bluuebunny/crossref_metadata_2025_split huggingface dataset:
1118. Viral Species Richness and Composition in Young Children With Loose or Watery Stool in Ethiopia
Authors: Aiemjoy Kristen , Altan Eda , Aragie Solomon , Fry Dionna , Phan Tung , Deng Xutao , Chanyalew Melsew , Tadesse Zerihun , Callahan Kelly , Delwart Eric , Keenan Jeremy 
Published: November 2018

Abstract

Background
Stool consistency is an important diagnostic criterion in both research and clinical medicine and is often used to define diarrheal disease.

Methods
We examine the pediatric enteric virome across stool consistency to evaluate differences in richness and community composition using fecal samples collected from children participating in a clinical trial in the Amhara region of Ethiopia. The consistency of each sample was graded according to the modified Bristol Stool Form Scale for children (mBSFS-C) before a portion of stool was preserved for viral metagenomic analysis. Stool samples were grouped into 29 pools according to stool consistency type. Differential abundance was determined using negative-binomial modeling.

Results
Of 446 censused children who were eligible to participate, 317 presented for the study visit examination and 269 provided stool samples. The mean age of children with stool samples was 2.7 years old. Species richness was highest in watery-consistency stool and decreased as stool consistency became firmer (Spearman’s r = −0.45, P = 0.013).The greatest differential abundance comparing loose or watery to formed stool was for norovirus GII (7.64, 95% CI 5.8, 9.5) followed by aichivirus A (5.93, 95% CI 4.0, 7.89) and adeno-associated virus 2 (5.81, 95% CI 3.9, 7.7).

Conclusion
We documented a difference in pediatric enteric viromes according to mBSFS-C stool consistency category, both in species richness and composition. Our results suggest that loose or watery stool, as measured by the mBSFS-C, may signal enteric viral infection in young children. Additional studies are warranted to confirm these findings.

Disclosures
All authors: No reported disclosures.
1119. Risk Factors for Clostridium difficile Acquisition and Persistence among Guatemalan Children
Authors: Gaensbauer James , Lamb Molly , Melgar Mario , Calvimontes Diva M , Contreras-Roldan Ingrid , Asturias Edwin , Dominguez Samuel 
Published: November 2018

Abstract

Background
Little is known about the epidemiology and risk factors for Clostridium difficile infection (CDI) among children in low and middle-income countries (LMICs). We sought to characterize the clinical, demographic, and environmental factors associated with C.difficile acquisition and persistence over time, and assess the relationship between CDI and additional diarrheal pathogens among rural and urban Guatemalan children.

Methods
Children 6–35 months old with acute nonbloody diarrhea (&lt;72 hours) were enrolled in an acute diarrhea clinical trial between March 2015 and January 2016 at two sites (one rural and one urban) in Guatemala. Stool samples collected at baseline and 30 days later were analyzed by multiplex PCR (FilmArray™ GI-Panel, BioFire, USA) that identifies 22 viral, parasitic and bacterial diarrheal pathogens including C. difficile. Subjects were characterized by combination of baseline and 30-day C.difficile sample results: −/+ (new acquisition), +/− (clearance), and +/+ (persistence). Associations between these categorizations and demographic, epidemiologic, and co-infecting pathogenic organisms were assessed using multivariable generalized linear models.

Results
CDI was present in 26 of 298 subjects at baseline; 13 (50%) had persistence at 30 days and 13 (50%) cleared. New acquisition at day 30 occurred in 23 subjects. In multivariable analysis adjusted for age, recent hospitalization was marginally significantly associated with C. difficile presence in stool at baseline (prevalence ratio [PR] 2.65, P = 0.07). In subjects with either new C. difficile acquisition or persistence between baseline and day 30, residence in the rural site (PR 0.33, P = 0.003)) and presence of E. coli pathotypes: enteropathogenic (EPEC), enteroaggregative (EAEC), and enterotoxigenic (ETEC) (PR 0.43, P = 0.01)) were associated with reduced risk of CDI.

Conclusion
In an LMIC pediatric population, the presence of E. coli pathotypes appeared protective against C. difficile persistence/new acquisition. These findings add to our current understanding that CDI occurs in part as a result of competition within the intestinal microbiota, which may be independent of the potential pathogenicity of competing microbes. We hypothesize that this phenomenon could be suppressing the C. difficile burden among children in LMICs.

Disclosures
All authors: No reported disclosures.
1121. Epidemiology and Risks for Infection Following Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy at an Australian Centre
Authors: Smibert Olivia , Slavin Monica , Thursky Karin , Teh Ben , Penno Janelle , Ismail Hilmy , Worth Leon 
Published: November 2018

Abstract

Background
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with improved cancer survival but increased risk of infection in patients with abdominal-pelvic malignancy. We evaluated risks and characteristics of infectious outcomes at an Australian cancer centre.

Methods
Patients undergoing CRS-HIPEC between January 2016 and November 2017 at Peter MacCallum Cancer Centre were retrospectively reviewed. Malignancy type, comorbidities, perioperative risk factors, and infectious complications were captured, using standardized definitions for surgical site infection. Association between risk factors and infection outcomes was evaluated by logistic regression modeling.

Results
Sixty-nine patients underwent CRS-HIPEC, predominantly for colorectal cancer and pseudomyxoma peritonei. Overall, 32 (46.3%) experienced an infectious complication, including infections at surgical site (16), respiratory tract (6), urinary tract (5), Clostridium difficile (2), and post-operative sepsis (10). In most, infection onset was within 7 days post-operatively. Median length of hospitalisation was 20 days for patients with infection, compared with 8 days for those without (P = 0.000). Of variables potentially associated with infection at surgical site, small bowel resection (OR 5.56, 95% confidence interval [CI] 1.09–28.19; P = 0.039) and number of resected viscera (OR 1.71, 95% CI 1.05–2.76; P = 0.029) were significantly associated with infection on univariate analysis.

Conclusion
We demonstrate a significant burden of early infective complications in patients undergoing CRS-HIPEC, including surgical and non-surgical site infections. Findings support the need for multimodal programs to reduce the risk of a broad range of infections in this population. Higher risk subgroups, including those with small bowel resection and increased number of resected viscera, may benefit from enhanced monitoring.

Disclosures
All authors: No reported disclosures.
1123. Individual and Household Risk Factors for Symptomatic Cholera Infection: A Systematic Review and Meta-Analysis
Authors: Richterman Aaron , Sainvilien Duarxy Rodcnel , Eberly Lauren , Ivers Louise C 
Published: November 2018

Abstract

Background
Cholera has caused seven global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published.

Methods
In accordance with PRISMA guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection.

Results
We identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary OR 2.64, 95% CI 1.41–4.92, I2 = 8%), unimproved water source (summary OR 4.78, 95% CI 3.02–7.57, I2 = 49%), open container water storage (summary OR 2.51, 95% CI 1.57–4.01, I2 = 33%), consumption of food outside the home (summary OR 5.02, 95% CI 2.34–10.76, I2 = 61%), household contact with cholera (summary OR 3.99, 95% CI 2.03–7.87, I2 = 89%), water treatment (summary OR 0.22, 95% CI 0.13–0.36, I2 = 37%), and handwashing (summary OR 0.17, 95% CI 0.10–0.30, I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and HIV infection.

Conclusion
We identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control.

Disclosures
All authors: No reported disclosures.
1125. Reduced Time to Pathogen Identification and Antibiotic Prescription Using Multiplex Molecular Testing for Gastrointestinal Infections
Authors: Kardasheva Aleksandra , Yount Evan , Rose Tracie , Verma Punam , Chihara Shingo 
Published: November 2018

Abstract

Background
A variety of microbial pathogens causes diarrhea which remains a significant global concern. The ability to rapidly identify the pathogen impacts the decision to treat, promotes antimicrobial stewardship, and assists with infection control and prevention. The objective of the study was to compare the time it took for rapid identification of microbial pathogens via a stool-culture based testing vs. real-time PCR using a Verigene Enteric Pathogens (EP) test.

Methods
The study was performed at Virginia Mason Medical Center, a tertiary medical center in Seattle. A retrospective chart review included the diagnosis of microbial pathogen, antibiotics prescribed (if any), time of prescription, duration of antibiotics course and patients’ outcome if they were hospitalized. Stool specimens from 136 patients in 2015 were analyzed via a stool-culture based method. The results were compared with a molecular-based method used to study specimens from 225 patients in 2017. Years 2015 and 2017 were chosen as in 2016 the culture-dependent testing was replaced by culture independent. T-test was used to examine the difference in time to identification of the pathogen and time to prescription between 2015 and 2017. SAS 9.4 was used for the analysis.

Results
In 2015, 2,194 stool specimens were tested and 136 (6.2%) were positive. In 2017, 2,037 stool specimens were examined and 225 (11%) returned positive. The median time to prescription in 2015 was 53.84 hours in comparison to 21.96 hours in 2017 (P &lt; 0.0001). The time to identification of the pathogen was 60.05 hours in 2015 vs. 22.53 hours in 2017 (P &lt; 0.0001). The TAT (turnaround time), defined as the time from the specimen being received in the laboratory to the finalized result, was 167.92 hours vs. 156.35 hours, respectively (P = 0.75).

Conclusion
Multiplex PCR assays for enteric pathogens showed higher sensitivity when compared with standard culture-based methods. When the clinician felt antibiotics were indicated, there was a significantly shorter time to antibiotics prescription. Aside from a shorter time to microbial identification, molecular assays detect an increased number of pathogens from a single specimen that has an important impact on infection prevention and appropriate treatment.

Disclosures
All authors: No reported disclosures.
1129. Targeted Voriconazole Prophylaxis in Heart Transplantation Recipients
Authors: Lin Michael , Echenique Ignacio , Angarone Michael , Anderson Allen , Stosor Valentina 
Published: November 2018

Abstract

Background
The use of antifungal prophylaxis, targeted or universal, remains controversial and unstudied. The goal of this study is to determine the role of targeted voriconazole prophylaxis (VORI) in prevention of invasive fungal infections (IFI) after heart transplantation (HT).

Methods
We conducted a single-center, prospective, observational cohort study of 276 HT recipients from June 2005 to April 2017 to characterize the incidence and outcome of IFI following targeted VORI. Starting in June 2013, HT recipients with thymoglobulin (ATG) treatment received VORI for 3 months. Probable/proven IFI were defined by EORTC/MSG criteria. Descriptive frequencies and univariate analyses were performed.

Results
Mean duration of follow-up post-HT was 1,165 days (0–3,152 days). 149 (54%) and 70 (25%) received basiliximab and thymoglobulin induction, respectively. Thirty-one (11%) received VORI, following use of ATG in the setting of induction (68%) or rejection (32%). VORI was started at median of 6 days (0–1,008 days) post-HT for a mean duration of 97 days (5–251 days). Overall, 23 IFIs occurred in 23 recipients (8%) at mean 283 days post-HT (range 2–1,579 days), including seven Aspergillus (one occurring after VORI completion), seven invasive Candida (five with candidemia), two Rhizopus, one Cunninghamella, two histoplasma, two blastomyces, one Cryptococcus, and one multifocal cutaneous Alternaria.

Conclusion
Targeted VORI resulted in reduced incidences of both early and overall IFI after HT although this did not reach statistical significance. Since instituting this strategy, we have observed a single case of aspergillosis following VORI discontinuation. Overall and 1-year mortality were not impacted. The use of antifungal prophylaxis following HT requires continued investigation both to determine efficacy and toxicity in this patient population.

Disclosures
All authors: No reported disclosures.
1134. Novel T2Candida Panel Assay Compared With Blood Cultures for Detection of Candidemia in Transplant and Non-Transplant Patients
Authors: Hussain Noman , Chaudhry Zohra , Rizvi Hira , Abreu-Lanfranco Odaliz , Ramesh Mayur , Busto Ramon Del , Osborn Zachary , Alangaden George 
Published: November 2018

Abstract

Background
Blood culture (BC) the current “gold” standard for detection of candidemia has a sensitivity of ~50% and turnaround time (TAT) of 2–5 days. T2Candida Panel (T2) a magnetic resonance nano-diagnostic test done directly on blood samples detects C. albicans/C. tropicalis, C. krusei/C. glabrata, and C. parapsilosis. Clinical trials of T2 showed good sensitivity, specificity, NPV 99% and TAT of 3–5 hours. The performance of T2 in high-risk transplant (Tx) population is unknown. T2 was implemented at our institution in October 2015. We evaluated the performance characteristics of T2 and BC in our Tx and non-transplant (non-Tx) patient populations.

Methods
This was an observational, retrospective, cross-sectional evaluation of patients with suspected candidemia that had T2 done from October 2015 to October 2017 at a multihospital healthcare system in Detroit, MI. Performance characteristics of the T2 and BC in Tx and non-Tx patients were compared. BC obtained within 7 days before or after the T2 test were included in the analysis. TAT, sensitivity, specificity, PPV and NPV were calculated using positive BC as the standard. Differences between groups were assessed using two sample proportions testing at α = 0.05.

Results
A total of 1,272 patients with suspected candidemia had T2 done: 1,162 (91%) non-Tx and 110 (9%) Tx patients. Average TAT for T2 was 13 hours (5–41) vs. 34 hours (21–109) to initial positive BC result and 4 days (3–13) to species-specific BC result. In four non-Tx patients with negative T2, C. lusitaniae, C. dubliniensis, and C. kefyr were isolated in BC. Performance characteristics of T2 and BC in the two groups is shown (Table 1). Of the T2+/BC− cases (n = 102), 9% had retinitis and 9% had invasive candidiasis.

Conclusion
The rapid TAT, good sensitivity, and high NPV of T2 in Tx patients has clinical implications and can help support antifungal stewardship efforts in this population. The clinical significance of T2 positivity in the presence of negative BC needs further investigation.

Disclosures
G. Alangaden, T2 Biosystems: Speaker’s Bureau, Educational grant and Speaker honorarium.
1140. GATA2 Mutations Are Frequently Identified Among Patients With Myeloid Malignancies Who Develop Invasive Aspergillosis
Authors: Bold Tyler D , Cheng Matthew P , Vedula Rahul S , Marty Francisco M , Lindsley R Coleman 
Published: November 2018

Abstract

Background
Patients with myeloid malignancies are at risk of invasive aspergillosis (IA), a cause of significant morbidity and mortality. Identification of patients at higher risk for IA may help optimize prophylactic or preemptive treatment decisions. Molecular genetic testing used to risk-stratify and guide therapy for hematologic malignancies may also have applicability toward predicting infectious outcomes. The purpose of this study was to identify mutations that may increase risk for IA among patients with myeloid malignancies.

Methods
We identified patients cared for at Dana-Farber/Brigham and Women’s Cancer Center between March 1, 2015 and January 31, 2018 who were diagnosed with probable or proven IA during the treatment of myeloid malignancies including acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). We reviewed pathogenic mutations detected by the Rapid Heme Panel (RHP), a clinical targeted next-generation sequencing panel of 95 recurrently mutated genes in hematologic malignancies.

Results
Twenty-four patients with myeloid malignancy (AML 20, MDS 4) were diagnosed with IA, 20 of whom (AML 17, MDS 3) had undergone genetic testing with the RHP at the time of their cancer diagnosis. We found that three of 20 patients (15%) had a pathogenic mutation in GATA2. All were missense mutations within the functional zinc-finger domains, including one resulting in an R398W amino acid change, one of the spectrum of germline mutations known to cause the primary immunodeficiency MonoMAC. Patients with GATA2 mutations in our cohort were ages 35–68 and variant allele fraction ranged from 16.3% to 49.7%, raising the possibility that both inherited and acquired GATA2 dysfunction could incur a similar infectious risk.

Conclusion
Mutations in GATA2, a gene associated with MonoMAC syndrome, were common among patients with myeloid malignancy who developed IA. These data suggest that personalized genetic analyses of patients with underlying hematologic malignancy may also be useful for assessment of infectious risk.

Disclosures
All authors: No reported disclosures.
1141. Microbial Assessment of Healthcare-Associated Pathogens on Various Environmental Sites in Patient Rooms After Terminal Room Disinfection
Authors: Kanamori Hajime , Rutala William , Gergen Maria , Sickbert-Bennett Emily , Anderson Deverick J , Sexton Daniel , Weber David ,   the CDC Prevention Epicenters Program
Published: November 2018

Abstract

Background
Hospital room environmental surfaces can be contaminated with healthcare-associated pathogens even if terminal room cleaning/disinfection is implemented. We examined the microbiological burden on hospital room environmental sites after standard or enhanced terminal room disinfection.

Methods
Microbial data from the Benefits of Enhanced Terminal Room Disinfection Study were utilized. All patient rooms were randomly assigned to standard disinfection (Quaternary ammonium [Quat]) or an enhanced disinfection (Quat/ultraviolet light [UV-C], Bleach, or Bleach/UV-C). Microbiological samples were obtained using Rodac plates (25 cm2/plate) from 8 of 10 hospital room sites, including bed rail, over-bed table, supply/medicine cart, chair, side counter, linen hamper lid, sink, toilet seat, shower floor, and bathroom floor. The number of colony forming units (CFU) of four target epidemiologically important pathogens (EIP), including multidrug-resistant Acinetobacter, Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci, was counted. A total of 3,680 samples from 736 environmental sites in all 92 patient rooms (21 standard rooms and 71 enhanced rooms) were analyzed.

Results
Overall, the frequency of all environmental sites positive for EIP was 11% (84/736) in all rooms, 21% (36/168) in standard rooms, and 8% (48/568) in enhanced rooms (P &lt; 0.001) (Figure 1). Environmental sites, other than the toilet seat, in standard rooms were likely to be more frequently contaminated with EIP than in enhanced rooms (P = 0.013 for overbed table, P = 0.010 for bed rail, and P &gt; 0.05 for other sites each). Mean CFU of EIP per room was 19.2 in all rooms, 60.8 in standard rooms, and 6.9 in enhanced rooms (P = 0.006) (Figure 2). All sites in standard rooms tended to have higher mean counts than in enhanced rooms (P = 0.001 for overbed table, P = 0.001 for bed rail, P = 0.012 for side counter, and P &gt; 0.05 for other sites each).

Conclusion
Our results demonstrate that an enhanced terminal room disinfection reduced microbial burden of healthcare-associated pathogens on environmental sites better than standard room disinfection. Environmental hygiene of touchable surfaces after terminal room cleaning using Quat needs to be improved.

Disclosures
W. Rutala, PDI: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. D. Weber, PDI: Consultant, Consulting fee.
1151. A Safer, More Effective Method for Cleaning and Disinfecting GI Endoscopic Procedure Rooms
Authors: Overholt Bergein , Reynolds Karen , Wheeler Donald 
Published: November 2018

Abstract

Background
Healthcare acquired infections are increasing. Current cleaning and disinfecting (C&D) methods subject staff to toxic chemicals and can be damaging to the facility. Hypochlorous acid (HOCl) is a disinfecting solution that is 80–200 times more effective than bleach in surface disinfection of bacteria yet is nontoxic to humans. The aim of this study was to determine whether HOCl is as effective as standard cleaning methods for C&D GI ambulatory surgery center (ASC) rooms as determined by ATP (adenosine triphosphate) measurements over a 2-week period.

Methods
Two similar GI ASCs, each with two procedure rooms, were studied. One ASC received postprocedure STANDARD C&D with quaternary ammonium compounds in nonwoven fabric for surface wiping of high touch areas followed by terminal benzalkonium chloride foam/spray on these areas. The second ASC received HOCl C&D using on-site freshly prepared HOCl, 1,000 ppm. Microfiber cloths semi-wet with HOCl were used for wiping surfaces for both C&D. In the HOCl rooms, after terminal manual wiping, misting with HOCl of the entire room was performed. Selected high touch area ATP testing was performed in all rooms before procedures in the AM and 10 minutes after terminal manual cleaning. In the HOCL rooms, testing was also performed 10 minutes after misting. High touch areas tested in each room included: endoscopic cart (three locations/cart), both gurney bed rails, computer mouse (two), working counters (two areas), light switch, door knob. ATP scores were compared within each site using analysis of means (ANOM).

Results
After terminal cleaning, the average ATP score in the HOCl CLEANING and DISINFECTING study arm was significantly lower than that for the STANDARD CLEANING and DISINFECTING rooms (P &lt; 0.0017) (Figure 1). In evaluating the effect of the HOCl misting, the ATP scores in the HOCl rooms had a post cleaning, pre-misting average score of 2.7. The post misting average score was 1.7, showing that misting produced a further significant reduction (improvement) in ATP scores (P = 0.01).

Conclusion
HOCl cleaning and disinfection in GI ASCs is more effective than standard procedures in lowering ATP scores following endoscopic procedures in procedure rooms. HOCl terminal misting of the rooms further improves the cleaning and disinfecting results.

Disclosures
B. Overholt, HOCl Solutions: Shareholder, none to date.