bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measles, Mumps, and Rubella Antibody: Patterns of Persistence and Rate of Decline Following the Second Dose of the MMR Vaccine
Authors: Seagle Emma , Bednarczyk Robert , Hill Tenisha , Fiebelkorn Amy Parker , Hickman Carole , Icenogle Joseph , Belongia Edward , Mclean Huong Q 
Published: October 2017

Abstract

Background
Antibodies to measles, mumps, and rubella decline an estimated average of 3% per year, and have a high degree of variation among individuals. Yet, this variation and differences in individual-level response to the 3 antigens are not well understood. To better understand potential implications on individual and population-level susceptibility, we reanalyzed existing longitudinal data to identify patterns of seropositivity and antibody persistence.

Methods
Wisconsin children given the second dose of measles, mumps, and rubella vaccine (MMR2) at age 4–6 years were followed up to 12 years postvaccination. The rate of antibody decline and factors associated with the rate of decline were assessed using regression models that accounted for differences between and among subjects.

Results
Most of the 302 participants were seropositive throughout follow-up (96% measles, 88% mumps, 79% rubella). The rate of antibody decline was associated with MMR2 response and baseline titer for measles and age at first dose of MMR (MMR1) for rubella. None of the demographic or clinical factors examined were associated with rate of decline for mumps. One month after MMR2, geometric mean titer (GMT) to measles was high (3892 mIU/mL), but declined on average 9.7% per year among subjects with the same baseline titer and &lt;2-fold increase in antibody titer after MMR2. Subjects with ≥2-fold increase experienced a slower decline (≤7.4%). GMT to rubella was 149 IU/mL one month after MMR2 and declined 2.6% and 5.9% per year among those who received MMR1 at 12–15 months and &gt;15 months, respectively. GMT to mumps one month after MMR2 was 151 and declined 9.2% per year. Only 14% of participants had the same trends in antibody persistence for all 3 antigens.

Conclusion
The rate of antibody decay varied substantially among individuals and among the 3 antigens. Despite waning titers, measles and rubella antibody levels remained high 12 years post MMR2. However, a fast rate of decline and high degree of variation was observed for mumps, yet no predictors of the decline were identified. Future research should focus on better understanding waning antibody titers to mumps and its impact on community protection and individual susceptibility, in light of recent mumps outbreaks in vaccinated populations.

Disclosures
All authors: No reported disclosures.
Differential Gene Expression Elicited by Children in Response to the 2015–2016 Live Attenuated vs. Inactivated Influenza Vaccine
Authors: Zimmerman Richard , Cole Kelly , Martin Judith , Horne William , Lin Chyongchiou J , Nowalk Mary Patricia 
Published: October 2017

Abstract

Background
In recent influenza seasons, the live attenuated influenza vaccine (LAIV) has not demonstrated the same level of vaccine effectiveness as that observed among children who received the inactivated influenza vaccine (IIV). To better understand this difference, this study compared the mRNA sequencing transcription profile (RNA seq) in children who received either IIV or LAIV.

Methods
Children 3–17 years of age receiving quadrivalent influenza vaccine were enrolled. Blood samples were collected on Day 0 prior to vaccination and again on Day 7 (range 6–10 days) following vaccination. Total RNA was isolated from PAXgene tubes and sequenced for a custom panel of 89 transcripts using the TruSeq Targeted RNA Expression method. Fold differences in normalized RNA seq counts from Day 0 to Day 7 were calculated, log2 transformed and compared between the two vaccine groups.

Results
Of 73 children, 47 received IIV and 26 received LAIV. Following IIV vaccination, 12 genes demonstrated significant differential expression at Day 7. In contrast, following LAIV vaccination, seven genes demonstrated significant differential expression at Day 7, five of which were not differentially expressed by IIV. Two genes demonstrated similar patterns of regulation in both IIV and LAIV recipients.

Conclusion
Differential regulation of genes was observed between 2015 and 2016 LAIV and IIV recipients. These results help to elucidate the immune response to influenza vaccines and might help explain the difference in vaccine effectiveness observed in recent years between LAIV and IIV.

Disclosures
R. Zimmerman, sanofi pasteur: Grant Investigator, Research grant Merck & Co, Inc.: Grant Investigator, Research grant Pfizer, Inc.: Grant Investigator, Research grant; C. J. Lin, Sanofi: Grant Investigator, Research grant Merck & Co, Inc.: Grant Investigator, Research grant Pfizer, Inc..: Grant Investigator, Research grant; M. P. Nowalk, Merck & Co, Inc.: Grant Investigator, Research grant Pfizer, Inc.: Grant Investigator, Research grant
Effectiveness of Antimicrobial Use and Diagnostic Testing in the Postoperative Setting for Colectomy, Craniectomy and Knee Arthroplasty
Authors: Saeed Huma , Grant Jennifer , Bhaimia Eric , Parikh Ronak , Lahrman Frances , McNulty Moira C , Robicsek Ari , Padman Rema , Shah Nirav 
Published: October 2017

Abstract

Background
Patients with postoperative fevers tend to receive empiric antibiotics and a diagnostic workup even though postoperative fevers are frequently physiologic. The yield of postoperative workups ranges from 2–24%. Studying the effectiveness of antibiotic use and diagnostic testing across surgeries may provide insight to improve value of care for the postoperative patient.

Methods
We evaluated all patients who had elective colectomy, craniectomy and knee arthroplasty (KA) at NorthShore University HealthSystem between October 2009 and December 2013. Inpatient clinical data were extracted from the electronic data warehouse. All complications were confirmed by chart review. Antimicrobial Effectiveness was defined as the use of antibiotics only when patient had a confirmed infectious complication (pneumonia, urinary tract infection, etc) during hospital course. Diagnostic Effectiveness was defined as the use of diagnostic test only when patient had a confirmed complication. Length-of-stay (LOS) and cost were compared using Student’s t-test.

Results
233 patients had a colectomy, 506 had a craniectomy and 4,693 had a knee arthroplasty. Antibiotic and Workup Effectiveness rates were 51% and 45.33% for colectomy, 18% and 22.53% for craniectomy, and 27%and 9.89% for KA, respectively. Effectiveness of antimicrobial use and diagnostic workups are shown in Figure 1. Patients without complications in all 3 surgeries who had a workup, as compared with those patients without a workup, were more likely to have a longer LOS (colectomy: 8.95 days vs. 5.08 days, P &lt; 0.0001; craniectomy: 4.88 days vs. 2.62 days, P &lt; 0.001; KA: 3.22 days vs. 2.95 days, P &lt; 0.0001) and a higher cost of hospitalization (colectomy: $76,034 vs. $42,865, P &lt; 0.001; craniectomy: $83,779 vs. $58,998, P &lt; 0.001; KA: $53,451 vs. $52,159, P &lt; 0.001).

Conclusion
A significant fraction of empiric antibiotics in the postoperative setting are unnecessary across multiple surgeries. Diagnostic testing effectiveness rates are low and have consequences in terms of healthcare utilization.

Disclosures
All authors: No reported disclosures.
Emergency Department Utilization During Self-Administered Outpatient Parenteral Antimicrobial Therapy
Authors: Ganguly Anisha , Brown Larry , Agrawal Deepak , Bhavan Kavita 
Published: October 2017

Abstract

Background
Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) has been established as a clinically safe and effective alternative to inpatient or outpatient extended-course intravenous antibiotics while reducing healthcare resource utilization. However, previous research has not confirmed that transferring patients from the hospital to home for treatment does not cause a compensatory increase in emergency department (ED) visits. We sought to validate S-OPAT clinical safety and healthcare costs associated with S-OPAT by confirming that S-OPAT does not increase ED utilization during treatment.

Methods
We conducted a before-after study of ED utilization among S-OPAT patients. We compared ED visits, hospital admissions resulting from ED visits, hospital admissions due to OPAT-related causes, and hospital charges associated with all ED visits 60 days before and after initiation of S-OPAT. A 60-day time frame was selected to effectively encompass the maximum treatment duration (8 weeks) for S-OPAT. Paired t-tests were used to compare the change in ED utilization before and after initiation of S-OPAT.

Results
Among our cohort of 944 S-OPAT patients, 430 patients visited the ED 60 days before or after starting treatment. Of the patients with ED visits, 69 were admitted to the hospital for OPAT-related causes and 228 incurred hospital charges from their visit. Initiation of S-OPAT was associated with a statistically significant reduction in total ED visits, all-cause hospital admission, OPAT-related hospital admission, and hospital charges (see Table 1).

Conclusion
Our review of ED utilization among S-OPAT patients demonstrates a reduction in multiple parameters of ED utilization with the initiation of S-OPAT treatment. Our findings confirm that S-OPAT does not yield an increase, but rather a decrease, in ED visits with the transfer of patients from hospital to home.

Disclosures
All authors: No reported disclosures.
Systematic Review of Professional Liability when Prescribing Β-Lactams for Patients with a Known Penicillin Allergy
Authors: Jeffres Meghan , Hall-Lipsy Elizabeth , King S Travis , Cleary John 
Published: October 2017

Abstract

Background
Patients labeled as penicillin allergic are more likely to receive second line non-β-lactam antibiotics, experience higher rates of treatment failure, and incur higher antibiotic costs. Fear of litigation has been identified as a reason clinicians avoid using β-lactams in a patient with a penicillin allergy. The systematic review objective is to describe medical negligence and malpractice cases in which known penicillin allergy patients received a β-lactam and experienced an adverse reaction.

Methods
Lexis-Nexus and Google Scholar were used to identify relevant legal cases. Variables collected from each case included date of publication, legal jurisdiction, date of injury, plaintiff and defendant demographics, health care setting, plaintiff clinical outcome, and legal outcome.

Results
Twenty-seven unique cases met inclusion criteria. The earliest case was published in 1959 and the most recent in 2013. The highest number of cases filed&#x2028;(n = 7) occurred in the most recent 10 year segment, from 2005 to 2015. Eighteen cases involved the receipt of a penicillin-based antibiotic; of these cases with a known legal outcome, the plaintiff (patient) prevailed or settled in 3 cases and defendants (providers) prevailed in 7 cases. Seven cases involved the receipt of a cephalosporin; of these cases with a known legal outcome, the plaintiff settled with physicians prior to trial in 1 case and defendants prevailed in 3 cases. Two cases involved the receipt of a carbapenem. Defendants prevailed in 1 case and the legal outcome of the other case is unknown. In cases where the defense successfully moved for summary judgment, judges cited a lack of scientific evidence demonstrating that a cephalosporin or carbapenem were contraindicated for a patient with a penicillin allergy.

Conclusion
The cases with published legal outcomes found limited professional liability and identify clear precedence for clinicians who prescribed cephalosporins or carbapenems to a patient with a known penicillin allergy. These results should decrease litigation fears of providers and risk managers within healthcare systems.

Disclosures
All authors: No reported disclosures.
Responses to Fever Overnight: Do Residents Choose Wisely?
Authors: Howard-Anderson Jessica , Schwab Kristin , Chang Sandy , Graber Christopher J , Quinn Roswell 
Published: October 2017

Abstract

Background
Residents at our institution rely heavily on the terminology “Full Fever Work Up” (FFWU) as a cognitive tool for cross-covering patients with a fever. Prior survey data revealed that residents vary considerably in how they respond to fevers and what FFWU means. We sought to determine what tests are included in the FFWU, how often the term is adhered to, and if it significantly changes clinical outcomes.

Methods
For 3 months, study investigators collected FFWU instructions for patients who experienced a fever at night. For each febrile episode, investigators reviewed chart data on patient factors, circumstances surrounding the fever, tests ordered, etiologies of the fever, and outcomes (immediately and 30-days after the fever). The UCLA Institutional Review Board approved this study.

Results
We reviewed 253 fever episodes. For 204 episodes, written sign-out by the primary team was available. 59% of the fevers were in male patients and the mean age was 59 years. 12% had an organ transplant and 45% qualified as highly immunocompromised. 79% met SIRS criteria, whereas only 3% met qSOFA criteria and 2% required escalation of care.
The cross-covering physician wrote a note in 4% of the cases and evaluated the patient in-person in 12% of the cases per chart review. Residents most often ordered bacterial blood cultures (48%), followed by urinary tests (34%) and chest X-rays (30%). These tests, as well as fungal blood cultures, lactate and CBC, were significantly more likely to be ordered by the cross-covering resident if the sign-out instructed to perform a FFWU. The mean number of diagnostic tests ordered was 2 and residents started or changed antibiotics in 14% of cases. 88% of the time patients were alive 30 days after their fever. 11% had an antibiotic-related complication and 8% of blood cultures drawn were positive.

Conclusion
Ordering practices overnight were significantly influenced by the FFWU sign-out instructions, yet evaluating the patient in-person was rare. We hypothesize that the FFWU standardization has replaced a more individualized evaluation overnight. Fortunately, poor outcomes including death, bacteremia, escalation of care, or antibiotic-related complications were low in this population.

Disclosures
All authors: No reported disclosures.
Epidemiology, Microbiology and Outcomes of Catheter-Associated Urinary Tract Infection and Complicated Urinary Tract Infection in the USA
Authors: Merchant Sanjay , Sarpong Eric M , Magee Glenn , Lapointe Nancy , Gundrum Jake , Zilberberg Marya 
Published: October 2017

Abstract

Background
An estimated 93,300 cases of healthcare-associated urinary tract infection (UTI) were recorded in US acute care hospitals in 2011. Many are classified as catheter-associated UTI (CAUTI) or complicated UTI (cUTI). Although CAUTI and cUTI share some commonalities, strategies differ for their prevention and treatment. We examined the epidemiology, microbiology and outcome of patients with CAUTI and cUTI in a large multicenter US database.

Methods
This was a retrospective cohort study using the 2013–2015 Premier Healthcare Database. ICD-9-CM codes were used to identify hospitalized adults (≥18 years) with CAUTI or cUTI. The demographics, clinical characteristics, microbiology, and hospital outcomes of all identified patients were compared. Differences between groups were examined using χ2 test for categorical variables and Student’s t-test for continuous variables. Statistical significance was set at&#x2028;P ≤ 0.05.

Results
Of 120,332 identified patients, 50,034 (41.6%) had CAUTI (87.0% present on admission [POA]) and the remainder had cUTI [95.3% POA]. Patients with CAUTI were older (71.3 ± 16.1 vs. 56.3 ± 19.5 years) and more likely to be male (62.5% vs. 30.6%) and white (71.6% vs. 66.7%) (all P &lt; 0.001). They also had greater comorbidity burden (Charlson Comorbidity Index of 2.8 ± 2.4 vs. 1.7 ± 2.2) and a higher ICU care rate (23.2% vs. 17.8%) than cUTI patients (all P &lt; 0.001). Although Escherichia coli was the most common pathogen in both (69.8% cUTI vs. 39.5% CAUTI), Pseudomonas aeruginosa accounted for one quarter of all CAUTIs and only 5.0% of cUTIs. Compared with cUTI, CAUTI carried a &gt;2-fold increase in unadjusted mortality (3.6% vs. 1.6%) and a higher rate of 30-day readmission (3.9% vs. 2.5%) (all P &lt; 0.001). Additionally, CAUTI was associated with a greater unadjusted ICU length of stay (LOS, 6.0 ± 8.8 vs. 5.5 ± 5.5 days), hospital LOS (8.4 ± 12.9 vs. 5.5 ± 6.4 days) and cost ($16,871+$29,513 vs. $11,915 ± $19,657) (all P &lt; 0.001).

Conclusion
The volume of CAUTI and cUTI hospitalizations in the US is high, and a majority of infections were present on admission. CAUTI is associated with greater mortality and resource use than cUTI. The high rate of P aeruginosa portends a greater potential for antimicrobial resistance in CAUTI, which may require different prevention and treatment approaches from cUTI.

Disclosures
S. Merchant, 1Merck & Co., Inc.: Employee and Shareholder, Salary E. M. Sarpong, Merck & Co., Inc.: Employee and Shareholder, Salary M. Zilberberg, EviMed Research Group, LLC,; Universtiy of Massachusetts: Shareholder, Research grant
Analytical and Clinical Performance of a Real-time Screening PCR Assay Identifying Congenital CMV Infection
Authors: Rohde Benjamin , Carillo-Marquez Maria , Tomlinson Ryan , Blanch Jacqueline , Kim-Hoehamer Young-In , Patel Hema , Patel Chirag , Zanalian Gita , Osborne Gertrude , Davis Joseph , Patel Anami , Devincenzo John P 
Published: October 2017

Abstract

Background
Congenital CMV infection (cCMV) is the most common identifiable cause of mental retardation in the United States but requires early diagnosis to define the infection and to institute effective antiviral therapy. Traditional identification strategies including hearing screens and physical exams likely miss many patients with cCMV. We therefore developed and evaluated the performance of a PCR assay optimized for low cost, specimen collection at time of dried blood spot collection, and detection thresholds below the salivary CMV concentrations known to occur in cCMV patients.

Methods
We utilized a real-time CMV PCR assay (SimplexaTM CMV)(DiaSorin, Cypress CA) amplifying the UL83 gene and the 3M Integrated Cycler. Saliva was collected from volunteers (Copan swab), and spiked with known concentrations of CMV culture supernatant quantified by COBAS AmpliprepTM. (Roche Diagnostics). Additionally, saliva was collected by copan swab from all births within a single multi-hospital system from 3/21/16 – 5/4/17. Newborns who were initial screen PCR positive were subsequently evaluated by urine CMV PCR by an outside laboratory for confirmation of cCMV.

Results
Analytical threshold of detection was well below 4 log copies/ML, with 100% of samples testing positive at 3.5 log copies/ML (Fig 1). 6127 newborn saliva samples were evaluated and 61 were PCR positive (£40 CT). 47 of these tests were confirmed by urine PCR (Fig 2) (PPV 0.9792, NPV 0.9988, Sens 0.8704, Spec 0.9998). Screen positive tests which were not confirmed by urine PCR had CT values £36. Adjusting the definition of a positive to CT £36 further improved the performance (PPV &gt;0.9999, NPV 0.9997, Sens 0.9592, Spec &gt;0.9999).

Conclusion
We demonstrate good performance of a congenital CMV methodology thus facilitating an effective universal newborn screening program

Disclosures
J. P. Devincenzo, AstraZeneca/MedImmune: Investigator, Research support
Molecular Investigation of an Ontario Mumps Outbreak using Whole Genome Sequencing
Authors: Stapleton Patrick , Eshaghi Alireza , Chong-King Eddie , Cardona Mark , Masney Steve , Li Aimin , Gubbay Jonathan , Patel Samir 
Published: October 2017

Abstract

Background
In early 2017 an outbreak of Mumps virus affected over 100 individuals in the province of Ontario, concurrent with multiple mumps virus outbreaks across North America. Traditional genotyping of mumps outbreaks relies on sequencing a portion of the small hydrophobic (SH) gene, but has limited capability to distinguish between strains of the same genotype. Most mumps cases in Ontario in recent years are of genotype G. We used a novel whole genome sequencing (WGS) protocol to perform a molecular epidemiological investigation of the outbreak.

Methods
Throat (n = 5) and buccal (n = 15) swabs positive by RT-PCR for SH or Fusion (F) gene targets were cultured in primary Rhesus monkey kidney cells. Cell free viral extract underwent RT-PCR and subsequent PCR amplification using overlapping primer pairs to cover the entire 15 kilobase (kb) genome. The first 8 samples were amplified with 18 pairs of overlapping primers, which was reduced to 9 sets (average fragment size 1.9 kb, range 1.6–2.8 kb) for the final 12 samples. Mumps cDNA libraries were prepared with Nextera XT kit and WGS of the indexed fragments was performed with V2 reagent kits on the Illumina MiSeq instrument. Reference based genome assembly was performed using samtools version 1.4. Phylogenetic analysis was performed by maximum likelihood method in MEGA7.

Results
We identified two distinct genotype G lineages comprised of 9 patients each and closely related to a 2009–2010 outbreak in Ontario and New York (Figure 1). Inter-lineage single nucleotide polymorphism (SNP) differences ranged from 25 to 31, whereas intra-lineage SNPs ranged from 0 to 8 SNPs. Two outlying sequences, of genotype C and G respectively, may represent sporadic introduction of virus from other areas. Time from virus isolation to SNP based analysis was approximately 4 days.

Conclusion
WGS of Mumps virus culture isolates using the PCR fragment method identified two distinct genotype G lineages in a large provincial outbreak. This method may aid public health authorities identify separate transmission chains in the case of large outbreaks.

Disclosures
All authors: No reported disclosures.
Comparison of Antibiotic Regimens in Intra-abdominal Infections
Authors: Hasanoglu Imran , Guner Rahmet , Bilmez Ruveyda , Kayaaslan Bircan , Buzgan Turan , Tasyaran Mehmet A 
Published: October 2017

Abstract

Background
Appropriate antimicrobial therapy and sometimes urgent surgery are life-saving in intra-abdominal infections (IAI).

Methods
We performed a retrospective case control study to evaluate the efficacy of ceftriaxone, ceftriaxone plus metronidazole, tigecycline, and ertapenem regimens in IAI. Patients aged &gt;18 years and diagnosed with IAI between 2015 and 2017 are included in the study. Definitions are based on IDSA IAI guideline. Significant resolution of all signs and symptoms of IAI with no further need for antimicrobial therapy or surgical intervention for infection is accepted as clinical response (CR). Microbiological response (MR) is assessed among patients with positive culture and defined as documented or presumptive microbiological eradication of pathogen.

Results
659 patients are included in the study. Mean age was 56 years. Source control was maintained in 45.5% of patients. Among 54 patients with available culture specimen, E.coli was the most isolated pathogen (81% ESBL +). Comparisons of antibiotics in all patients and in complicated IAI are shown in Table 1 and 2, respectively.

Conclusion
Ertapenem, and especially tigecycline are good options in IAI in the era of high antimicrobial resistance.

Disclosures
All authors: No reported disclosures.