bluuebunny/crossref_metadata_2025_split huggingface dataset:
1638. Tele-Infectious Disease Consultation Produces Equivalent Outcomes as In-Person Consultation
Authors: Younus Faheem , Girio-Herrera Leonardo , Barrueto Fermin , Ahmed Zaka , Zimand Paul 
Published: November 2018

Abstract

Background
Technology can extend Infection Disease Consultants (IDCs) into resource limited small community US hospitals. We compared in-person infectious disease (ID) consults with Tele-ID consults to determine whether length of stay, antibiotic usage, drug cost, or readmission rates will remain the same between both groups over a 3-month period.

Methods
University of Maryland Harford Memorial Hospital (UM-HMH) is a 95-bed hospital including a 6-bed ICU. From May to August 2017 (study period) there was no IDC at UM-HMH. During study period, IDCs from a regional UM hospital provided formal Tele-ID consults through an HIPAA compliant secured Skype Business account. Patient history and wound examination were done by the IDC via video monitor while a bedside nurse assisted in performing the physical examination. Laboratory and radiological data were reviewed in real time as both hospitals shared the same electronic medical record and IT infrastructure (Meditech 6.15). A formal consultation was dictated and computer orders were entered by the IDC within 24 hours of the consult request. Daily Tele-ID follow-up rounds were conducted. IDCs had the authority to transfer a patient to the regional hospital for in-person care if deemed necessary. Study period was compared with a baseline period (May–August 2016) when IDCs were providing in-person consults at UM-HMH.

Results
Baseline period had 148 inpatient stays and study period had 148 inpatient stays. Despite similar case mix index in both groups, there was no statistical difference between the clinical outcomes. Results are shown in Table 1.

Conclusion
Tele-ID at our hospitals was noninferior to in-person ID consults. An integrated computer system, nursing support, and daily follow-up are key components of a successful Tele-ID program.

Disclosures
All authors: No reported disclosures.
1639. Efficacy of Voriconazole Prophylaxis Followed by Therapeutic Liposomal Amphotericin B for the Treatment of Murine Pulmonary Aspergillosis Caused by Azole-Resistant Aspergillus fumigatus Strains
Authors: Olson Jon , Slarve Matthew , Adler-Moore Jill 
Published: November 2018

Abstract

Background
Antifungal treatment for pulmonary aspergillosis is more difficult if the fungal strain causing the infection is azole resistant. To investigate this problem, we used a murine model of pulmonary aspergillosis caused by azole-resistant Aspergillus fumigatus strains V29 and V45, and compared treatment with voriconazole (Vr, oral 40 mg/kg, bid) or liposomal amphotericin B (L-AmB, 5 mg/kg, IV) used alone or in combination.

Methods
Mice (n = 14/gp) were immunosuppressed with 24 mg/kg triamcinolone acetonide, IP, d-3, d-1, and d+1 relative to fungal challenge (d0). For 2 groups, Vr was given prophylactically (proph) d-3, d-2, d-1 followed by L-AmB or buffer, d+1, d+2, and d+3. The other groups were given Vr, L-AmB, Vr+L-AmB, or buffer d+1, d+2, and d+3. On d0, mice were given 1.3 to 1.6 × 107A. fumigatus spores intranasally (Vr MIC = 64 μg/mL, V29; Vr MIC = 8 μg/mL, V45). On d+3, lungs were collected from 7 mice/gp and fungal burden determined by plating for colony forming units; 7 mice/gp were then monitored for morbidity to d+21.

Results
Optimum treatment was observed when Vr was given proph, followed by L-AmB post-challenge (Vr/L-AmB), with better survival (100%) for both fungal strains vs. buffer or Vr post-challenge (P ≤ 0.04); for V29, significantly better survival was also seen with Vr/L-AmB vs. L-AmB or Vr+L-AmB post-challenge (P ≤ 0.01). For strain V45, lung fungal burden was significantly lower for Vr/L-AmB versus all other treatments (P ≤ 0.04), while for strain V29, fungal burden was lower for the Vf/L-AmB and L-AmB post-challenge groups versus the other groups, but the differences were not significant. Notably, although the lung fungal burden with Vr proph and Vr postchallenge were both similar to the buffer control, Vr proph yielded significantly better survival than Vr post-challenge (P ≤ 0.001).

Conclusion
These preclinical observations demonstrate that combining L-AmB with Vr for the postchallenge treatment of pulmonary aspergillosis caused by azole-resistant strains is not an effective therapeutic option. However, the results do show that Vr proph, but not Vr postchallenge, can have some limited antifungal activity, and can significantly enhance the antifungal effects of post-challenge L-AmB. This regimen could be considered in areas where there is a high incidence of azole-resistant A. fumigatus.

Disclosures
All authors: No reported disclosures.
1645. Exploring Clinical and Antiviral Efficacy of Baloxavir Marboxil in a Phase 3, Randomized, Double-Blind, Placebo- and Active-Controlled Study of Otherwise Healthy Adults/Adolescents in Seasonal Influenza: Impact on Regional Participants, Treatment Time and Influenza Type B Virus Infection (CAPSTONE-1 Study)
Authors: Kawaguchi Keiko , Portsmouth Simon , Shishido Takao , Uehara Takeki , Hayden Frederick 
Published: November 2018

Abstract

Background
Baloxavir marboxil (BXM), a selective cap-dependent endonuclease inhibitor, has demonstrated efficacy + safety for influenza in otherwise healthy patients. We present subgroup analyses for (i) United States vs. Japan (J), (ii) time (t) of treatment (early: ≥0 to ≤24 hours, vs. late: &gt;24 to ≤48 hours), and (iii) influenza type B infections from the global Ph 3 trial (16/17 season).

Methods
A multicenter, randomized, double-blind, placebo (PLC)- and oseltamivir (OV)-controlled study recruited patients in Japan (n = 846) and United States (n = 590). Inclusion criteria: age 12–64 years, fever + flu symptoms, and ≤48 hours from symptom onset. Patients (20–64 years) randomized (2:2:1) to a single oral dose of BXM, PLC, or 75 mg OV BID for 5 days; patients 12–19 years were randomized (2:1) to receive BXM or PLC. BXM dose: 40/80 mg for BW &lt;/≥80 kg. Primary endpoint: time to alleviation of symptoms (TTAS) in ITTI population (pop). Viral titers measured from pre-/postdose nasal swabs.

Results
BXM reduced the median TTAS by 30.6 hours versus PLC (87.3 versus 117.9 hours, P = 0.1373) in the US pop and t to cessation of viral shedding: 24 versus 72 hours for PLC (P &lt; .0001). Median TTAS in the United States versus J pop was longer, due to imbalances between groups. In both early/late treatments from symptom onset, BXM reduced TTAS versus PLC (Table 1). Regardless of the t to treatment from symptom onset, BXM reduced virus titer significantly from BL versus PLC and OV (Table 2). No significant reduction in TTAS was seen, while BXM reduced virus titer versus PLC and OV in type B virus infection.

Conclusion
Outcomes for United States were aligned with the Ph 3 Results. Early treatment with BXM leads to a significantly faster TTAS vs. PLC. BXM caused significant viral titer reduction regardless of treatment time versus OV. BXM reduced virus titer vs. PLC and OV in type B virus infection.

Disclosures
K. Kawaguchi, Shionogi & Co., Ltd.: Employee, Salary. S. Portsmouth, Shionogi Inc: Employee, Salary. T. Shishido, Shionogi & Co., Ltd.: Employee, Salary.T. Uehara, Shionogi & Co., Ltd.: Employee, Salary. F. Hayden, Shionogi & Co., Ltd.: Scientific Advisor, Consulting fee (donated) and travel support for attending 6th ESWI meeting, 10–13 September 2017, Latvia, to present phase 3 OWH results.
1648. Incidence of Norovirus and Rotavirus From Multisite Active Surveillance in Veteran’s Affairs Hospitals, December 2016–February 2018: Results From the SUPERNOVA Network
Authors: Cardemil Cristina V , Kambhampati Anita , Grytdal Scott , Rodriguez-Barradas Maria C , Vargas Blanca , Beenhouwer David , Evangelista Karen , Marconi Vincent , Meagley Kathryn , Brown Sheldon , Perea Adrienne , Lucero Cynthia , Holodniy Mark , Browne Hannah , Gautam Rashi , Bowen Michael D , Vinje Jan , Parashar Umesh D , Hall Aron J 
Published: November 2018

Abstract

Background
Viruses are frequently implicated in acute gastroenteritis (AGE) outbreaks, yet the endemic burden of norovirus and rotavirus disease in adult populations is not well characterized. In 2016, we implemented a multisite AGE surveillance platform capturing cases and controls in 4 VA hospitals (Atlanta, Bronx, Houston, and Los Angeles), collectively serving &gt;320,000 patients annually.

Methods
Inpatient AGE cases and age- and time-matched controls were identified through prospective screening of admissions via standardized case definitions. Outpatient cases were passively identified using stool samples submitted for routine clinical microbiological diagnostics. Samples were tested with the FilmArray Gastrointestinal Panel, followed by genotyping of virus positives. Incidence was estimated using population denominators of unique patients served annually by site.

Results
From December 1, 2016 to February 28, 2018, 875 cases (496 inpatients, 379 outpatients), and 374 controls were enrolled. Norovirus and rotavirus prevalence was highest among outpatient AGE cases (11.6% and 2.9%, respectively) followed by inpatient cases (3.4% and 1.6%, respectively); few controls were positive (norovirus, 1.3%; rotavirus, 0%). Norovirus-associated inpatient incidence was 15.2 per 100,000 population (range by site: 10.7–19.9/100,000) and rotavirus-associated inpatient incidence was 7.5 per 100,000 population (range by site: 0–12.8/100,000). The predominant norovirus genotype was GII.P16-GII.4 Sydney (50%), and rotavirus genotype was G12P[8] (83%). Norovirus was detected every calendar month and peaked in December–January, while rotavirus peaked in April. Nine deaths were documented among AGE inpatient cases, including one norovirus-associated death.

Conclusion
Implementation of a multisite AGE surveillance platform captured a wide spectrum of illness for norovirus and rotavirus in US Veterans including outpatient visits, inpatient hospitalizations, and one norovirus-associated death. Norovirus was the leading viral pathogen and was detected year-round. Ongoing surveillance using this platform will allow for further characterization of the pathogen distribution and associated AGE disease burden in adults.

Disclosures
V. Marconi, ViiV: Investigator, Research support and Salary. Bayer: Investigator, Research support. Gilead: Investigator, Research support.
1722. The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Emerging Risk Factor for Candidemia
Authors: Zhang Alexia Y , Shrum Sarah , Williams Sabrina , Vonbank Brittany , Hillis Sherry , Barter Devra , Petnic Sarah , Harrison Lee H , Dumyati Ghinwa , Phipps Erin C , Pierce Rebecca , Schaffner William , Farley Monica M , Mody Rajal K , Chiller Tom , Jackson Brendan R , Vallabhaneni Snigdha 
Published: November 2018

Abstract

Background
Known risk factors for candidemia include diabetes, malignancy, antibiotics, total parenteral nutrition (TPN), prolonged hospitalization, abdominal surgery, and central venous catheters. Injection drug use (IDU) is not a common risk factor. We used data from CDC Emerging Infections Program’s candidemia surveillance to assess prevalence of IDU among candidemia cases and compare IDU and non-IDU cases.

Methods
Active, population-based candidemia surveillance was conducted in 45 counties in 9 states during January–December 2017. Data from 2014 to 2016 were available from 4 states and were used to look for trends. A case was defined as blood culture with Candida in a surveillance area resident. We collected clinical information, including IDU in the past 12 months. Differences between IDU and non-IDU cases were tested using logistic regression.

Results
Of 1,018 candidemia cases in 2017, 123 (12%) occurred in the context of recent IDU (1% in Minnesota and 27% in New Mexico) (Figure 1). In the 4 states with pre-2017 data, the proportion of IDU cases increased from 7% in 2014 to 15% in 2017, with the proportion in Tennessee nearly tripling from 7% to 18% (Figure 2). IDU cases were younger than non-IDU cases (median 34 vs. 62 years, P &lt; 0.001). Compared with non-IDU cases, IDU cases were less likely to have diabetes (16% vs. 35%; OR 0.4, CI 0.2–0.6), malignancies (7% vs. 30%; OR 0.2, CI 0.1–0.3), abdominal surgery (6% vs. 19%; OR 0.3, CI 0.1–0.6), receive TPN (6% vs. 27%; OR 0.2, CI 0.1–0.4) and were more likely to have hepatitis C (96% vs. 47%; OR 16.1, CI 10.4–24.9), be homeless (13% vs. 1%; OR 17.8, CI 7.1–44.6), and have polymicrobial blood cultures (33% vs. 17%; OR 2.4, CI 1.6–3.6). Median time from admission to candidemia was 0.5 vs. 3 days and in-hospital mortality was 7% vs. 28% for IDU and non-IDU cases, respectively.

Conclusion
In 2017, 1 in 8 candidemia cases had a history of IDU, including a quarter of cases in some sites. The proportion of such cases increased since 2014. IDU cases lacked many of the typical risk factors for candidemia, suggesting that IDU may be an independent risk factor. Given the growing opioid epidemic, further study is necessary to elucidate how people who inject drugs acquire candidemia and design effective interventions for prevention.

Disclosures
All authors: No reported disclosures.
1723. Mumps Attack Rates Following Administration of a Third Dose of MMR Vaccine to School-Aged Children, Arkansas, 2016–2017
Authors: Guo Angela , Ayers Tracy , Leung Jessica , Fields Virgie , Va Puthiery , Safi Haytham , Waters Catherine , Wheeler J Gary , Marin Mona , Patel Manisha , Routh Janell , Haselow Dirk 
Published: November 2018

Abstract

Background
During the 2016–2017 school year, the largest mumps outbreak in the United States since 2006 occurred in Arkansas with nearly 3,000 cases. As part of outbreak response, a third dose of measles–mumps–rubella vaccine (MMR3) was offered at 27 schools with mumps attack rates ≥5 cases/1,000 students. We compared attack rates after vaccination clinics among students who received MMR3 and students with 2 MMR vaccine doses.

Methods
We obtained information on school enrollment and student immunization status from school registries, and mumps case status from Arkansas’s National Electronic Disease Surveillance System database. We included students aged 6–21 years who had previously received ≥2 doses of MMR vaccine. We used Arkansas’s Immunization Information System to identify students who received MMR3.
We included schools with at least 1 mumps case after their vaccination clinic. We calculated mumps attack rates by 2- and 3-dose MMR vaccine recipients. Observation time started 14 days after each clinic to allow for development of an immune response to MMR3, and continued to the end of the 2016–2017 school year. Observation time varied by school as schools held clinics on different dates.

Results
A total of 18 schools (10 elementary, 8 middle/junior high) with 10,275 students who had previously received ≥2 doses of MMR (85% of total enrolled) met inclusion criteria. Median number of students per school was 553. Median student age was 11 years (range, 6–18) and 1,525 students received MMR3. MMR3 uptake varied by school (median, 12%; range, 2–33%; interquartile range, 7–22%). A total of 12 mumps cases occurred among MMR3 recipients and 122 cases among 2-dose recipients. School-specific attack rates ranged from 0 to 23 cases/1,000 students among 3-dose recipients, and 2–41 cases/1,000 students among 2-dose recipients. Mumps attack rates within each school were lower for 3-dose recipients vs. 2-dose recipients in all but one school (P &lt; .05). The differences in attack rates between 2- and 2-dose recipients ranged from −5 to 23 cases/1,000 students (median, 5/1,000).

Conclusion
Mumps attack rates were lower in 3-dose vs. 2-dose MMR vaccine recipients after MMR3 vaccination clinics, supporting a benefit of MMR3 for persons in outbreak settings. Further analysis is needed to determine impact of MMR3 on duration and size of mumps outbreaks.

Disclosures
All authors: No reported disclosures.
1725. Addressing Presenteeism: Variability in Facility Healthcare Personnel Work Restriction Policy Monitoring and Enforcement
Authors: Babcock Hilary , Beekmann Susan E , Polgreen Philip M 
Published: November 2018

Abstract

Background
Presenteeism, or working while ill by healthcare personnel (HCP) experiencing influenza-like illness (ILI), increases the likelihood of illness transmission to coworkers and patients. The CDC recommends that HCP with ILI not work until they are afebrile for at least 24 hours. Operationally, hospital policies and practices may not facilitate HCP staying home when ill.

Methods
In March 2018, the Emerging Infections Network surveyed their national network of infectious diseases physicians with hospital epidemiology responsibilities or interests to describe institutional experiences with and policies for HCP working with ILI.

Results
Of the 715 (51%) ID physicians, 367 responded. Of the 367, 135 were not aware of institutional policies and opted out of the rest of the survey. Of the remaining 232 respondents, 206 (89%) reported that their inpatient facility had institutional policies regarding work restrictions for HCP with influenza or ILI, but only 63% said that this policy was communicated to staff at least annually. Work restrictions were most often enforced for staff by sending ill HCP home and by encouragement to call in sick if necessary, while work restrictions for physicians-in-training and attending physicians were most often not enforced or variably enforced. A majority of respondents (53%) reported that adherence to work restrictions was not monitored. Ninety-six percent reported that lab confirmed influenza in patients was tracked by their facility, while 37% reported tracking patient ILI. For employees, 47% reported tracking of laboratory-confirmed influenza and 23% reported tracking ILI. For independent physicians, 13% reported tracking laboratory-confirmed influenza and 5% reported tracking ILI. Sixty-three percent reported that antiviral prophylaxis was provided to at least some employees after occupational exposures, while 9% reported provision of antiviral prophylaxis after nonoccupational (e.g., household) exposures.

Conclusion
Most institutions have policies to prevent HCP from working while ill. However, the dissemination, monitoring, and enforcement of these policies is highly variable. Improving communication about work restriction policies, as well as monitoring and enforcement of these policies, may help prevent the spread of infections from HCP to patients.

Disclosures
All authors: No reported disclosures.
1726. A Random Forest Prediction Model Accurately Identifies Periods at Increased Risk for Positive Legionella Cultures in a Hospital Water Distribution System
Authors: Decker Brooke K , Kelly Monique B , Mikolic Joseph , Walker Jon D , Clancy Cornelius J 
Published: November 2018

Abstract

Background
Hospitals devote considerable resources to water distribution system (WS) surveillance and remediation for Legionella in an effort to reduce risk of transmitting Legionnaires disease (LD). There are no models that accurately predict periods of greatest risk for Legionella culture positivity (cx +) within a WS. Our goal was to build and validate a model based on weather and water parameters that predicted Legionella cx+ in our hospital WS.

Methods
One liter water samples from fixtures at 2 campuses were cultured for Legionella on BCYE plates with cysteine as part of infection prevention protocols. Logistic regression (LR) and random forest (RF) models included daily hospital WS measurements and Pittsburgh FAA weather observation station data. Training and validation used 2014–2015 and 2016–2017 data, respectively. Models predicted a first +cx within 14 day windows.

Results
Cxs were defined as + by loop-day, if any cx from within a unique WS loop was + for Legionella on a given day. Of the 7,272 water samples, 5,304 were collected from 16 buildings on 2 campuses in which ≥1 cx + was obtained. A total of 1,262 WS loop-days were collected over 339 unique days from these buildings. Details on training and validation data sets appear in figure. Overall, water was Legionella cx + on 3% of loop-days. Models predicted positivity if risk was &gt;6%. The LR model comprised of independent predictors of cx + had sensitivity/specificity of 44%/80% (AUC: 0.715; misclassification error: 0.21), and PPV/NPV of 9%/97% in the validation data set. The RF model comprised of the same predictors had sensitivity/specificity of 100%/98% (AUC: 1.0; misclassification error: 0.02), and PPV/NPV of 67%/100%. The most important RF variables in the validation data set were WS temperature and minimum pH over the 7 days prior to cx.

Conclusion
An RF model using water and weather data was validated as an accurate predictor of new Legionella cx+ within a hospital WS. Most importantly, NPV for the model was 100%, meaning that no positive Legionella cxs were recovered during periods identified as low-risk. The RF model is a powerful tool for most efficiently directing resources to Legionella surveillance and LD prevention.

Disclosures
All authors: No reported disclosures.
1756. Prediction of Bloodstream Infection Prior to Onset of Symptoms by Plasma Metagenomic Sequencing in Pediatric Patients With Relapsed or Refractory Malignancy (PREDSEQ)
Authors: Goggin Kathryn , Inaba Yuki , Gonzalez-Pena Veronica , Allison Kim J , Chan Ka Lok , Hollemon Desiree , Ahmed Asim , Hong David , Maron Gabriela , Hayden Randall , Choi John , Rubnitz Jeffrey , Gawad Charles , Wolf Joshua 
Published: November 2018

Abstract

Background
Patients undergoing treatment for relapsed or refractory malignancies are at high risk of life-threatening bloodstream infection (BSI). A predictive screening test for BSI might allow pre-emptive therapy, but no validated test is currently available. We tested the hypothesis that plasma metagenomic next generation pathogen sequencing (NGS) would predict BSI before the onset of attributable symptoms.

Methods
We enrolled 31 pediatric patients receiving for treatment relapsed or refractory malignancy in an IRB-approved prospective cohort study (PREDSEQ) of predictive sequencing. Episodes of febrile neutropenia or documented infection were collected prospectively from the medical record. BSI was defined according to NHSN criteria. Control Samples were defined as samples collected ≥7 clear days before or after any fever or documented infection. Residual clinical samples were stored for NGS; after filtering human sequences, reads were aligned to a curated pathogen database, and organisms above a predefined threshold were reported (Karius Inc., Redwood City, CA). Only bacteria and fungi were included in this analysis.

Results
A total of 11 BSI episodes occurred in 9 participants (Table 1) during the study period. Predictive sensitivity of NGS in the 2 days before onset of infection (n = 9) was 78% (95% CI 45–94%), and diagnostic sensitivity on the day of infection (n = 11) was 82% (95% CI 52–95%). Specificity of NGS for development of fever or infection within 7 days (n = 16) was 81% (95% CI 57–93%). NGS was positive up to 6 days prior to onset of BSI. In samples collected before or during documented infections, NGS also identified additional bacteria and fungi that were not detected by standard clinical testing.

Conclusion
Plasma NGS shows promise for the detection of BSI prior to onset of symptoms in high-risk patients.

Disclosures
K. Goggin, Karius Inc.: Investigator, Research support. K. L. Chan, Karius Inc.: Employee, Salary. D. Hollemon, Karius Inc.: Employee, Salary. A. Ahmed, Karius, Inc.: Employee, Salary. D. Hong, Karius, Inc.: Employee, Salary. R. Hayden, Roche Molecular: Scientific Advisor, Consulting fee. Abbott Molecular: Scientific Advisor, Consulting fee. Quidel: Scientific Advisor, Consulting fee. C. Gawad, Karius Inc.: Investigator, Research support. J. Wolf, Karius Inc.: Investigator, Research support.