bluuebunny/crossref_metadata_2025_split huggingface dataset:
90. Risk Factors for Community Colonization with Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) in Botswana An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Authors: Mannathoko Naledi , Mosepele Mosepele , Gross Robert , Smith Rachel Mann , Alby Kevin , Glaser Laurel , Richard-Greenblatt Melissa , Sharma Aditya , Jaskowiak-Barr Anne , Sewawa Kgotlaetsile , Cowden Laura , Reesey Emily , Otukile Dimpho , Cressman Leigh , Paganotti Giacomo , Mokomane Margaret , Lautenbach Ebbing 
Published: December 2022

Abstract

Background
The epidemiology of ESCrE in low- and middle-income countries (LMICs) is poorly described. While risk factors for ESCrE clinical infection have been studied, little is known of the epidemiology of ESCrE colonization. Identifying risk factors for ESCrE colonization specifically is nonetheless critical to inform antibiotic resistance reduction strategies.

Methods
This study was conducted in 6 clinics located in 3 districts in Botswana. In each clinic, we surveyed a random sample of outpatients. We also invited each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also invited to refer their children. All subjects had rectal swabs collected which were inoculated onto chromogenic media for preliminary identification of ESCrE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. Data were collected on demographics, comorbidities, antibiotic use, healthcare exposures, travel, and farm and animal contact. Subjects with ESCrE colonization (cases) were compared to non-colonized subjects (controls). Bivariable and multivariable analyses were conducted to identify risk factors for ESCrE colonization.

Results
Enrollment occurred from 1/15/20–9/4/20 and 2,000 subjects were enrolled. There were 959 (48.0%) clinic subjects, 477 (23.9%) adult community subjects, and 564 (28.2%) child community subjects. 725 (36.3%) subjects lived in the same household as another subject. The median (IQR) age was 30 (12–41) and 1,463 (73%) were female. There were 555 cases and 1,445 controls (i.e., 27.8% of subjects were ESCrE colonized). Unadjusted comparisons are noted in Table 1. Independent risk factors for ESCrE were younger age, hospital exposure, travel, and presence of an ESCrE colonized household member (Table 2).

Conclusion
ESCrE colonization was common and associated with several exposures. Our results suggest even modest healthcare exposure may be important in driving ESCrE. The strong link to household member ESCrE colonization highlights the potential role of household transmission or common exposure. These findings warrant further prospective studies and provide vital information to inform strategies to curb further emergence of ESCrE in LMICs.

Disclosures
All Authors: No reported disclosures.
790. Can Electronic Clinical Decision Support Systems Improve the Diagnosis of Urinary Tract Infections?: A Systematic Review and Meta-Analysis
Authors: Hojat Leila S , Saade Elie , Donskey Curtis , Deshpande Abhishek 
Published: December 2022

Abstract

Background
Urinary tract infection (UTI) is a commonly misdiagnosed infectious condition. Stewardship interventions which successfully reduce rates of asymptomatic bacteriuria treatment (ASB) are often labor intensive, and thus a systematic solution is desirable. In this study, our objective was to systematically review studies to evaluate the effect of implementing a clinical decision support system on the ordering of urine culture tests for the diagnosis of UTI across diverse clinical settings.

Methods
We conducted a comprehensive electronic search of 5 databases and manual reference list review for peer-reviewed articles published prior to July 2, 2021. Studies which described an intervention designed to reduce unnecessary or incorrect diagnosis of UTI through utilization of CDS were included. The primary outcome of interest was rate of urine culture tests ordered. Two investigators independently screened studies and extracted and compiled data.

Results
A total of 5,013 studies were screened, of which 14 met inclusion criteria for the systematic review (Table 1). The most common intervention was urinalysis with reflex to urine culture based on pre-specified urinalysis parameters, such as a threshold level of pyuria. All 9 studies with statistical comparisons reported a decreased urine culture rate post-intervention, 8 of which were statistically significant (Table 2). Overall, a 37% decrease in urine culture rate was detected after CDS implementation (Table 3). Several studies also reported improvements in antimicrobial-related measures such as days of therapy and guideline-concordant therapy. Catheter-associated urinary tract infection rate was decreased in 2 studies and unchanged in 1 study. A limited number of included studies reported no adverse outcomes including increased bloodstream infection and mortality rates.

Conclusion
Electronic clinical decision support systems appear to be effective in decreasing unnecessary urine culture tests and improving UTI diagnosis. Prospective studies are needed to evaluate the impact on antimicrobial prescribing, patient-relevant outcomes, and potential adverse effects.

Disclosures
Elie Saade, MD, MPH, Janssen: Advisor/Consultant Curtis Donskey, MD, Pfizer, Clorox, Ecolab, and Professional Disposables International: Grant/Research Support Abhishek Deshpande, MD, PhD, Clorox: Grant/Research Support|Merck & Co., Inc., Kenilworth, NJ, USA: Advisor/Consultant|Merck & Co., Inc., Kenilworth, NJ, USA: Stocks/Bonds|Seres Therapeutics: Grant/Research Support.
877. Synovial Fluid Testing Using the BioFire® Joint Infection (JI) Panel Potentially Decreases Time to Antibiotic Optimization for Acute Joint Infections
Authors: Whitt Benjamin , Kilic Abdullah , Palavecino Elizabeth , Beardsley James , Ohl Christopher , Stone Tyler , Taylor Alex D , Luther Vera 
Published: December 2022

Abstract

Background
Traditional synovial fluid culture for acute joint infection (AJI) is time-consuming, potentially delaying initiation of targeted antimicrobial therapy. The BioFire® Joint Infection (JI) panel, a multiplex PCR for synovial fluid, has been shown to have 90.2% sensitivity and 99.8% specificity for diagnosis of AJI. We sought to determine the potential impact of the JI panel on antimicrobial use for AJI at our institution.

Methods
Antimicrobial use was retrospectively reviewed in a cohort of adult inpatients who underwent synovial fluid culture and were diagnosed with septic arthritis or periprosthetic joint infection from Sept 2021-Apr 2022. Patients were excluded if there was an alternative source of infection or septic shock. Synovial fluid specimens were tested using the JI panel, and results were compared to those of traditional culture methods. Patients who were initially treated with broad-spectrum antimicrobials for AJI were included in a review of antimicrobial prescribing. Records were reviewed to determine the time at which a transition to targeted therapy was made when using culture. This was compared to the time at which panel results could be available and acted upon, in this study presumed to be 12 hours after culture collection.

Results
42 inpatients met study criteria for comparison of culture and JI panel results. The panel identified the organism that was grown in culture in 21 cases while detecting an organism in 5/16 culture-negative cases (table 1). In 5 cases, culture identified an organism not included on the JI panel. 29 patients met criteria for review of antimicrobial prescribing. Of these, therapy in 14/16 with positive cultures could have been changed earlier (table 2), resulting in an average reduction of time to targeted therapy of 57 hours (range 27–107 h, median 50.5 h) per patient. Targeted therapy could have occurred in 5/13 culture-negative cases.
Summary of comparison of culture and BJI panel results.
*Organisms identified by culture: Coagulase-negative staphylococci (n=4), Pasteurella multocida (n=1)
**Organisms detected by JI panel: Streptococcus pyogenes (n=2), Streptococcus agalactiae (n=1), Finegoldia magna (n=1), Enterobacter cloacae (n=1)
Proportion of patients eligible for a change in antimicrobial therapy.

Conclusion
Use of the JI panel could have prompted earlier optimized therapy in approximately two-thirds of patients. In 5 instances where cultures were negative, important AJI pathogens were identified. Another potential benefit includes reduced exposure to unnecessary broad-spectrum antimicrobials. Future study should evaluate the actual impact of the JI panel in practice.

Disclosures
All Authors: No reported disclosures.
887. Race and ethnicity differences in hospital length of stay for children with acute osteomyelitis in the United States
Authors: Campbell Jeffrey , Shanahan Kristen H , Bartick Melissa , Ali Mohsin , Goldmann Donald , Shaikh Nadia , Allende-Richter Sophie H 
Published: December 2022

Abstract

Background
Changes in management of bone infections, particularly early transition to oral antibiotic therapy, have decreased length of stay (LOS) for children hospitalized with acute osteomyelitis. However, evaluation of differences in length of stay by race and ethnicity have been limited.

Methods
Using the Kids’ Inpatient Database, we conducted a cross-sectional study of children ages 0–20 years hospitalized in 2016 or 2019 with a primary or secondary diagnosis of acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled length of study (LOS) by race and ethnicity, accounting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included predictors of LOS &gt; 7 days (equivalent to LOS in the highest quartile), central venous catheter (CVC) placement, and time to debridement.

Results
We identified 2,388 patients discharged with acute osteomyelitis. Median LOS was 5 days (IQR 3–7). Black race (adjusted incidence rate ratio [aIRR] 1.15, 95%CI 1.05–1.27), Hispanic ethnicity (aIRR 1.11, 95% CI 1.02–1.21), and other race and ethnicity (aIRR 1.12, 95% CI 1.01–1.23) were associated with longer LOS, compared to White race (Figure 1). Additional factors associated with prolonged LOS were Medicaid/self-pay status (aIRR 1.14, 95% CI 1.07–1.21) and other insurance (aIRR 1.21, 95% CI 1.02–1.45), compared to private insurance; debridement procedure (aIRR 1.31, 95%CI 1.23–1.31); CVC placement (aIRR 1.41, 95% CI 1.31–1.51), and complex chronic condition (aIRR 1.21, 95% CI 1.11–1.33). The odds of Black children experiencing LOS &gt; 7 days was 46% higher compared to White children (aOR 1.46, 95% CI 1.01–2.11; Figure 2). There were no differences by race and ethnicity on odds of CVC placement or time to debridement.
Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile.
Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile.

Conclusion
Black, Hispanic, and other race and ethnicity children with acute osteomyelitis experienced longer LOS than White children. Further research into mechanisms underlying these differences, including social determinants such as access to care or structural racism, may be important to improve care for children with osteomyelitis.

Disclosures
All Authors: No reported disclosures.
1164. Antibacterial Utilization for Febrile Illnesses and Laboratory-Confirmed Bloodstream Infections in Northern Tanzania
Authors: Moorthy Ganga S , Madut Deng , Kilonzo Kajiru G , Lwezaula Bingileki , Mbwasi Ronald , Mmbaga Blandina , Ngocho James , Saganda Wilbrod , Officer Clinical , Bonnewell John P , Carugati Manuela , Egger Joseph R , Hertz Julian , Maze Michael J , Maro Venance , Crump John A , Rubach Matthew 
Published: December 2022

Abstract

Background
Antimicrobial resistance is an important cause of morbidity and mortality globally; low- and middle-income countries (LMICs) face an especially high burden. Ineffective antimicrobial prescriptions and use of broad-spectrum agents contribute to resistance. We describe antibacterial prescribing patterns in patients with febrile illnesses and bloodstream infections (BSI) in northern Tanzania.

Methods
We compared data from two hospital-based prospective cohort studies, cohort 1 (2011-2014) and cohort 2 (2016-2019), both enrolled febrile pediatric and adult inpatients in Moshi, Tanzania. Aerobic blood culture was obtained in all patients and standard methods were used to determine isolate antimicrobial susceptibility. To describe management of febrile illness, we analyzed antibacterial drug prescription prior to and after enrollment. Broad-spectrum antibacterials were categorized using published frameworks. Treatments were categorized as discordant if a blood culture isolate was not susceptible to the patient’s antibacterial regimen. We performed descriptive statistics and logistic regression to understand predictors of receiving an antibacterial.

Results
In total, 2,176 febrile inpatients were enrolled. Antibacterials were administered to 430 (42.0%) and 501 (45.1%) patients prior to enrollment, and 930 (89.1%) and 1,060 (93.6%) during admission in cohorts 1 and 2, respectively. Infancy and duration of fever were associated with higher antibacterial prescribing prior to enrollment (Table 2). Broad-spectrum antibacterials were administered to 548 (52.5%) in cohort 1 and 682 (60.2%) in cohort 2. Laboratory-confirmed bacteremia was detected in 87 (4%) patients. Susceptibility results were available in 73 patients; of these, 41 (56.2%) received discordant antibacterials.

Conclusion
Antibacterials were commonly administered for febrile illness in outpatient and inpatient settings; over half of patients received broad-spectrum antibacterials. A high proportion of patients with culture-positive BSI were treated with ineffective antimicrobials. Improved laboratory diagnostics for febrile illness, antimicrobial stewardship interventions, context-specific clinical guidelines, and provider education may improve prescribing practices.

Disclosures
Julian Hertz, MD, Roche Diagnostics: Grant/Research Support.
1167. Changing spectrum of aetiology of Acute Fever with Jaundice (Tropical Jaundice) in Adults presenting to Emergency Care--- A study from a Tertiary Care Hospital in North India
Authors: Suri Vikas , Singh Mandeep , Duseja Ajay , Biswal Manisha , Singh M P , Goyal Kapil , Mohindra Ritin , Singh Harpreet , Bhalla Ashish , Ratho R 
Published: December 2022

Abstract

Background
The spectrum of infections causing the above acute onset fever with jaundice has changed over the last few years from the conventional hepatotropic viruses to new emerging infections.

Methods
250 adult patients ≥ 14 years of age) with acute fever (body temperature &gt; 101ᵒF of 14 days or less in duration) without any localized source of infection on initial clinical evaluation accompanied with jaundice (hyperbilirubinemia ≥ 1.5 mg/dl or elevation of ALT or AST ≥ three times upper limit) were enrolled.All these patients with fever and jaundice were evaluated on the basis of a standard proforma and were evaluated for malaria (peripheral smears/rapid diagnostic kits), scrub typhus( PCR /IgM ELISA), leptospirosis(IgM ELISA), enteric fever by blood cultures and dengue by dengue (NS1 antigen test and IgM ELISA), Hepatitis(IgM ELISA of EBV/HSV, IgM ELISA of HAV/HEV and HBsAg with IgM HBc ELISA if HBsAg positive)

Results
62.5 % were males and 37.5 % were females. The mean duration of fever before the presentation was 8.1 ± 2.58 days. 10 patients (4%) died, while 133 patients (96%) improved with treatment. Scrub typhus 57 (22.8%), Hepatitis E 33 (13.2%), malaria 9 (3.6%), dengue fever, enteric fever, hepatitis A and leptospirosis in 26 (10.4%), 6 (2.4%), 6 (2.4%) patients and 4 (1.6%) patient respectively were the prominent aetiology a patient presenting with fever and jaundice. Probable sepsis (Fulfilling SIRS criteria with a negative culture) accounted for 40(16%) patients. In 69(27.6%) cases no diagnosis could be made on serological testing Conjunctival suffusion (OR=23.17), respiratory crepitations (OR=5.17), thrombocytopenia (OR=1.14), normal INR (OR=0.29) were significant predictors of a diagnosis of scrub typhus in patients with fever and jaundice. Severe anaemia (Hb&lt; 8), Hypoalbuminemia, severe thrombocytopenia (Platelet count &lt; 50,000) and a near-normal INR at admission were predictors of a malarial vs a viral aetiology of Tropical jaundice. Co-infection with scrub typhus and malaria was seen in 6 patients (vivax-5 and falciparum-1) and viral hepatitis A & E was observed in 10 patients.

Conclusion
Neglected Tropical diseases like Scrub typhus infection is emerging as common aetiology of acute onset tropical jaundice in adults presenting to emergency services.

Disclosures
All Authors: No reported disclosures.
1171. Epidemiology of Old World Cutaneous Leishmaniasis among Members of the U.S. Military
Authors: Cebula Brenan R , Porter William D , Wortmann Glenn , Byrne William R , Polhemus Mark , Billick Kendall , Bernstein Wendy B , Hawkes Cliffton , Marovich Mary , Aronson Naomi E 
Published: December 2022

Abstract

Background
Cutaneous leishmaniasis (CL) is a threat to U.S. Military personnel as they deploy to endemic areas. As treatment may require evacuation, CL undermines operations. Elucidating the epidemiology of CL in this population is key for prevention.

Methods
We retrospectively reviewed data from a CL sodium stibogluconate treatment trial at Walter Reed Army Medical Center, Washington DC. 412 military members with parasitologically confirmed CL and deployment to Southwest Asia from May 2002 - August 2004 enrolled. Subjects’ CL lesions were counted and measured. 334 subjects completed a risk survey. Given no control group, we used number of CL lesions (NL), total lesion area (TLA), and lesion location as outcomes to assess CL risks. Non-parametric tests and logistic regression were used as appropriate.

Results
Permethrin treated bed net use was associated with lower NL (p = 0.000), TLA (p = 0.024), and odds of head/face lesion (OR 0.12, p = 0.047). Sleeping in a combat uniform was associated with lower TLA (p = 0.000) and odds of leg/foot lesion (OR 0.39, p = 0.023). Use of a permethrin treated uniform (p = 0.002) and N,N-diethyl-meta-toluamide (DEET) insect repellent at night (p = 0.046) were associated with lower NL. Noting unit members with similar lesions was associated with higher NL (p = 0.007) and odds of head/face lesion (OR 12.1, p = 0.019). National Guard status followed by Active Duty was associated with higher NL (p = 0.002) and TLA (p = 0.000) than Reserve. Sleeping in a building was associated with higher TLA (p = 0.008) and odds of arm lesion (OR 2.28, p = 0.016). Sleeping near animal burrows was associated with higher NL (p = 0.031). Sleeping on a cot (p = 0.006), certain ethnicities (p = 0.020) and certain military occupational specialties (p =0.038) were associated with higher TLA. Increasing age (p = 0.001) and years of service (p = 0.000) were positively correlated with TLA.

Conclusion
This is the largest group of U.S. Military members with CL reported and provides insight into risks for CL which will guide preventive efforts to reduce the burden of illness in this population.
The opinions and assertions expressed herein are those of the author(s) and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.

Disclosures
Naomi E. Aronson, M.D., Elsevier: Royalties as text editor, honoraria for chapter writing|UpToDate: royalties for writing chapters.
1186. Zika Virus Screening in Pregnancy in the Military Health System, 2012-2019
Authors: Wellington Trevor , Fraser Jamie , Kuo Huai-Ching , Hickey Patrick , Lindholm David A 
Published: December 2022

Abstract

Background
Zika virus (ZIKV) is an emerging arthropod-borne viral disease capable of causing fetal complications in pregnant patients exposed to the virus. Pregnant women are at risk of contracting ZIKV when they (or their partners) travel to areas with known transmission. Currently, asymptomatic prenatal screening for ZIKV is not routinely recommended, regardless of travel history, though rates of birth defects are similar between symptomatic and asymptomatic women. We sought to evaluate the rate of true positivity among pregnant patients coded for ZIKV in the Military Health System (MHS).

Methods
KAPOS (Deployment and Travel Health: Knowledge, Attitudes, Practices, and Outcomes Study) is a multi-cohort study evaluating the burden of travel-associated diseases in the MHS. The MHS Data Repository was searched for International Classification of Diseases (ICD)-10 codes for ZIKV infection in military beneficiaries receiving care during fiscal years 2012-2019. Subjects then underwent chart review for history of travel, diagnostic confirmation, pregnancy status, and pregnancy complications.

Results
230 unique subjects coded for ZIKV were identified. 124 subjects underwent chart review for diagnostic confirmation, of which 58 (47%) were pregnant. Of pregnant subjects captured for ZIKV, 41 (71%) were ruled out by laboratory evaluation, while 7 (12%) subjects were determined to have suspected, probable, or confirmed ZIKV. All subjects but one were asymptomatic. Travel locations associated with ZIKV in pregnancy were Puerto Rico (n=2), Guyana (n=2), and Brazil (n=1). Two subjects reported only partner travel to ZIKV regions (Cuba, Guyana). There were no documented cases of microcephaly, fetal loss, or preterm birth.

Conclusion
ZIKV infection in pregnancy can result in fetal malformations, though the role of laboratory screening in pregnant patients remains uncertain. While a majority of pregnant subjects coded for ZIKV were excluded by laboratory evaluation upon review, several cases of ZIKV were identified through screening, particularly in those with travel (or partner travel) to endemic regions. This study provides further insight into the importance of prenatal screening for ZIKV in pregnancy, particularly among those with personal and/or partner travel to endemic regions.

Disclosures
All Authors: No reported disclosures.
1198. Impact of Quaternary Ammonium Disinfectants on Transfer of viruses from Fomites to the Finger
Authors: Gerba Charles P 
Published: December 2022

Abstract

Background
Hard and soft surfaces (fomites) can play a role in the transmission of both enteric and respiratory viruses. Transmission can occur by touching of contaminated surfaces and bringing the hand to the either the mouth or nose or by re-aerosolization of the virus from the surface. In adults face touching occurs every 3 to 4 minutes. The amount of virus transfer which occurs depends on the nature of the surface, the virus and the degree and type of activity within a facility.

Methods
We conducted studies on the finger transfers of both a non-enveloped (MS-2 coliphages) and an enveloped virus (coronavirus 229E).

Results
The greatest degree of the non-enveloped virus occurred with acrylic plastic and stainless steel, while the greatest transfer of the enveloped virus occurred from porcelain. Transfer to the finger from surfaces of the coronavirus was reduced by treatment of surfaces with various commercially available quaternary ammonium disinfectants after 24 hours of application to the fomites by 37% to 99.9%. Using MS-2 coliphage as a tracer virus placed on a high touch fomite, we found that the use of quaternary ammonium containing disinfecting wipes in a long term care facility reduced the contamination of fomites by 80%.

Conclusion
The results indicate that spread of viruses in a facility and exposure via hand contact can be significantly reduced by disinfection of fomites.

Disclosures
Charles P. Gerba, PhD, Allied Biosciences: Grant/Research Support|Boeing: Grant/Research Support|Corning: Grant/Research Support|GOJO: Grant/Research Support|Rickett: Advisor/Consultant|Rickett: Grant/Research Support.