bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastroenteritis Severity: A Prospective Cohort Comparison of Children in Emergency Department and Home Settings
Authors: Vanderkooi Otto G , Xie Jianling , Lee Bonita , Ali Samina , Pang Xiao-Li , Chui Linda , Payne Daniel C , Tarr Phillip , Zhuo Ran , Parsons Brendon , Osterreicher Lara , Kim Kelly , Freedman Stephen 
Published: October 2017

Abstract

Background
While nearly 2 million children are brought to emergency department (ED) annually due to vomiting and/or diarrhea from acute gastroenteritis (AGE), it is estimated that 90% of AGE cases do not seek medical care. We sought to determine whether the disease severity and enteropathogen burden of disease of children with AGE brought for ED care is different from those cared for at home.

Methods
Subjects were prospectively recruited by the APPETITE team in pediatric EDs in 2 urban centers and via HealthLink, a province-wide nurse telephone advice line. Eligibility criteria included: &lt; 18 years old, AGE defined by ≥ 3 episodes of vomiting or diarrhea in the preceding 24 hours, and &lt; 7 days of symptoms. The primary outcome was index encounter disease severity quantified using the modified Vesikari Scale (MVS) score. To eliminate the impact of the index encounter on the score we excluded the index ED visit and intervention from all calculations. Secondary objectives included the enteropathogen burden of disease. Two rectal swabs and stool were collected and tested for enteropathogens by enteric bacterial culture, Luminex xTAG GPP, and a 5-virus in-house RT-qPCR panel.

Results
Between December 9, 2014 and December 31, 2016, 1,623 participants were enrolled with 81.5% from the EDs. Median age was 20.1 months. Children who went to ED were less likely to have a family physician (62 vs. 82%, P &lt; 0.001), more likely to have clinical dehydration (Clinical Dehydration Scale score 3 vs 1, P &lt; 0.001) and vomiting (91 vs. 85%, P = 0.004), previously received IV fluids (4.1 vs. 0.7%, P = 0.001) or been admitted (5.4 vs. 1.3%, P = 0.002). The MVS score was similar between groups when the contribution of the index visit to the score was excluded (8.1 vs. 7.8, P = 0.15). Participants recruited in the ED were not significantly more likely to have bacterial pathogens (8.0 vs. 3.7%, P = 0.09) but were less likely to have viral pathogens identified (64.1 vs. 80.7, P &lt; 0.001).

Conclusion
Children presenting for ED care had disease severity scores that were similar to children managed at home when the contribution of the index ED visit was accounted for. Viral pathogens were more common in AGE receiving care at home while those presenting to the ED and potentially have a clinically greater likelihood of having a bacterial enteropathogen.

Disclosures
All authors: No reported disclosures.
Risk Factors for the Development of Bacteremia in Previously Healthy Children with Non-typhoidal Salmonella Gastroenteritis
Authors: Burdick Bethany , Dutta Ankhi , Hess Lauren , Minard Charles 
Published: October 2017

Abstract

Background
Non-typhoidal Salmonella (NTS) causes approximately 1.2 million illnesses per year in the United States. There are very few pediatric studies which has investigated the risk factors for NTS bacteremia in healthy children with NTS gastroenteritis (NTS-AGE).

Methods
This was a retrospective study of children admitted to Texas Children’s Hospital, Houston, TX, with NTS-AGE from 2007–2016. Exclusion criteria included: patients aged ≤3 m or &gt; 18 years, immunodeficiencies, hemoglobinopathies, extraintestinal manifestations or those in whom blood cultures were not obtained. Demographics, clinical and laboratory data were collected from electronic medical records. Patients with NTS bacteremia (NTS-B) were compared with patients who were non-bacteremic (NTS-NB).

Results
Of 350 patients reviewed, 83 patients met inclusion criteria: 53 with NTS-B and 30 NTS-NB. The median age of diagnosis was 1.58 years (range 3.5 months-18 years). Thirty-nine patients (47.0%) were female and 44 (53.0%) were male. Majority of patients were non-Hispanic White (n = 70; 84.3%). The most common serotype was Salmonella Group C (n = 41(49.4%). There was no difference in risk factors between NTS-B vs. NTS-NB in terms of age, duration of diarrhea prior to admission, travel or pet exposure, prior antibiotic exposure or white blood cell count at presentation. Duration of fever prior to admission was statistically significant with median duration for NTS-B being 6.11 days compared with NTS-NB at 1.97 days (P = &#x2028;0.0000006). There was an increased trend for bacteremia in males and Salmonella Group C bacteremia (P = 0.07 and P = 0.08 respectively).

Conclusion
To our knowledge this is first pediatric study in the United States to evaluate risk factors for NTS bacteremia in healthy children with NTS-AGE. Duration of fever prior to admission was associated with increased risk of NTS-B along with increased trend with males and infection with Group C Salmonella. These risk factors should prompt clinicians to monitor patients with NTS-AGE closely and help in deciding whether antimicrobials are warranted or not.

Disclosures
All authors: No reported disclosures.
Impact of Fecal Microbiota Transplantation on Digestive Tract Colonization due to Carbapenem-resistant Enterobacteriacae and Vancomycin-resistant Enterococci
Authors: Davido Benjamin , Batista Rui , Michelon Hugues , Escaut Lelia , Fessi Hafedh , Senard Olivia , Matt Morgan , Deconinck Laurene , De Truchis Pierre , Salomon Jérôme , Dinh Aurelien 
Published: October 2017

Abstract

Background
Fecal Microbiota Transplantation (FMT) has proved to be an efficient therapy for recurrent C. difficile infection. Its indication is currently discussed for the decolonization of Multidrug-resistant organisms (MDRO) on the basis of mice experiments. Two recent publications suggest that it could be an efficient strategy for patients colonized with digestive MDRO colonization but few data are available for Carbapenem-Resistant Enterobacteria (CRE) and Vancomycin-Resistant Enterococcus (VRE) colonization.

Methods
We performed a FMT among patients colonized by CRE or VRE documented by at least 3 nonconsecutive positive swabs (including one in the week prior to the FMT).
Procedure: 2 days prior to the FMT, patients received a proton pump inhibitor and a naso-duodenal tube was inserted to perform a bowel lavage with X-prep. FMT was performed with frozen feces from 4 donors previously screened for potential diseases using 5 syringes of 50 cc of feces diluted with saline. Patients were discharged after 24h and benefited of outpatient control swabs (PCR + culture) on day 7, 14, 21, 28 and each month during 3 months in order to assess the decolonization. The study is registered at ClinicalTrials.gov (NCT03029078).

Results
Seventeen individuals were included. Mean age was 69 ± 12.7 (SD) years.
Eight patients were positive for CRE (KPC, OXA48 or NDM-1) and 9 for VRE.
All suffered from severe underlying condition (hemodialysis, dementia, cirrhosis) or chronic wounds. Median functional autonomy scale was evaluated using the French Iso-Resources Groups (GIR)=4/6 IQR[3–6] supporting they were dependent persons.
At 1-month follow-up, 3/8 patients were free from CRE and 5/9 from VRE. At 3-month follow-up, 3/8 patients were still free from CRE whereas 7/8 were free from VRE, considering one death from cirrhosis.
Moreover, one of them received antibiotics during a week for a hospital-acquired infection a long time after FMT. No adverse events were reported.

Conclusion
FMT seems to be an attractive option to eradicate colonization of MDRO, especially for VRE. Limited data are available in the literature to determine response factors. Meanwhile its efficacy is moderate; it provides an alternative solution to quarantine for fragile and frequently hospitalized patients. More data and a controlled trial are required.

Disclosures
All authors: No reported disclosures.
The Global Burden of Shigella and Enterotoxigenic E. coli: Results from the Global Burden of Disease Study 2016
Authors: Khalil Ibrahim 
Published: October 2017

Abstract

Background
Diarrhea is the seventh leading cause of death globally, responsible for more than 1,600,000 deaths in 2016 and nearly 90% of these deaths occurred in sub-Saharan Africa and South Asia. The Global Burden of Disease Study (GBD) is an annual effort to produce and refine estimates of diarrheal disease burden attributable to Shigella spp., enterotoxigenic Escherichia coli (ETEC), and other enteric pathogens.

Methods
We used a counter-factual approach to estimate deaths, incidence, years of life lost (YLLs), years living with disability (YLDs), and total disability adjusted life years (DALYs) attributable to diarrhea and its etiologies, including Shigella and ETEC. To estimate the burden of diarrhea etiologies, we conducted a systematic review of the proportion of diarrheal cases positive for each pathogen and modeled these data using a Bayesian meta-regression tool called DisMod-MR. This tool generates estimates of the pathogen distribution for national and some subnational geographies, all age groups, and for both sexes from 1990 to 2016. We used these estimates, in conjunction with odds ratios for diarrhea given pathogen detection from the Global Enteric Multicenter Study, to calculate the population attributable fraction for each pathogen.

Results
In 2016, Shigella was responsible for 75,000 deaths among children under-5 and 270,000 deaths among all ages and ETEC was responsible for 22,000 deaths among children under-5 and 60,000 deaths among all ages. Shigella and ETEC ranked second and fourth with regard to pathogen contributions to global diarrheal deaths.

Conclusion
The global burden of disease attributable to Shigella and ETEC is substantial. GBD 2016 estimates on the age- and location-specific impact of Shigella and ETEC enable evidence-based decision making regarding interventions to reduce the burden of these pathogens. Our findings call for accelerated efforts for the development of vaccines against ETEC and Shigella.

Disclosures
All authors: No reported disclosures.
Frequency of Antimicrobial Resistance in Shiga Toxin-Producing Escherichia coli (STEC) and Non-Typhoidal Salmonella (NTS) Clinical Infections and Association with Epidemiological Factors
Authors: Mukherjee Sanjana , Mosci Rebekah , Anderson Chase , Snyder Brian , Collins James , Rudrik James , Manning Shannon D 
Published: October 2017

Abstract

Background
STEC and NTS are leading causes of foodborne infections in the US. Monitoring resistance in these pathogens is essential to understand the distribution of resistance profiles and because of the high likelihood of horizontal transfer of resistance genes to other pathogens. Data involving resistance in clinical STEC and NTS isolates from Michigan is lacking.

Methods
Clinical STEC (n = 353) and NTS (n = 148) isolates from the MDHHS (2010–2014) were examined for resistance using disk diffusion, E-test or broth microdilution. Case information and epidemiological data for STEC isolates was extracted and associations with resistant infections were determined using chi square tests in SAS 9.3 and EpiInfo™ 7.

Results
Overall, 31 (8.8%, n = 353) STEC isolates were resistant to at least one antibiotic; high frequencies of resistance were observed for ampicillin (7.4%) and trimethoprim-sulfamethoxazole (4.0%). Resistance to ciprofloxacin (0.28%) and all three drug classes (0.28%) was less common. Preliminary results indicate that O157 resistance to ampicillin (4.8%) and trimethoprim-sulfamethoxazole (3.4%) was higher in Michigan compared with national frequencies (ampicillin = 2.7%, trimethoprim-sulfamethoxazole= 1.5%). Higher resistance frequencies were also observed in counties with high (11.3%) vs. low (7.7%) antibiotic prescription rates. For NTS, 23 (15.5%) isolates were resistant to ≥1 antibiotic. Resistance varied by serotype with high frequencies in Typhimurium (20%, n = 20), Newport (17.6%, n = 17) and Enteritidis (4.8%, n = 42); 11 (7.4%) NTS isolates were resistant to ≥3 antimicrobial classes.

Conclusion
Continuous monitoring of resistance in clinical STEC and NTS is warranted due to their importance as food pathogens. The identification of risk factors for resistance is crucial to develop alternative prevention practices to reduce the health burden of resistant infections in Michigan, which is not part of the FoodNet surveillance network.

Disclosures
All authors: No reported disclosures.
Activity of Ceftolozane-Tazobactam and Comparators When Tested against Bacterial Surveillance Isolates Collected from Pediatric Patients in the US during 2012–2016 as Part of a Global Surveillance Program
Authors: Shortridge Dee , Duncan Leonard R , Pfaller Michael a , Flamm Robert K 
Published: October 2017

Abstract

Background
Ceftolozane-tazobactam (C-T) is an antibacterial combination of a novel antipseudomonal cephalosporin and a β-lactamase inhibitor. C-T was approved by the US Food and Drug Administration in 2014 and by the European Medicine Agency in 2015 to treat complicated urinary tract infections, acute pyelonephritis, and complicated intra-abdominal infections in adults. The Program to Assess Ceftolozane-Tazobactam Susceptibility (PACTS) monitors C-T resistance to gram-negative (GN) isolates worldwide.

Methods
A total of 4121 GN isolates were collected during 2012–2016 from pediatric patients (&lt;18 years old) in 31 US hospitals and tested for C-T susceptibility (S) by CLSI broth microdilution method in a central monitoring laboratory (JMI Laboratories). Other antibiotics tested were amikacin (AMK), cefepime (FEP), ceftazidime (CAZ), colistin (COL), levofloxacin (LVX), meropenem (MER), and piperacillin-tazobactam (TZP). Antibiotic-resistant phenotypes identified using CLSI (2017) clinical breakpoints included: carbapenem-resistant Enterobacteriaceae (CRE), non-CRE extended-spectrum β-lactamase screen positive (ESBL, non-CRE), ceftazidime-nonsusceptible (CAZ-NS), and meropenem-NS (MER-NS). EUCAST (2017) COL clinical breakpoints were used for Enterobacteriaceae (ENT).

Results
The most common infection type in hospitalized pediatric patients was pneumonia (n = 1,488) followed by urinary tract infection (n = 1,143) and bloodstream infection (n = 767). A total of 2,969 ENT and 1,152 non-enterics were isolated. The 5 most common species were Escherichia coli (EC: 1,311), Pseudomonas aeruginosa (PSA: 821 isolates), Klebsiella pneumoniae (KPN: 429), Enterobacter cloacae complex (ECC: 360), and Serratia marcescens (SM: 264). Susceptibilities of C-T and comparators for the main species and resistant phenotypes are shown in the Table. Only 7 isolates were CRE in this study.

Conclusion
C-T demonstrated good activity against pediatric ENT isolates (96.1%S), EC (99.2%S), and KPN (97.9%S). For ENT, all agents but COL had &gt;90% S. For PSA, C-T demonstrated potent activity (99.5%S) and was the most potent antibiotic tested with activity similar to COL.

Disclosures
D. Shortridge, Merck: Research Contractor, Research grant; L. R. Duncan, Merck: Research Contractor, Research grant; M. A. Pfaller, Merck: Research Contractor, Research grant; R. K. Flamm, Merck: Research Contractor, Research grant
Analysis of Oritavancin Activity against Gram-Positive Clinical Isolates Responsible for Bacterial Endocarditis in United States and European Hospitals (2008–2016)
Authors: Pfaller Michael A , Sader Helio S , Shortridge Dee , Flamm Robert K , Mendes Rodrigo E 
Published: October 2017

Abstract

Background
Oritavancin (ORI) has documented in vitro activity against gram-positive (GP) isolates. This study analyzed ORI tested against organisms causing endocarditis in United States (US) and European (EU) sites.

Methods
A total of 424 organisms recovered from patients with a diagnosis of bacterial endocarditis at US and EU sites during the SENTRY Antimicrobial Surveillance Program (2008–2016) were included (see Table). Isolates were identified by standard biochemical algorithms and MALDI-TOF. Susceptibility (S) testing was performed by CLSI methods, and MICs were interpreted per CLSI and/or EUCAST criteria.

Results
Among the 424 isolates, 212 (50.0%) were S. aureus (SA; 31.6% methicillin-resistant [MRSA]), 47 (11.1%) were coagulase-negative staphylococci (CoNS), 81 (19.1%) were E. faecalis (EFC), 21 (5.0%) were E. faecium (EFM), 24 (5.7%) were BHS, and 39 (9.2%) were viridans group streptococci (VGS). ORI had similar MIC90 values (0.06 µg/mL) against SA and CoNS, inhibiting 98.8% of these isolates at ≤0.12 µg/mL. ORI MIC50 values were 8- to 32-fold lower than those for vancomycin (VAN), daptomycin (DAP), and ceftaroline (CPT) against staphylococci. ORI showed MICs against EFM (MIC50/90, 0.008/0.03 µg/mL) that were 2-fold lower than against EFC (MIC50/90, 0.015/0.03 µg/mL; 97.5%S against all or 100%S against indicated VAN-S isolates). ORI inhibited 98.0% of all enterococci, including VAN-resistant isolates at ≤0.12 µg/mL. VAN, DAP, ampicillin (MIC50/90, ≤1/2 µg/mL), and linezolid (LZD) (MIC50/90, 1/2 µg/mL) were similarly active against EFC, while DAP and LZD had coverage (100.0%S) against EFM. Overall, BHS were highly S to all agents tested, except for erythromycin (70.8%S) and tetracycline (43.5%S). ORI was the most active agent (MIC90, 0.12 µg/mL) tested against VGS.

Conclusion
ORI showed potent in vitro activity against isolates recovered from patients with endocarditis in US and EU sites. The data presented here warrant further investigations to determine whether ORI has a role for treating endocarditis.

Disclosures
M. A. Pfaller, The Medicines Company: Research Contractor, Research grant; H. S. Sader, The Medicines Company: Research Contractor, Research grant; D. Shortridge, The Medicines Company: Research Contractor, Research grant; R. K. Flamm, The Medicines Company: Research Contractor, Research grant; R. E. Mendes, The Medicines Company: Research Contractor, Research grant
In Vitro Evaluation of Delafloxacin Activity when Tested Against Contemporary community-Acquired Bacterial Respiratory Tract Infection Isolates (2014–2016): Results from the Sentry Antimicrobial Surveillance Program
Authors: Shortridge Dee , Streit Jennifer M , Huband Michael D , Rhomberg Paul R , Flamm Robert K 
Published: October 2017

Abstract

Background
Delafloxacin (DLX) is a broad-spectrum fluoroquinolone (FQ) antibacterial that has completed clinical development (oral and intravenous formulations) with the new drug application currently under the Food and Drug Administration review for the treatment of acute bacterial skin and skin structure infections (ABSSSI). DLX is also in clinical trials for community-acquired bacterial pneumonia. In this study, in vitro susceptibility results for DLX and comparator agents were determined for clinical isolates from community-acquired respiratory tract infections (CA-RTI) collected in medical centers in the United States and Europe participating in the SENTRY surveillance program during 2014–2016.

Methods
A total of 3,093 isolates that included 1,673 Streptococcus pneumoniae (SPN), 805 Haemophilus influenzae (HI) and 555 Moraxella catarrhalis (MC) were collected during 2014–2016 and included only 1 isolate/patient/infection episode. Isolate identifications were confirmed at JMI Laboratories. Susceptibility testing was performed according to CLSI reference broth microdilution methodology, and results were interpreted per CLSI (2017) breakpoints. Other antibacterials tested included levofloxacin (LVX) and penicillin. Β-lactamase production for HI and MC was determined by the nitrocephin disk test.

Results
DLX demonstrated potent in vitro activity against SPN (MIC50/90 0.015/0.03 mg/L). Activity remained the same for penicillin-intermediate or -resistant isolates. For 23 LVX nonsusceptible SPN, the DLX MIC50/90 were 0.12/0.25 mg/L with all isolates having DLX MIC values ≤1 mg/L. For HI, the DLX MIC50/90 were ≤0.001/0.004 mg/L, and for MC the MIC50/90 were 0.008/0.008 mg/L. DLX activity was unaffected by the presence of β-lactamase for either HI or MC. Activity of DLX was similar for US and European isolates.

Conclusion
Delafloxacin demonstrated potent in vitro antibacterial activity against CA-RTI pathogens, including SPN, HI, and MC. These data support the continued study of DLX as a potential treatment for community-acquired pneumonia.

Disclosures
D. Shortridge, Melinta Therapeutics: Research Contractor, Research grant;
J. M. Streit, Melinta Therapeutics: Research Contractor, Research grant; M. D. Huband, Melinta Therapeutics: Research Contractor, Research grant; P. R. Rhomberg, Melinta Therapeutics: Research Contractor, Research grant; R. K. Flamm, Melinta Therapeutics: Research Contractor, Research grant
In vitro Susceptibility Testing of Essential Oils against Gram-positive and Gram-negative Clinical Isolates, including Carbapenem-resistant Enterobacteriaceae (CRE)
Authors: Patterson Jan E , McElmeel M.L , Wiederhold Nathan P 
Published: October 2017

Abstract

Background
In the era of antibiotic resistance, alternative anti-infectives must be explored. The National Action Plan for Combating Antibiotic-Resistant Bacteria calls for developing nontraditional therapeutics, including natural compounds such as essential oils (EOs) (Goal 4.4). A pilot study previously showed in vitro activity of EOs against CRE and warranted further study of their antibacterial activity. We studied cinnamon bark, clove, lavender, lemongrass, eucalyptus, oregano, rosemary, thyme, tea tree, manuka, and Thieves® blend (Young Living Essential Oils, Lehi UT) against an expanded panel of Gram-positive and Gram-negative isolates.

Methods
30 Gram-positive and 70 Gram-negative clinical isolates, including CRE, were tested using CLSI methods. Isolates were grown overnight on TSA; 0.5 McFarland suspensions in sterile water were swabbed over Mueller–Hinton agar using the Kirby–Bauer method. 20 μl of full-strength oils were pipetted onto blank paper disks in a sterile dish. Disks were placed aseptically onto the plates immediately after inoculating disks. Vancomycin was tested with Gram-positives and meropenem with Gram-negatives. Median zone diameters are shown.

Results
EOs oregano, thyme, cinnamon bark, and lemongrass had the largest zones of inhibition against Gram-positive organisms and were larger than those of vancomycin for MRSA/MSSA. Cinnamon bark had the largest zone of inhibition against P. aeruginosa and was larger than that of meropenem. Oregano, thyme, cinnamon bark had the largest zones of inhibition against Enterobacteriaceae and were larger than those of meropenem against K. pneumoniae and E. cloacae.

Conclusion
Essential oils showed significant in vitro activity against clinical isolates, including CRE. Further study of the clinical activity of essential oils is warranted.

Disclosures
J. E. Patterson, Young Living Essential Oils: Independent Contractor, Salary