bluuebunny/crossref_metadata_2025_split huggingface dataset:
Respiratory Syncytial Virus bronchiolitis: Impact of second-hand smoke exposure on immune profiles
Authors: Diaz Alejandro , Cohen Daniel M , Jaramillo Lisa , Smith Bennett , Groner Judith , Ramilo Octavio , Mejias Asuncion 
Published: October 2017

Abstract

Background
RSV is the leading cause of hospitalization for bronchiolitis in infants and young children worldwide. Second-hand smoke (SHS) exposure has been associated with increased morbidity in children with respiratory infections. The objectives of this study were to explore the association between SHS measured by hair nicotine and disease severity in infants with RSV infection, and to define its impact on the blood transcriptional immune profiles.

Methods
Single-center, prospective study of previously healthy infants presenting to the Emergency Department with RSV bronchiolitis with and without SHS exposure assessed by hair nicotine levels. Exclusion criteria included: prematurity; chronic medical conditions, and insufficient hair. Clinical outcomes were assessed using a clinical disease severity score (CDSS; ranging from 0 to 15) and care provided (hospitalization and intensive care). Blood samples from patients and healthy controls were obtained at enrollment for gene expression profiling, and differences in profiles stratified by SHS exposure.

Results
A total of 70 infants with RSV were enrolled (median age 2.7 months; 44 (62.8%) males; 44 (62.8%) white). Hair nicotine was detected in 45 (64.2%) infants with RSV while 25 RSV+ infants had undetectable hair nicotine levels. Demographic variables were not significantly different between SHS exposed and nonexposed infants. Median nicotine concentrations in infants with severe (CDSS &gt;10) vs. mild RSV disease (CDSS &lt; 5) were 5.3 and 2.1ng/mg (P = 0.49). In addition, blood transcriptional profiles in RSV infants exposed to SHS vs. nonexposed, were characterized by significantly greater overexpression of genes related to inflammation, apoptosis and cell death, and greater suppression of T and B cell-related genes (Figure 1).

Conclusion
In otherwise healthy infants with RSV infection exposure to SHS was associated with greater inflammation and blunted T and B cell responses. Although not statistically significant, hair nicotine levels were higher in patients with more severe RSV bronchiolitis.

Disclosures
O. Ramilo, Abbvie: Board Member, Consulting fee; Regeneron: Board Member, Consulting fee; Janssen: Board Member and Investigator, Consulting fee and Research grant; NIH: Grant Investigator, Research grant; A. Mejias, Janssen: Investigator and Scientific Advisor, Consulting fee and Research support; Abbvie: Consultant and Scientific Advisor, Speaker honorarium; Novartis: CME lecture, Speaker honorarium; NIH: Investigator, Research grant
Predictors of Linkage to and Retention in HIV Care Following Release from Connecticut Jails and Prisons
Authors: Loeliger Kelsey B , Altice Frederick L , Desai Mayur M , Ciarleglio Maria M , Gallagher Colleen , Meyer Jaimie P 
Published: October 2017

Abstract

Background
One in six people living with HIV (PLH) in the USA transition through prison or jail annually. During incarceration, people may engage in HIV care, but transition to the community remains challenging. Linkage to care (LTC) post-release and retention in care (RIC) are necessary to optimizing HIV outcomes, but have been incompletely assessed in prior observational studies.

Methods
We created a retrospective cohort of all PLH released from a Connecticut jail or prison (2007–2014) by linking Department of Correction demographic, pharmacy, and custody databases with Department of Public Health HIV surveillance monitoring and case management data. We assessed time to LTC, defined as time from release to first community HIV-1 RNA test, and viral suppression status at time of linkage. We used generalized estimating equations to identify correlates of LTC within 14 or 30 days after release. We also described RIC over three years following an initial release, comparing recidivists to non-recidivists.

Results
Among 3,302 incarceration periods from 1,350 unique PLH, 21% and 34% had LTC within 14 and 30 days, respectively, of which &gt;25% had detectable viremia at time of linkage. Independent correlates of LTC at 14 days included incarceration periods &gt;30 days (adjusted odds ratio [AOR] = 1.6; P &lt; 0.001), higher medical comorbidity (AOR = 1.8; P &lt; 0.001), antiretrovirals prescribed before release (AOR = 1.5; P = 0.001), transitional case management (AOR = 1.5; P &lt; 0.001), re-incarceration (AOR = 0.7; P = 0.002) and conditional release (AOR = 0.6; P &lt; 0.001). The 30-day model additionally included psychiatric comorbidity (AOR = 1.3; P = 0.016) and release on bond (AOR = 0.7; P = 0.033). Among 1,094 PLH eligible for 3-year follow-up, RIC after release declined over 1 year (67%), 2 years (51%) and 3 years (42%). Recidivists were more likely than nonrecidivists to have RIC but, among those retained, were less likely to be virally suppressed (Figure 1).

Conclusion
For incarcerated PLH, both LTC and RIC as well as viral suppression are suboptimal after release. PLH who receive case management are more likely to have timely LTC. Targeted interventions and integrated programming aligning health and criminal justice goals may improve post-release HIV treatment outcomes.

Disclosures
All authors: No reported disclosures.
Selected CNS Outcomes Among INSTI Antiretrovirals
Authors: Wohl David , Mills Anthony , Mera Robertino , Piontkowsky David 
Published: October 2017

Abstract

Background
Higher rates of neuropsychiatric events among patients on dolutegravir (DTG) compared with other integrase inhibitors (INSTIs) have been reported from clinic cohorts and one blinded trial. We compared select neurological and psychiatric events in a large sample of patients treated with different INSTIs.

Methods
The Quintiles IMS database, which includes pharmacy and medical claims records, was examined for HIV infected patients treated from 2006 to 2016 with DTG (TIVICAY/TRIUMEQ), elvitegravir (EVG, STRIBILD), or raltegravir (RAL, ISENTRESS). The dependent variable outcomes were insomnia/sleep disturbance and depression. A propensity score was created to adjust for variables associated with treatment with a particular INSTI including age, gender, year of initial INSTI exposure, and enrollment time. Multivariate Poisson mixed models were used to generate incidence rate ratios (IRRs).

Results
Records for 54,151 distinct HIV-infected patients treated with DTG, EVG, or RAL were identified. In the multivariate model the rate of insomnia/sleep disturbance events was significantly higher for patients treated with DTG vs. EVG (IRR 1.21 [95% CI 1.09–1.33, P &lt; 0.001]), but was not significantly different when comparing DTG to RAL (IRR 1.04 [95% CI 0.94–1.14, P = 0.459]). Likewise, the rate of incident depression was significantly higher for patients treated with DTG vs. EVG (IRR 1.18 [95% CI 1.09–1.27, P &lt; 0.001], but not when comparing DTG to RAL (IRR 0.93 [95% CI 0.87 – 1.01, P = 0.068]).

Conclusion
In this analysis using a large healthcare database, significantly higher adjusted rates of both incident insomnia/sleep disturbances (21% more) and depression (18% more) were found among patients treated with DTG compared with EVG. In contrast, a significant difference in the rates of either outcome was not observed when comparing DTG and RAL. Further studies are warranted to determine the risk of neuropsychiatric events in patients treated with different INSTIs.

Disclosures
D. Wohl, Gilead Sciences: Consultant and Investigator, Consulting fee and Research grant; Viiv: Consultant and Investigator, Consulting fee and Research grant; Janssen: Consultant, Consulting fee; Bristol-Myers Squibb: Consultant, Consulting fee; A. Mills, Gilead Sciences: Consultant, Investigator and Speaker’s Bureau, Consulting fee, Research grant and Speaker honorarium; Viiv: Consultant and Investigator, Consulting fee and Research grant; Merck: Consultant, Investigator and Speaker’s Bureau, Consulting fee, Research grant and Speaker honorarium; Janssen: Investigator, Research grant; Bristol-Myers Squibb: Investigator, Research grant; Sangamo Bio Sciences: Investigator, Research grant; R. Mera, Gilead Sciences: Employee and Shareholder, Salary; D. Piontkowsky, Gilead Sciences: Employee and Shareholder, Salary
The Impact of active surveillance culture and decolonization programs on NICU MRSA transmission: A multicenter, mechanistic modeling approach.
Authors: Pierce Rebecca , Elward Alexis , Bryant Kristina , Lessler Justin , Milstone Aaron M 
Published: October 2017

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) remains a major threat to patient safety in the neonatal intensive care unit (NICU). The aim of this study was to assess the effectiveness of active surveillance cultures (ASC) and decolonization in reducing MRSA transmission in the NICU.

Methods
Retrospective cohort data, including admission and discharge times, weekly surveillance culture results and mupirocin-administration information, were collected from three urban, tertiary care NICU in the US. The study period was 2007–2014, during which ASC and decolonization strategies were employed for MRSA control. We used Markov-Chain Monte Carlo methods to fit a probabilistic transmission model to the data. To account for the interval-censored nature of weekly surveillance screening, we used an integrated Bayesian framework to impute the date of conversion to MRSA-positive. We estimated the risk of MRSA acquisition associated with non-patient sources, undetected MRSA carriers, detected MRSA carriers on contact precautions, and MRSA carriers on contact precautions that also received decolonization treatment.

Results
Of the 12,677 neonates that were screened for MRSA colonization at study sites, 533 (4.2%) had a MRSA-positive surveillance culture. Neonates with undetected MRSA colonization were estimated to be the source of 67% (95% credible interval [CI]: 0.64–0.69) of MRSA acquisition. Compared with undetected MRSA carriers, detection and placement on contact precautions deceased the odds of transmission by 99.8% (odds ratio [OR]: 0.0016, 95% CI: 0.0000026–0.033), 99.6% (OR = 0.0036, 95% CI: 0.0000025–0.13), and 99.8% (OR = 0.0024; 95% CI: 0.00000042–0.043) at sites A, B, C, respectively. A 99.9% reduction in transmissibility was sustained among MRSA carriers who also received decolonization treatment (OR = 0.0014, 95% CI: 0.0000080–0.024).

Conclusion
In this multi-centered NICU cohort, ASC and decolonization programs were highly effective in reducing transmission risk from MRSA carriers. Detection of MRSA carriers and the use of contact precautions, alone, were associated with a near-complete reduction in transmission risk. Improving time-to-detection as well as prioritizing nonpatient reservoirs of MRSA could further reduce MRSA acquisition in the NICU.

Disclosures
All authors: No reported disclosures.
Role of M Cells in Human Mucosal Immunity to Mycobacterium tuberculosis
Authors: Nair Vidhya , Khan Haaris , Mitchell Ron , Shiloh Michael U 
Published: October 2017

Abstract

Background
Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis (TB), is a bacterial pathogen that infects roughly one-third of the worldÕs population and causes 1–2 million deaths per year. The current paradigm is that phagocytosis of Mtb by patrolling alveolar macrophages initiates Mtb infection. While this model can account for pulmonary TB, it does not adequately explain the occurrence of extrapulmonary forms of TB that manifest in the absence of obvious lung involvement, such as tuberculous cervical lymphadenitis, also known as scrofula. We hypothesized that specialized epithelial cells called microfold cells (M cells) may be an alternate portal of entry for Mtb. Previously we demonstrated that Mtb is able to transcytose across an epithelial barrier in an M cell dependent manner and that M cell mediated transcytosis is vital for Mtb pathogenesis in a mouse model of tuberculosis.

Methods
We used an in vitro M-cell mediated translocation assay and a Mtb mutant lacking a key virulence factor, ESAT6. We used biochemistry and genetics to identify a novel receptor for ESAT6. We also developed a novel explanted human adenoid Mtb infection model to study mucosal immunity.

Results
We now demonstrate that the Mtb virulence factor ESAT6 is necessary and sufficient to mediate binding and transcytosis by M cells in vitro and in vivo, and that uptake of Mtb by M cells requires a unique cell surface ESAT6 receptor. We developed a novel explanted human adenoid model of M cell biology and demonstrate rapid Mtb transcytosis by primary human tissue within 60–120 minutes. Using flow cytometry we find that Mtb is first ingested by M cells and then after transcytosis, by tissue resident antigen-presenting cells. Explanted adenoids from 10 independent donors display a wide range of Mtb uptake.

Conclusion
We conclude that Mtb ESAT6 is necessary for Mtb uptake by M-cells and that binding and transcytosis require a host receptor. Because explanted adenoids display a wide range of Mtb uptake, M cell mediated transcytosis may confer differential susceptibility to scrofula and disseminated disease. These findings are significant as M cells could potentially serve as the basis for novel therapeutic targets against primary Mtb infection.

Disclosures
All authors: No reported disclosures.
Wide Range of Carbapenem-resistant Enterobacteriaceae Incidence and Trends in Emerging Infections Program Surveillance, 2012–2015
Authors: Duffy Nadezhda , Brown Cedric J , Bulens Sandra N , Bamberg Wendy , Janelle Sarah J , Jacob Jesse T , Bower Chris , Wilson Lucy , Vaeth Elisabeth , Lynfield Ruth , Vagnone Paula Snippes , Phipps Erin C , Hancock Emily B , Dumyati Ghinwa , Concannon Cathleen , Beldavs Zintars G , Cassidy P Maureen , Kainer Marion , Muleta Daniel , See Isaac 
Published: October 2017

Abstract

Background
Carbapenem-resistant Enterobacteriaceae (CRE) are an urgent threat in the United States because of high morbidity and mortality, few treatment options, and potential for rapid spread among patients. To assess for changes in CRE epidemiology and risk among populations, we analyzed CDC Emerging Infections Program (EIP) 2012–2015 surveillance data for CRE.

Methods
Active, population-based CRE surveillance was initiated in January 2012 at 3 EIP sites (GA, MN, OR) and expanded to 5 additional sites (CO, MD, NM, New York, TN) by 2014. An incident case was the first Escherichia coli, Enterobacter, or Klebsiella isolate (non-susceptible to at least one carbapenem and resistant to all third-generation cephalosporins tested) collected from urine or a normally sterile body site from a patient during a 30-day period. Data were collected from patients’ medical records. Cases were hospital-onset (HO) or long-term care facility (LTCF) onset if patients were in the respective facility ≥3 days prior to culture or at the time of culture; and community-onset (CO) otherwise. We calculated incidence rates based on census data for EIP sites and described by type of infection onset.

Results
A total of 1,582 incident CRE cases were reported in 2012–2015. Most cases (88%) were identified through urine cultures; 946 (60%) were female, and median age was 66 years (interquartile range: 55–77). The median incidence by site was 2.95 per 100,000 population (range: 0.35–8.98). Among the three sites with four full years of data, a different trend was seen in each (Figure). Trends in GA and MN were statistically significant, and no significant trend was seen in OR. Overall, 480 cases (30%) were HO, 524 (33%) were LTCF onset, and 578 (37%) were CO. Of CO cases, 308 (53%) had been hospitalized, admitted to a long- term acute care hospital or were a LTCF resident in the prior year.

Conclusion
CRE incidence varied more than 20-fold across surveillance sites, with evidence of continued increases in MN. Measuring impact of programs aimed at reducing CRE transmission in other regions will require obtaining local data to identify cases occurring during and after healthcare facility discharge. Further study of changes in incidence in some settings and areas might offer opportunities to refine and expand effective control strategies.

Disclosures
All authors: No reported disclosures.
Uropathogens and Antibiotic Resistance Among Nursing Home Residents - National Healthcare Safety Network (NHSN)
Authors: Eure Taniece , Stone Nimalie D , Thompson Nicola D , Bell Jeneita , Mungai Elisabeth 
Published: October 2017

Abstract

Background
Knowledge of urinary tract infection (UTI) pathogen and susceptibility patterns is necessary to inform antibiotic prescribing and monitor resistance. We describe bacterial pathogens and UTI antibiotic resistance patterns among residents in nursing homes (NHs) reporting to the National Healthcare Safety Network (NHSN) long-term care facility (LTCF) component.

Methods
All UTI events from January 1, 2013 to December 31, 2016 were included; up to three organisms per UTI event may be reported. Pathogen susceptibility results for selected antibiotics are reported as: Susceptible (S), Intermediate (I), Resistant (R), or Not tested (N). For this analysis, resistance was defined as I or R. We described pathogens and summarized antibiotic resistance only when ≥100 isolates of a bacterial species had susceptibility test results for a particular antibiotic reported to NHSN.

Results
In 166 NHs located in 37 states, a total of 4,054 pathogens were reported for 2,827 residents. Six organisms accounted for 81% of all UTI events (n = 3,599) (Table). A large proportion of Escherichia coli isolates, which accounted for 41% of uropathogens, were resistant to trimethoprim-sulfamethoxazole (35%) and levofloxacin (50%). Among Proteus mirabilis isolates, 53% were resistant to levofloxacin (Figure). Methicillin resistance was 74% among Staphylococcus aureus, and vancomycin resistance among Enterococcus spp. was 18%.

Conclusion
This is the first summary of UTI pathogens and susceptibility data from U.S. nursing homes reporting to a national surveillance system. Resistance to antibiotics commonly used to treat UTIs was high. Tracking and preventing resistance for key pathogens is a CDC priority and NHSN reporting by NHs provides a crucial opportunity to track antibiotic resistance, highlighting the importance of enrolling more NHs into NHSN.

Disclosures
All authors: No reported disclosures.
Prevalence of and Factors Associated with Clostridium difficile Co-infection Among Patients with Candidemia, United States, 2014–2016
Authors: Tsay Sharon , Benedict Kaitlin , Beldavs Zintars G , Farley Monica M , Harrison Lee H , Schaffner William , Gerth Taryn , Chiller Tom , Vallabhaneni Snigdha 
Published: October 2017

Abstract

Background
Candidemia and Clostridium difficile infection (CDI) are two common healthcare-associated infections (HAIs) and share risk factors such as antibiotic use and prolonged hospitalization. CDI and CDI treatment disrupt gut microbial diversity, allowing Candida overgrowth and translocation to the bloodstream. We describe CDI co-infection among patients with candidemia.

Methods
Population-based surveillance for candidemia was conducted through CDC’s Emerging Infections Program during 2014–2016. A case of candidemia was defined as a blood culture positive for Candida species collected from a surveillance area resident. Demographic and medical information, including occurrence of CDI was collected. We defined co-infection as CDI within 90 days of candidemia and performed bivariable analysis to assess factors associated with co-infection.

Results
Among 2129 cases of candidemia, 190 (9%) had CDI co-infection; 116 (5%) had CDI in the 90 days before candidemia (median: 10 days) and 60 (3%) had CDI following candidemia (median: 8 days). The median age of those with CDI-candidemia co-infection was 61 years and 100 (53%) were male. Compared with candidemia alone, the odds of CDI-candidemia co-infection was significantly greater for patients of black race (OR 1.41, 95% CI 1.05–1.90), those with diabetes (OR 1.68, 1.24–2.27), pancreatitis (OR 1.91, 1.01–3.61), or solid organ transplant (OR 4.15, 2.09–8.22). Those with co-infection had higher odds of certain healthcare exposures: hemodialysis (OR 2.27, 1.57–3.28), hospital stay in the past 90 days (OR 1.9, 1.37–2.64), ICU admission in the past 14 days (OR 1.78, 1.20–2.66), and central venous catheter (CVC) at the time of candidemia (OR 1.71, 1.19–2.46). There were no significant differences in 30-day mortality or in type of Candida species, although C. parapsilosis was less common in the co-infection group (8% vs. 13%).

Conclusion
Nearly one in ten patients with candidemia also had CDI co-infection. Black race, certain underlying conditions, hemodialysis, previous hospitalization, ICU stay, and the presence of a CVC were associated with co-infection. Clinicians should be vigilant for coinfection of CDI and candidemia, particularly in situations with associated risk factors.

Disclosures
W. Schaffner, Pfizer: Scientific Advisor, Consulting fee; Merck: Scientific Advisor, Consulting fee; Novavax: Consultant, Consulting fee; Dynavax: Consultant, Consulting fee; Sanofi-pasteur: Consultant, Consulting fee; GSK: Consultant, Consulting fee; Seqirus: Consultant, Consulting fee
Outcomes of women with laboratory evidence of Zika infection in pregnancy
Authors: Gunaratne Naiomi , Bartlett Michelle , Crane Anise , Greissman Samantha , Kwal Jaclyn , Lardy Meghan , Picon Michelle , Starker Rebecca , Tse Colette , Rodriguez Patricia , Gonzalez Ivan , Curry Christine 
Published: October 2017

Abstract

Background
Zika virus (ZIKV) infection in pregnancy is a global health concern. With onset of local transmission, obstetricians in Miami-Dade County, FL, United States, are now in the unique position of providing care to both pregnant women with locally-transmitted and travel-associated ZIKV infections. This study provides data regarding the testing and pregnancy outcomes of women with laboratory evidence of ZIKV infection in pregnancy.

Methods
A retrospective chart review was conducted using laboratory records of ZIKV testing (PCR and IgM) completed from January through December 2016 at multiple tertiary care centers located in Miami-Dade County. Testing was based on CDC guidelines at time of testing, leading to heterogeneity in tests performed. Data was extracted from charts of women with positive ZIKV PCR in serum and/or urine or positive ZIKV IgM with confirmatory, pending, or insufficient PRNT results. Routine obstetrics parameters and the presence of fetal or neonatal abnormalities were recorded.

Results
Of the 2327 pregnant women screened for ZIKV, 88 (3.8%) screened positive with PCR and/or IgM in serum or urine. Of those women with positive ZIKV testing, 53 (60%) had no documented ZIKV symptoms and 40 (45%) had no known travel history outside of Miami-Dade County during their pregnancy. Sixty-six women had antenatal ultrasounds, 14 (21%) of which ever had a head circumference or biparetial diameter measurement less than the third percentile, but none showed evidence of intracranial calcifications. Fifty-four women with positive testing have delivered: 46 at term and 8 preterm. Fifty-four infants have been born to women with positive ZIKV testing; 2 infants (1.98%) had documented congenital abnormalities. One infant was born with clinically-defined microcephaly (1.9%) and intracranial calcifications and the other had only intracranial calcifications. Ninety-four positive IgM tests were sent to the CDC for confirmatory plaque reduction neutralization testing (PRNT). 49 PRNT tests returned positive (ZIKV titer ≥10), while 28 returned negative (ZIKV titer &lt; 10), representing a false-positive rate of 30.4%.

Conclusion
As this epidemic persists, data from this unique cohort of pregnant women with both local and travel-associated ZIKV exposure contributes to the growing knowledge base regarding implications of ZIKV in pregnancy.

Disclosures
All authors: No reported disclosures.