scholarly journals 704. Contemporary Salmonella spp. Infections in Houston, TX (2019 and 2020) and Emergence of Cephalosporin Resistance

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S452-S453
Author(s):  
christy tabarani ◽  
Anthony R Flores ◽  
Anthony R Flores ◽  
Cesar A Arias ◽  
Audrey Wanger
Keyword(s):  
Risk Factor ◽  
Retrospective Chart Review ◽  
The United States ◽  
Generation Cephalosporin ◽  
Clinical Samples ◽  
Research Support ◽  
Salmonella Spp ◽  
Foreign Travel ◽  
Salmonella Infections ◽  
Definitive Therapy

Abstract Background Salmonella spp. Infections are a significant cause of morbidity in children in the United States. Contemporary clinical and microbiological characteristics of pediatric Salmonella infections in urban cities are not well described. Methods We used a retrospective chart review of records (0-18 years of age) from a network of hospitals (n=11) in Houston, TX. Only patients with Salmonella spp. isolated from clinical samples in 2019 and 2020 were included. Demographic, clinical, and microbiological data were extracted from the medical record. Results A total of 35 pediatric cases of Salmonella spp infection were identified over the two-year period. Median age was 1.6 years with over one-third (13/35, 37.1%) under one year (Table 1). Nearly half (15/35, 42.9%) of patients required hospitalization with a median length of stay of 2 days. From cases with available clinical data (n=31), most common symptoms were fever (22/31, 71%) and bloody diarrhea (21/31, 67.7%) (Table 2). Bacteremia was detected in 17.1% (6/35) of cases (Table 3). Exposure history was elicited in 29% (9/31) of cases with foreign travel being most common risk factor (Table 2). All speciated isolates were Salmonella enterica with the majority (24/29, 82.8%) subspecies enterica. Of 24 samples with serotype information, the most common was infantis (Table 3). A single isolate was resistant to all antibiotics tested except meropenem (Table 3) and was recovered from a patient after travel to Pakistan. Nearly half of patients (15/31, 48.4%) received definitive therapy with a third generation cephalosporin antibiotic. Complications were rare and included septic arthritis/osteomyelitis (n=1), UTI (n=3), coagulopathy (n=1), and hepatitis (n=1). Conclusion Salmonella spp. Infections were common in the Houston metropolitan area over the 2-year period and occurred primarily in young children. Foreign travel seems to be a major risk factor for acquisition of this infection in children. For the first time, the identification of a multi-drug resistant Salmonella isolate suggests that this phenotype is likely to increase and highlights the importance of ongoing surveillance. Disclosures Anthony R. Flores, MD, MPH, PhD, Nothing to disclose Cesar A. Arias, M.D., MSc, Ph.D., FIDSA, Entasis Therapeutics (Grant/Research Support)MeMed Diagnostics (Grant/Research Support)Merk (Grant/Research Support)

scholarly journals 698. Contemporary Clinical Epidemiology of Pediatric Shigella and Campylobacter Infections in Houston, TX, 2019 and 2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S449-S450
Author(s):  
christy tabarani ◽  
Anthony R Flores ◽  
Anthony R Flores ◽  
Cesar A Arias ◽  
Audrey Wanger
Keyword(s):  
Pediatric Patients ◽  
Clinical Epidemiology ◽  
Retrospective Chart Review ◽  
The United States ◽  
Clinical Samples ◽  
Research Support ◽  
Significant Burden ◽  
Shigella Spp ◽  
Campylobacter Spp ◽  
Campylobacter Infections

Abstract Background Infections due to Gram-negative, diarrheal pathogens are a significant cause of morbidity in children. Clinical features of pediatric Shigella and Campylobacter infections in urban cities in the United States are not well described. Methods We used a retrospective chart review of records (0-18 years of age) from a network of hospitals in Houston, TX. Only patients with Shigella spp. or Campylobacter spp. isolated from clinical samples in 2019 and 2020 were included. Demographic, clinical, and microbiological data were extracted from the medical record. Results We identified a total of 59 and 16 pediatric patients with Shigella spp. and Campylobacter spp. infections, respectively. Hospital admission occurred in 27.1% (16/59) of Shigella and 25% (4/16) of Campylobacter. Length of stay ranged between 1 and 2 days for both pathogens (Table 1). Of cases with available clinical data, Shigella infections were more likely to report fever during their illness compared to Campylobacter (80% versus 45.4%) (Table 2). Seizures were observed in 4 Shigella infected patients. No episodes of Shigella or Campylobacter bacteremia were identified. Among patients with an identified exposure, daycare attendance and contact with individuals experiencing similar symptoms were most common (Table 2). The vast majority of Shigella species were S. sonnei (96.6%) and all Campylobacter were C. jejuni (Table 3). Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was common (40/55, 72.7%) among Shigella isolates tested. No resistance to fluoroquinolones or third generation cephalosporins in any of the Shigella spp. isolates was observed. Susceptibility testing was not performed in Campylobacter due to lack of isolates. The most frequent antibiotic used was azithromycin (in 73.3% and 75% of patients with Shigella and Campylobacter, respectively). Major complications included urinary tract infection (n=1), rectal prolapse (n=1) and splenomegaly (n=1). Conclusion Infections due to Shigella and Campylobacter were a significant burden among pediatric patients between 2019 and 2020 in Houston, TX. The observed high frequency of resistance to TMP-SMX and emergence of multi-drug resistant Shigella in other countries warrants continued surveillance. Disclosures Anthony R. Flores, MD, MPH, PhD, Nothing to disclose Cesar A. Arias, M.D., MSc, Ph.D., FIDSA, Entasis Therapeutics (Grant/Research Support)MeMed Diagnostics (Grant/Research Support)Merk (Grant/Research Support)

scholarly journals 1146. Lactococcus species Catheter-Related Bloodstream Infections in Pediatrics: A Case Series

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S665-S665
Author(s):  
Sarah E Firmani ◽  
Holly Maples ◽  
Archana Balamohan
Keyword(s):  
United States ◽  
Case Series ◽  
The United States ◽  
Generation Cephalosporin ◽  
Definitive Treatment ◽  
Common Source ◽  
Beta Lactam ◽  
Sensitivity Testing ◽  
Pubmed Database ◽  
Definitive Therapy

Abstract Background Central venous catheters (CVC), may lead to central line-associated blood stream infections (CLABSIs). In the past, Lactococcus species have seldom been considered pathogenic. However, clinically significant infections have been reported, of which few are pediatric cases, all outside the United States. Methods We retrospectively identified pediatric patients with bacteremia secondary to Lactococcus spp. admitted to a tertiary pediatric hospital from January 2018 - December 2020. We reviewed the PubMed database for cases of pediatric Lactococcus spp. infections in English, peer-reviewed literature. Results We identified 3 patients with Lactococcus spp. bacteremia. The average patient was 17 months old (range, 6–24 months). All had a CVC; two had short bowel syndrome and 1 had nephrotic syndrome. None received probiotics. Empiric treatment for all included vancomycin. Two of 3 patients were de-escalated to ceftriaxone. All isolates were susceptible to penicillin. Duration of treatment was 10-14 days. Two of 3 were managed with CVC retention and none had recurrence of infection. A literature review revealed 9 additional cases (Table 1). The most common source of infection was blood (33%), with 66% (2/3) occurring in patients with central lines. Other sources included liver abscess (11%), brain abscess (11%), cerebrospinal fluid (11%), urine (11%), and endocarditis (22%). Median patient age was 12 months (range, 14 days-14 years). Five of 9 patients had an underlying risk factor. Duration of therapy ranged from 7-40 days. Most definitive treatment regimens consisted of a third-generation cephalosporin (44%). Of bacteremia, 2/3 received vancomycin as part of their definitive therapy. Five of 9 reported quantitative antimicrobial sensitivity testing (AST) or interpretation of AST to beta-lactam antibiotics; 80% (4/5) were susceptible. Conclusion To the best of our knowledge, these are the first reported pediatric cases of Lactococcus infections in the United States and suggests Lactococcus spp. should be considered pathogenic in the appropriate circumstances. This series adds to the limited literature, including AST. Continued accrual of susceptibility data may raise the possibility of using a 3rd generation cephalosporin as empiric therapy for Lactococcus bacteremia. Disclosures All Authors: No reported disclosures

scholarly journals Appropriate Use of Ceftriaxone in the Emergency Department of a Veteran’s Health Care System

2017 ◽  
Vol 33 (6) ◽  
pp. 215-218 ◽  
Author(s):  
Spencer H. Durham ◽  
Mary J. Wingler ◽  
Lea S. Eiland
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care System ◽  
Inappropriate Prescribing ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
The United States ◽  
Generation Cephalosporin ◽  
Veteran’S Health ◽  
Care System

Background: Ceftriaxone is a third-generation cephalosporin commonly utilized as an empiric antibiotic treatment option in the emergency department (ED). Overuse can lead to decreased susceptibility and emergence of multidrug-resistant pathogens, increased costs, and unnecessary adverse effects. Objective: The purpose of this project was to determine the appropriateness of ceftriaxone usage in the ED of a veteran’s health care system. Methods: This retrospective chart review included all veterans who received at least one dose of ceftriaxone in the ED between June 1, 2014, and June 1, 2015. The primary outcome was the percentage of appropriate ceftriaxone use. Usage appropriateness was determined on a case-by-case basis by examining current published guidelines and local recommendations based on the institutional antibiogram. Results: Ceftriaxone was prescribed for a wide variety of indications and was determined to be inappropriately prescribed in 164 patients (53%). The most common reason for inappropriate prescribing was lack of a first-line indication for ceftriaxone (64%). Only 120 patients (38.5%) exhibited systemic signs of infection based on vital signs and laboratory parameters, and 25 patients (8%) likely did not require antibiotic therapy at all. Conclusions: Ceftriaxone was used inappropriately in more than half of the patients who received the drug in the ED. The literature on the prescribing habits for ceftriaxone is limited in the United States, but these results are similar to studies conducted in other countries. Attempts should be made to educate prescribers on appropriate indications for the use of ceftriaxone.

scholarly journals 1600. Closing the gap on moxifloxacin breakpoints for Stenotrophomonas maltophilia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S796-S796
Author(s):  
Tyler J Stone ◽  
Kate Summers ◽  
John Williamson ◽  
Elizabeth Palavecino ◽  
Elizabeth Palavecino
Keyword(s):  
Stenotrophomonas Maltophilia ◽  
Susceptibility Testing ◽  
Medical Center ◽  
The United States ◽  
Clinical Samples ◽  
Research Support ◽  
Suspected Infection ◽  
Lower Minimum Inhibitory Concentration ◽  
Research Grant

Abstract Background Moxifloxacin (MOX) has in vitro activity against Enterobacterales and Stenotrophomonas maltophilia (SM). Although MOX commonly displays lower minimum inhibitory concentration (MIC)50/90 values against SM when compared to levofloxacin, there are currently no established MOX breakpoints for treatment of SM. The Clinical and Laboratory Standards Institute (CLSI) has established interpretive categories and MIC breakpoints for levofloxacin (S ≤2µg/ml) against SM. The US Food and Drug Administration and European Committee on Antimicrobial Susceptibility Testing provide MOX breakpoints for Enterobacterales with susceptible MICs represented at ≤ 2 µg/mL and ≤ 0.25 µg/mL, respectively. The purpose of this study was to evaluate MOX MIC distribution against SM strains recovered from clinical specimens. Methods Clinical samples from patients with suspected infection during calendar year 2018 and 2019 were processed in the microbiology lab of Wake Forest Baptist Medical Center. After incubation, SM colonies were identified by MALDI-TOF system. MOX susceptibility testing was performed for these clinical isolates by gradient diffusion strip methodologies. Results were displayed as MIC (µg/mL) without interpretation. MIC50/90 and susceptibility rates at potential breakpoints were calculated. Results A total of 211 isolates were tested, 112 from 2018 and 99 from 2019. MOX MIC50 and MIC90 for all isolates was 0.25 µg/mL and 2 µg/mL, respectively. The range of MIC distribution was ≤ 0.006 µg/mL to ≥ 64 µg/mL. Percent susceptibilities at incremental MICs, including established MOX breakpoints against Enterobacterales and established levofloxacin breakpoints against SM, are represented in Table 1. MIC distribution was plotted in Figure 1. Table 1. Susceptibility rates of S. maltophilia to moxifloxacin at theoretical breakpoints Figure 1. Moxifloxacin MIC Distribution against All S. maltophilia Isolates Conclusion With no established breakpoint, these data represent one of the largest samples of MOX MICs against SM in the United States. Using the CLSI breakpoint for levofloxacin in SM (MIC of ≤2ug/ml) the overall susceptibility rate is 93%. This finding highlights the importance of performing susceptibility testing to this agent by the microbiology laboratory and the critical need for MOX breakpoints in SM. Disclosures Tyler J. Stone, PharmD, Paratek (Research Grant or Support) John Williamson, PharmD, Paratek (Research Grant or Support) Elizabeth Palavecino, MD, Paratek (Grant/Research Support)Paratek (Grant/Research Support)

scholarly journals Ocular Findings and Visual Function in Children Examined during the Zika Health Brigade in the US Virgin Islands, March 2018

2021 ◽  
Vol 6 (2) ◽  
pp. 66
Author(s):  
S. Grace Prakalapakorn ◽  
Lucas Bonafede ◽  
Linda Lawrence ◽  
Daniel Lattin ◽  
Nicola Kim ◽  
...  
Keyword(s):  
Visual Function ◽  
Retrospective Chart Review ◽  
The United States ◽  
Virgin Islands ◽  
Neurologic Examination ◽  
Zikv Infection ◽  
Us Virgin Islands ◽  
Ocular Findings ◽  
Ocular Structure ◽  
The Us

Among children born with laboratory-confirmed Zika virus (ZIKV) infection, visual impairment (VI) can occur despite normal ocular structure. The objective of this report is to describe ocular findings and visual function among children examined during the Department of Health Zika Health Brigade (ZHB) in the United States Virgin Islands in March 2018. This analysis is based on a retrospective chart review of children eligible to participate in the ZHB (i.e., part of the US Zika Pregnancy and Infant Registry) and who were examined by ophthalmologists. Eighty-eight children attended the ZHB. This report includes 81 children [48 (59.3%) males] whose charts were located [average gestational age = 37.6 weeks (range: 27.6–41.3) and average adjusted age at examination = 9.1 months (range: 0.9–21.9)]. Of those examined, 5/81 (6.2%) had microcephaly at birth, 2/81 (2.5%) had a structural eye abnormality, and 19/72 (26.4%) had VI. Among children with normal ocular structure and neurologic examination, 13/51 (25.5%) had VI. Despite a low incidence of abnormal ocular structure and microcephaly, about a quarter of children examined had VI. Our findings emphasize that ophthalmological examinations should be performed in all children with suspicion for antenatal ZIKV infection, even children with normal ocular structure and neurologic examination.

scholarly journals 798. Metronidazole Exposure Prior to Clostridiodes difficile Infection (CDI) is a Risk Factor for Severe C. difficile Disease in Cancer Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S442-S443
Author(s):  
Denise Marie A Francisco ◽  
Liangliang Zhang ◽  
Ying Jiang ◽  
Adilene Olvera ◽  
Eduardo Yepez Guevara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cancer Patients ◽  
Research Study ◽  
Research Support ◽  
Factors Associated ◽  
Patients With Cancer ◽  
Study Investigator ◽  
Severity Levels ◽  
Permutation Analysis

Abstract Background Antibiotic use is a risk factor for CDI. Few studies have correlated use of prior antibiotics with CDI severity in cancer patients. This study identified clinical and microbiology risk factors associated with severe CDI in patients with cancer. We hypothesized that previous antibiotic exposure and microbiome composition at time of CDI presentation, are risk factors for severe disease in cancer patients. Methods This non-interventional, prospective, single-center cohort study examined patients with cancer who had their first episode or first recurrence of CDI between Oct 27, 2016 and Jul 1, 2019. C. difficile was identified using nucleic acid amplification testing. Multivariate analysis was used to determine significant clinical risk factors for severe CDI as defined in the 2018 IDSA/SHEA guidelines. Alpha, and beta diversities were calculated to measure the average species diversity and the overall microbial composition. Differential abundance analysis and progressive permutation analysis were used to single out the significant microbial features that differed across CDI severity levels. Results Patient (n=200) demographics show mean age of 60 yrs., 53% female, majority White (76%) and non-Hispanic (85%). Prior 90 day metronidazole use (Odds Ratio OR 4.68 [1.47-14.91] p0.009) was a significant risk factor for severe CDI. Other factors included Horn’s Index > 2 (OR 7.75 [1.05-57.35] p0.045), Leukocytosis (OR 1.29 [1.16-1.43] p< 0.001), Neutropenia (OR 6.01 [1.34-26.89] p0.019) and Serum Creatinine >0.95 mg/dL (OR 25.30 [8.08-79.17] p< 0.001). Overall, there were no significant differences in alpha and beta diversity between severity levels. However, when identifying individual microbial features, the high presence of Bacteroides uniformis, Ruminococceae, Citrobacter koseri and Salmonella were associated with protection from severe CDI (p< 0.05). Table 1 - Results of multivariate logistic regression analysis of factors associated with severe CDI Figure 1. Microbiome features identified by progressive permutation analysis as seen in a volcano plot. Conclusion A number of risk factors for severe CDI were identified among this population, including prior 90 day metronidazole use. Also, increased relative abundance of Bacteroides uniformis, Ruminococceae, Citrobacter koseri and Salmonella were linked to protection from severe CDI. Reducing metronidazole use in patients with cancer may help prevent subsequent severe CDI. Disclosures Adilene Olvera, MPH MLS (ASCP), MERK (Grant/Research Support, Scientific Research Study Investigator) Kevin W. Garey, PharmD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator) Ryan J. Dillon, MSc, Merck & Co., Inc., (Employee) Engels N. Obi, PhD, Merck & Co. (Employee)

scholarly journals 652. Comparison of fosfomycin (FOF) activity and prevalence of subpopulations between Escherichia coli (EC) and Klebsiella pneumoniae (KP) during susceptibility testing

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S384-S384
Author(s):  
Jadyn C Anderson ◽  
Amanda R Krueger ◽  
Elizabeth C Smith ◽  
Morgan L Bixby ◽  
Hunter V Brigman ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Inhibitory Concentration ◽  
Panel Member ◽  
Colony Growth ◽  
The United States ◽  
Research Support ◽  
Review Panel ◽  
Agreement Rate ◽  
Future Studies ◽  
Agar Dilution

Abstract Background In the United States, interpretive criteria for FOF are established only for EC, yet those criteria are often extrapolated to KP. Recent studies have highlighted both inferior clinical outcomes after FOF treatment and difficulties in interpretation of inner colony subpopulations, the presence of which may affect clinical efficacy. We sought to compare FOF activity against EC and KP and to determine the prevalence of inner colony subpopulations following disk diffusion (DD) testing of the two species. Methods A convenience collection of 73 KP and 42 EC isolates from 3 U.S. institutions were included. Minimal inhibitory concentration (MIC) testing was performed in duplicate on separate days using agar dilution (AD) and DD as recommended by the Clinical and Laboratory Standards Institute guidelines, with application of EC susceptibility (≤ 64mg/L) breakpoints. The frequency and counts of inner colonies observed during DD testing was calculated, and colonies were subcultured for use in future studies. Results MIC50/90 values were 1/16 mg/L and 32/256 mg/L for EC and KP respectively. All EC isolates were considered susceptible and therefore categorical agreement was 100%. The majority of KP isolates were considered susceptible (83.6% with AD and 86.3% with DD) and categorical agreement between the methods was 84.9%. Inner colonies were observed during DD testing in 88.1% of EC isolates and 80.8% of KP isolates during at least one replicate, with 47.6% of EC isolates and 39.7% of KP isolates showing inner colony growth during both DD test replicates. More than 10 inner colonies were observed in 50% of EC isolates compared to 12.3% of KP isolates. Conclusion KP isolates demonstrated considerably higher FOF MIC values compared to EC, as evidenced by MIC50/90 values 4-5 dilutions higher than those for EC. The categorical agreement rate was higher among EC than KP, highlighting concerns regarding the practice of extrapolating FOF susceptibility breakpoints for EC to KP. The high frequency of inner colonies observed in DD for both species necessitates further studies to determine best practices for interpreting their relevance, fitness, and resistance in order to identify potential impacts to clinical efficacy of FOF. Disclosures Elizabeth B. Hirsch, PharmD, Merck (Grant/Research Support)Nabriva Therapeutics (Advisor or Review Panel member)

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