bluuebunny/crossref_metadata_2025_split huggingface dataset:
2151. Time to Positivity in Blood Cultures at a Free-Standing Level IV NICU
Authors: Nishihara Yo , MacBrayne Christine , Prinzi Andrea , Zenge Jeanne , Grover Theresa , Parker Sarah K 
Published: December 2022

Abstract

Background
In the Neonatal Intensive Care setting, subtle clinical deterioration of the infant combined with the lack of specificity in clinical signs to identify true infection often triggers an evaluation for sepsis. Blood cultures are obtained, and empiric antibiotics are initiated. Limiting the duration of antibiotic exposure has potential benefits in curtailing antimicrobial resistance and reducing unwanted adverse effects. We aimed to determine the time to positivity (TTP) of blood cultures in a level IV NICU over a 6-year period, with the goal to reassess our antimicrobial practice.

Methods
Data were extracted from the Children’s Hospital Colorado data warehouse for all neonates admitted to the NICU with a positive blood culture between Jan 2013 to Dec 2018. These patient’s charts were reviewed for both microbiologic and clinical data. TTP was calculated based on date and time culture was collected, compared to the date and time growth was first reported. Micro-organisms were categorized into absolute pathogens, potential pathogens, common contaminants, yeast and other less frequently identified organisms.

Results
A total of 309 positive blood cultures were identified from 268 neonates. The mean gestational age was 34.7 weeks with an average birthweight of 2353g. Overall TTP median and interquartile range (IQR) was 21.1 (14.4 ,25.4) hours. The median (IQR) TTP for gram-positive absolute pathogens and gram-negative absolute pathogens were 16.3 (13.0, 22.4) and 12.6 (11.3, 14.4) hours, respectively. Of the 309 positive culture results, 295 (95%) had been initiated with antibiotics; 110 (37%) were later deemed as contaminant, and treatment discontinued. Central line associated bacterial infection was documented in 35 cases (11%). Death within 4 weeks of culture positivity was recorded in 25 (9.5%) cases.

Conclusion
The majority of gram-positive and gram-negative pathogens were identified within 24h of blood culture collection. A substantial number of cases were later categorized as contaminants, highlighting the importance of correct sterile technique when obtaining cultures. These findings highlight opportunities for antimicrobial stewardship to limit antibiotic exposure in the NICU. The high mortality within 4 weeks of blood culture positivity warrants further study.

Disclosures
All Authors: No reported disclosures.
2155. Evaluation of the Effect of Omicron Variant on Case Numbers in Children
Authors: Arslan Aslı , Yıldırım Arslan Sema , Avcu Gülhadiye , Durusoy Raika , Çiçek Candan , Şahbudak Bal Zümrüt , Özkınay Ferda , Kurugöl Nuri Zafer 
Published: December 2022

Abstract

Background
SARS-CoV-2 Omicron variant has become dominant in many countries, and a significant increase in the number of cases has been noted due to this highly contagious variant. This study aimed to determine the changes in case numbers, age distribution and hospitalized patients’ characteristics in children with COVID-19 by comparing the Omicron variant that was dominant before.

Methods
5647 pediatric patients with SARS-CoV-2 PCR positive between 11 March 2020 and 28 February 2021 at Ege University Hospital were included in the study. Two time periods of 2.5 months were determined: Omicron predominant period (16 December 2021 and 28 February 2022) and the pre-Omicron period (1 October and 15 December 2021). The information was obtained from the files of patients retrospectively.

Results
The Omicron variant caused a significant increase in pediatric patients after December 15, 2021 (Graphic 1). There were 2893 pediatric patients since the beginning of the pandemic, while 2754 pediatric patients after the Omicron variant only the 2.5 months. While the test positivity rate was 10.4% on average before the Omicron, it increased to 30.37% on average after Omicron (Graphic 2). The comparison of the epidemiological characteristics of the Omicron and the pre-Omicron period is given in Table 1. In the Omicron period, 17.1% of the cases were 0-4 years old, and 0-6 months was 3.9%. While the disease was more common in children over 5 years old in the pre-Omicron period, a 4.6-fold increase was observed in 0-4 years after Omicron. Children under the age of 5 constitute 51.9% of the hospitalized children; a 4.5-fold increase occurred in the Omicron period. While hospitalization rates increased after the Omicron, no significant difference was found in intensive care unit admission. There was a significant decrease in the number of patients receiving oxygen and the need for mechanical ventilation.
Number of SARS-CoV-2 PCR positive children by months in Ege University Hospital
Test positivity rate in children by month at Ege University Hospital
Comparaiton of pre-Omicron and Omicron period

Conclusion
The number of cases in children increased with the effect of the Omicron variant, especially the increase was more pronounced between 0-4 years of age. Despite this increase in the cases, no serious increase was observed in the severity of the disease, but a decrease in pneumonia, oxygen demand, and mechanical ventilator requirement was observed. While the number of tests decreased, test positivity rates increased.

Disclosures
All Authors: No reported disclosures.
2159. Monoclonal Antibody Treatment for COVID-19 in Children: Experience of a Pediatric Tertiary Care Center
Authors: Ibrahim Osama , Ferlisi Kristen , McCormick Winston , Alcorta Cristina E , Koster Michael 
Published: December 2022

Abstract

Background
Pediatric patients are more likely than adult patients to experience mild COVID-19 infection but may still suffer severe infection with lasting sequalae or death. One treatment modality is monoclonal antibodies (MABs), which prevent viral replication by binding the epithelial surface receptor for the SARS-CoV-2 spike protein. The Food and Drug Administration (FDA) issued emergency use approval (EUA) for multiple MAB regimens. Clinical trials have shown decreasing viral loads and reductions in hospitalization and death in high-risk adult COVID-19 patients after MAB administration, yet casirivimab/imdevimab (C/I) and bamlanivimab/etesevimab (B/E) have decreased efficacy against Omicron compared to other variants. There is insufficient literature studying MABs in clinical practice among the pediatric population.

Methods
This study seeks to fill this knowledge gap by reporting the experiences and outcomes with MAB administration of a single pediatric tertiary care center in Rhode Island.Our retrospective case-series documents all mild-to-moderate COVID-19-infected patients who received MABs at Hasbro Childrens Hospital in Providence, RI from January 2021 to March 2022. Included patients had at least one risk factor for severe COVID-19 infection as indicated by the FDA EUA.

Results
Overall, 108 patients received MABs. Out of the 108 patients, 97 had COVID-19, 11 received post-exposure prophylaxis, 62 patients received B/E, 36 received C/I, 9 received B, and 1 patient received Sotrovimab. Regarding comorbid conditions, 65 had 1 condition and 43 had 2+ conditions. The most common comorbidities were obesity (48), chronic lung disease (37), and immunocompromised state (33). There were 7 cases of infusion-related reaction that resolved during observation in the infusion site. In all, 101 patients completed their recovery at home without events, 1 patient was admitted to the ICU for worsening respiratory status, 3 patients presented to the ED for worsening symptoms and were discharged home, and 3 patients presented for unrelated symptoms within 28 days.

Conclusion
This study suggests MABs are well-tolerated and effective for preventing severe COVID-19 infection or death among high-risk pediatric patients and for decreasing the health burden of COVID-19 during surges.

Disclosures
All Authors: No reported disclosures.
2165. Surveillance of Severe Viral Respiratory Infections among Children Presenting to Hôpital Saint Damien in Haiti
Authors: Turner Jasmine C M , Gassant Pascale , Gautier Jacqueline , Joseph Marie Betanie , Gustinvil Robens , Deroncelay Alexandra , Dor Vanessa , Lee Natalie , Homsi Maysam R , Webby Richard , Caniza Miguela A 
Published: December 2022

Abstract

Background
Learning the burden and seasonality of respiratory viral infections in children in resource-limited settings is critical for hospital infection care and prevention and national public health programs. We built a prospective surveillance program of severe acute respiratory illness (SARI) in hospitalized children at Hôpital Saint Damien - Nos Petits Frères et Soeurs to gather local evidence and support informed clinical and policy decision-making. The COVID-19 pandemic erupted as we were launching our project, requiring the use of available point-of-care diagnostics.

Methods
Children &lt; 18 years of age with cough, history of fever ≥ 38 C°, of &lt; 10 days evolution, and requiring hospitalization were included in the study. We obtained a nasopharyngeal swab and collected demographic and clinical data for eligible patients. Samples were tested using antigen test on-site for influenza A (Flu A) and B (Flu B), respiratory syncytial virus (RSV), and SARS-CoV-2. Afterwards, all specimens (both negative and positive) were stored and shipped for molecular studies.

Results
We obtained and tested 167 samples from patients since April 30, 2021, through January 31, 2022. Single isolates were detected in 88 samples (53%), multiple isolates in 20 samples (12%), and no isolates in 59 samples (35%). Positive cases for RSV, Flu A, and Flu B peaked between November and January. Rhinovirus 1A (RhV) was detected throughout the study period, with peaks around August-September and was the most often detected viral isolate (49, 38%), followed by RSV (37, 29%). Co-infections were seen with RSV, Flu A, RhV, and SARS-CoV-2. Molecular studies detected 7 isolates of Flu A not detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2. However, it failed to detect 2 isolates of Flu A detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2.

Conclusion
Our study captured circulating respiratory viruses in children with SARI in Haiti during the COVID-19 pandemic. Preliminary data suggest an increase in respiratory viruses between August and January. Improving point-of-care diagnostics can better inform providers of the local epidemiology of respiratory viruses and support clinical decision-making, such as good use of antibiotics. However, we confirmed the sensitivity of molecular testing.

Disclosures
All Authors: No reported disclosures.
2174. Development and Validation of a Clinical Prediction Model for Community-Onset Pneumonia caused by Extended-Spectrum Beta-lactamase-Producing Enterobacteriaceae
Authors: Enriquez Jhon Ryan G 
Published: December 2022

Abstract

Background
The study aims to identify specific risk factors associated with developing pneumonia cause by ESBL producing organisms and develop a Clinical scoring model base on the risk factors identified to be able to provide guidance on appropriate empiric antibiotic therapy

Methods
We conducted a single-center retrospective cohort study in a tertiary hospital on Pasig City, Philippines including 150 patients admitted with Community onset Pneumonia from 2018 to 2019
Baseline Characteristics
Independent variables included in the study

Results
Among 150 patients admitted with Community onset Pneumonia, 70.2% their respiratory isolates were K. Pneumoniae followed be E. coli at 14.57%. The Total ESBL rate among all the respiratory isolate was 45.3%. Univariate analysis of all the risk factors showed significant statistical difference in female Sex (OR 0.49; 5% CI: 0.26-0.96), Charlson Score (OR 26.00; 95% CI: 10.66-63.39), Recent Hospitalization (OR: 29.35; 95% CI: 11.53-74.46), Recent Antibiotic Use (OR 84.49; 95% CI: 28.66 – 251.87), Prior History of ESBL (OR: 57.14; 95% CI: 12.96 – 525.01), and Frequent ED visits (OR:45.88; 95% CI; 15.92 – 132.23). Multivariate analysis was done to generate the final model. The results shows that Charlson Score (OR 11.86, 95%CI: 2.55 – 55.18, p value 0.002), Recent Antibiotic Use (OR: 31.09, 95%CI: 5.36-180.44, p value &lt; 0.001). and Frequent ED visits (OR 6.52; 95% CI 1.04-41.07) were found to be significant predictor of ESBL. The final model of the three risk factors has a performance AU ROC Curve of 0.9780 at distinguishing between the positive and negative samples.
Sensitivity, Specificity, PPV, NPV and ROC area of each of the variables included in the final model

Conclusion
The results of this study suggest a simple and easy-to-use prediction model to predict Community-onset pneumonia caused by ESBL-producing Enterobacteriaceae.

Disclosures
All Authors: No reported disclosures.
2175. Diagnostic Utility of Pneumococcal Urinary Antigen Assay in Clinical Practice: a Retrospective Study in a Community Hospital in Evanston, Illinois
Authors: Egoryan Goar , Nava Guillermo Rodriguez , Nava Guillermo Rodriguez , Kishmiryan Armen 
Published: December 2022

Abstract

Background
While the pneumococcal urine antigen test (PUAT) is a validated tool for diagnosing pneumonia, recent evidence suggested lower sensitivity than expected (approximately 60-65%) and limited impact on clinical outcomes. A lack of clinical indicators for a positive test result and the absence of clear recommendations based on high-quality evidence create grounds for potential test misuse in real practice.

Methods
We performed a Workbench report to retrieve individual orders of Streptococcus pneumoniae urine antigen test (BinaxNOWTM) from our community hospital in Evanston, Illinois, between January 1, 2011, and December 31, 2021. We then identified patients with or without clinical pneumonia based on McGeer criteria: new infiltrates on chest x-ray plus cough, shortness of breath, oxygen saturation &lt; 94%, or respiratory rate ≥ 25 plus fever, leukocytosis, or altered mental status.

Results
Among 8,110 individuals tested for PUAT, only 273 positive results were identified (3.36%); of those, 83 (30.4%) did not meet criteria for clinical pneumonia (Figure 1). The median age of patients in a group with clinical pneumonia and without was 67 and 69 years, respectively. The prevalence of diabetes mellitus, COPD/asthma, and immunosuppression was not statistically significant between groups (Table 1). The signs and symptoms are presented in Table 2.S. pneumoniae was cultured in only 13.9% of cases in patients with clinical pneumonia, which correlates with the known sensitivities of this test (Table 3). More ICU admissions and NIPPV use were noted in patients with clinical pneumonia (p = 0.04 each). However, there was no difference in the use of antibacterial therapy among the two groups (p = 0.83), mechanical ventilation rates (p = 0.2), and length of hospital stay (p = 0.2) (Table 4). The positive predictive value of PUAT was 69% in our study (Table 5).

Conclusion
Our study demonstrated a low positivity rate of PUAT despite a large sample size and a significant proportion of positive test results in patients without clinical pneumonia. The widespread use of PUAT should be carefully reconsidered and applied only to a selected category of patients. Such a strategy will reduce the discrepancy between current guidelines and real-world care patterns and provide an additional benefit of cost-effectiveness.

Disclosures
All Authors: No reported disclosures.
2179. Multiple cytokine analysisbased on QuantiFERON-TB Gold Plus in different tuberculosis infection status:anexploratory study
Authors: Yang Zhengrong , Zhang Lifan , Ge Qiping , Zhang Yueqiu , Wu Fengying , Gao Mengqiu , Liu Xiaoqing 
Published: December 2022

Abstract

Background
To explore the differences of multiple cytokines secretion based on QuantiFERON-TB Gold Plus(QFT-Plus)antigens stimulation, and to screen cytokines with potential to differentiate tuberculosis infection status.

Methods
Twenty patients diagnosed microbiologically with active tuberculosis(ATB)in Peking Union Medical College Hospitaland Beijing Chest Hospital from February to April 2022 were enrolled.Fifteen healthcare workers(HCWs) with latent TB infection(LTBI),10 HCWs with previous TB and 10 HCWs as healthy control(HC) were recruited during the same period. After stimulated by QFT-Plus antigens,the secretion of interferon gamma(IFN-γ),tumor necrosisfactor-α(TNF-α), interleukin(IL)-2(IL-2), IL-6, IL-5, IL-10, interferon-inducible protein-10(IP-10), IL-1 receptor antagonist(IL-1Ra),chemokine(C-X-C)Ligand-1(CXCL-1)and macrophage chemoattractant protein 1(MCP-1)) in Plasma were measured by Luminex Assays.

Results
1.After stimulation with QFT-Plus TB1 orTB2 antigens, the level of IFN-γin ATB and LTBI groups was significantly higher than that in HC group(p&lt;0.05),while there was no significant difference between ATB and LTBI groups(p &gt;0.05).Cytokines including IL-2,IL-1Ra, CXCL-1have the similar secretion patterns to IFN-γ. 2.After stimulation with TB1 antigen, the level of IP-10 in ATB group was significantly higher thanthat inLTBI,previous TBand HC groups(p&lt;0.05).After stimulation with TB2 antigen, the level of IL-6in ATB group was significantly higher thanthat in LTBI and HC groups(p&lt;0.05). 3.There was no significant difference incytokines secretion levels in QFT-Plus specific CD8 response(TB2-TB1) in most groups.

Conclusion
In addition to IFN-γ, thedetection of IL-2, IL-1Ra, CXCL-1by QFT-Plusmay havethe potential to detect tuberculosis infection.Combined detection of IP-10 and IL-6 levels may have the potential to differentiate ATB from LTBI

Disclosures
All Authors: No reported disclosures.
2182. Pneumonia in Patients who Inhale drugs, experience in a tertiary care hospital
Authors: Suryadevara Madhu , Bishburg Eliahu , Nagarakanti Sandhya , Amin Krushna , Ejayeriese Eguono 
Published: December 2022

Abstract

Background
Drug use (DU) is associated with various infectious diseases complications including pneumonia. Inhalational drug use (IHDU) associated pneumonia have not been well described. We sought to describe our experience with pneumonia associated with IHDU.

Methods
A retrospective chart review from 2015-2021 in a tertiary care teaching hospital. Patients (pts) diagnosed with pneumonia who reported IHDU were included. Data was collected for age, type and route of DU, comorbidities, etiological diagnosis, radiological results and outcome.

Results
A total of 237 pts were identified. Median age 53 years (range of 22-75), females 128 (54%). Smoking drugs in 158 (66.6%), 115 (48%) used drugs by sniffing/snorting, 19(8%) reported also active intravenous drug use (IVDU) and 16(6.7%) had a past history of IVDU. Overall 120 (50.6%) used cocaine, heroin in 78 (33.3%), while 156 (66%) used both heroin and cocaine. HIV infection in 57 (23.7%). Blood cultures were positive in 18/153: 4 Staphylococcus aureus, 2 Streptococcus pneumonia, 1 Serratia spc., 1 Pseudomonas aeruginosa. Sputum cultures were (+) in 20/69 and bronchoalveolar lavage (BAL) was (+) in 8/10, of them 7 Staphylococcus aureus, 2 Streptococcus pneumonia, 2 Klebsiella pneumonia, 2 Haemophilus influenza and 1 Pneumocystic carnii. Pneumococcal urine Ag in 3. Chest imaging was done in 228 (96%). Imaging was (+) in 192 (84.2%), infiltrates in 83 (43%), opacities in 30 (17%), consolidation in 21 (11%), 1 lung cavity and 44 (23%) had mixed findings. Negative imaging in 36 (15.8%) and no imaging in 9 (4%). In 6(2.5%) there was no imaging or cultures to diagnose pneumonia. The average length of stay was 5.8 days. Rehospitalization in 107/237 (45.1%) within 6 months of initial admission of these 43/107 (40.2%) were diagnosed with pneumonia, 74 (69%) were diagnosed with another pulmonary diagnosis. Five (2.1%) patients expired; of them 3 Had HIV and 3 were active IVDU.

Conclusion
In our hospital pts with IHNU diagnosed with pneumonia had an increased risk of rehospitalization within 6 months of admission. There were no predominant radiological findings or microorganism isolated. Etiological diagnosis was found in a small number of patients. Mortality rate was relatively low.

Disclosures
All Authors: No reported disclosures.
2192. Clinical and Molecular Characteristics of Severe Respiratory Syncytial Virus Pneumonia in Critically Ill Adults
Authors: Kim Taeeun , Hong Sang-Bum , Huh Jin Won , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Kim Sung-Han , Sung Heungsup , Lee Sang-Oh , Kim Yang Soo , Choi Sang-Ho 
Published: December 2022

Abstract

Background
Respiratory syncytial virus (RSV) has been increasingly recognized as a frustrating cause of morbidity and mortality in adults. However, the clinical impact and molecular characteristics of severe RSV-associated pneumonia in critically ill adult patients have rarely been addressed.

Methods
This study, nested in a prospective cohort of severe pneumonia, was conducted at a 2,700-bed tertiary care hospital and comprised two parts. In part 1, the clinical characteristics of severe RSV-associated pneumonia were compared with severe influenza virus (IFV)-associated pneumonia between 2010 and 2019. In part 2, we performed phylogenetic and amino acid analyses of the G protein of RSV strains from three groups of different infection severity between 2015 and 2019 (Figure 1). Figure 1.Clinical samples for whole-genome sequencing in part 2.

Results
In part 1, 92 RSV- and 163 IFV-positive patients were identified. Structural lung diseases, diabetes mellitus, and malignancy were common underlying diseases in both groups. Immunocompromise (57.6% vs. 34.4%, p &lt; 0.001) and hospital acquisition (47.8% vs. 23.9%, p &lt; 0.001) were significantly more common in the RSV group. Clinical manifestations at diagnosis between the groups were generally similar. The mortalities of patients in both groups were similarly high (Table 1). In part 2, 26 RSV strains from three groups (group 1: 11 strains, group 2: 8 strains, and group 3: 7 strains) were analyzed. All isolated RSV-A and -B strains belonged to the ON1 and the BA9 genotypes, respectively. The phylogenetic analysis revealed that the adult severe pneumonia strains clustered by contemporary strains rather than other severe pneumonia strains. There were no significantly different genetic variations among the three groups, including the subtype clades, amino acid sequence substitutions, and changes in potential glycosylation sites. Table 1.Characteristic and outcomes of 255 patients with virus-associated severe pneumonia

Conclusion
Severe RSV pneumonia was more commonly associated with hospital acquisition and immunocompromised status. Overall clinical features and mortalities of the RSV group were comparable to the IFV group. The molecular characteristics of RSV strains from the adults with severe pneumonia were not distinct from strains from non-pneumonic adults or children, underscoring that the severity of RSV respiratory tract infection is mainly determined by host factors, not by viral factors.

Disclosures
All Authors: No reported disclosures.