z , Whitman Timothy J , Petfield Joseph L , Tribble David R , Blyth Dana M 
Published: November 2018

Abstract

Background
Klebsiella pneumoniae infections present a challenge to the clinician due to increasing resistance. K. pneumoniae was the third most common species of multidrug-resistant (MDR) Gram-negative organism in trauma patients sustaining injuries in Iraq and Afghanistan from 2009 to 2014. This study aims to elucidate the epidemiology of these infections by characterizing clinical aspects, risk for MDR infections, and outcomes.

Methods
All initial and serial (≥7 days from prior isolate) infecting K. pneumoniae isolates were collected from the Trauma Infectious Disease Outcomes Study (TIDOS) (6/09-12/14). Antimicrobial susceptibilities were determined using the BD Phoenix Automated Microbiology System and CLSI criteria. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of an ESBL or KPC.

Results
Of 588 K. pneumoniae isolates in the TIDOS registry, 141 infecting isolates (98 initial) from 51 patients met inclusion criteria. Initial isolates were respiratory (31%), wound (25%), blood (20%), urine (10%), intra-abdominal (8%) and other (6%). All patients were male with a median age of 23 years (IQR 21–28). The majority of patients (82%) suffered blast injuries; of which, 88% were from improvised explosive devices. Patients had a median injury severity score (ISS) of 38 (IQR 30–45) and time from injury to first infecting K. pneumoniae isolate was 15 days (IQR 8–31). The median hospital stay was 49 days (IQR 28–70) and four patients died. All patients had received antibiotics prior to diagnosis. Twenty-three (46%) patients had initial isolates classified as MDR. There was no difference in age, ISS, or time from injury to first isolation among those who did and did not have initial MDR isolates. Sixteen patients had 64 serial isolates, of which 24 were wound, 20 respiratory, 14 blood and six urine. Three of these 16 patients died compared with 1 of 35 patients without serial isolates.

Conclusion
K. pneumoniae infections are common among combat casualties. Patients with K. pneumoniae infections were severely injured and almost half of initial infecting isolates were MDR, complicating treatment.

Disclosures
All authors: No reported disclosures.
1199. Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae: A Comparative Study Between Facilities in the United States and the Dominican Republic
Authors: Mena Lora Alfredo J , Fermin Rita Rojas , Guzman Anel , Borgetti Scott , Bleasdale Susan C 
Published: November 2018

Abstract

Background
The prevalence of multi-drug-resistant organisms (MDRO) is on the rise globally. MDRO infections carry high morbidity and mortality. There is a paucity of data on Carbapenem-resistant Klebsiella pneumoniae (CRKp) in the Dominican Republic (DR). Evaluating CRKp in various settings will provide data on contrasting epidemiologic risk factors. We evaluated the epidemiology of CKRp in three contrasting settings, a 495-bed urban academic center (AC), a 151-bed urban community hospital (CH) and a 200 bed teaching hospital in the DR (DRH).

Methods
We performed a retrospective cohort study of patients with CRKp cultures from 2014 to 2016 from AC, CH and DRH. A comparative evaluation of the epidemiology of CRKp between the cohorts was performed. Demographics, co-morbid conditions, antibiotic sensitivity, and outcomes were compared between hospital cohorts.

Results
Cohort AC had 64 patients, compared with eight from CH and eight from DRH. AC (59%) and CH (62%) cohorts included more men than the DRH cohort (25%). Average age was 62, 66, and 51, respectively. History of MDRO, antibiotic use in the past 6 months and hospitalization within the past year were common risk factors (Figure 1). Diabetes and end-stage renal disease were common comorbidities at all facilities (Figure 2). Charleston Comorbidity Index (CCI) score was highest at AC (6.6) and DRH (6.4) compared with CH (4). Mortality was highest in DRH (63%, 6/8) and AC (11%, 7/64) while CH had no deaths. Urine was the most common source at AC (67%) and CH (75%) while blood was most common at DRH (62.5%). CRKp isolates were susceptible to colistin at varying rates (AC=85%, CH = 63%, DRH = 80%).

Conclusion
Prior antibiotic use and hospitalization were common risk factors in all settings. Mortality and CCI scores for CRKp was highest at AC and DRH, which are tertiary referral centers. CH had less overall mortality and higher rates of colistin resistance. Further studies are needed to understand these risk factors. Strengthening antimicrobial stewardship and infection control practices in the United States and abroad may help curb the spread of resistance in different clinical settings.

Disclosures
All authors: No reported disclosures.
1200. Molecular Epidemiology of Cephalosporinases and Extended Spectrum β-Lactamases (ESBLs) in Proteus mirabilis Isolates From Croatia: Following the Spread of Resistance Determinants Between Long-Term Care Facilities and the Community
Authors: Mestrovic Tomislav , Lukic-Grlic Amarela , Bogdan Maja , Bandic-Pavlovic Daniela , Cavric Gordana , Drenjancevic Domagoj , Sreter Katherina Bernardette , Bencic Ana , Sardelic Sanda , Bedenic Branka 
Published: November 2018

Abstract

Background
Previous studies on P. mirabilis strains isolated from Croatian healthcare institutions revealed the predominance of TEM-52 extended spectrum β-lactamase (ESBL), as well as the emergence of plasmid AmpC β-lactamases. Our aim was to molecularly characterize cefalosporinases in P. mirabilis isolates from long-term care facilities (LTCFs) and to compare their resistance profile and dynamics with community isolates.

Methods
From a total of 3,321 P. mirabilis isolates collected from two LCTFs and from outpatients between 2015 and 2017, 1.23% of them were resistant to third generation of cephalosporins. Antimicrobial sensitivity was tested by broth microdilution method. ESBLs and plasmid-mediated AmpC β-lactamases were detected with phenotypic inhibitor-based tests and polymerase chain reaction (PCR). Antibiotic resistance dissemination and genetic context of bla genes were interrogated by conjugal mating and PCR mapping, respectively. Plasmids were characterized by conjugation and transformation experiments, as well as PCR-based replicon typing.

Results
High-level of resistance to amoxicillin, co-amoxiclav, first, second and third generation of cephalosporins was found in all isolates. Three isolates tested positive in inhibitor-based test with clavulanic acid, and 38 both in Hodge test and combined disk test with phenylboronic acid, indicating the production of ESBLs and plasmid-mediated AmpC β-lactamases, respectively. Two ESBL-positive organisms yielded amplicons with primers for CTX-M β-lactamase of group 1 and one for TEM. All AmpC-positive organisms were identified by PCR as CMY (with an additional TEM). Insert sequence ISEcp-1 was found upstream of blaCMYi blaCTX-M genes. CTX-M positive strains harbored IncK plasmid, whereas AmpC-positive strains were negative for known plasmid types. This is also a first description of P. mirabilis harboring CTX-M-15 β-lactamase in Croatia.

Conclusion
Our study showed the persistence of CMY β-lactamases in one LTCF, but also the dissemination of characteristic resistance determinants to another LTCF and the community. Similar to some other studies, there was a clear trend of cephalosporinase dynamic switch from TEM variants to CMY and CTX-M, with impending consequences for treatment decisions.

Disclosures
All authors: No reported disclosures.
1210. Staphylococcal Acute Post-Operative Prosthetic Joint Infection (PJI) Treated With “DAIR” (Debridement and Implant Retention) and Impact of Rifampin: A Retrospective Cohort Study in France
Authors: Becker Agathe , Triffault-Fillit Claire , Forestier Emmanuel , Lesens Olivier , Boyer Bertrand , Descamps Stéphane , Chidiac Christian , Lustig Sébastien , Montbarbon Eric , Batailler Cécile , Cazorla Celine , Ferry Tristan 
Published: November 2018

Abstract

Background
Staphylococci are the most frequent bacteria in PJI. In patients with acute PJI (i.e., &lt;1 month following the implantation), DAIR with exchange of removal components followed by a combination of antibiotics including rifampin (RMP) (particularly RMP + fluoroquinolone) are recommended. Unfortunately, some patients could not receive RMP due to drug–drug interaction or stopped it due to an adverse event. Finally, it is unclear whether the dose and the duration of RMP influenced the prognosis.

Methods
Retrospective cohort study in four hospitals including patients with staphylococcal acute post-operative PJI treated with DAIR in 2011–2016. Univariate and multivariate Cox analysis and Kaplan–Meier curves were used to determine the risk factors for treatment failure.

Results
Seventy-nine patients were included (median age: 71 years [IQR 53–89]; 55 men [69.6%]; median ASA score: 2 [IQR 2–3]). Cultures revealed 65 (82%) S. aureus and 15 (19%) coagulase negative staphylococci infections, including 14 methicillin-resistant strains (18%). Among all isolates, only two (3%) were resistant to RMP and 16 (20%) were resistant to fluoroquinolone. The median duration of antimicrobial therapy was 92 days (IQR 31–152). Only 59 patients received RMP (75%), and 35 (44%) the combination RMP + fluoroquinolone. Median duration of RMP was 57 days (IQR 16–86) and median dose 14.6 mg/kg/d (IQR 13–17). Forty patients (51%) received RMP in the first 2 weeks and 43 patients (54%) received at least 2 weeks of RMP. Six patients (8%) developed an adverse event leading to RMP interruption. During a median follow-up of 443 days (IQR 220–791), 21 patients (27%) experienced a treatment failure including 12 persistence of the initial pathogen (57%) and nine superinfections (43%). An ASA score &gt;2 (OR 2.8; 95% CI 1.26–6.15), the use of RMP (OR 0.4; 95% CI 0.71–0.95) and the duration of RMP treatment (OR 0.83; 95% CI 0.75–0.92 per week of treatment) were significant determinants of the outcome (but not methicillin-resistance). Receiving &gt;2 weeks of RMP prevented the failure, but an introduction during the first 2 weeks did not influence the outcome.

Conclusion
In patients with staphylococcal acute PJI, the use of RMP and its duration strongly influenced the prognosis. As 25% of patients could not receive RMP, new drugs with anti-biofilm activity are required.

Disclosures
All authors: No reported disclosures.
1213. Evaluation of an Alcohol-Based Antiseptic for Nasal Decolonization of Methicillin-Resistant Staphylococcus aureus (MRSA)
Authors: Kanwar Anubhav , Cadnum Jennifer L , Mana Thriveen Sankar Chittoor , Gestrich Scott , Jencson Annette , Donskey Curtis J 
Published: November 2018

Abstract

Background
Due to concerns for emergence of mupirocin resistance, there is an interest in use of topical antiseptics for nasal decolonization of Staphylococcus aureus. Alcohol-based nasal antiseptics have recently been developed as an alternative to mupirocin, but there is limited data on efficacy, particularly among patients where the burden of carriage is often high.

Methods
We evaluated the effectiveness of a one-time application of a commercial alcohol-based nasal sanitizer for reduction in nasal methicillin-resistant Staphylococcus aureus (MRSA) in MRSA-colonized patients. Patients received either a single dose or triple dose over 3 minutes; the triple dose is recommended for preoperative dosing. Swabs were used for quantitative culture of MRSA from the anterior nares and vestibule prior to and 10 minutes, 2 hours, and 6 hours after application. For a subset of patients, cultures for MRSA were collected from hands, clothing, groin, and chest/axilla.

Results
Of 34 MRSA carriers enrolled, 27 (79%) had MRSA detected in nares, 32 (94%) were male, and the mean age was 65. Of the 27 carriers positive for nasal MRSA, 15 (56%) received a single alcohol dose and 12 (44%) received a triple dose over 3 minutes. As shown in the figure, the single and triple dose applications significantly reduced MRSA concentrations at 2 hours post-treatment when the initial burden was low (i.e., &lt;2 log10colonies per swab), but there was no significant reduction at 6 hours; there was no significant reduction with either dose when the initial burden was high (≥2 log10colonies per swab).

Conclusion
A single application of an alcohol nasal sanitizer significantly reduced nasal MRSA at 2 hours post-application when the initial burden of colonization was low, but not when a high burden of carriage was present. Additional studies are needed to determine whether higher alcohol doses or repeated applications might result in improved efficacy.

Disclosures
All authors: No reported disclosures.
1214. High Frequency of Genes Encoding Resistance to Heavy Metals in Methicillin-Resistant Staphylococcus aureus (MRSA) Endemic Lineages From South America
Authors: Diaz Lorena , Solano Juan , Rios Rafael , Carvajal Lina P , Munita Jose M , Rincon Sandra , Arias Cesar , Reyes Jinnethe 
Published: November 2018

Abstract

Background
MRSA-USA300 is a community-associated clone that has spread worldwide, becoming the most successful clone in the USA. Since 2005, the MRSA-USA300 Latin-American Variant (USA300-LV) has disseminated in community and hospitals in Northern South America. Phylogenetic analysis revealed that USA300-LV is not derived from the USA300 (NA-USA300) but rather, the two clones diverged from a common ancestor. During their evolution, NA-USA300 strains incorporated the ACME element and USA300-LV acquired a copper and mercury resistance mobile element designated COMER. Interestingly, contamination by heavy metals in South American has been recently highlighted and could be driving the selection of resistant genetic lineages. We investigated the frequency of merA, merB, and copB in genomes of clinical isolates of S. aureus from Latin America (LA).

Methods
The presence of merA/merB and copB encoding mercury and copper resistance, respectively, were investigated in 515 S. aureus sequenced genomes recovered from bacteremic patients in hospitals from nine Latin American hospitals trough BLAST searches.

Results
The prevalence of merAB in S. aureus was 35% (181 out of 515 genomes). Interestingly, among 181 merAB-positive S. aureus, 174 were MRSA (96%). Moreover, 71%, 60%, 59%, and 51% of MRSA genomes from Peru, Ecuador, Colombia, and Venezuela, respectively, harbored mercury resistance genes. Similarly, 65%, 60%, and 22% of MRSA genomes from Ecuador, Colombia, and Venezuela, contained the copB gene. Among 174 MRSA harboring merAB, ST8 and ST5 were the most predominant lineages in (43% and 45% of genomes, respectively). In contrast, among 95 MRSA carrying copB, ST8 was the most frequent lineage (96% of isolates). MRSA from countries with high prevalence of mercury genes showed association with ST5 and ST8. 88% of Colombian and 87% of Ecuadorian MRSA harboring merAB belonged to ST8 lineage, whereas ST5 was predominant in 88% of Peruvian MRSA. In Venezuela, ST5 and ST8 were found in 44% and 33%, respectively, of MRSA positive for merAB.

Conclusion
High levels of mercury in rivers of Colombia, Ecuador and Peru has been reported. Thus, the prevalence of heavy metal resistance genes in MRSA clinical isolates suggest an adaptation of endemic genotypes to heavy metal contamination caused by activities like metal mining.

Disclosures
J. M. Munita, Pfizer: Grant Investigator, Research grant. C. Arias, Merck & Co., Inc.: Grant Investigator, Research support. MeMed: Grant Investigator, Research support. Allergan: Grant Investigator, Research support.
1218. Retapamulin as a Potential Decolonizing Agent: Activity against Mupirocin-Resistant Strains From Pediatric Patients With Methicillin-Resistant Staphylococcus aureus Infection
Authors: Patel Ami , Lighter-Fisher Jennifer , Fulmer Yi , Copin Richard , Ratner Adam , Shopsin Bo 
Published: November 2018

Abstract

Background
Controlling methicillin-resistant Staphylococcus aureus (MRSA) colonization is a common strategy to prevent transmission and recurrent infection. Standard decolonization regimens include nasal application of mupirocin ointment; however, increasing rates of mupirocin-resistance (Mup-R) have been noted globally. At our institution there has been an increase in community-acquired MRSA (CA-MRSA) infections among children living in Brooklyn, New York. A genotypic geographic cluster of an outbreak clone of the CA-MRSA strain USA 300 with a high rate (&gt;85%) of mupirocin resistance, mediated by the plasmid borne mupA gene, was identified prompting investigation into an alternative decolonizing agent. We sought to investigate retapamulin, a topical pleuromutilin antibiotic, which has been shown to be effective against S. aureus with in vitro and in vivo activity against MRSA and a low propensity to develop resistance.

Methods
Broth microdilution was used to determine the minimum inhibitory concentrations (MIC) of retapamulin against 53 Mup-R MRSA isolates collected from pediatric patients (aged 9 months–17 years) presenting to our institution over an 18 month period with clinical MRSA infection. Susceptibility defined as ≤0.5 mg/L susceptible (EUCAST). Whole genome sequence data were analyzed for the presence of rplC and cfr gene mutations known to confer resistance to retapamulin.

Results
All 53 isolates were susceptible to retapamulin. 49/53 (92%) strains were inhibited at MIC 0.25 mg/L, 2/53 (4%) at MIC 0.125 mg/L, and 2/53 (4%) at MIC 0.5 mg/L. DNA sequence analysis showed that one isolate had a first-step mutation in the rplC gene, but it was not associated with reduced phenotypic susceptibility to retapamulin, as the MIC of that isolate was 0.25 mg/L.

Conclusion
Retapamulin demonstrated excellent in vitro activity against a genotypic cluster of Mup-R isolates from pediatric patients presenting to our institution with MRSA infection. These data suggest that retapamulin may be a promising alternative decolonization therapy for MRSA and a viable option to prevent the spread of mupirocin-resistant MRSA clones. Further research includes an ongoing randomized, placebo-controlled trial testing the in vivo efficacy of retapamulin as a nasal and perirectal decolonizing agent in children.

Disclosures
A. Patel, Aqua Pharmaceuticals: Investigator inititiated grant, Research grant. J. Lighter-Fisher, Aqua Pharmaceuticals: Investigator Initiated Grant, Research grant.
1219. Increasing Methicillin Resistance of Staphylococcus lugdunensis in a Tertiary Care Community Hospital in Japan
Authors: Ichikawa Takahiro , Kodama Fumihiro 
Published: November 2018

Abstract

Background
Staphylococcus lugdunensis, a coagulase-negative staphylococcus, has virulence and pathogenicity similar to that of Staphylococcus aureus. Methicillin resistance and presence of mecA gene are not common in S. lugdunensis in many parts of the world. Recently, higher prevalence of methicillin-resistant S. lugdunensis is reported from Taiwan and Japan. We describe the change in methicillin resistance of S. lugdunensis in a tertiary care community hospital in Sapporo, Japan.

Methods
We performed a retrospective study of S. lugdunensis, isolated from inpatients and outpatients at our hospital from 2008 to 2017. Rate of methicillin resistance of the first 5 years from 2008 to 2012, and that of the second 5 years from 2013 to 2017 were compared. Risk factors of methicillin resistance were also evaluated. Phenotypic detection of methicillin resistance was identified using broth microdilution by VITEK two system (bioMérieux).

Results
A total of 369 cases of S. lugdunensis were detected during the study period. Of all cases, 228 (61.8%) were men, and 177 (48.0%) were hospitalized. Twenty-one isolates (5.7%) were positive in blood culture, 216 (58.5%) were positive in cultures of skin and soft tissue. Methicillin-resistant strains were found in 43 (31.6%) of 136 isolates from 2008 to 2012, and in 108 (46.4%) of 233 from 2013 to 2017 (OR 1.87; 95% CI 1.20–2.91; P = 0.006). Of patients with methicillin-resistant S. lugdunensis, 105 cases (69.5%) were hospitalized (P &lt; 0.001).

Conclusion
In our hospital, methicillin-resistant S. lugdunensis is increasing over the 10 years. Further research is needed to assess trend of methicillin resistance of S. lugdunensis in other healthcare facilities and countries.

Disclosures
All authors: No reported disclosures.