bluuebunny/crossref_metadata_2025_split huggingface dataset:
1193. Comparison of the Clinical Outcomes of Patients With IMP-Type Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae and Carbapenem-Sensitive Enterobacteriaceae in Japan
Authors: Saito Sho , Hayakawa Kayoko , Ishikane Masahiro , Tajima Taichi , Matsunaga Nobuaki , Ide Satoshi , Kinoshita Noriko , Kusama Yoshiki , Fujitomo Yumiko , Nakamoto Takato , Toda Yuta , Ohmagari Norio 
Published: November 2018

Abstract

Background
Carbapenem-resistant Enterobacteriaceae (CRE) infections are spreading worldwide and have become a global menace. Different types of carbapenemases contribute to carbapenem resistance. The outcome of patients with IMP-type carbapenemase-producing CRE (IMP-CRE) is not well known.

Methods
A matched case–control study from January 2012 to December 2016 was conducted at NCGM. All unique patients with IMP-CRE isolation were included and matched with carbapenem-sensitive Enterobacteriaceae (CSE) patients. Meropenem non-susceptible and/or ceftazidime-resistant Enterobacteriaceae, per CLSI criteria, were tested for metallo-β-lactamase production with further confirmation of blaIMP by PCR. Multivariate analyses were conducted for outcomes, adjusting for a propensity score predicting the likelihood of isolation of CRE vs. CSE. The balance of each group was determined by standardized biases &lt;0.25 for variables on baseline characteristics.

Results
In total, 192 patients (96 CRE, 96 CSE) were included (132 Enterobacter sp., 60 Klebsiella pneumoniae). Isolations sites were sputum (n = 76 [39.6%]), urine (n = 62 [32.3%]), blood (n = 22 [11.3%]), and wound (n = 14 [7.2%]). The median age of the patients was 75 years [IQR: 66–84], and 109 (56.8%) were male. Thirty-one (32.3%) patients with CRE and 55 (57.3%) patients with CSE developed infections. The others were considered as colonization. qSOFA was positive (≥2) in seven patients with CRE infection and nine with CSE infection. In bivariate analysis, mortality and length of hospital stay (LOS) after CRE/CSE isolation were similar between the two groups, even after stratification by bacterial species and infection/colonization. After controlling for the propensity score (table), mortality and LOS remained similar between the two groups.

Conclusion
IMP-CRE might not contribute to the worsened clinical outcomes when compared with CSE. Further evaluations are needed for additional outcome parameters.

Disclosures
All authors: No reported disclosures.
1211. Increasing Incidence of Invasive Methicillin-Resistant and Methicillin-Sensitive S. aureus Infections Among Persons Who Inject Drugs, 2014–2017
Authors: Felsen Christina B , Gellert Anita , See Isaac , Dumyati Ghinwa 
Published: November 2018

Abstract

Background
In 2011, persons who inject drugs (PWID) were estimated to be 2.6% of the US population 13 years of age and older. Infectious endocarditis (IE) and hepatitis C infections among PWID are increasing. We describe trends in invasive Staphylococcus aureus (iSA) infections among PWID.

Methods
Population-based surveillance for invasive (from normally sterile site) methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) has been conducted in Monroe County, NY (2010 Census population: 744,344) as part of the CDC’s Emerging Infections Program since September 2014. Cases are county residents with an iSA infection; iSA incidence was calculated as cases/100,000 census population.

Results
During September 2014–August 2017, 1,460 iSA cases were identified; 150 (10%) in PWID. The incidence of PWID-associated iSA doubled among 18–49 year olds during years 1–3 (Table 1). The proportion of cases occurring in PWID increased among both MRSA (7% to 20%) and MSSA (6% to 11%). PWID were significantly younger (P &lt; 0.0001) than noninjection drug users, and more often White (P = 0.003) and non-Hispanic (p = 0.004). Among PWID with iSA, 45% had IE. Almost all PWID with iSA used other illicit drugs (n = 112, 91% of 123 unique cases); 89% (110) were smokers, and 46% (56) had chronic liver disease. PWID with iSA had a longer mean length of stay (26 days [SD 22] vs. 21 [37], P = 0.01); PWID with MRSA were more likely to have septic shock (22% vs. 8%, P = 0.03) and pneumonia (9% vs. 1%, P = 0.04) when compared with PWID with MSSA. Among iSA, a history of recurrent skin abscess/boil (24% vs. 8%, P = 0.02) was more common in PWID with MRSA; fewer PWID with MRSA were obese (2% vs. 15%, p = 0.02).

Conclusion
The increasing incidence of invasive MRSA/MSSA among PWID, frequently accompanied by concurrent chronic liver disease, polysubstance use, and need for extended hospital stays, poses an increasing challenge to the public health and clinical communities. This highlights the critical need to prevent worsening of the epidemic of injection drug use and provide comprehensive treatment for individuals engaging in highest risk drug-related behaviors.

Disclosures
All authors: No reported disclosures.
1241. Surveillance for Viral Respiratory Infections in Pediatric Chronic Care Facilities
Authors: Prill Mila M , Kim Lindsay , Wilmont Sibyl , Whitaker Brett L , Lu Xiaoyan , Neu Natalie , Gerber Susan I , Garg Shikha , Stone Nimalie D , Larson Elaine , Saiman Lisa 
Published: November 2018

Abstract

Background
Residents of pediatric chronic care facilities (PCCFs) are vulnerable to acute respiratory infections (ARIs) due to their underlying medical conditions and infection control challenges in congregate living.

Methods
We conducted active, prospective surveillance for ARIs (defined as ≥2 new signs/symptoms of respiratory illness) among all residents in three PCCFs near New York City from December 7, 2016 to May 7, 2017. The parents/guardians of some residents also provided consent for research specimen collection at the start of the study. In that subset, nasopharyngeal swabs were obtained ≤4 days of ARI symptom onset and weekly for 4 weeks of follow-up to assess viral shedding. Influenza, respiratory syncytial virus (RSV), rhinovirus (RV), coronavirus (229E, NL63, OC43, HKU1), parainfluenzavirus (PIV 1–4), metapneumovirus (MPV), adenovirus (AdV), bocavirus (BoV), enterovirus, parechovirus, and M. pneumoniae were tested by the Fast Track Diagnostics Respiratory Pathogens 21 real-time RT-PCR panel.

Results
Subset with research specimen collection: Among 79 residents (aged 0–20 years, median = 8), 60 ARIs were reported in 37 (47%) residents. Swabs were obtained at illness onset for 53/60 ARI episodes; among these, there were 25 single-virus detections and five co-detections. An additional 33 single- and five co-detections occurred in 175 follow-up swabs (table). Molecular typing of 32 RV+ specimens identified 13 RV types.
All residents: During the 2016–2017 influenza season, 308/322 (96%) age-eligible residents received influenza vaccine and 168/364 (46%) received prophylactic antivirals for influenza exposures. Although influenza was not detected in research swabs, it was detected in 3/200 tests conducted for clinical purposes.

Conclusion
ARIs were common among residents of three PCCFs, and a variety of respiratory viruses were detected. The rarity of influenza may reflect strong infection control practices in these facilities, including vaccination and prophylactic use of antivirals.

Disclosures
All authors: No reported disclosures.
1246. Acinetobacter baumannii in the Post-Acute Care Setting: Prevalence and Resistance Rates in Patients, Health Care Personnel and the Environment
Authors: Cassone Marco , Zhu Ziwei , Gibson Kristen , Lansing Bonnie , Cao Jie , Mody Lona 
Published: November 2018

Abstract

Background
Acinetobacter baumannii is an important agent of healthcare-acquired infections, sporting high resistance to major antibiotics in acute care. Since A. baumannii is an opportunistic pathogen commonly found in the environment, we aimed to investigate: (1) its prevalence as colonizer on patients, environment, and healthcare personnel (HCP) in Nursing Facilities (NFs) with intermediate intensity of care but high antibiotic pressure and (2) whether resistance rates in colonizing strains vary between patient, environmental, and HCP isolates.

Methods
We analyzed A. baumannii patient and HCP colonization and environmental contamination in six NFs in Michigan. Samples were collected from HCPs hands, and from multiple patient body sites and high-touch surfaces at admission, 14 days, and monthly up to 6 months. Ciprofloxacin, imipenem, and ceftazidime resistance was tested according to CLSI guidelines.

Results
651 patients were screened (average follow-up time was 29 days). Patient colonization with A. baumannii was found in 59/1,620 (3.64%) of visits, and environmental contamination in 267/1,620 visits (16.48%) (P &lt; 0.001). Interestingly, HCP showed at least as high or possibly higher colonization rates than patients (32/574) (5.25%) (P = 0.06). Resistance rates differed significantly between HCP, environmental, and patient isolates, ranging from 35 to 38% for patient isolates, 26 to 30% for environmental isolates, and only 8 to 17% for HCP isolates (table).

Conclusion
In our NFs, A. baumannii is more likely to be found on HCPs than on patients. However, HCP isolates have much lower resistance rates. Environmental contamination is alarmingly common, with worrisome resistance rates even in post-acute care settings.

Disclosures
All authors: No reported disclosures.
1256. New Acquisitions of ET-12 Burkholderia cenocepacia in Adults With Cystic Fibrosis: Role of Whole Genome Sequencing in Outbreak Investigation
Authors: Blanchard Ana C , Tadros Manal , Tang Lin , Muller Matthew , Spilker Theodore , Waters Valerie , Lipuma John , Tullis Elizabeth 
Published: November 2018

Abstract

Background
Transmission of Burkholderia cenocepacia ET-12 strain (ET-12Bc) can cause epidemics in the cystic fibrosis (CF) population. The Toronto Adult CF center currently follows 500 patients; 20% have infection with B. cepacia complex (BCC), including 48 patients infected with ET-12Bc. The center adheres to the 2013 infection prevention and control guidelines and patients are also segregated by clinics. Despite this, there have been 11 new acquisitions of ET-12Bc since 2008. The objective of this study was to describe the investigation of an ET-12Bc outbreak in CF patients, using whole-genome sequencing (WGS).

Methods
Investigations included multilocus sequence typing (MLST) and WGS of 34 isolates (11 new ET-12Bc acquisitions, 18 isolates of known ET-12Bc patients (including all patients with hospital admissions that overlapped with new acquisitions), four isolates from CF patients in the USA and the J2315 reference strain). Each of the seven MLST alleles from ET12Bc strain J2315 was downloaded from PubMLST and used to “Blast” each of the 16 WGS databases. WGS was done using 150 bp paired-end runs on an Illumina HiSeq4000. Single nucleotide polymorphisms (SNPs) between the newly sequenced strains and J2315 were profiled.

Results
Ten patients had a hospital admission within the 2 months preceding their first ET-12Bc positive sputum culture, except for one in whom ET-12Bc was detected 12 months following hospital admission. In all isolates, the seven alleles (atpD, gltB, gyrB, recA, lepA, phaC and trpB) matched 100% to sequence type 28 and clonal complex 31, and were identical to J2315. WGS SNP analysis confirmed that transmission occurred from known cases on the unit in 10/11 (90.9%) patients. To date, 8/11 patients with new acquisitions have died (median survival of 95 days).

Conclusion
Our investigations found epidemiological evidence suggestive of ET-12Bc transmission on the CF unit, which was confirmed by MLST and WGS SNP analysis. Compared with MLST, WGS SNP analysis had better discriminatory power and was well correlated with the identified epidemiological links between patients. Recognition of ET-12Bc transmission with associated high mortality rates has led to a change in our hospital policy. ET-12Bc positive patients will no longer be cared for on the same unit as ET-12Bc negative patients with CF.

Disclosures
All authors: No reported disclosures.
1290. A Model for “At-Distance” PrEP Navigation: Acceptability and Early Insights
Authors: Perlson Jacob , Kruger Blake , Padullaparti Sravanthi , Eccles Elizabeth , Lahey Tim 
Published: November 2018

Abstract

Background
HIV pre-exposure prophylaxis (PrEP) awareness and uptake among at-risk individuals remains suboptimal despite clear evidence of efficacy. Health navigators and peer educators have been employed to facilitate linkage and retention in many aspects of HIV prevention and care, including to improve PrEP utilization. Yet, the use of health navigators to improve PrEP utilization has not been well-explored in rural areas where unique challenges to HIV care have been well documented. Little is known, too, about how telemedicine may strengthen these efforts. We assessed acceptability and evaluated a health navigation program that primarily engages clients through at-distance technology-based methods.

Methods
To guide the design and implementation of a pilot PrEP tele-navigation program, we conducted a survey in at-risk clients contacted through social networks and at a state-funded STI clinic in New Hampshire. Approximately nine months after the launch of the navigation platform, we analyzed characteristics of client-navigator interactions. Feedback surveys were distributed to clients 3 months following engagement with the navigator.

Results
From July 2017 to April 2018, 139 individuals engaged the navigator program via email, text, chat, phone call, or in-person. Among the most common services provided were PrEP counseling (n = 63 or 45% of inquiries), referral to STI/HIV testing (22%), and risk reduction counseling (19%). Eight clients have been linked to PrEP care to-date. Qualitative analysis of client-navigator interactions revealed a variety of recurring barriers expressed by clients including concerns maintaining confidentiality with parents and partners, side effects of PrEP, and financial constraints. Clients provided suggestions for program improvement and indicated they felt engagement with the program increased knowledge of PrEP as well as linkage to testing and HIV prevention services.

Conclusion
Our pilot program highlighted the diverse obstacles to PrEP utilization in at-risk rural clients, and suggests at-distance PrEP navigation and telemedicine can support improved PrEP utilization in the rural United States. Such a navigator program should be equipped to engage clients along the PrEP care continuum.

Disclosures
All authors: No reported disclosures.
1300. Young Heterosexual Men in Rural South Africa Want Access to PrEP
Authors: Hannaford Alisse , Khoza Bulelani , Moll Anthony P , Shenoi Sheela V 
Published: November 2018

Abstract

Background
While many HIV prevention services in South Africa specifically support women and girls, substantial gaps exist in HIV prevention, testing and treatment services targeting men and boys. We aimed to characterize HIV prevention knowledge, sexual-risk behaviors and interest in HIV pre-exposure prophylaxis (PrEP) among young men in rural KwaZulu-Natal.

Methods
Men were identified at community settings such as taverns, fast-food restaurants, and local stores. Interviews were conducted confidentially and anonymously in Zulu, and were recorded, translated and transcribed. Transcripts were coded to identify themes.

Results
Thirty-one HIV negative men (median age 26, IQR 23–31) were interviewed, 52% with a history of STI and 77% unemployed. While most (61%) perceived themselves to be at risk for HIV, less than half had tested for HIV in the prior 3 months (36%), the majority reported inconsistent condom use (87%), and most reported partners outside their relationship (84%). While only a quarter had previously heard of PrEP, all were interested in initiating. Four participants felt PrEP should only be for men because polygamy is acceptable. While most men wanted their partners on PrEP (77%), they also felt that their female partners initiating PrEP would signify a lack of trust in the relationship, while paradoxically acknowledging that their own multiple sexual relationships put their partner at risk. Men expressed fear of destabilizing new relationships by asking about HIV status, and admitted being less likely to discuss HIV status and condoms during sexual encounters involving alcohol. Men felt that using PrEP might lead to decreased condom use and enable their female partners to be sexually active with other men. Men were concerned that if they initiated PrEP they would be mistaken as HIV positive.

Conclusion
Men in heterosexual relationships in rural South Africa acknowledge engaging in high HIV risk behaviors and feel that they should have access to PrEP. They report contradictory perspectives about their female partners accessing PrEP, and are concerned about PrEP increasing HIV risk behaviors, which needs further exploration. Heterosexual men in sub-Saharan Africa should be targeted for combination HIV prevention services, including PrEP.

Disclosures
S. V. Shenoi, Amgen Pharmaceuticals: Spouse does part-time contract work, Salary.
1301. Evaluation of the Rates of HIV Post-Exposure Prophylaxis Completion After the Implementation of an Automated Referral System in the Emergency Department
Authors: Schwarz Erika Reategui , Gysi Madeleine , Schubert Finn , Ita-Nagy Fanny 
Published: November 2018

Abstract

Background
A 28-day regimen of Post-Exposure Prophylaxis (PEP) administered within 72 hour significantly reduces HIV infection, for both occupational and nonoccupational exposures (NOE); however, adherence to PEP for NOE has been reported to have poor rates of completion.1 To optimize PEP referrals from our ED to our clinics, we implemented an automated referral system to maximize PEP completion and link patients to outpatient care and HIV pre-exposure prophylaxis (PrEP), if appropriate.

Methods
In our ED, PEP patients receive a starter kit from an automated medication dispensing system. Starting in March 2017, a daily automated report of patients who received a starter kit in the ED was generated and emailed to patient navigators who would contact patients and offer follow-up appointments. Our main objective was to describe the rate of outpatient follow-up of patients initiated on PEP for NOE from March 2017 to March 2018, as well as patient demographics and linkage to PrEP.

Results
Out of 128 patients seen in the ED for PEP, 30% (38) were for NOE. Of these, 68% were female, with a median age of 27 years old (range: 14–59). Nearly half had no insurance (45%). The majority (84%) reported sexual intercourse or sexual assault as the exposure. Most patients were contacted for follow-up (76%) and half (48%) had a follow-up appointment. Patients who presented to the ED &gt;24 hours after exposure were less likely to complete a follow-up (35% vs. 75%, P = 0.035), as were uninsured patients (24% vs. 57%, P = 0.052). From 38 patients, 13 (34%) qualified for PrEP, eight (62%) followed as outpatients and one (8%) was started on PrEP.

Conclusion
The automated system ensured that half our PEP patients were seen by an outpatient provider, increasing their likelihood of finishing the 28 days of PEP. Patients presenting late to the ED and uninsured patients were less likely to follow-up. Further research is needed to identify interventions to improve follow-up. Finally, transition to PrEP was low and additional interventions should be explored to improve this process.

Reference
1. Kahn JO, Martin JN, Roland ME, et al. Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: the San Francisco PEP Study. J Infect Dis 183(5):707–714.

Disclosures
All authors: No reported disclosures.
1304. From Information Bolus to Continuous Infusion: Resident Knowledge and Satisfaction With an “Antibiotic of the Month” Educational Initiative at an Academic Children’s Hospital
Authors: Madigan Theresa , Radel Luke , Fatemi Yasaman , Rajapakse Nipunie 
Published: November 2018

Abstract

Background
Medical trainees play a critical role in the prescribing of antimicrobials. Prescriber education is one of the CDC core elements of antimicrobial stewardship programs. Optimal strategies for educating residents about antimicrobials have not been identified; however, the common practice of teaching all classes of available antibiotics over a short period of time (usually a single 1–2 hour lecture or “bolus”) is generally not well received and likely ineffective.

Methods
We developed a novel antibiotic of the month (AOTM) education program (“continuous infusion”) for pediatric residents. It included a monthly 10-minute presentation by an infectious diseases physician or fellow about a single commonly prescribed antibiotic, a handout summarizing important aspects of the antibiotic and a display posted in the resident workroom. An anonymous survey was sent to all pediatric residents before and 6 months after implementation of the AOTM program. The survey consisted of questions on demographics, satisfaction with the program, and antibiotic knowledge. Responses were tabulated and analyzed using Microsoft Excel. Responses were summarized and reported as a proportion of total responses.

Results
Both pre- and post-implementation surveys were completed by 21 pediatric residents (51% response rate). Prior to the AOTM program, 55% of respondents felt very or somewhat uncomfortable about their current level of knowledge about antimicrobials and antimicrobial prescribing. Six months after initiation of the program, 86% and 76% agreed or strongly agreed that their knowledge of antimicrobials and antimicrobial resistance, respectively, had improved. After introduction of the program, 81% felt more comfortable or much more comfortable with antimicrobial prescribing. Fifty-seven percent had referenced the handout at some point after the teaching session and 100% agreed that the program was worthwhile continuing in the next academic year.

Conclusion
A continuous infusion of antimicrobial education in the form of an AOTM education program was well received among pediatric residents and increased their knowledge and comfort level with antimicrobial prescribing. Further studies to measure knowledge retention with this strategy are required.

Disclosures
All authors: No reported disclosures.