bluuebunny/crossref_metadata_2025_split huggingface dataset:
1335. Retrospective evaluation of doxycycline for the treatment of Lyme disease among young children
Authors: Brown Katie , Handel Andrew S 
Published: December 2022

Abstract

Background
Lyme disease is the most common pediatric tickborne infection. Due to largely disproven concerns of doxycycline-related dental staining among patients &lt; 8 years old, no prospective data exist on efficacy and adverse effects in young children with Lyme disease. Based on emerging data, our institution has used doxycycline during the past decade when alternatives cannot be given. Our study aims to describe short-term adverse effects and treatment failures among young children receiving oral doxycycline for Lyme disease.

Methods
Retrospective chart review of patients &lt; 8 years old within the Stony Brook Medicine system from 2010-2020. Patients were identified by ICD-9/-10 codes for Lyme disease prescribed doxycycline at the same visit. We excluded those lacking an objective finding of Lyme disease, including single or multiple erythema migrans (EM), facial nerve palsy, carditis, meningitis (headache with pleocytosis &gt;5 WBC/μL), and/or arthritis, those with an alternative diagnosis, and those receiving post-tick exposure prophylactic doxycycline. Data collected included demographics, symptoms, laboratory results, treatments, and outcomes. Descriptive statistics were calculated.

Results
32 charts were included. Average age was 5.1 years. 66% were male. The majority of the patients presented with a single EM (Table for presenting symptoms). Initial antibiotics were doxycycline (63%) or a beta-lactam (37%). Rationale for doxycycline included beta-lactam allergy or intolerance (47%), required for treatment of clinical syndrome (such as CNS disease) (28%), concern for alternative tickborne infection (3%), and no reason given (22%). There were no severe adverse reaction to doxycycline; 2 patients stopped due to nausea/vomiting and 1 due to refusal of oral medications. Among the 29 patients who completed doxycycline, there were no known Lyme disease treatment failures.
Presenting symptoms of children &lt;8 years old treated with doxycycline for Lyme disease
Total percent exceeds 100% due to patients presenting with multiple symptoms. Percent calculation based on all included patients (n = 32).

Conclusion
In this small cohort of young children with Lyme disease, doxycycline was generally well-tolerated, without severe short-term adverse effects, and resulted in no treatment failures. As there is no prospective data evaluating doxycycline in this population and future randomized trials are unlikely, the data presented provides reassurance that doxycycline is effective and safe for this indication.

Disclosures
All Authors: No reported disclosures.
1356. Case Series of Children with Hepatitis and Adenovirus Infection, Alabama, October 2021—February 2022
Authors: Buchfellner Markus A , Amanda Ingram L , Shiau Henry , Sanchez Luz Helena Gutierrez , Saaybi Stephanie , Britt William , Sanchez Veronica , Potter Jennifer L , Kelly David , Lu Xiaoyan , Ayers-Millsap Stephanie , Willeford Wesley G , Rassaei Negar , Bullock Hannah , Reagen-Steiner Sarah , Martin Ali , Lamson Daryl M , Parashar Umesh D , Hall Aron J , MacNeil Adam , Tate Jacqueline E , Kirking Hannah L 
Published: December 2022

Abstract

Background
Human adenoviruses (HAdV) are a common cause of respiratory and gastrointestinal infections but rarely cause end-organ disease in children. From October 2021 to February 2022, several previously healthy children admitted to a single center for significant hepatitis also tested positive for HAdV. The aim of this investigation is to describe characteristics of these children.

Methods
Children admitted to Children’s of Alabama (COA) from October 2021 to February 2022 with hepatitis who tested positive for HAdV by whole blood RT-PCR were included. Demographic, clinical, laboratory and treatment data were collected from medical records. Residual blood specimens were sent for adenovirus typing.

Results
Nine pediatric patients with hepatitis and HAdV infection were identified (78% female; median age 3.0 years; IQR 1.7-3.0). Before admission, six reported diarrhea and three had respiratory symptoms. At presentation, eight had scleral icterus, six had jaundice, seven had hepatomegaly, and one was encephalopathic. All patients had elevated transaminases (AST range: 447-4000 U/L, ALT range: 784-4695 U/L); initial total bilirubin varied [range 0.23-13.5 mg/dL]). All had confirmed HAdV by RT-PCR on whole blood (initial qPCR range: 991-70,680 copies/mL). Notably, two children who transferred to another facility were negative for HAdV by RT-PCR when plasma was tested (instead of whole blood). Six children underwent liver biopsy showing varying degrees of hepatitis with no adenovirus detected on immunohistochemistry stains. Five children had HAdV type 41 confirmed. Three children presented or progressed to acute liver failure, two children were treated with cidofovir, and two underwent successful liver transplantation. No known epidemiologic links between patients were identified and all were from geographically distinct parts of Alabama.

Conclusion
HAdV is a potentially underrecognized cause of hepatitis. Whole blood specimens may be preferred over plasma for HAdV RT-PCR testing. HAdV type 41 was identified in all patients with typing results available. Improved type-based surveillance may help determine HAdV patterns of circulation and inform future diagnostic testing.

Disclosures
William Britt, MD, First Energy Corporation: Stocks/Bonds|Hookipa Pharma: Advisor/Consultant|Kroger Care: Stocks/Bonds|MDU Resources Group: Stocks/Bonds|PG&E Corporation: Stocks/Bonds.
1357. Collateral consequence of COVID pandemic: Increased incidence of cat scratch disease.
Authors: Praino Maria L , Infectologist Peditric , Julia Grigioni , Infectologist Peditric , Tineo Soledad , Infectologist Peditric , Martinez Mayra , Caratozzolo Ana , Toledano Analía , Cazes Claudia , Infectologist Peditric , Contrini María M , López Eduardo L 
Published: December 2022

Abstract

Background
Cat scratch disease (CSD) is a zoonosis caused primarily by Bartonella henselae.
The aim of our study was to determine the incidence CSD before the preventive and obligatory social isolation/distancing that was indicated in Argentina as a consequence of the SARS-CoV-2 pandemic on March 19, 2020 ("first period") and to compare it with the incidence since then to present ("second period").

Methods
Retrospective analysis of patients with CSD admitted to the Infectious Diseases outpatient office at Ricardo Gutiérrez Children’s Hospital (a tertiary care center) from March 2012 to March 2022. Charts were reviewed for demographic and epidemiological data, duration of symptoms, clinical manifestations and systemic compromise.

Results
Two hundred twenty-nine patients were observed during the study period. The median delay between symptoms onset and medical consultation was 15 days (IQR 9-30d), without statistically significant differences between periods The median age at presentation was 101.67 months (range 11.3 to 211.87 months) Age and gender were similar between periods.
The average number of cases per month was 1.63 (158 in 97 months) versus 3.23 (71 cases in 22 months) in the first and second periods, respectively, with an increasing incidence of 98%. The frequency of systemic compromise was higher in the second period: 47.89% versus 32.28% (p= 0.01).
The months with the highest incidence were February to July.

Conclusion
A significant increase of CSD were observed during the COVID pandemic probably related to a closer children´s contact with pets due to the strict quarantine that health authorities implemented. Moreover, an unexpected finding was a higher proportion of patients with systemic CSD during the pandemic period.

Disclosures
All Authors: No reported disclosures.
1371. Tularemia During Pregnancy: A Systematic Review of Treatment and Outcomes
Authors: Cooley Katharine M , Scheets Camryn , Meaney-Delman Dana , Nelson Christina , Fleck-Derderian Shannon 
Published: December 2022

Abstract

Background
Francisella tularensis, the gram-negative bacterium that causes tularemia, is endemic throughout the Northern Hemisphere and is a Tier 1 bioterrorism agent. Signs and symptoms can include fever, lymphadenopathy, pharyngitis, or pneumonia. Aminoglycosides, fluoroquinolones, and tetracyclines are effective for treatment; however, data on their use for tularemia in pregnancy is lacking. We performed a systematic review of tularemia during pregnancy to describe antimicrobial treatment and examine maternal, fetal, and neonatal outcomes.

Methods
We searched nine literature databases using terms related to tularemia and pregnancy and included articles describing cases of tularemia with at least one maternal or fetal outcome. Information abstracted included clinical features of tularemia; antimicrobial treatment during pregnancy; and maternal, pregnancy, and neonatal outcomes.

Results
Of 4,181 articles identified, 25 articles describing 47 cases of tularemia in pregnant patients were eligible for inclusion. Cases were reported between 1930 and 2021 from eight countries. Among cases with clinical form described, oropharyngeal tularemia was the most common (n=13/22, 59%), followed by ulceroglandular (n=5/22, 23%), glandular (2/22, 9%), and oculoglandular (n=2/22, 9%) forms. Patients were initially infected during the 1st trimester (26%), 2nd trimester (47%), 3rd trimester (18%), and before pregnancy (9%). Nineteen (40%) mothers were treated with at least one antimicrobial effective against F. tularensis: gentamicin (n=13), ciprofloxacin (n=6), doxycycline (n=1), and streptomycin (n=1). Four intrauterine fetal deaths (IUFD) occurred, all among pregnancies in which the mother received no effective antimicrobials. No pregnancy losses were reported among treated mothers. Among 34 live births, two were preterm and one case of hydranencephaly was identified, all among untreated mothers. No maternal deaths were reported.

Conclusion
Pregnancy loss and preterm birth have been documented in pregnant patients with tularemia who did not receive effective antimicrobial treatment. Prompt recognition and treatment of tularemia during pregnancy is important and could minimize risk for adverse outcomes.

Disclosures
All Authors: No reported disclosures.
1378. Fungal infections in burn patients during Northern California wildfires
Authors: Hauser Naomi , Branch Barbara , Palmieri Tina 
Published: December 2022

Abstract

Background
Wildfires are an increasing human health concern. In 2020 there were nearly 10,000 fires in California including 5 of the 6 largest wildfires recorded in the state, burning 4.1million acres. In addition to the known risks of direct burn and inhalation injury, extreme heat exposure, and psychological stress, there are unrecognized infection risks associated with smoke exposure. Fungal elements travel great distances in the air, and smoke significantly alters the number and diversity of fungal particles in affected geographical regions. Aims: To analyze the incidence and contributing factors for mould infections in hospitalized burn patients in the fall of 2020, during the peak of wildfire season.

Methods
We reviewed the electronic medical records for all patients admitted with burns in the fall of 2020 and recorded demographics, treatment, and outcomes. Data was stored in a secure electronic database.

Results
Of the 10 patients admitted with wildfire related burns, 4 developed mould infections. Two additional cases were diagnosed in patients burned in a plane crash and one in a house fire. Five of the 7 patients (71%) were men; patients had a mean age of 37.7 years (range 24-56 years); mechanism in 4 of the 7 was direct wildfire exposure (57.1%); mean total body surface area (TBSA) burned was 69% (range 44-90%). Mould infection was identified on or after hospital day 14 in all patients. A total of 5 mould genera were isolated, with Aspergillus mould genus isolated from 6 patients (85.7%). All 7 patients (100%) were treated with at least 2 days of antibacterials before identification of mould infection; 4 (57.1%) of the patients died before leaving the hospital. Following this period, mould cases decreased to baseline low levels of &lt; 10% for all burn sizes.

Conclusion
Wildfires in the western United States have had a devastating effect on the ecosystem and human health. We suspect that wildfires may increase the risk of invasive mold infections in burn patients with ambient wildfire smoke exposure. We observed a disproportionate number of invasive mould infections in hospitalized burn patients during large wildfires, which may have a significant impact on the seasonal treatment of burn patients. The relationship between wildfires and fungal infection warrants future investigation.

Disclosures
All Authors: No reported disclosures.
1382. Invasive Infections due to Groupable Streptococci at a Large Veterans Affairs Hospital: Clinical Characteristics and Outcomes
Authors: Seo Jung M , Krause Heidi , Hills Emma , Musher Daniel M , Kulkarni Prathit A 
Published: December 2022

Abstract

Background
Groupable streptococci (A, B, C, etc.) are known to cause a variety of clinical syndromes, including skin and soft tissue infection, primary bacteremia, osteoarticular infection, pneumonia, and endocarditis. However, there is a lack of recent literature on the clinical characteristics and outcomes of these infections. The purpose of this study was to describe the clinical characteristics of patients with invasive infections due to the groupable streptococci, identify risk factors for infection, and evaluate response to antimicrobial therapy.

Methods
We reviewed medical records of patients identified by the Infection Control service database at our Veterans Affairs (VA) hospital as having an invasive infection due to a groupable Streptococcus spp. Study inclusion criteria were: hospitalization between 2016 – 2019, age &gt;18, and growth of a groupable Streptococcus spp in a clinical specimen from a normally sterile site (excluding urine). Patients were excluded from the study if the positive culture was due to colonization rather than true infection and if inpatient admission was not required.

Results
A total of 75 patients were identified. The median age was 63; 97% of patients were male; and 52% were Caucasian. Comorbid conditions included diabetes (73%), peripheral vascular disease (33%), malignancy (20%), and chronic kidney disease (15%). The majority of infections was due to group B Streptococcus (72%), followed by group C (21%) and group A (7%). The most common sites of infection were soft tissue (41%) and bone (41%), and a substantial proportion of patients required intensive care (16%). The overall clinical cure rate was 83%. Reinfection occurred within one year in 11% of patients, and one patient (1%) died from another cause prior to completing the prescribed treatment regimen. The overall mortality rate from initial infection was 5%.

Conclusion
This study demonstrates that the modern clinical cure rate of invasive infections due to the groupable streptococci at a large VA hospital was 83%, even with appropriate source control and correct antimicrobial therapy. A substantial proportion of patients required admission to intensive care. These findings highlight the continued morbidity and mortality of these infections even in the modern era.

Disclosures
Prathit A. Kulkarni, M.D., Vessel Health, Inc.: Grant/Research Support.
1383. Necrotizing Fasciitis and Streptococcus pyogenes (GAS) Infection Seasonality and Risk Factors for Infection— a Multicenter Research Network Study
Authors: Kennis Matthew , Tagawa Alex , Kung Vanessa , Montalbano Gabrielle E , Narvaez Isabella , Franco-Paredes Carlos , Barahona Lilian Vargas , Shapiro Leland , Chastain Daniel B , Henao-Martínez Andrés F 
Published: December 2022

Abstract

Background
Streptococcus pyogenes causes acute pharyngitis and type II necrotizing fasciitis. Seasonal variations in the incidence of S. pyogenes infections are not robustly characterized. We aim to identify seasonal variations and risk factors of S. pyogenes infections and all causes of necrotizing fasciitis.

Methods
From 2010 to 2019, we identified all infectious adult cases of S. pyogenes using ICD-10 diagnoses and lab results (PCR and antigen-based assays) and cases of necrotizing fasciitis using ICD-10 diagnoses within a federated research network. We extracted seasonal (quarterly) incidence rates. We used an autoregressive integrated moving average (ARIMA) model to assess the seasonality of the cases (6-month intervals). Demographic characteristics and 3-month outcomes of S. pyogenes pharyngitis were compared to a cohort of patients with acute upper respiratory illnesses excluding S. pyogenes.

Results
We identified 238,088 cases of S. pyogenes pharyngitis and 26,931 cases of necrotizing fasciitis in adults. S. pyogenes infection average incidence was higher during the winter than the summer: 0.34 vs. 0.20 cases per 1,000 patients. Necrotizing fasciitis diagnoses were highest during the summer months (average 0.026 per 1000 patients). There was a significant ARIMA seasonal variation in the time series analysis for S. pyogenes infections (p=0.006) (figure 1). However, necrotizing fasciitis was not significant (p=0. 0.79) (Figure 2).
Compared to adults with acute respiratory infections other than S. pyogenes, adults with S. pyogenes pharyngitis were more likely to be younger (25.8 ± 14.9 vs. 45.4 ± 19.9 years old, p&lt; 0.0001) and of Hispanic or Latino ethnicity (11% vs. 8%, p &lt; 0.0001). For age-matched outcomes, adults with S. pyogenes pharyngitis had lower rates of hospitalization (0.888% vs. 1.714%, p&lt; 0.0001) and mortality (0.114% vs. 0.174%, p&lt; 0.0001) at three months relative to adults with acute respiratory infections other than S. pyogenes. Figure 1.Seasonal variation of adults with established ICD code or testing for Streptococcus pyogenes (GAS) infectionsFigure 2.Seasonal variation of adults with established ICD code for necrotizing fasciitis

Conclusion
Peaks in S. pyogenes infections are more likely to occur in the winter months, although spring and fall seasons can display variably high rates of S. pyogenes year over year. Necrotizing fasciitis of any microbiological did not show a significant seasonal variation.

Disclosures
All Authors: No reported disclosures.
1387. Prevalence and Risk Factors for Bacterial Resistance in Diabetic Foot Infections at a Hospital in Nicaragua.
Authors: Sandoval-Rojas Kevin A , Maliaños-Miranda Roger , Marenco-Avilés Sunaya , Castillo-Cano Maikelyn A , Porras-Cortés Guillermo D 
Published: December 2022

Abstract

Background
The bacterial resistance could have an deleterious outcome in patients with diabetic foot infections (DFI). The aim of this study was to determine the prevalence, the main risk factors, and clinical outcomes for DFI caused by bacterias that were resistant to different classes of antimicrobials in a hospital in Nicaragua.

Methods
A case-control study was conducted between January 2019 and March 2020 at Hospital Dr. Fernando Vélez Paiz in Managua (Nicaragua). Cases were patients with diabetic foot infections caused by drug-resistant organisms (DRO) and the controls were patients infected by non-drug resistant organisms (NDRO). The resistance to quinolones, beta-lactams, and carbapenems were evaluated in the Gram negative bacterias. In the cases of Staphylococcus aureus the resistant to methicillin was evaluated. Samples of tissue and exudates obtained by aspiration were processed. Conventional methods as blood agar and McConkey agar were used, and the final identification method was Vytek 2 System. Different variables of both groups were compared.

Results
A total of 76 bacterias were identified in 61 patients. Forty-four patients had an infection with at least one resistant bacteria for a prevalence of 72%. Staphylococcus aureus was the most prevalent bacteria and 76.9% of them were resistant to methicillin (MRSA). A 71% of the Gram negative bacterias were resistant to at least one class of antibiotic; 58% of them were resistant to quinolones, 40% were ESBL positive, and 12% were resistant to carbapenems. A total of 12 isolates were multi-drug resistant organisms (MDRO). The main risk factor to have an infection with a resistant bacteria was the use of antibiotics into the previous 3 months (OR:4.28; CI95%: 1.31-13.98). An infection caused by DRO was associated with a increased risk of amputation. Infections caused by NDRO had more probability of clinical resolution (OR:0.14; CI95%:0.04-0.48).
Prevalence of Resistant Bacterias to Different Classes of Antibiotics in Diabetic Foot Infections.

Conclusion
In this setting, the bacterial resistance in diabetic foot infections has to be considered significative. MRSA had a high prevalence and the Gram negative organisms showed an important resistance rate to different classes of antibiotics. The main risk factor was the previous use of antibiotics. The clinical outcome is affected by the bacterial resistance.

Disclosures
All Authors: No reported disclosures.
1388. Seasonality of Microbiology of Combat-related Wound Infections in Afghanistan
Authors: Soderstrom Matthew A , Blyth Dana M , Carson Leigh , Campbell Wesley R , Yabes Joseph , Shaikh Faraz , Stewart Laveta , Tribble David R , Murray Clinton K , Kiley John L 
Published: December 2022

Abstract

Background
We examined the seasonality of wounds and wound infections, including occurrence of multidrug resistance, among combat casualties injured in Afghanistan.

Methods
The Trauma Infectious Disease Outcomes Study is a retrospective observational study of infectious complications among military personnel wounded during deployment (06/09-12/14). Wound cultures obtained ≤7 days following injury in Afghanistan were assessed. Epidemiologic, clinical, and microbiologic data were analyzed by injury season [winter (1 Dec-28/29 Feb), spring (1 Mar-31 May), summer (1 Jun-31 Aug), and fall (1 Sep-30 Nov)]. Multidrug-resistant (MDR) determinations for Gram-negative and Gram-positive organisms were per standardized definitions.

Results
The study population included 316 patients with a median of 3.5 (IQR 3-5) days from injury to initial culture. Gram-negatives (N=188, 59.5%) were more commonly isolated from wound cultures in summer (N=81, 43.1%) and fall (N=57, 30.3%) versus winter (N=18, 9.6%) and spring (N=32, 17%) (p&lt; 0.001). The MDR Gram-negatives (N=69, 21.8%) were more common in summer (N=26, 37.7%), and fall (N=26, 37.7%) versus winter (N=3, 4.3%) and spring (N=14, 20.3%) (p=0.028). Wound infections were diagnosed in 198 (63%) patients. The pattern for infecting Gram-negative isolates (N=143, 72.2%, Table 1) was similar to that of overall Gram-negative isolates: summer (79.5%) and fall (83.6%; p&lt; 0.001); MDR Gram-negatives (summer, 25.6%) and (fall, 41.8%; p=0.015). Escherichia coli and Enterobacter spp. were the most common infecting Gram-negative bacilli with no significant difference across the seasons. There was a higher proportion of infecting Acinetobacter baumannii isolates in the summer and fall compared to winter and spring. Infecting Gram-positive isolates (N=128, 65%) were not significantly different by season. Anaerobes associated with infections were also identified (N=30, 15%) with a higher proportion in the winter compared to summer, fall, and spring (p=0.036).

Conclusion
Gram-negatives, including MDR Gram-negative infecting organisms, were more common in summer/fall months in service members injured in Afghanistan. This may have implications for empiric antibiotic coverage during these months.

Disclosures
David R. Tribble, DrPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.