bluuebunny/crossref_metadata_2025_split huggingface dataset:
1048. Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multi-National Cohort
Authors: Fernandez-Hidalgo Nuria , Gharamti Amal , Aznar María Luisa , Chu Vivian H , Rizk Hussein , Kanafani Zeina 
Published: November 2018

Abstract

Background
β-Hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with β-hemolytic streptococcal infective endocarditis in a large multi-national cohort, and compare them to patients with oral Viridans IE, a more common cause of IE.

Methods
The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multi-national database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form (CRF) developed by ICE collaborators. Patients with BHS IE were compared with patients with IE due to Oral Viridans Streptococci (OVS).

Results
Among 1336 cases of streptococcal IE, 823 (62%) were caused by OVS and 147 (11%) by BHS. The majority of patients in both groups belonged to the male gender and had similar median age. Among the predisposing conditions, congenital heart disease and native valve predisposition were more commonly associated with OVS IE than with BHS IE (P &lt; 0.005). The presence of endocavitary cardiac device is associated more with BHS IE than with OVS IE (P = 0.026). BHS were more likely to be penicillin-susceptible than OVS (P = 0.001). Clinically, patients with BHS IE are more likely to present acutely (P &lt; 0.005) and with fever (P = 0.024). BHS IE is more likely to be complicated by stroke (P &lt; 0.005) and other systemic embolism (P &lt; 0.005). The overall in-hospital mortality of BHS IE was significantly higher than that of OVS IE (P = 0.001). The independent factors associated with in-hospital mortality for β-hemolytic streptococcal IE were age, per 1-year increment (OR 1.044; CI 1.014–1.075; P = 0.004) and prosthetic valve IE (OR 3.029; CI 1.171–7.837; P = 0.022). The complications associated with a higher in-hospital mortality were CHF (OR 2.513; CI 1.074–5.879; P = 0.034), especially CHF NYHA III or IV (OR 4.136; CI 1.707–10.025; P = 0.002), and stroke (OR 3.198; CI 1.343–7.619; P = 0.009).

Conclusion
Our findings suggest that BHS IE is an aggressive disease characterized by an acute presentation. It is associated with a significant rate of complications and a high rate of in-hospital mortality. This underlines the importance of early surgery to prevent the progression of disease.

Disclosures
All authors: No reported disclosures.
1050. Oral Antibiotics for the Treatment of Gram-Negative Bloodstream Infections: Prescribing Practices and Outcomes at a Large Academic Medical Center
Authors: Claeys Kimberly , Loughry Nora , Chainani Sanjay , Leekha Surbhi , Heil Emily 
Published: November 2018

Abstract

Background
There is limited data to guide the use of oral (PO) antibiotics for the treatment of Gram-negative (GN) bloodstream infection (BSI). The objective of this study was to describe the characteristics and outcomes at a large academic medical center.

Methods
Retrospective observational cohort of adult patients (age ≥18 years) with at least one blood culture positive for aerobic Gram-negative organism(s) treated with antibiotic therapy (IV or oral [PO]) at University of Medical Center from November 2015 to May 2017. Oral antibiotics were described based on bioavailability. The primary outcome of interest was 30-day infection-related readmission. Secondary objectives included evaluation of patient characteristics associated with PO antibiotic use.

Results
During the defined study period 310 patients met inclusion; 113 (36.5%) were switched to PO antibiotic therapy for the treatment of GN BSI within a median of 5 (IQR 3–11) days. Oral antibiotics were initiated at discharge for 50 (44%) of patients switched. Patients switched to PO were less likely to have has a stay in the ICU (24.8% vs. 47.7%, P &lt; 0.0001) and were less likely to have an ID consult (57.5% vs. 71.1%, P = 0.034). There was no difference in median Charlson Comorbidity Score (2, IQR 0–4). The most common sources of infection among those switched to PO agents were urinary (50, 44.2%) and intra-abdominal (25, 22.1%). The majority of patients were placed on a PO agent with high bioavailability (61, 54%), which included levofloxacin and moxifloxacin. There was a slightly higher proportion of use of high (vs. low) bioavailable antibiotics in patients with ID consult compared with those without (59% vs. 41%, P = 0.053). PO antibiotics were more frequently prescribed for patients discharged home (78, 69%) compared with patients discharged to Rehab/Short-term facility (28, 24.8%). Thirty-day hospital readmission was more common among the patients treated with PO antibiotics (18.6 vs. 8.1%, P = 0.006); however, ID-related readmission was rare (0.9% vs. 1%, P = 0.91).

Conclusion
Urinary and intra-abdominal sources and home discharge were common among those with PO antibiotic use. ID-related outcomes were similar among those treated with IV vs. PO agents. More research is necessary to determine optimal time to PO antibiotic switch.

Disclosures
K. Claeys, Nabriva: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. E. Heil, ALK-Abelló: Grant Investigator, Research grant.
1057. Treatment Efficacy of Ceftriaxone vs. Cefazolin for Methicillin-Susceptible Staphylococcus aureus Infections
Authors: Bhavan Kavita , Ganguly Anisha , King Helen , Schmalstieg Aurelia , Mang Norman , Collins Ryan 
Published: November 2018

Abstract

Background
Methicillin-susceptible Staphylococcus aureus (MSSA) infections are traditionally treated with intravenous (IV) nafcillin, oxacillin, or cefazolin, all antibiotics that require multiple doses per day. Despite theoretical limitations of using ceftriaxone in MSSA infections, some clinical studies suggest noninferiority of ceftriaxone compared with standard of care. At Parkland Memorial Hospital, many patients diagnosed with MSSA infections receive self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT). Daily-dosed ceftriaxone is often used for convenience and feasibility of medication adherence.

Methods
We conducted a retrospective cohort study among S-OPAT patients receiving cefazolin and ceftriaxone for treatment of MSSA infections. We compared infection type and planned duration of therapy as baseline differences between the treatment cohorts. Our clinical outcomes of interest were 30-day readmission rates and treatment failure as defined by repeat positive blood culture within 6 months.

Results
We identified 184 patients treated with cefazolin and 74 patients treated with ceftriaxone. Characteristics of treatment plan are shown in Table 1. There were no statistically significant differences in infection type or mean duration of therapy between the two treatment cohorts. Outcomes are shown in Table 2. There were no statistically significant differences in readmission rates and rate of treatment failure.

Conclusion
Our retrospective review suggests patients treated with ceftriaxone for MSSA bacteremia had similar clinical outcomes as those treated with cefazolin. While this study is limited in its retrospective nature, the findings suggest that ceftriaxone may be a safe and more convenient antibiotic option in certain MSSA infections.

Disclosures
All authors: No reported disclosures.
1070. Epidemiological and Clinical Features of Panton–Valenton Leukocidin-Positive Staphylococcus aureus Bacteremia: A Case–Control Study
Authors: Kausar Humera , Smith Stephen , Qu Ming Da , Lazar Peter G , Kroll-Desrosiers Aimee , Barton Bruce , Ward Doyle V , Ellison III Richard T 
Published: November 2018

Abstract

Background
The presence of the binary Panton-Valentine Leukocidin (PVL) toxin in Staphylococcus aureus has been associated with both severe pneumonia and skin and soft-tissue infections. However, there is only limited data on how this virulence factor impacts S. aureus bacteremia and whether it might affect the clinical course or complications of bacteremic infections.

Methods
Between September 2016 and March 2018, a convenience sample of S. aureus isolates from clinical cultures obtained in inpatient units and the Emergency Departments of UMass Memorial Medical Center underwent comprehensive genomic sequencing. Four hundred sixty-nine (29%) of 1,681 S. aureus sequenced isolates were identified as containing the LukF and LukSPV genes that encode for PVL. Case patients with one or more positive blood cultures for LukF/LukSPV + strains were randomly matched with control patients having positive blood cultures for LukF/LukSPV− strains for a retrospective chart review.

Results
The 55 case and 56 control patients were comparable in age and gender; case patients were more likely to have a history of injection drug use, while controls more likely to undergo hemodialysis or have had indwelling IV catheters. Case patients more commonly had chest pain and more prolonged fever; but had the same incidence of sepsis and septic shock. Isolates from 42 (76%) of case patients were methicillin resistant as compared with 16 (29%) from control patients. Elevations in serum creatinine and alkaline phosphatase were more common in control patients. Case patients had a higher incidence of pneumonia, with no differences seen in the incidence of endocarditis, osteomyelitis, or septic arthritis. The percentage of patients who were clinically cured or expired were comparable.

Conclusion
These results are consistent with prior observations associating the PVL toxin with community-acquired MRSA strains as well as severe staphylococcal pneumonia. However, it does not appear to otherwise influence the natural history of bacteremic S. aureus disease other than in prolonging the duration of fever.

Disclosures
All authors: No reported disclosures.
1084. Nocardia Cyriacigeorgica Endocarditis
Authors: Bhayani Nikhil , Priest Jaclyn 
Published: November 2018

Abstract

Background
Nocardia are beaded, branching Gram-positive rods that are partially acid fast and usually slow growing. Nocardia cyriacigeorgica was first described in 2001, and antimicrobial susceptibility patterns correspond with type VI Nocardia asteroides complex. Nocardia species are not a commonly associated with endocarditis, less than 20 cases to date have been documented. However, when Nocardia endocarditis is identified, the mortality rate is reported to be as high as 41% making antibiotic selection vital in the inpatient and outpatient

Methods
A 62-year-old male with a past medical history significant for severe chronic obstructive pulmonary disease (COPD), atrial fibrillation, atrial tachyarrhythmia, and congestive heart failure (CHF) presented to the emergency department (ED) with shortness of breath for 1 week. The patient was initiated on IV diltiazem, meropenem, and eventually required intubation. On hospital day, two blood cultures grew Gram-positive rods, which were eventually identified as aerobic Actinomycete. Culture was sent out for DNA sequencing and N. cyriacigeorgica was identified. Transthoracic echocardiogram showed possible mitral vegetation.

Results
Antimicrobial therapy was initially de-escalated from meropenem to ampicillin, but had to be escalated to ceftriaxone once N. cyriacigeorgica was identified by DNA sequencing. The organism was reported to be susceptible to amikacin, ceftriaxone, linezolid, tobramycin, and trimethoprim/sulfamethoxazole. The patient received 1 week of ceftriaxone therapy inpatient, and was discharged on an additional 3 weeks of ceftriaxone and 6 months of minocycline suppressive therapy.
Two months later the patient was re-admitted for N. cyriacigeorgica bacteremia and a pulmonary embolism. During his hospital stay, the patient had a STEMI, but due to multiple comorbidities did not undergo cardiac catheterization. The family elected to withdrawal care, and the patient expired.

Conclusion
N. cyriacigeorgica is more commonly identified in brain abscesses or skin infections, in the setting of immunosuppression. We report here on an unusual case of N. cyriacigeorgica endocarditis in a patient with COPD. Other than COPD the patient had no known risk factors for N. cyriacigeorgica, including chronic steroid use.

Disclosures
All authors: No reported disclosures.
1101. Comparison of Clinical Characteristics and Demographics of GII.4 vs. Other GII Noroviruses Associated With Sporadic Acute Gastroenteritis in Children in Nashville, TN, 2012–2015
Authors: Batarseh Einas , Hamdan Lubna , Piya Bhinnata , Stewart Laura , Chappell James D , Dunn John , Payne Daniel C , Wikswo Mary E , Vinjé Jan , Hall Aron J , Halasa Natasha 
Published: November 2018

Abstract

Background
Norovirus is a leading cause of acute gastroenteritis (AGE) in all age groups. Although at least 28 different genotypes infecting humans have been reported, most outbreaks over the last 15 years have been caused by genogroup II (GII) viruses, of which GII.4 viruses have caused more than 50%. Since clinical differences between different genotypes are poorly understood, we sought to compare clinical characteristics in children infected with GII.4 and non-GII.4 viruses.

Methods
Children between 15 days and 17 years who presented with AGE defined as diarrhea (≥3 loose stools in a 24 hour period) or vomiting (≥1 episodes in a 24 hour period) within 10 days duration were recruited in outpatient, emergency, and inpatient settings in Nashville, TN, during 2012–2015. Stool specimens were tested by RT-qPCR for GI and GII norovirus. Norovirus-positive specimens were genotyped by sequencing of a partial region of the capsid gene. In this study, we excluded children infected with GI, mixed GI/GII and non-typeable GII viruses.

Results
Of 3,705 AGE subjects enrolled, 2,892 (78%) specimens were collected, 637 (22%) tested norovirus-positive (567 [89%] GII, 62 [10%] GI, and 8 [1%] mixed GI/GII). Of the 567 GII viruses, 461 (81%) were able to be genotyped and of those 238/461 (51.6%) were typed as GII.4 and 223/461 (48.3%) were typed as other GII genotypes (non-GII.4, primarily GII.3 [65/ 461, 14.1%], GII.6 [48/461, 10.4%] and GII.7 [36/461, 7.8%]). Over three AGE seasons, GII.4 represented 64/117 (54%), 79/178 (44%), and 71/166 (57%), of the GII infections, respectively. Compared with non-GII.4 subjects, GII.4 subjects were more likely to be younger (15.5 vs. 21.3 months, P &lt; 0.01), and less likely to attend daycare (23% vs. 39%, P &lt; 0.01). GII.4 subjects also were more likely to present with diarrhea (75% vs. 57%, P &lt; 0.01) and had higher median modified Vesikari score (7 vs. 6, P &lt; 0.01).

Conclusion
Children infected with GII.4 viruses were younger, less likely to attend child care, more likely to present with diarrhea, and had a more severe illness compared with those with non-GII.4 infections. These data provide important information on the genotype distribution of norovirus in children with AGE in Tennessee and highlight GII.4 as the most prevalent strain.

Disclosures
N. Halasa, sanofi pasteur: Investigator, Research support. GSK: Consultant, Consulting fee. Moderna: Consultant, Consulting fee.
1124. Effects of Co-infection on the Severity, Response to Treatment and Duration of Hospital Stay in Patients with Clostridium difficile Infection
Authors: Shafiq Muhammad , Alturkmani Hani , Zafar Yousaf , Mittal Vishal , Lodhi Hafsa , Brewer Joseph 
Published: November 2018

Abstract

Background
According to the multicenter evaluation of the FilmArray® multiplex gastrointestinal (GI) panel for etiologic diagnosis of infectious gastroenteritis, the GI panel detected at least one potential pathogen in 53.5% of the stool specimens that were collected. Out of the positive samples, 31.5% tested positive for more than one potential pathogen. The samples that were co-infected showed that Clostridium difficile infection (CDI) was present in 53.4% of them. This lead to the idea of our project to determine whether the presence of another GI infection affects CDI outcomes in terms of severity, treatment escalation, duration of hospital stay and recurrence.

Methods
Inclusion criteria: 18-year-old and above patients. Exclusion criteria are GI panel performed on outpatient basis, presence of any co-founder that had independent effect on the outcomes such as end-stage renal disease, cirrhosis, presence of non-GI infection (pneumonia, urinary tract infection, osteomyelitis etc.), and recurrent CDI.
Out of the 2,576 GI panels performed from January 1, 2015 until December 31, 2016; only 235 patients were selected for retrospective chart review based on the above criteria. Out of 235 patients, 38 patients had co-infection (CDI + another GI infection = Group A) and reminder had only CDI (Group B). Chi-square test, Fisher’s exact test (for severity, treatment escalation and recurrence) and Independent T-test (for duration of hospital stay) were used to compare Group A with Group B. Alpha criterion was 0.05.

Results
The P-values for each outcome are given below: (a) 0.16 for severity according to definition of American College of Gastroenterology. (b) 0.77 for severity according to definition of Infectious Disease Society of America. (c) 0.23 for treatment escalation. (d) 0.41 for duration of hospital stay. (e) 0.49 for CDI recurrence.

Conclusion
All the resulted P-values are greater than 0.05. These results are suggestive of the fact that presence of another GI infection does not affect the outcomes for CDI in terms of severity, treatment escalation, duration of hospital stay, and recurrence. As there were only 38 patients in co-infection group, it limits the ability to determine the effect of individual infectious agent on the outcomes of CDI.

Disclosures
All authors: No reported disclosures.
1133. Epidemiology of Invasive Fungal Infections in Lung Transplant Recipients: Harnessing Data Mining Tools to Build a Comprehensive Database
Authors: Yek Christina , Xie Donglu , Barros Nicolas , Liu Terrence , Wallace Ashley , Adams-Huet Beverley , Haley Robert W , Hoz Ricardo La 
Published: November 2018

Abstract

Background
Despite advances in diagnostic and therapeutic tools, mortality of invasive fungal disease (IFD) in lung transplant (LT) recipients remains high. This study aimed to describe the epidemiology of IFD in LT recipients at a large academic center.

Methods
This retrospective single-center cohort study included all first-time LT recipients transplanted between 2010 and 2016 at the University of Texas Southwestern Medical Center in Dallas, TX. Data mining tools were used to extract data from the electronic health record and merge it with information from the Scientific Registry of Transplant Recipients and the Social Security Death Index (Figure 1). Medical records of subjects with positive fungal serologies, cultures or histopathology were manually reviewed and presence of IFD adjudicated using standardized definitions. Multivariable analysis was conducted using Cox proportional hazard models, with input variables treated as time dependent covariates where applicable, to identify risk factors for IFD and 1-year mortality.

Results
Of 393 LT recipients that met inclusion criteria, 68 (17%) developed a proven or probable IFD with median time to onset of 110 days (IQR 46–213) (Figure 2). The most common pathogens were: Aspergillus sp. (41%), and Candida sp. (34%). The most common sites of IFD were: lower respiratory tract (38%), tracheobronchial (25%), pleural/pericardial (15%), and bloodstream (7%). In multivariable analysis, incidence of IFD was associated with male gender (P = 0.02; HR=2.05, 95% CI 1.14–3.68), and prior CMV disease (P = 0.003; HR=4.16, 95% CI 1.65–10.50) (Figure 3). The 12-week mortality after the first episode of IFD was 3%; IFD was not associated with 1-year mortality (P = 0.51, HR = 1.27, 95% CI 0.63–2.53).

Conclusion
IFD is a frequent complication after LT. Efforts to identify risk factors may help guide the development of targeted interventions to reduce the burden of IFD in this vulnerable population.

Disclosures
All authors: No reported disclosures.
1142. Use of DNA Markers to Assess the Potential for Pathogen Transmission from Physicians’ White Coats
Authors: Van Aartsen Daniel , Thakur Manish , Dousa Khalid M , Kanwar Anubhav , Cadnum Jennifer , Wong Yilen Karen Ng , Mana Thriveen , John Amrita , Alhmidi Heba , Donskey Curtis J 
Published: November 2018

Abstract

Background
Physicians’ white coats are often contaminated, but seldom cleaned. A “bare below the elbows” dress code policy has been advocated as a strategy to reduce the risk for transmission of healthcare-associated pathogens by white coats. However, transfer of contamination by clothing has not been demonstrated in clinical settings and it is not known if long sleeves are the major source of transfer.

Methods
We observed physicians during routine patient encounters and characterized the frequency of direct and indirect contact between white coats and the patient or environmental surfaces. To assess transfer from white coats in clinical settings, we applied one cauliflower mosaic virus DNA marker to the sleeve cuffs and another to the coat pockets of physicians prior to routine patient encounters. Polymerase chain reaction was used to determine whether DNA markers from the clothing sites were transferred to patients or environmental surfaces.

Results
Ninety percent of observed patient encounters included one or more direct or indirect contacts between a physician’s white coat and a patient or the environment. Direct contact occurred on average 1.7 times per encounter and indirect contact (i.e., physicians’ hands contacting the coat prior to touching the patient or environment) occurred on average 2.3 times per encounter. The figure shows the frequency and distribution of sites of direct and indirect contact with white coats. Of 11 patient encounters with DNA-contaminated white coats, five (45%) resulted in transfer of one or both DNA markers; there were three transfers from sleeve cuffs and three from coat pockets.

Conclusion
Contaminated white coats may be an under-appreciated source for transmission of healthcare-associated pathogens. Our results provide support for the bare below the elbows policy, but also highlight the potential for indirect transfer of pathogens from other sites on white coats.

Disclosures
All authors: No reported disclosures.