bluuebunny/crossref_metadata_2025_split huggingface dataset:
795. Review of Treatment of Latent Tuberculosis Infection at VA Portland Healthcare System
Authors: Xu Teena , Forrest Graeme N 
Published: November 2018

Abstract

Background
Treatment of latent tuberculosis infection (LTBI) is important for tuberculosis elimination in low-incidence countries. Currently, the VA Portland Health Care System (VAPORHCS) offers both 3HP (12-dose rifapentine plus isoniazid directly observed therapy (DOT)) and 9H (9-month daily isoniazid) for treatment of LTBI. Majority of veterans are treated with 9H despite increasing evidence showing higher rates of completion with 3HP. We reviewed the rates of completion and adverse events (AE) between veterans treated with 3HP and 9H.

Methods
We performed a retrospective chart review on all patients within the VAPORHCS who initiated LTBI treatment with 9H or 3HP between January 2011 and December 2016. LTBI was diagnosed through tuberculin skin testing or interferon-γ release assay. 9H treatment was self administered while 3HP was under DOT. Collected data included demographics, co-morbid conditions, immunosuppression, treatment completion, and AE. Treatment completion was determined through chart documentation.

Results
A total of 93 patients were treated for LTBI. Most patients were white (71%) and male (86%). The median age was 57 years old. Seventy-two patients (77%) were treated with 9H, and 21 (23%) were treated with 3HP. The overall completion rate was 86%. Completion rates between 9H (91%) and 3HP (86%) were not significantly different (P = 0.46). Twenty-three patients (31.9%) on 9H and six patients (28.6%) on 3HP were on chronic immunosuppression with TNF inhibitors and/or corticosteroids (P = 0.78) with an overall completion rate of 86%. Nine patients (13%) on 9H and two patients (10%) on 3HP had HIV (P = 0.95). Overall rates of AEs were similar between the groups (4%, 14%, P = 0.11), including hepatotoxicity (2%, 0%, P = 0.57) and neurotoxicity (4%, 5%, P = 0.94).

Conclusion
The overall treatment completion rates were high and statistically similar between 9H and 3HP groups, even with immunosuppressive therapy. There were no significant differences in rates of adverse events. While the majority of patients were treated with 9H, these results suggest an opportunity for more use of the 3HP, possibly without the need for DOT regimen going forward.

Disclosures
All authors: No reported disclosures.
804. Impact of Azithromycin Prophylaxis in Lung Transplant Recipients on the Risk of Nontuberculous Mycobacterial Infections
Authors: Workman Adrienne , Kaza Vaidehi , Bennett Scott , Chong Pearlie 
Published: November 2018

Abstract

Background
Azithromycin has been shown to improve FEV1 in lung transplant recipients (LTR) with bronchiolitis obliterans syndrome (BOS). The impact of azithromycin use on the incidence of infections due to Mycobacterium avium complex (MAC) and M. abscessus in LTR is currently unknown.

Methods
We conducted a nested case–control study of a retrospective cohort of adult LTR transplanted between 2007 and 2017. Cases were defined as LTR with nontuberculous mycobacterial (NTM) infections due to MAC and/or M. abscessus. Controls were defined as LTR without NTM infections. NTM infection was defined by presence of pulmonary symptoms and radiographic changes (clinical criteria) in addition to positive cultures from ≥2 sputa or ≥1 bronchial specimens (microbiological criteria) according to the IDSA/ATS criteria. LTR who meet microbiological, but not clinical criteria were considered colonized and not included for analysis. Azithromycin use was defined as ≥90 days for BOS treatment.

Results
Among 538 LTR, 60% (321/538) were male and 81% (434/538) received double LTs. Indication for LT was idiopathic pulmonary fibrosis (28% [152/538]), chronic obstructive pulmonary disease (23% [121/538]), cystic fibrosis [CF] (13% [68/538]), and other (37% [197/538]). The overall incidence of NTM infections was 4.3% (23/538); of which 65.2% (15/23), 17.4% (4/23), and 17.4% (4/23) were due to MAC, M. abscessus and polymicrobial infections, respectively. Thirty-one percent (165/538) of LTR received azithromycin. LTR who received azithromycin prophylaxis had 0.21 times the odds of developing NTM infections compared with LTR who did not receive azithromycin prophylaxis (OR: 0.21, 95% CI: 0.02 – 0.86, P = 0.02). Age (P = 0.88), type of LT (P = 0.81), pretransplant NTM colonization (P = 0.46), and CF (P = 0.22) were evaluated as possible risk factors, but were not associated with increased risk of developing NTM infections in bivariable analyses. In a multivariable logistic regression model, azithromycin prophylaxis was independently associated with decreased risk of NTM infections after adjusting for CF and pretransplant NTM colonization (aOR: 0.20, 95% CI: 0.05–0.88, P = 0.01).

Conclusion
Azithromycin use was associated with lower risk of NTM infections due to M. abscessus and MAC in our LTR.

Disclosures
All authors: No reported disclosures.
809. Osteitis Caused by Bacillus Calmette-Guerin Tokyo 172 Strain in Immunocompetent Patients
Authors: González Saldaña Napoleón , Parra Mercedes Macías , De Colsa Ranero Agustín , Garza Eduardo Arias De La , Trujillo Diego Galvis , Bejarano José Iván Castillo 
Published: November 2018

Abstract

Background
Immunization with BCG vaccine has been associated with local and systemic complications. Osteitis secondary to Mycobacterium bovis-BCG is a rare complication with frequency of 0.1/100,000 doses. Below we report a series of a third level pediatric hospital in Mexico City.

Methods
This is a retrospective, descriptive, and observational study of subjects diagnosed with TB at the National Institute of Pediatrics (INP) in Mexico City during the 2010–2018 period. Subjects under 18 years with skeletal TB and positive culture for M. bovis-BCG strain were included.

Results
From 2010 to 2018, 118 cases of TB were treated, from which 3 (2.5%) were osteitis secondary to M. bovis-BCG Tokyo 172 strain, two male and one female. All three cases had BCG immunization at birth. The age at diagnosis was 1, 2, and 3 years, respectively. The most common symptoms were pain, edema, and limp. Sites of injury were right proximal tibia, epiphysis of left distal femur, and left ileopubic eminence. Lytic lesions with periosteal reaction were reported in plain radiographs of all cases. The TST and COMBE studies were negative. Diagnosis was confirmed by biopsy with identification of M. bovis-BCG Tokyo 172 strain by Genotype. All strains were sensitive to rifampicin. The treatment given was INH, RIF, E, PZA, and Clarithromycin during 2 months of intensive phase followed by 7 months of maintenance phase with INH-RIF. A surgical approach was performed with curettage and graft placement in two cases. Tetrazoil nitro blue tests and immunoglobulin levels were normal. Outcome was favorable in all three cases.

Conclusion
In Mexico the BCG vaccine is part of the national immunization program and is applied to 99% of newborns. This work is the first report in Mexico of osteitis secondary to M. bovis-BCG strain Tokyo 172. We suggest considering the diagnosis in patients with osteitis under 5 years of age with a history of BCG vaccination.

Disclosures
All authors: No reported disclosures.
810. Diagnosis of BCG Aortitis by Plasma Metagenomic Sequencing
Authors: Cooper Chris , Hong David , Blair Lily , Bercovici Sivan , Ahmed Asim 
Published: November 2018

Abstract

Background
The use of intra-vesicular Bacille Calmette-Guerin (BCG) for bladder cancer can result in disseminated/endovascular BCG infection. The diagnosis of BCGosis in this setting is complicated by the risks of biopsy of an endovascular focus and the long duration of acid-fast bacilli (AFB) cultures.

Methods
A 68-year-old male with a history of hypertension, aortic aneurysm (status post repair), and bladder cancer treated with intravesicular BCG complicated by BCGosis presented several years later with two weeks of fevers, chills, night sweats, and back pain. Computed tomography (CT) scan demonstrated aortitis with periaortic abscess. There was concern for BCG aortitis given the antecedent BCG exposure and prior BCGosis. Blood cultures were negative; AFB blood cultures were contaminated. A sample of plasma was sent to Karius (Redwood City, CA) for next-generation sequencing (NGS). Cell-free DNA was extracted and NGS performed. Human sequences were removed and remaining sequences were aligned to a curated pathogen database of &gt;1,000 organisms. Organisms present above a statistical threshold were reported. The patient underwent surgical replacement of the infected endograft; endovascular samples were sent for AFB culture.

Results
Plasma-based NGS of cell free DNA detected M. tuberculosis (Mtb) complex at 48 hours (within 28 hours of sample receipt). Within the Mtb complex, the majority of sequences aligned to M. bovis with five reads aligning uniquely to M. bovis. No reads aligned to the region of deletion 1 (RD1) deleted in BCG. Surgical AFB cultures were positive for Mtb complex by PCR probe at nine days; Mtb complex was recovered in culture at 19 days.

Conclusion
Plasma metagenomic sequencing can be used to rapidly diagnose BCG-associated endovascular infection.

Disclosures
C. Cooper, Karius, Inc.: Consultant, Consulting fee. D. Hong, Karius, Inc.: Employee, Salary. L. Blair, Karius: Employee, Salary. S. Bercovici, Karius, Inc.: Employee, Salary. A. Ahmed, Karius, Inc.: Employee, Salary.
812. Case–Control Trial to Evaluate the Cytokine Response to the Use of Capsule Thalidomide in Erythema Nodosum Leprosum in Leprosy Patients
Authors: Chopra Ajay , Mitra Debdeep , Mitra Barnali 
Published: November 2018

Abstract

Background
Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Type II lepra reaction or Erythema Nodosum Leposum is a Type III hypersentivity immune response during the chronic course of the illness. This immune response presents as systemic symptoms and neutrophilic leukocytosis, similar to sepsis. Capsule Thalidomide is considered the drug of choice, when it comes to the treatment of this acute immunological emergency. A rational study into the immunological markers involved in the pathogenesis of erythema nododsum leprosum and its successful suppression by Thalidomide should be helpful in early diagnosis and prompt successful therapy. On the basis of previous studies, our aim was to find a correlation with interferon-γ, tumour necrosis factor-α, and Cd-64 expression on activated circulating neutrophils during Type II lepra reaction and successful response to capsule Thalidomide.

Methods
This case-controlled study included one group of patients diagnosed to have leprosy and the other group was healthy controlled individuals with matched age, sex, and area of residence. All the patients with type II lepra reaction responded to Capsule Thalidomide clinically, and all the skin lesions resolved in 7–14 days. Blood samples and skin biopsy were subjected to histopathology, immunoflourescence assay, immunohistochemical staining, quantitative RT-PCR (reverse transcriptase-polymerase chain reaction), and flow cytometry.

Results
Interferon-γ and TNF-α are sensitive markers in diagnosing erythema nodosum leprosum and Cd-64 expression on activated circulating neutrophils is both a specific and sensitive marker in Type II lepra reaction. Cd-64 expression also had a positive correlation with Thalidomide treatment and clinical response. High polymorphonuclear Cd-64 expression was correlated with severity of ENL.

Conclusion
Cd-64 expression on circulating neutrophils is a potential early biophysical marker for diagnosing erythema nodosum leprosum and can be used as a tool to assess thalidomide response. It is however not a good index to diagnose leprosy infection as it was specific for Type II lepra reaction. Interferon-γ and TNF-α are sensitive markers to screen for lepra reactions and this study showed no significant correlation with Thalidomide therapy.

Disclosures
All authors: No reported disclosures.
986. Evaluation of Moderate-to-Severe Influenza Disease in Children 6 Months to 8 Years of Age in Colorado
Authors: Rao Suchitra , Lamb Molly , Moss Angela , Yanni Emad , Bekkat-Berkani Rafik , Schuind Anne , Innis Bruce , Cotter Jillian , Mistry Rakesh , Asturias Edwin J 
Published: November 2018

Abstract

Background
A clinical endpoint of moderate-to-severe (M/S) influenza has been proposed in children, defined as fever &gt;39°C, otitis media, lower respiratory tract infection, or serious extrapulmonary manifestations. This definition has not been evaluated against clinically relevant outcomes like hospitalization, emergency room care, antimicrobial use, and child/parental absenteeism.

Methods
We conducted a prospective observational study of children aged 6 months–8 years with influenza at the Children’s Hospital Colorado Emergency Department (ED) and its affiliates during two influenza seasons (2016–2017 and 2017–2018). Children with influenza-like-illness (ILI) were enrolled and tested for influenza by polymerase chain reaction (PCR). Parents of influenza cases and matched influenza-negative controls were contacted 2 weeks later for follow-up. The primary outcome was hospitalization for M/S influenza vs. mild influenza. Secondary outcomes included recurrent ED visits, antimicrobial use, child/parental absenteeism. Interim analyses were conducted using SAS v9.4.

Results
Among the 1,480 enrolled children with ILI, 410 (28%) tested positive for influenza by PCR. The median age of influenza cases was 4.0 years (IQR 2.2–6.1), and 20% were considered high-risk for influenza complications. Of influenza cases, 284 (69%) met the definition for M/S influenza. Among M/S influenza subjects, 8.4% were hospitalized, compared with 1.6% with mild influenza (risk difference (RD) 6.9%; 95% CI: 3.0–10.8, P &lt; 0.01). Subjects with M/S influenza were more likely to receive antibiotics (RD 12.0%, 95% CI: 3.4–20.6, P &lt; 0.01) with a trend to higher antiviral use (RD 6.9%, 95% CI: −0.7–14.5, P = 0.09). There was no significant difference for recurrent ED visits nor child/parental absenteeism. After adjusting for comorbidities, age, and influenza strain, the relative risk (RR) of hospitalization or recurrent ED visits was higher among those with M/S influenza vs. mild influenza (RR 2.18, 95% CI: 1.02–4.64, P = 0.04).

Conclusion
Children with M/S influenza have a higher risk of hospitalization compared with mild disease. This proposed definition is a useful clinical endpoint to study the public health and clinical impact of influenza interventions in children.

Disclosures
S. Rao, GSK: Investigator, Research grant. E. Yanni, GSK: Employee, Salary. R. Bekkat-Berkani, GSK: Employee, Salary. A. Schuind, GSK: Employee, Salary. B. Innis, GSK: Employee, Salary. R. Mistry, GSK: Investigator, Research support. E. J. Asturias, GSK: Investigator, Research grant and Research support.
990. Impact of Influenza Vaccination Setting on Timing of Vaccination in a National Sample of Influenza-Vaccinated Adults
Authors: Luther Megan 
Published: November 2018

Abstract

Background
The CDC recommends annual influenza vaccination by the end of October if possible. Timing of vaccination is vital since people over 65 may be at risk for intraseason immunity waning. Traditionally, vaccinations occur in doctor’s offices, but other settings are increasing the availability and convenience of vaccines. The objective was to assess the association between timing and setting of influenza vaccination.

Methods
The 2015 Behavioral Risk Factor Surveillance System (BRFSS) telephone survey was used to identify adults in the United States who reported a flu shot in the past year. Based on self-reported date of flu shot, the 2014–2015 flu season was included and divided into early (July–October) vs. late (November–May) vaccination. Settings of vaccination included doctor’s office, clinic/hospital, store, and work. Covariates of interest were demographics, having a checkup within previous 1 year, insurance, obesity (BMI ≥ 30), alcohol use, current smoking status, and comorbidities. Comorbidities (hypertension, high cholesterol, stroke, angina, heart attack, skin cancer, other cancer, arthritis, depression, kidney disease, diabetes, asthma, and chronic obstructive pulmonary disease) were categorized as 0, 1–2, or 3+ present. Logistic regression, stratified by age ≥65, identified predictors of early vaccination.

Results
A total of 130,615 patients were included. Patients vaccinated in doctor’s offices and stores tended to be older and have higher rates of comorbidities compared with those in clinics or at work. In age-stratified analyses, patients 18–64 had higher odds of early vaccination at clinics (odds ratio 1.11, 95% confidence interval 1.02–1.22), stores (OR 1.09, 95% CI 1.002–1.19), and work (OR 1.88, 95% CI 1.71–2.05) compared with doctor’s offices. Patients aged ≥65 had higher odds of early vaccination at stores (OR 1.17, 95% CI 1.07–1.27) and work (OR 1.67, 95% CI 1.33–2.09). Patients with certain traits (e.g., males, smokers, and those with children) have lower odds of early vaccination.

Conclusion
Vaccination setting is associated with vaccination timing: nontraditional (store, work) settings increase the odds of receiving a flu shot before the end of October. Age plays a key role in when and where patients receive flu vaccinations. Vaccination programs in nontraditional settings should consider targeting the later flu season to increase participation.

Disclosures
All authors: No reported disclosures.
1025. Microbial Epidemiology of Infectious Endocarditis in the Intravenous Drug Abuse Population: A Retrospective Study in East Tennessee
Authors: Lorson William , Das Avi , Heidel R Eric , Shorman Mahmoud 
Published: November 2018

Abstract

Background
Infective endocarditis (IE) is one of the most serious infections affecting intravenous drug users (IVDU). IVDU have a higher incidence of IE compared with the general population. There are a limited number of reports on the epidemiology of this infection from the South Eastern United States. We determined the prevalence, and the microbial epidemiology, of IE cases at our institution. We then compared this to data from other geographical regions. This was done to help aid physicians with choosing empiric treatment regimens, for IE, pending culture results.

Methods
A retrospective cohort of 299 cases of IE was analyzed between January 2013 and July 2017 at a university hospital in East Tennessee. Demographic, microbiologic, intravenous substance use status, radiographic, and echocardiographic data were collected.

Results
Of the 299 cases, 184 (61.5%) were IVDU and 115 cases (38.5%) were non-IVDU. IVDU and non-IVDU positive cultures rates were similar at 87% and 86%, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) was more likely to occur in IVDU (OR 2.8, P &lt; 0.001) and was the most common pathogen at 77 out of the 184 cases (42%). Twenty-three of the 115 (20%) cases grew MRSA in the non-IVDU population. Methicillin-sensitive Staphylococcus aureus was the second most common bacteria for IVDU with 36 out of 184 cases (19.6%). IVDU patients were more likely infected with Pseudomonas aeruginosa (OR 3.384, P = 0.027), which occurred in 20 of the 184 cases (10.9%). IVDUs also experienced more right heart involvement vs. left sided involvement (OR 2.19, P = 0.004).

Conclusion
S. aureus was the most common pathogen for IE in IVDU followed by P. aeruginosa. Data from this study solidify that in IVDU, or if there is suspicion of intravenous drug use, first-line broad-spectrum antibiotics with excellent MRSA and P. aeruginosa coverage is essential to empirically cover for IE. Extra attention for right-sided heart involvement should also be made on IVDU with imaging modalities.

Disclosures
All authors: No reported disclosures.
1026. Trends in Infective Endocarditis During the Substance Use Disorder Epidemic at an Academic Medical Center
Authors: Martin Craig A , Burgess Donna R , Wallace Katie L , Vanhoose Jeremy , Cotner Sarah , Burgess David S 
Published: November 2018

Abstract

Background
In many areas of the United States, substance use disorders (SUD) have increased dramatically over the past decade. Overdose deaths have increased as well, and Kentucky ranks among the nation’s leaders in deaths per 100,000 population. Infective endocarditis (IE) is a well-known complication of intravenous drug use, contributing to significant morbidity and mortality, but few studies have evaluated the effect of the current SUD epidemic on rates and demographics of IE. We sought to examine the trends in IE and IE with SUD at our institution.

Methods
We collected data from patients admitted to a large academic medical center in Kentucky between January 1, 2013 and December 31, 2016. Patients were classified according to the International Classification of Diseases, Tenth Revision. Patients were considered to have IE if they received codes I33 or I38. Patients were considered to have an SUD if they received codes F11.10, F15.10, F14.10, F19.10, or Z86.59. Data were collected through the TriNetX database (TriNetX, Cambridge, MA).

Results
There were 2,100 cases of IE during the study period. The mean (SD) age was 53 years (21). Of those, 440 also had an SUD. The mean (SD) age of these patients was 41 years (11). Patients in both the IE and IE/SUD categories were primarily male (54% and 55%) and white (94% and 94%). The number of cases of IE increased from 190 in 2013 to 430 in 2016 (R2 = 0.9877). The number of IE cases diagnosed as having an SUD increased from 30 (16% of all IE cases) in 2013 to 130 (30% of all IE cases) in 2016 (R2 = 0.7352 for the trend). This increase in cases corresponds to a 333% increase in the number of cases of IE with SUD.

Conclusion
Between 2014 and 2016, opioid overdose deaths in Kentucky rose from 24.7 to 33.5 per 100,000 population, a 35.6% increase. During a similar timeframe, the number of IE cases associated with SUD at our institution rose 333%. While it is possible that increased coding of substance use disorders factored into this dramatic increase, it appears that the number of IE cases associated with SUD is rising at a disproportionately rapid rate.

Disclosures
All authors: No reported disclosures.