bluuebunny/crossref_metadata_2025_split huggingface dataset:
1022. Rising Rates of Injection Drug Use Associated Infective Endocarditis in Virginia With Missed Opportunities for Injection Drug Use Disorder Treatment Referral: A Retrospective Cohort Study
Authors: Gray Megan , Rogawski Elizabeth , Scheld Michael W , Dillingham Rebecca 
Published: November 2018

Abstract

Background
Injection drug use disorder (IDD) is a growing public health threat in Virginia, although there is limited knowledge of related morbidity. The purpose of this study was to describe the temporal, geographic, and clinical trends and characteristics of infective endocarditis associated with IDD (IDD-IE) and to identify opportunities for better-quality care of people with IDD.

Methods
We reviewed charts for all admissions coded for both IE and drug use disorders at the University of Virginia Medical Center (UVA) from January 2000 to July 2016. A random sample of 30 admissions coded for IE per year were reviewed to evaluate temporal trends in the proportion of IDD associated IE cases.

Results
There were a total of 76 patients with IDD-IE during the study period, with a 7-fold increase in cases of IDD-IE from the early 2000s to 2016. The proportion of IE that was IDD-associated increased by nearly 10% each year (prevalence ratio of IDD per year: 1.09, 95% CI: 1.05–1.14). Patients with IDDIE had longer hospital stays [median days (interquartile range); IDD-IE, 17 (10–29); non-IDD-IE, 10 (6–18); P = 0.001] with almost twice the cost of admission as those without IDD [median (interquartile range); IDD-IE, $47,899 ($24,578–78,144); non-IDD-IE, $26,460 ($10,220–60,059); P = 0.001]. In 52% of cases, there was no documentation of any discussion regarding addiction treatment.

Conclusion
IDD-IE cases are increasing in Virginia leading to higher morbidity and healthcare costs. IDD-IE may provide an opportunity for the delivery of IDD treatment, counseling, and harm reduction strategies.

Disclosures
All authors: No reported disclosures.
1024. First Episode Infective Endocarditis in Persons Who Inject Drugs (PWIDs); A Retrospective Cohort Study
Authors: Rodger Laura , GlockerLauf Dresden , Shojaei Esfandiar , Sherazi Adeel , Hallam Brian , Ball Laura , Koivu Sharon , Gupta Kaveri , Hosseini-Moghaddam Seyed , Silverman Michael 
Published: November 2018

Abstract

Background
Persons who inject drugs (PWID) represent a distinct demographic of patients with infective endocarditis (IE). Many centers do not perform valvular surgery on these patients due to concerns about poor outcomes.

Methods
Retrospective cohort study comparing PWID patients to non-PWID patients presenting between February 2007 and March 2016 in London, Ontario, among adult (&gt;18) inpatients with first episode IE.

Results
In 370 first episode IE cases, 53.9% occurred in PWIDs. PWID patients were younger (35.4 SD 10.0 vs. 59.4 SD 14.9) (P &lt; 0.001), more likely to have right-sided infection [125/202 (62%), vs. 16/168 (9.5%) (P &lt; 0.001)], and more often due to S. aureus (156/202 (77.3%) vs. 54/168 (32.1%), P &lt; 0.001). Myocardial and aortic root abscesses were less common in PWIDs [17/202 (8.4%) vs. 50/168 (30%) (P &lt; 0.01)]. There was no difference in the frequency of noncardiac complications. In total, 36.5% of patients were treated surgically with PWID patients less likely to undergo surgery [39/202 (19.3%) vs. 98/168 (58%) P &lt; 0.001]. Cox regression analysis identified the protective effect of cardiac surgery with regards to survival in all patients, with a hazard ratio of 0.49 (95% CI 0.31–0.76, P &lt; 0.001), as well as among PWIDs (HR 0.39, 95% CI 0.17–0.87, P = 0.02). Among all patients, lower survival was associated with older age (HR 1.03, 95% CI 1.00–1.05, P &lt; 0.001), injection drug use (HR 2.72, 95% CI 1.52–4.88, P &lt; 0.001), left-sided infection (HR 3.48, 95% CI 2.01–6.03, P &lt; 0.001), and bilateral infection (HR 3.19, 95% CI 1.45–7.01, P = 0.004). The lower survival of left-sided infection (HR 4.01, 95% CI 1.97–8.18, P &lt; 0.001) or bilateral infection (HR 6.94, 95% CI 2.39–20.2,P &lt; 0.001) was re-demonstrated in PWIDs.

Conclusion
This study identifies important clinical differences between PWIDs and nondrug users with respect to valve involvement, causative organism, complications, and management strategies. Our results highlight the important role of surgical treatment in a carefully selected PWID patient population.

Disclosures
All authors: No reported disclosures.
1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series
Authors: Pettigrew Adam , Jariwala Ripal , Zeitler Kristen , Montero Jose , Gompf Sandra , Toney John 
Published: November 2018

Abstract

Background
While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined.

Methods
We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned.

Results
Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia.

Conclusion
CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB.

Disclosures
All authors: No reported disclosures.
1038. Edwardsiella tarda Bacteremia: Epidemiology, Clinical Features, and Outcomes
Authors: Kamiyama Shinya , Kuriyama Akira , Hashimoto Toru 
Published: November 2018

Abstract

Background
Edwardsiella tarda is primarily associated with gastrointestinal disease, but an increasing number of cases with extraintestinal disease have been reported. Additionally, E. tarda bacteremia (ETB) may be associated with high mortality; however, little is known about its clinical epidemiology.

Methods
We collected all clinical information of ETB patients identified between January 2005 and December 2016 from their electronic medical records. We described the epidemiology, clinical features, and 30- and 90-day mortality of these patients.

Results
A total of 182,668 sets of blood cultures were obtained during the study period, of which 40 sets (0.02%) taken from 26 patients were E. tarda positive. Twenty-six patients (13 men and 13 women) with a median age of 75 years were diagnosed with ETB. Clinical diagnoses by infection site included cholangitis (n = 9), liver abscess (n = 6), enterocolitis (n = 4), cholecystitis (n = 3), and spontaneous bacterial peritonitis, mycotic aneurysm, necrotizing fasciitis, empyema, osteomyelitis, and secondary peritonitis (n = 1 each). The overall 30-day and 90-day mortality rates of ETB in our cohort was 11.5% (3/26) and 26.9% (7/26), respectively. There was no seasonal variation in the incidence of E. tarda infection. All E. tarda strains isolated from blood cultures were susceptible to all tested antibiotics. Additionally, hepatobiliary infection was more frequently seen in ETB compared with non-bacteremic E. tarda infections.

Conclusion
This study is the largest case series on ETB to date. We found that ETB is a rare entity that is not associated with high mortality. Hepatobiliary infection is the most common clinical manifestation.

Disclosures
All authors: No reported disclosures.
1046. Clinical and Microbiological Characteristics of Patients With Septicemia Caused by IMP-1-Producing Enterobacteriaceae in a Tertiary Hospital in Japan
Authors: Mori Nobuaki , Kagawa Narito , Aoki Kotaro , Ishii Yoshikazu , Tateda Kazuhiro , Aoki Yasuko 
Published: November 2018

Abstract

Background
Carbapenemase-producing Enterobacteriaceae (CPE) infection has become a great threat to public health worldwide. Although KPC and OXA-48 infections have mostly described, IMP-1 producing Enterobacteriaceae (IMP1-E) are not well studied. We investigated the clinical and microbiological characteristics of septicemia due to the IMP1-E.

Methods
This observational study of inpatients who developed IMP-1E septicemia was conducted in a Japanese tertiary hospital from April 2013 to March 2017. IMP1-E was defined as a decreased susceptibility to meropenem (minimum inhibitory concentration, ≥2 mg/L), as well as a positive sodium mercaptoacetic acid test, and polymerase chain reaction for blaIMP genes. Clinical data were collected from medical charts. Antimicrobial susceptibilitly was determined by the MicroScan Walkway. We performed total genomic analysis, plasmid analysis, and multilocus sequence typing (MLST) using whole genome sequencing data.

Results
In total, six patients were identified (median age: 55 years). All had severe underlying disease on admission, and five were admitted to the intensive care unit. The sources of IMP1-E septicemia were as follows: two catheter-related BSI, one pyelonephritis, one cholangitis, one bacterial peritonitis, and one unknown focus. Four isolates were Enterobacter cloacae and two were Klebsiella pneumoniae. All patients had a previous history of antibiotic treatment and long-term hospitalization. All patients were treated with either levofloxacin (LVFX) only or LVFX and aminoglycoside (AG). Follow-up blood culture was negative for all patients. All-cause 30-day mortality rate was 50%. Although no isolates were resistant to LVFX and AG, they harbored aac(6’)-Ⅱc, sul1, and tet(B) genes.Two isolates harbored the qnrB6 gene. There was a high probability that blaIMP-1 was carried by IncHI2 plasmids. MLST sequence type of E. cloacae isolates comprised three ST78, and one ST997; K. pneumonia isolates comprised ST134, and ST252.

Conclusion
This study showed that IMP1-E septicemia was isolated in patients with severe disease and long-term hospitalization. Selection of antibiotics therapy based on antimicrobial susceptibility induced microbiological cure, but clinical response was dependent on the underlying diseases.

Disclosures
All authors: No reported disclosures.
1060. Risk Factors for Recurrent Staphylococcus aureus Bacteremia
Authors: Choi Seong-Ho , Ruffin Felicia , Park Lawrence , Sharma-Kuinkel Batu K , Souli Maria , Warren Bobby , Hansen Brenda , Medie Felix Mba , Fowler Vance G 
Published: November 2018

Abstract

Background
Recurrent Staphylococcus aureus bacteremia (Re-SAB) occurs in 2–17% of patients with SAB within 3–12 months after resolution of the first episode. The risk factors for Re-SAB are incompletely understood.

Methods
Re-SAB was defined as a second episode of SAB after the resolution of the first episode occurring at least 14 days from the date of the last positive blood culture of the first episode. Using the SAB Group Prospective Cohort Study (SABG-PCS) data between January 2008 and May 2015, patients with Re-SAB were selected and compared with those without it. Pulsed-field gel electrophoresis (PFGE) was done for the clinical isolates from the Re-SAB group, and spa typing was for those from both groups. Baseline sera from patients with Re-SAB and age/race/gender matched (1:1) control subjects with SAB but without Recurrence underwent Luminex multiplex cytokine array.

Results
Seventy patients experienced Re-SAB (9.3%) and 686 SAB patients did not. In the Re-SAB group, 156 episodes of SAB were observed. Median time to Re-SAB was 147.5d (IQR, 76–358). Among 65 PFGE-analyzed pairs of isolates from the first and the subsequent episodes, the time to Re-SAB of &lt;300 days was more commonly found in the PFGE-identical pairs than in the PFGE-different pairs (75.6% vs. 33.8%, P = 0.001). In the comparison of clinical factors between 56 Re-SAB patients with available data and 686 without Re-SAB, African American race, dialysis dependence, the presence of foreign body, persistent bacteremia, metastatic abscess formation, and methicillin-resistant S. aureus (MRSA) were more frequently observed in patients with Re-SAB. In a multivariate analysis to identify risk factors for Re-SAB, African American race, dialysis dependence, metastatic abscess formation, and MRSA were independent risk factors. The distribution of spa types between the two group was presented in Figure 1.

Conclusion
Re-SAB involves a combination of multiple factors of host, microbe, and treatment. Further laboratory investigation for any determinants in host and microbe is required.

Disclosures
V. G. Fowler Jr., Merck, Cerexa/Actavis, Pfizer, Advanced Liquid Logis, NIH, MedImmune, Basilea, Karius, Contrafect, Regneron, Genentech, Affinergy, Locus, Medical Surface, Inc., Achaogen, Astellas, Arsanis, Bayer, Cubist, Debiopharm, Durata, Grifols, Medicines Co, Novartis: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research grant and Research support.
1069. Predictive Factors for Metastatic Infection in Patients With Bacteremia Caused by Staphylococcus aureus
Authors: Shimizu Akihiro , Horino Tetsuya , Hosaka Yumiko , Hoshina Tokio , Nakaharai Kazuhiko , Lee Kwangyeol , Miyajima Makiko , Nakazawa Yasushi , Yoshida Masaki , Yoshida Hiroshi , Hori Seiji 
Published: November 2018

Abstract

Background
Metastatic infections, such as infective endocarditis and pyogenic spondylitis, are very serious complications of Staphylococcus aureus bacteremia (SAB), because failure to identify metastatic infections may cause poor prognosis. The aim of the present study is to determine the predictive factors for metastatic infections of SAB.

Methods
This retrospective cohort study was conducted among patients with bacteremia due to S. aureus (including both methicillin-sensitive S. aureus and methicillin-resistant S. aureus: MSSA and MRSA) in The Jikei University Kashiwa Hospital. The study population comprised 125 adult patients with SAB between January 2014 and December 2017. Patients, that died or transferred within 3 months after the initial positive blood culture, were excluded, because metastatic infection was defined as deep-seated infection detected within 3 months after the initial positive blood culture. We analyzed several factors, including demographics, comorbidities, community acquisition, primary site of infection, persistent fever and laboratory data such as c-reactive protein (CRP) levels after treatment.

Results
Seventy-four patients met inclusion criteria of this study. The most common primary site of bacteremia was catheter-related [24 (32.4%) of 74]. Metastatic infection occurred in 22 (29.7%) of 74 patients, and spondylitis was most common, following psoas abscess. Of these, 11 infections (50% of 22) were community acquired. We did not find any significant differences in demographics and comorbidities, except central venous catheter-associated bloodstream infection, which was associated with low rate of metastatic infection. By multivariate analysis, the predictive factors associated with the development of metastatic infection were community onset of infection (OR 11.6; 95% CI 2.98–45.1; P &lt; 0.001), persistent fever over 72 hours (OR 6.7; 95% CI 2.12–21.8; P = 0.001), and higher CRP levels (&gt;3 mg/dL) lasting 2 weeks after the administration of appropriate antibiotics (OR 7.47; 95% CI 2.39–23.3; P &lt; 0.001).

Conclusion
This study demonstrated that additional diagnostic tests to identify metastatic infection should be performed, especially in the patients with community-acquired SAB, persistent fever or persistently high CRP levels after the administration of appropriate antibiotics.

Disclosures
All authors: No reported disclosures.
1074. Management and Outcomes of Infective Endocarditis Due to Nutritionally Variant Streptococci
Authors: Fida Madiha , Mansoor Tarab , Saleh Omar Abu , Hamdi Ahmed , Desimone Daniel C , Wilson Walter R , Steckelberg James , Baddour Larry M , Sohail M Rizwan 
Published: November 2018

Abstract

Background
Nutritionally variant streptococci (NVS) are an infrequent cause of infective endocarditis (IE) and management recommendations are based on weak levels of evidence largely derived from case reports, small case series, and animal models of experimental endocarditis. Moreover, taxonomic changes have led to some confusion in designation of these organisms.

Methods
We retrospectively collected and analyzed data from 33 patients with NVS IE from 1970 to 2017. Only patients who met modified Duke Criteria for IE were included.

Results
Mean patient age was 55 years and 61% were males. The most common comorbidities included diabetes mellitus (12%), malignancy (3%), heart failure (16%), coronary artery disease (25%), and chronic liver disease (9%). Predisposing valve abnormalities included rheumatic heart disease (11%), bicuspid aortic valve (22%), transplant valvulopathy (3%), mitral valve prolapse (3%), and congenital heart disease (11%). Cultures were reported as NVS (70%), Granulicatella species (18%) and Abiotrophia species (12%). Echocardiogram findings included vegetations (67%), new regurgitation (55%), perivalvular abscess (3%), mitral valve prolapse (3%), and ruptured mitral valve chordae (3%). Both prosthetic (26%) and native valve IE (74%) was seen, and the valves involved were aortic (37%), mitral (50%) and both aortic and mitral (13%). Complications were seen in 27% of patients, including heart failure (17%), splenic infarct (11%), stroke (8%), mycotic aneurysm (3%), and glomerulonephritis (2%). In vitro susceptibility to penicillin, ceftriaxone, and vancomycin was 88%, 80%, and 100%, respectively. The majority (77%) of patients were treated with a combination of β-lactam and aminoglycoside. Median duration of treatment was 33 days. Surgery was performed in 50% of patients with no significant difference in survival between those who were treated with combined medical/surgical treatment and those treated with medical therapy alone. Overall survival at 1, 4, and 10 years was 93%, 83%, and 66%, respectively.

Conclusion
IE due to NVS is a rare entity and is associated with a high rate of serious complications and may involve multiple valves. Long-term, two-thirds of the patients survived more than 10 years.

Disclosures
All authors: No reported disclosures.
1076. What Is the Positivity Delay of Blood Cultures in Infective Endocarditis?
Authors: Issa Nahema , Peuchant Olivia , Lecomte Raphael , Machelart Irene , Greib Carine , Wirth Gaetane , Camou Fabrice 
Published: November 2018

Abstract

Background
Blood culture is a key test for the positive diagnosis of infective endocarditis (IE). In order to detect certain so-called fastidious bacteria and to avoid the absence of documentation, it is customary to repeat the blood cultures (at least three series) and to keep them for 21 days. However, objective data regarding the positivity delay of blood cultures in case of infective endocarditis are lacking.

Methods
To determine the time to positivity of blood cultures during IE, all patients with documented IE by bacterial blood culture and presented to the Endocarditis team of our center were prospectively included. The study was conducted in a university hospital between 2013 and 2017.

Results
During the study, 441 patients with IE were hospitalized and 401 IE had a bacteriological documentation (91%), including 380 by blood cultures. In 21 cases, the bacteriological documentation was made by serological tests or specific PCR assays. Information on positivity delay was available for 237 patients (135 IE on native valve and 102 on prosthetic valve) and 183 of them (77%) had 4 aero-anaerobic series or more blood cultures. Of the 988 series sampled, 978 (99%) were positive. The main documented bacteria were staphylococci (41%), streptococci (32%), and enterococci (21%). The median time to positivity of the first blood culture was 11.4 hours [interquartile = 7.3 hours–16.7 hours] and the maximum delay was 93 hours. There was no difference in positivity delay between the 123 community acquired IE and the 114 healthcare-associated IE: 11.2 hours vs. 11.4 hours. The median growth time was 9.9 hours for S. aureus vs. 18 hours for coagulase negative staphylococci, 11 hours for enterococci and 10.4 hours for streptococci. In the case of IE complicated by extracardiac emboli, the median positivity delay was 9.7 hours in the case of S. aureus vs. 12.3 hours for the other bacteria.

Conclusion
In case of IE, our study shows that the median time positivity of the first blood culture is about 11 hours and no blood culture becomes positive beyond the fourth day. Slow-growing bacteria are identified by other diagnostic methods. We can, therefore, wonder about the need to multiply and conserve blood cultures beyond a week to document IE.

Disclosures
All authors: No reported disclosures.