bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Spectrum of Pediatric Osteoarticular Infections: A Comparative Study
Authors: Alhinai Zaid , Elahi Morvarid , Foo Bill , Lee Brian , Chapin Kimberle C , Dennehy Penelope H , Koster Michael , Sanchez Pablo J , Michelow Ian C 
Published: October 2017

Abstract

Background
There is a paucity of data relating to pediatric subacute or chronic hematogenous osteomyelitis (SCHO), non-hematogenous osteoarticular infections (NHO), and osteoarticular hardware infections (HI). A comparative analysis of the entire spectrum of pediatric osteoarticular infections was conducted to identify distinguishing clinical features and biological markers.

Methods
Using ICD9/10 code searches, we identified pediatric patients ≤18 years of age at Hasbro Children’s Hospital (2006–2016) and Nationwide Children’s Hospital (2015–2016) with osteoarticular infections. Cases of Lyme arthritis or ENT-related infections were excluded. Eligibility criteria were confirmed by reviewing medical records and clinical and laboratory data were collected systematically.

Results
428 children met inclusion criteria: 211 (49%) had acute hematogenous osteomyelitis (AHO), 61 (14%) suppurative arthritis (SA), 42 (10%) SCHO, 60 (14%) NHO, and 54 (13%) HI. The age distribution differed significantly across the five infection types: AHO (median, 9.2 years), SA (5.0), SCHO (10.2), NHO (11.5), and HI (14.5); P &lt; 0.001. Median initial CRP values were significantly higher (P &lt; 0.001) in AHO (65 mg/dl) and SA (44) compared with SCHO (15), NHO (15) and HI (24). An ESR &gt;19 mm/hours at presentation was more sensitive than a CRP &gt;8.0 mg/dl in identifying SCHO (80% vs. 64%; P = 0.035). Bacteremia occurred more frequently in AHO (42%) and SA (25%) compared with SCHO (7%), NHOI (5%) and OHI (4%); P &lt; 0.001. Patients with HI had significantly more complications as reflected by more ICU admissions (33% vs. ≤3% for other groups), and longer antibiotic treatment durations (median, 65 vs. ≤37 days for other groups); P &lt; 0.001 for each comparison. S. aureus was the most common organism isolated for all infections, but the proportion of other Gram- and Gram-negative pathogens was significantly higher in SCHO, NHO, and HI compared with AHO and SA (P &lt; 0.001). The ratio of MSSA to MRSA among isolates was 3:1, and did not differ significantly across the infection types.

Conclusion
SCHO, NHO, and HI commonly present with minimal evidence of inflammation, and differ in the spectrum of causative pathogens compared with AHO and SA. Further studies are required to optimize the diagnosis and management of non-acute, non-hematogenous osteoarticular infections.

Disclosures
All authors: No reported disclosures.
Septic Arthritis due to Oral Streptococcal Species Following Intra-articular Injection: A Case Series and Retrospective Chart Review
Authors: Cain Stacy , Sifri Costi D , Lewis Jessica 
Published: October 2017

Abstract

Background
Oral streptococcal species are a rare cause of septic arthritis. We hypothesized that one possible source of infection is oral bacteria from the mouth of a practitioner performing joint injection without a mask. While the use of a face mask is standard practice during lumbar puncture and other spinal procedures due to the risk of iatrogenic meningitis, mask usage during joint injection is not a standard recommendation.

Methods
The clinical microbiology laboratory database was reviewed to identify joint fluid cultures positive for oral streptococcal bacteria between January 2007 and December 2015. The corresponding patient charts were reviewed for evidence of joint injection within 90 days prior to the positive culture.

Results
We identified 18 cases of septic arthritis due to oral streptococcal species. Of those joint injection was performed prior to the development of acute septic arthritis in four (22%) cases. The implicated pathogen was Streptococcus mitis/oralis in two cases, Streptococcus sanguinis in one case, and Abiotrophia defectiva in one case. All four cases occurred in males over the age of 60 and affected native joints. Three of four patients had underlying osteoarthritis, and three of four had a history of diabetes. The patients all presented with acute worsening of joint pain and swelling 2–5 days after undergoing joint injection. Three cases followed corticosteroid injection and 1 followed an MRI arthrogram. All four patients underwent at least one surgical procedure (two required repeat irrigation and debridement) to treat the infection and received at least 4 weeks of antibiotic therapy.

Conclusion
Oral streptococcal species should be considered in the differential of causative species of septic arthritis in patients presenting with worsening pain after a joint injection. The use of a face mask during joint injection should be explored as a simple and inexpensive precaution to prevent this rare but serious complication.

Disclosures
All authors: No reported disclosures.
Clinical Experience with Tigecycline in the Treatment of Prosthetic Joint Infections
Authors: Lastinger Allison , Dietz Matthew , Guilfoose John , Sarwari Arif R 
Published: October 2017

Abstract

Background
As the population in the United States ages, the number of people who will require a joint arthroplasty is expected to rise dramatically. The most serious complication of this surgery is prosthetic joint infection (PJI) which can lead to long-term morbidity and even mortality. Biofilms play a major role in these infections, and studies have suggested that tigecycline may work better than other antimicrobials in the setting of biofilms. In this study, we examined our institution’s experience with using tigecycline to treat PJI.

Methods
This was a retrospective review of all adult patients with PJI treated at West Virginia University from January 2008 to March 2016 who received tigecycline for 50% or greater of the treatment course. Demographic data, rationale for tigecycline use, type of surgery, microbiologic data, outcome and complications were assessed. Failure was defined as need to return to the operating room for an infectious complication or persistent drainage from the joint.

Results
In total, 34 patients met inclusion criteria. The median age was 65 years, and 62% of the patients were female. The most common reason for tigecycline use was empiric therapy, but other reasons included antimicrobial allergies and resistant organisms. The antimicrobial was used as frontline therapy in 29 cases (85%), and the mean duration of tigecycline therapy was 38 days. The most common organisms isolated were methicillin resistant Staphylococcus aureus (n = 7), coagulase negative Staphylococci (n = 5), and Enterococcus species (n = 4), but 12 cases (35%) were culture negative. Treatment success was documented for 21 cases (62%); though, there was limited follow-up (2 months or less) in four of the successful cases. Nausea and vomiting was the most common adverse event, occurring in three patients.

Conclusion
Tigecycline is a glycylcycline approved for use in a variety of infections including intra-abdominal and skin soft-tissue infections, but little is known about its use in the treatment of PJI. We found that tigecycline is well tolerated even when given for 6 weeks duration. Twenty-one of the 34 patients (62%) met our definition of successful treatment outcome with tigecycline. More studies are needed to assess tigecycline’s use in the treatment of PJI.

Disclosures
All authors: No reported disclosures.
Factors Associated with Not Using a Condom at Last Sex Among Sexually Active US Navy and Marine Corps Personnel Across a Shipboard Deployment
Authors: Harbertson Judith , De Vera Kimberly , Scott Paul , Shaffer Richard , Michael Nelson , Hale Braden 
Published: October 2017

Abstract

Background
Condom use is highly effective in preventing sexually transmitted infections (STIs); however, data on this are limited among US military personnel who may be at a higher risk for STI acquisition across a deployment cycle. This study examined factors associated with no condom use at last sex at three time points, pre- (T1), during (T2), and post-deployment (T3), across a US military shipboard deployment cycle.

Methods
Data were collected among active duty US Navy and Marine Corps personnel assigned to 11 deploying ships using an anonymous, voluntary, self-completed survey, including demographics, condom use at last sex, sexual risk behavior, STI diagnosis, alcohol misuse (Alcohol Use Disorders Identification Test–Consumption), and drug use with sex. Descriptive and generalized regression model analyses were conducted to determine the effects of main exposures after adjusting for demographic characteristics, with statistical significance defined as P &lt; 0.05. When longitudinal data were included, generalized estimating equations were used. Models included their interaction with time.

Results
Among participants, n = 1,900 (T1), n = 549 (T2), and n = 1,168 (T3) reported age and sex, were sexually active, and included in the analysis. The proportion of individuals who used a condom at last sex was significantly higher during T2 (53%, P &lt; 0.0001) than T1 (27%) and T3 (28%), with an STI prevalence of 1% (T1), 7% (T2), and 2% (T3). In adjusted models, participants not using a condom at last sex were significantly more likely to report an STI diagnosis (OR 2.26, 95% CI 1.19–4.28), screen positive for hazardous alcohol use (OR 1.44, 95% CI 1.21–1.71), and use drugs to enhance sex (OR 1.37, 95% CI 1.06–1.77), but less likely to engage in transactional sex (OR 0.69, 95% CI 0.50–0.94). Associations between condom use and main exposures did not differ significantly by time point.

Conclusion
Although condom use was significantly higher during T2, STI prevalence remained high, which suggests those who do not use a condom during deployment are at a higher risk for STI acquisition than pre- or post-deployment. These data may inform interventions targeting high STI acquisition risk individuals and time periods to increase condom use.

Disclosures
All authors: No reported disclosures.
Reducing Dissemination of Viruses from Computer Touchscreens through Patient Hand Hygiene and an Automated Ultraviolet-C Touchscreen Disinfection Device
Authors: Alhmidi Heba , Cadnum Jennifer , Piedrahita Christina , John Amrita , Donskey Curtis 
Published: October 2017

Abstract

Background
Computer touchscreens in patient waiting areas are a potential source for spread of viral and bacterial pathogens in healthcare facilities. Patient hand hygiene is recommended to prevent acquisition of pathogens on hands.

Methods
We tested the efficacy of patient hand hygiene alone or in combination with a novel automated ultraviolet-C (UV-C) touchscreen disinfection device for reduction in dissemination of the nonpathogenic non-enveloped virus bacteriophage MS2 from contaminated touchscreens. Subjects randomized to control, alcohol hand sanitizer (10 or 30 second application), UV-C (30-second cycle), or alcohol hand sanitizer plus UV-C contacted 4 sites routinely used during operation of the touchscreen and then fingerpads were cultured. The log plaque-forming units (PFU) recovered were compared for each group. Patients were observed to determine the frequency of hand hygiene after use of a touchscreen in a waiting area.

Results
As shown in the figure, the mean log10PFU of bacteriophage MS2 recovered from fingerpads was significantly reduced by each of the interventions (P &lt; 0.001). However, only the combination of hand hygiene and UV-C was effective in completely preventing virus transfer. Of 20 patients observed in a waiting area, 0 (0%) used hand sanitizer that was available adjacent to the touchscreen.

Conclusion
Our results suggest that use of alcohol hand sanitizer alone or in combination with an automated UV-C touchscreen disinfection device could reduce transmission of viruses from contaminated touchscreens. There is a need for education of patients on the importance of hand hygiene after contact with touchscreens.

Disclosures
All authors: No reported disclosures.
An Appeal to Incorporate Hand Hygiene Education into Standard Elementary School Curriculum
Authors: Watson Jasmine , Owens Alexandria , Imrit-Thomas Kavita , Malone Miranda , Tobias Andy , Goudar Lakshmi 
Published: October 2017

Abstract

Background
The Center for Disease Control and Prevention reports that 160 million school days are lost each year due to infectious illnesses. Hand hygiene is one of the most effective ways to prevent illness that can lead to absenteeism among school-aged children, yet few schools have a formal education program as a preventative strategy.

Methods
A Pilot Hand Hygiene experiment was initiated for 90 second grade students at a Virginia Beach Public School. The experiment was designed to bring awareness and to satisfy a scientific module requirement. Students cultured their hands on general purpose agar plates with the assistance of physicians and a microbiologist. The proper hand washing technique was demonstrated. Students were equally divided into two groups: hand washing group and sanitizer group. They were instructed to re-culture hands after intervention. Students observed cultures for five days and documented results.

Results
Overall, student observation of decreased microbial growth was an average of 91% (Figure 1). Education improved compliance, which resulted in a favorable behavioral change on average of 89% (Figure 2). There was a 71% decrease in incidence of illness-related absences 30 days after the hand hygiene intervention (Figure 3). In three out of five classes, hand sanitizer was more effective when compared with hand washing. In addition, a random sample of cultures were incubated in a microbiology lab to identify the common microbes among the second-grade elementary school population. It revealed both resident and transient flora. Post-intervention, there was a rise in coagulase-negative Staphylococci resident flora. This indicated a successful decrease in transient flora, which is most likely to cause illness.

Conclusion
Hand Hygiene education is remarkably beneficial, especially in children who are at greater risk of illness. It is clearly effective in decreasing infectious disease risk, while teaching a life-long skill. For the impact as a preventative strategy to be felt, its implementation into elementary school curriculum is warranted.

Disclosures
All authors: No reported disclosures.
Bivalent Norovirus VLP Vaccine Candidate in Older Adults: Impact of MPL and a Second Dose in a Randomized, Controlled, Double-Blind Clinical Trial
Authors: Sherwood Jim , Cramer Jakob , Cam Nancy Bouveret Le , Lin Stella , Baehner Frank , Mendelman Paul , Borkowski Astrid 
Published: October 2017

Abstract

Background
Acute norovirus (NoV) gastroenteritis may cause significant morbidity in healthy adults and can prove fatal in older subjects. We investigated the safety and immunogenicity in older adults of one or two doses of an intramuscular bivalent virus-like particle (VLP) vaccine candidate (genotypes GI.1 and multivalent consensus GII.4c) formulated with alum and with and without MPL (3-O-deacyl-4′-monophosphoryl lipid A) adjuvant.

Methods
In a phase II, double-blind, controlled trial, 294 healthy adults &#x2028;≥ 60 years of age randomized to 4 equal groups received one or two immunizations 28 days apart. One dose groups received placebo (saline) on Day 1. Vaccine formulations contained 500μg Al(OH)3adjuvant with 15μg GI.1 and 50μg GII.4c VLP antigens, with or without 15μg MPL adjuvant. A fifth group of 26 healthy 18–49 year-olds received one dose of MPL-free vaccine. Humoral immunity was assessed as ELISA pan-Ig and histo-blood group antigen blocking (HBGA) antibody titers at Days 1, 8, 29 and 57. Cell-mediated immunity (CMI) and avidity indices (AI) were also measured. Safety was assessed as solicited local and systemic adverse events (AE) for 7 days, and unsolicited AEs until Day 28 after each vaccination.

Results
Marked increases in pan-Ig and HBGA to both genotypes occurred by Day 8 after first vaccination. Geometric mean titers were similar in magnitude in all groups and persisted at similar levels through Day 56. No increases were observed with a second vaccine dose on Day 29 or with the formulations containing MPL. Responses were similar in magnitude when assessed by age groups (60–74, 75–84 and ≥ 85 years of age) and when compared with those to a single vaccine dose in 18–49 year-olds. No clinically relevant differences in CMI responses or changes in antibody avidity were observed between formulations. Both formulations were generally well tolerated, the most frequent reaction being mild pain at the injection site. No vaccine-related SAEs were reported.

Conclusion
Older adults aged over 60 years displayed immune responses to NoV VLP vaccines that were similar to those in younger adults with no apparent signs of immunosenescence. These data support the further development of the MPL-free vaccine candidate in older adults.

Disclosures
J. Sherwood, Takeda Pharmaceuticals International AG: Employee, Salary; J. Cramer, Takeda Pharmaceuticals International AG: Employee, Salary; N. Bouveret Le Cam, Takeda Vaccines Inc.: Employee, Salary; S. Lin, Takeda Vaccines Inc.: Employee, Salary; F. Baehner, Takeda Pharmaceuticals International AG: Employee, Salary; P. Mendelman, Takeda Vaccines Inc.: Employee, Salary; A. Borkowski, Takeda Pharmaceuticals International AG: Employee, Salary
HIV Risk Assessment using Longitudinal Electronic Health Records
Authors: Feller Daniel , Zucker Jason , Yin Michael , Gordon Peter , Elhadad Noemie 
Published: October 2017

Abstract

Background
Universal HIV screening programs are costly, labor-intensive, and in practice unable to identify all individuals at risk of HIV infection. Automated risk assessment methods that leverage longitudinal electronic health records (EHRs) could catalyze targeted screening programs in Emergency Departments and across public health jurisdictions. While information on social and behavioral determinants of health are typically collected in unstructured fields, previous analyses have only considered structured EHR data. We sought to characterize whether clinical notes can improve predictive models of HIV diagnosis.

Methods
181 individuals who received care at an academic medical center in New York City prior to a confirmatory HIV diagnosis were included in the study cohort. 543 HIV- controls with similar utilization patterns were selected using propensity score matching. Demographics, laboratory tests, and diagnosis codes were extracted from longitudinal records. Clinical notes were preprocessed using both topic modeling and an n-grams approach. We fit 3 predictive models using Random Forests including a baseline model which included only structured EHR data, the baseline model plus topic modeling, and baseline model plus clinical keywords.

Results
Predictive models demonstrated a range of performance with F-measures of 0.59 for the baseline model, 0.63 for the baseline plus topic modeling and 0.74 for the baseline plus clinical keyword model. The baseline plus topic model displayed low precision but high recall while the baseline plus clinical keyword model displayed high precision but low recall. Clinical keywords including ‘msm’, ‘unprotected’, ‘hiv’, and ‘methamphetamine’ were indicative of elevated risk.

Conclusion
Clinical notes improved the performance of predictive models for automated HIV risk assessment. Future studies should explore novel techniques for extracting social and behavioral determinants from unstructured text in longitudinal EHRs.

Disclosures
All authors: No reported disclosures.
Assessment of personal experiences navigating medical systems and society for patients of a midwestern Ryan White funded HIV Clinic
Authors: Cruz Chancelor , Melendez Elsa Vazquez , Farrell John 
Published: October 2017

Abstract

Background
In the early years of the HIV/AIDS crisis, the debilitating consequences of HIV/AIDS stigma and discrimination became known as part of “the 3rd phase of the epidemic.” Many of these consequences still impact HIV/AIDS care today. In the state of Illinois, the HIV prevalence in Chicago and its collar counties does supersede the prevalence of HIV elsewhere in the state of Illinois, and past HIV research has utilized mostly urban MSM populations. Unfortunately, although HIV is not an exclusively urban disease, little is known about HIV stigma in smaller communities and lower prevalence contexts.

Methods
Participants were recruited from our local HIV clinic in a county population of 184,000 people. The clinic serves the HIV/AIDS population of Peoria proper as well as the 14 surrounding, more rural counties. Twenty participants were invited for a 1 hour recorded interview speaking of their experiences with HIV stigma. Using a qualitative approach in grounded theory, two researchers independently coded the transcripts and then came to a consensus. Core themes were then summarized.

Results
Sources of stigma included the general community in central Illinois, other outpatient medical clinics, medical testing facilities such as ancillary laboratories, and the LGBT community. Major sources of support included family and loved ones, the HIV medical clinic, and the HIV patient community. Many patients reported HIV education to be assuring, and though facing many social obstacles, ultimately feeling strengthened by adversity. In order to address HIV stigma in the community patients suggested greater networking among HIV infected patients and increased education for the general public.

Conclusion
HIV stigma is still a distressing social force to HIV infected patients in the heart of Illinois. Though medical management of HIV has advanced significantly in recent years, the stigma that accompanies a diagnosis of HIV infection remains to be effectively addressed in a comprehensive and conscientious manner. Our study points to the need for tailored interventions in outpatient medical settings, as well as throughout the general community in central Illinois.

Disclosures
All authors: No reported disclosures.