bluuebunny/crossref_metadata_2025_split huggingface dataset:
1172. Travel-Associated Multidrug-Resistant Organism Acquisition and Risk Factors Among US Military Personnel
Authors: Buchek Gregory , Mende Katrin , Telu Kalyani , Kaiser Susan J , Tribble David R , Fraser Jamie , Mitra Indrani , Lalani Tahaniyat , Yun Heather 
Published: November 2018

Abstract

Background
International travel is a risk factor for incident colonization with extended spectrum β-lactamase (ESBL)-producing organisms. These and other multidrug-resistant (MDR) bacteria are major pathogens in combat casualties. We evaluated risk factors for colonization with MDR bacteria in US military personnel traveling internationally for official duty.

Methods
TravMil is a prospective observational study enrolling subjects presenting to military travel clinics. We analyzed surveys, antimicrobial use data, and pre- and post-travel self-collected perirectal swabs in military travelers to regions outside the continental United States, Canada, Western or Northern Europe, or New Zealand presenting to one clinic from December 2015 to December 2017. Gram-negative isolates recovered from swabs underwent real-time identification and susceptibility testing (BD Phoenix). Characteristics of trip and traveler were analyzed to determine risk factors for MDR organism colonization.

Results
One hundred ten trips were planned by 99 travelers (74% male, median age 38 years [IQR 31, 47.25]); 72 trips were completed by 64 travelers. Median trip duration was 21 days (IQR 12.75, 79.5). Of those with trips completed, 17% traveled to Mexico/Caribbean/Central America, 15% to Asia, 57% to Africa, and 10% to South America; 56% stayed in hotels and 50% in dormitories/barracks. Travelers used doxycycline (15%) for malaria prophylaxis, 11% took an antibiotic for travelers’ diarrhea (TD) treatment (fluoroquinolone 7%, azithromycin 4%). Incident MDR organism colonization occurred in eight travelers (incidence density 3.5/1,000 travel days; cumulative incidence 11% of trips [95% CI: 4%–19%]), all ESBL-producing E. coli. A higher incidence of ESBL-producing E. coli acquisition was associated with travel to Asia (36% vs. 7%, P = 0.02) but not with travel to other regions, TD, or use of antimicrobials. No relationship was seen between fluoroquinolone or doxycycline exposure and resistance to those antimicrobials.

Conclusion
Consistent with other studies of US military personnel travelers, incident colonization with MDR organisms following official travel occurs at a lower rate in this population compared with civilian travelers, with no identified modifiable risk factors. The highest incidence of ESBL acquisition was observed during travel to Asia.

Disclosures
All authors: No reported disclosures.
1176. Risk Factors for ESBL Enterobacteriaceae Colonization Identified by Universal Admission Screening in a London Teaching Hospital
Authors: Batra Rahul , Otter Jonathan , Natale Alex , Tosas Olga , Dyakova Eleonora , Edgeworth Jonathan 
Published: November 2018

Abstract

Background
Individual risk factors such as antibiotic use and foreign travel are typically associated with ESBL-producing Enterobacteriaceae (ESBL-E) carriage. Few studies have evaluated variations in community demographics or social and material deprivation as risk factors for ESBL-E carriage.

Methods
All admissions to a London hospital group were screened for ESBL-E carriage from rectal swabs for four months in 2015. Patients completed a risk factor questionnaire, and those with a residential postcode in the catchment area were linked to a database containing community-based risk factor data. Risk factors for ESBL-E carriage were determined by binary logistic regression. Isolates that were ESBL-E phenotypically were confirmed by microarray (CT103XL Check-MDR, CheckPoint). The Check-MDR array simlutaneously detects common ESBL and carbapenemase genes, including plasmid-mediated AmpC. Genotypic ESBL-E were split into three groups: CTX-M-15 (Group 1), CTX-M-9 (Group 2), and other (Group 3) for further analysis.

Results
Three hundred sixty (9.0%) of 4,006 patients carried ESBL-E; of which, 1,633 had a residential postcode within the catchment area. In multivariable analysis, risk factors for phenotypic ESBL-E carriage included travel to Asia (OR 5.0, CI 2.5–10.0) or Africa (OR 2.9, CI 1.2–7.0) in the past 12 months, and two or more courses of antibiotics in the past 6 months (OR 2.2, CI 1.5–3.4). Residence in an area with a high proportion of Arab residents and residence in an area with a low proportion of houses with two or more bedrooms were associated with ESBL-E carriage in univariable but not multivariable analysis. Risk factors for the three genotypic ESBL groups were broadly similar to the analysis of phenotypic ESBL carriage, although the number of days traveling abroad in the past 12 months was more associated with Group 1 (CTX-M-15) and Group 3 (other), and older age was associated with Group 3 (other) ESBLs.

Conclusion
We linked individual risk factor information with community-based risk factor information, concluding that individual risk factors (including antibiotic use and overseas travel) were more important than community-based risk factors for predicting colonization with ESBL-E at the time of hospital admission. This information is useful when identifying risk groups for targeted screening.

Disclosures
All authors: No reported disclosures.
1179. Incidence of Bacteremia and Bacteriuria With Antibiotic-Resistant Enterobacteriaceae After Transrectal Ultrasound-Guided Biopsy of the Prostate (TRUSBP)
Authors: Saade Elie , Dousa Khalid M , Wilson Brigid , Perez Federico , Donskey Curtis J 
Published: November 2018

Abstract

Background
Infection with Escherichia coli after TRUSBP is common, but other Enterobacteriaceae also occur. In the absence of microbiological data, prophylaxis with co-trimoxazole (TMP-SMX) or fluoroquinolones (FQ) is usually prescribed. We estimated the incidence of bacteremia and bacteriuria after TRUSBP with distinct species of Enterobacteriaceae and their rate of resistance to common antibiotics.

Methods
Using Veterans Healthcare Administration (VHA) databases, we identified patients undergoing TRUSBP between January 1, 2013 and December 31, 2017. We determined the incidence of Enterobacteriaceae isolated from urine and blood cultures obtained within 30 days of TRUSBP. Using microbiology data from VHA, we determined rates of resistance to TMP-SMX, FQ (ciprofloxacin as marker), ESC (ceftriaxone as marker), and carbapenems (Carb) (ertapenem as marker).

Results
Overall, 377 (0.3%) and 1,739 (1.4%) of 126,761 TRUSBPs were complicated by bacteremia or bacteriuria with Enterobacteriaceae, respectively. E. coli was predominant (91% of blood and 81% in urine). Rates of FQ resistance were low in Klebsiellaand Enterobacter but exceeded 60% in E. coli. In general, TMP-SMX resistance exceeded 30%. Of note, 16.6% of blood and 11% of urine Enterobacteriacaea were resistant to ESC, while Carb-resistance was rare.

Conclusion
FQ and ESC-resistant Enterobacteriaceae are prevalent in bacteremia and bacteriuria after TRUSBP. Antibiotics used for prophylaxis and empirical treatment are likely to be ineffective. The prevention and management of TRUSBP-related infections should include microbiology-guided approaches.

Disclosures
All authors: No reported disclosures.
1181. Use of the Combination Antibiogram in the Era of MDR Gram-Negative Pathogens
Authors: Klinker Kenneth , Cherabuddi Kartikeya , Redell Mark , Balogh Matthew , Massey Jill , Dudley Michael 
Published: November 2018

Abstract

Background
Combinations of two or more antimicrobial agents are frequently used in empiric therapy regimens to ensure at least one agent demonstrates activity against suspected pathogens. A combination antibiogram can assess the increase in empiric coverage of a particular combination vs. either of the agents alone (i.e., percent gain). These data could assist in developing empiric regimens that may be particularly useful in settings with problematic multidrug-resistant Gram-negative pathogens.

Methods
An Excel-based model to construct combination antibiograms was developed to assist clinicians in evaluating institutional susceptibility data. The University of Florida Health Shands Hospital microbiology laboratory supplied susceptibility data for ceftriaxone (CFX), cefepime (CEF), ciprofloxacin (CIP), and amikacin (AMI) to assess % gain achieved with combinations for E. coli all blood isolates (n = 206) and blood isolates with an ESBL phenotype (n = 35). The same laboratory provided susceptibility data for CEF, piperacillin–tazobactam (PTZ), AMI and CIP for P. aeruginosa (all, n = 250; carbapenem-resistant (CARB-R), n = 30).

Results
Percent gains achieved by adding AMI or CIP to CFX and CEF to capture at least one agent exhibiting in vitro susceptibility against all blood E. coli were calculated: CFX-AMI, 16%; CFTX-CIP, 3%; CEF-AMI, 10%; CEF-CIP, 1%. The percentage gain specific to E. coli blood isolates with an ESBL phenotype ranged from 9% to 86%. The combination with the greatest percent loss against blood E. coli isolates, comparing all blood isolates to those with an ESBL phenotype, was CFX-CIP (∆-66%). Percentage gain achieved against all isolates of Pa by adding AMI or CIP to PTZ and CEF were CEF-AMI, 8%; CEF-CIP, 5%; PTZ-AMI, 15%; PTZ-CIP, 9%; percent gain of the same combinations against P. aeruginosa CARB-R isolates were 23%, 10%, 47%, and 30%, respectively. Adding AMI to either β-lactam: PTZ % S increased from 47% to 77% (+CIP) and to 94% (+AMI); CEF % S increased from 60% S to 70% (+CIP) and to 83% (+AMI).

Conclusion
Combination antibiogram models can assist clinicians in identifying regimens which may provide improved targeting of MDR phenotypes through calculation of percent gain.

Disclosures
K. Klinker, Melinta Therapeutics: Consultant, Speaker honorarium. Nabriva Therapeutics: Scientific Advisor, Consulting fee. M. Redell, Melinta Therapeutics, Inc.: Employee and Shareholder, Salary. M. Balogh, Melinta Therapeutics, Inc.: Employee and Shareholder, Salary. J. Massey, Melinta Therapeutics, Inc.: Employee and Shareholder, Salary. M. Dudley, The Medicines Company: Employee, Salary.
1182. Risk Factors for the Acquisition of IMP-Type Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae in Japan: A Matched Case–control Study
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
The majority of CRE in Japan are IMP-type carbapenemase-producing CRE (IMP-CRE). However, research on risk factors for the acquisition of IMP-CRE has been limited, and questions exist regarding whether IMP-CRE have risk factors similar to other types of CRE such as KPC.

Methods
We conducted a matched case–control study involving patients from whom IMP-CRE had been isolated. The controls were selected among patients with carbapenem susceptible Enterobacteriaceae (CSE). Non-meropenem-susceptible per CLSI criteria and/or ceftazidime-resistant Enterobacteriaceae were screened, and metallo-β-lactamase–positive isolates were examined for blaIMP by PCR (January 2012 to December 2016).

Results
Ninety-six patients with CRE were matched with 96 patients with CSE. They comprised Enterobacter sp. (n = 132 [CRE: 66, CSE: 66], 68.8%) and Klebsiella pneumoniae (n = 60 [CRE:30, CSE:30], 31.2%), and bacteria were most commonly isolated from sputum (n = 76 [39.6%]), followed by urine (n = 62 [32.3%]). Background factors such as age (median = 75 [IQR: 66–84]), sex (male = 56.8%), and the Charlson comorbidity index (median = 2 [IQR: 1–3.8]) were similar between CRE and CSE. In multivariate analysis, independent risk factors were identified: history of gastrointestinal (GI) endoscopy or surgery, history of ICU stay, and a previous exposure within 1 month to penicillins with β-lactamase inhibitors, cephalosporines, or carbapabnems.

Conclusion
Histories of GI endoscopy and ICU stay as well as broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Infection control measures combined with enhanced antimicrobial stewardship are key to preventing the spread of IMP-CRE.

Disclosures
All authors: No reported disclosures.
1183. Epidemological, Clinical, and Microbiological Characteristics of Carbapenemase-Producing Entereobacteriaceae Bloodstream Infection in Republic of Korea
Authors: Park Jung Wan , Park Se Yoon , Lee Hyungmin , Kim Tae Hyong , Lee Eun Jung , Lee Eunyoung 
Published: November 2018

Abstract

Background
Carbapenemase producing Enterobacteriaceae (CPE) is major pathogens in nosocomial infections, and disease burden due to CPE is also on the rise globally. Nevertheless, only few studies have been conducted regarding CPE infection and its epidemiological factors in the Republic of Korea (ROK). In this paper, we analyzed clinical, microbiological, and epidemiological characteristics of CPE bloodstream infection (BSI) in ROK.

Methods
We designed retrospective cohort study by analyzing reports of epidemiological conducted by Epidemic Investigation Officers in KCDC from January 2015 to December 2016. CPE-infected cases were collected through the nationwide surveillance system. Numbers of sentinel surveillance hospitals included in the system were 100 hospitals in year 2015, and 115 hospitals in 2016. We selected cases with confirmed CPE BSI by Korea National Institute of Health that detected gene types of carbapenemase.

Results
Total of 131 CPE BSI were identified during the study period. Prevalence of CPE BSI among total CPE isolates was 7%. Nationwide, Klebsiella pneumoniae accounts for 69% of CPE BSI and 66% produced K. pneumoniae carbapenemase (KPC). The antibiotics susceptibility examination results showed that CPE prevalent in ROK had susceptibility to Amkacin, Tigecycline, or Gentamicin (76%, 41%, and 39%, respectively). Colistin sensitivity test was performed on only 29 patients, and 1 of those patients showed colistin resistance. 85% (111/131) of cases were classified to hospital acquired infections. Prevalence of CPE BSI among CPE isolates was 7% (131/2020). Most common BSI sources were lung (29%), primary (16%), and biliary tract (15%). Thirty-day mortality rate due to CPE BSI was 47.3%. A multivariable analysis showed that use of adequate antibiotics for CPE (p = 0.01) and APACHE II score (P &lt; 0.001) at the time of CPE detection in the blood stream were significantly associated with decreased 30-day mortality.

Conclusion
CPE bacteremic episodes were already prevalent in the Republic of Korea. Moreover, most of CPE BSI originated from hospital acquired infection, pointing out the need for improvement of hospital infection control strategies. The use of adequate antibiotics therapies upon recognition of CPE infection could decrease mortality due to CPE blood stream infections.

Disclosures
All authors: No reported disclosures.
1187. Retrospective and Prospective Analysis of Acinetobacter Modern-Day Clinical Isolates in a Large Mid-West Hospital System
Authors: Calix Juan , Burnham Carey-Ann D , Feldman Mario 
Published: November 2018

Abstract

Background
The epidemiology of contemporary Acinetobacter calcoaceticus-baumannii complex (AcbC) strains in the United States is understudied. In addition to increasing multidrug resistance, there is concern that the rates of AcbC infections acquired outside of hospitals and the anatomic distribution of these infections may differ from what is previously reported. Furthermore, the epidemiology of non-AcbC clinical isolates is poorly characterized.

Methods
We retrospectively identified all cases associated with Acinetobacter clinical isolates in the Barnes-Jewish/Children’s Hospital system (St. Louis, MO) from 2007 to 2017. First isolates were classified as AcbC or non-AcbC. Tissue of origin, hospital-day of isolation, and antibiotic resistance profiles were determined. Results were compared with an ongoing prospective analysis of Acinetobacter isolates in the same system, started in July 2017.

Results
We identified 2,959 and 1,243 cases associated with AcbC and non-AcbC isolates, respectively. In both groups, isolates were most commonly obtained from respiratory (34% and 30% of total isolates) and connective tissue (34% and 27% of total isolates) sites. Urinary tract specimens were more likely to occur among AcbC isolates compared with non-AcBC isolates (664/2,959 [22%] vs. 147/1,243 [12%], P &lt; 0.001). The percentage of isolates obtained prior to hospital-day-2 are 62% and 78% for AcbC and non-AcbC isolates, respectively. AcbC isolates were markedly more resistant to all classes of antibiotics. Analysis of 77 AcbC and 58 non-AcbC prospectively collected isolates revealed similar clinical findings.

Conclusion
Our study confirms the protean nature of Acinetobacter clinical isolates, and begins to describe relevant differences between AcbC and non-AcbC strains. These distinctions support the practice of identifying clinical isolates using AcbC and non-AcbC labels. Ongoing studies will further describe the patient characteristics and clinical outcomes associated with Acinetobacter disease in our system.

Disclosures
All authors: No reported disclosures.
1190. Reduction of Carbapenem-Resistant Enterobacteria (CRE) Infections and Total Polymyxin B Use Due to a Comprehensive Infection Control Strategy in Colombia
Authors: Velez Juan Diego , Rosso Fernando , Mora Barbara Lucia , Cedano Jorge , Orrego Marly , Beltran Ivan Andres , Echeverry Jhon Jairo 
Published: November 2018

Abstract

Background
Colombia is an endemic country for CRE infections, with an increased rate of hospital-acquired infection due to this microorganism. Therefore, we have a high empirical use of carbapenem, colistin, and polymyxin B in nosocomial suspected septic patients. Infection control strategies could reduce CRE infection rates and lower antibiotic consumption.

Methods
Since 2014, a Comprehensive Infection control strategy was implemented in our hospital. This strategy included: (1) Hospital daily CHX bathing (4% soap or 2% pads) was applied to all patients in our institution (intensive care units and medical/surgical wards). Additionally, recommendations for patient care were provided to patients and family. (2) Active surveillance of perirectal CRE screening was implemented toward high suspected patients. (3) Isolation of all CRE colonized or-infected patient, and gloves use, and alcohol for hand sanitation was reinforced. To evaluate the effectiveness of this strategy, annually nosocomial infection rates due to CRE were compared. Defined daily dose (DDD) of polymyxin B use was obtained annually.

Results
After introducing this protocol, we found a progressive decrease in CRE bacteremia from 2.24 infections per 10,000 patients-day in 2014, to 1, 26 during 2015, 0.92 in 2016 and 0.78 infections per 10,000 patients day during 2017. This was also correlated to a decrease in the use of polymyxin in the adult population, DDD drop from 2.36 to 1.06.

Conclusion
Universal hospital daily CHX bathing, CRE screening, and Isolation as a comprehensive strategy was effective decreasing CRE nosocomial infections and polymyxin use.

Disclosures
All authors: No reported disclosures.
1195. Where You Live Matters: United States Region as a Significant Predictor of Mortality for ESBL Infection Based on a Descriptive Study Using NIS Database
Authors: George Elizabeth , Aurit Sarah , Destache Christopher , Vivekanandan Renuga 
Published: November 2018

Abstract

Background
Extended-spectrum β-lactamase (ESBL) enzymes are produced by multidrug-resistant (MDR) pathogens and confer resistance to β-lactam antibiotics. Infections due to MDR organisms, particularly those ESBL producing pathogens, are of major concern worldwide and are associated with prolonged hospital stay and increased case-fatality rate. Carbapenems are the treatment of choice for severe infections however overuse of this class of antibiotics is leading Carbapenemase-producing pathogens. Variations have been observed in the prevalence of ESBL strains from different US regions; however, it is unclear whether morbidity and mortality follow a similar pattern. This study was conducted to explore the incidence of ESBL infections in the inpatient setting and factors that affect morbidity/mortality.

Methods
The National Inpatient Sample (NIS) was used to identify all hospitalizations during 2002 to 2014; all primary and secondary diagnoses were searched to identify-resistant infection that utilized the ICD-9 code “V091.” All hospitalizations were stratified based on the indication of resistant infection, and comparisons were made with the chi-square test and linear regression for categorical and continuous variables, respectively. A multivariable binary logistic regression model was used to examine survival for those with ESBL infection. All analyses were conducted with SAS version 9.4; P &lt; 0.005 was considered significant.

Results
The analysis identified 320,888,511 hospitalizations with 17,732 identified with ESBL infection. Significant differences for those with and without an ESBL infection were found based on the US region with the pertinent results as follows; Northeast: 19.95% vs. 23.30%, Midwest: 14.71% vs. 16.81%, South: 25.14% vs. 40.53%, and West: 40.20% vs. 19.35%; P &lt; 0.001. Results indicated the US region as a significant predictor of mortality for those with ESBL infection. Regions identified in Figure 1.

Conclusion
Notable findings from this study include a statistically significant variation in mortality risk between US regions. Comparatively lower risk of mortality as related to ESBL infection was noted in the Midwest region when compared with the West region. A greater understanding of the regional epidemiology of β-lactamases is needed to clarify why this disparity exists.
Figure 1

Disclosures
All authors: No reported disclosures.