Abstract
Background
Infective endocarditis (IE) is a rare but serious complication of pregnancy. Its impact on delivery outcomes is unknown. In this study, we use a national administrative database ...to compare outcomes of deliveries complicated by IE to non-IE deliveries.
Methods
The National Readmissions Database was used to identify discharges between Oct. 2015 and Dec. 2017 for deliveries in patients aged 12 – 55 years with concomitant IE, which were compared to those deliveries without IE. Demographics, comorbidities, and outcomes were obtained. Differences between groups were analyzed using weighted Chi-squared test for categorical variables and weighted linear regression for continuous variables. Weighted multivariate regression models adjusted for demographic, facility, and comorbidity conditions were used to evaluate the association between IE and delivery outcomes.
Results
We identified 88 individuals with IE complicating their delivery hospitalization, corresponding to a national estimate of 162 admissions during the study period, who were compared to 4,401,879 delivery hospitalizations not complicated by IE (weighted national estimate 8,375,536). Patients with IE were more likely to reside in ZIP codes with median incomes in the lowest national quartile (46.3% vs. 28.1%, P = 0.003) and were more likely to be insured by Medicaid (76.5% vs. 42.1%, P < 0.001). Rates of pre-existing cardiac valve disease (39.9% vs. 0.2%, P < 0.001) and congenital heart disease (6.6% vs 0.1%, P < 0.001) were higher in those with IE, as well as drug abuse (69.3% vs. 2.6%, P < 0.001). Unadjusted analyses demonstrated higher rates of in-hospital mortality for IE-associated admissions (12.1% versus 0.005%), along with high rates of severe maternal morbidity, stillbirth, preterm birth, and cesarean birth, and longer lengths of stay and total hospital costs. These differences persisted despite adjustment using multivariate methods (Table).
Clinical and Resource Utilization Outcomes
Conclusion
The presence of IE during an admission for delivery is associated with poorer outcomes for both pregnant patients and their fetuses. The occurrence of IE during pregnancy was associated with lower income, a history of cardiac disease, and drug abuse.
Disclosures
Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Actavis (Grant/Research Support)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Research Grant or Support)Affinium (Consultant)Allergan (Grant/Research Support)Ampliphi Biosciences (Consultant)Basilea (Consultant, Research Grant or Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Research Grant or Support)Contrafect (Consultant, Research Grant or Support)Cubist (Grant/Research Support)Debiopharm (Consultant)Destiny (Consultant)Durata (Consultant)Forest (Grant/Research Support)Genentech (Consultant, Research Grant or Support)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Research Grant or Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)Medimmune (Consultant, Research Grant or Support)Merck (Consultant, Research Grant or Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Research Grant or Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Research Grant or Support)Tetraphase (Consultant)Theravance (Consultant, Research Grant or Support)Trius (Consultant)xBiotech (Consultant)
Abstract
Background
Solid organ transplant (SOT) recipients are characterized by extensive healthcare exposure and have high rates of Staphylococcus aureus bacteremia (SAB). The clinical ...characteristics and outcome determinants of SAB in this population are poorly understood. We undertook a prospective cohort study compared the bacterial genotype and clinical outcomes of SAB among SOT and non-solid organ transplant (non-SOT) recipients.
Methods
Consecutive patients presenting to our institution with SAB between January 1, 2016 and December 31, 2019 were eligible for study inclusion. Each subject’s initial S. aureus bloodstream isolate was genotyped using spa typing and assigned to clonal complexes using Ridom StaphType software.
Results
A total of 32 SOT and 634 non-SOT recipients with SAB were included. Bacterial genotype did not differ significantly between SOT and non-SOT recipients (p=0.4855), including the proportion of SAB caused by USA300 (12.5% vs 16.7%, p=0.6339). Ninety-day mortality and incidence of metastatic complications did not significantly differ between SOT and non-SOT recipients (18.8% vs 30.1%, p=0.2329, and 37.5% vs 48.6%, p=0.2769, respectively). Transplant status was significantly associated with septic shock (50.0% vs 21.8%, adjusted OR 2.63, 95% CI: 1.22 to 5.66). Infection with USA300 was not associated with 90-day mortality or septic shock among SOT recipients (p=1.0000 for both).
Staphylococcus aureus Genotype by Transplant Status
Conclusion
In conclusion, SOT recipients with SAB do not experience greater mortality than non-SOT recipients. Differences in genotype of the infecting bacteria do not appear to be a significant determinant of outcome in SOT recipients with SAB.
Disclosures
Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Grant/Research Support)Affinium (Consultant)Akagera (Consultant)Allergan (Grant/Research Support)Amphliphi Biosciences (Consultant)Aridis (Consultant)Armata (Consultant)Basilea (Consultant, Grant/Research Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Other Financial or Material Support, Educational fees)Contrafect (Consultant, Grant/Research Support)Debiopharm (Consultant, Other Financial or Material Support, Educational fees)Destiny (Consultant)Durata (Consultant, Other Financial or Material Support, educational fees)Genentech (Consultant, Grant/Research Support)Green Cross (Other Financial or Material Support, Educational fees)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Grant/Research Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)MedImmune (Consultant, Grant/Research Support)Merck (Grant/Research Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Grant/Research Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Grant/Research Support)sepsis diagnostics (Other Financial or Material Support, Pending patent for host gene expression signature diagnostic for sepsis.)Tetraphase (Consultant)Theravance (Consultant, Grant/Research Support, Other Financial or Material Support, Educational fees)Trius (Consultant)UpToDate (Other Financial or Material Support, Royalties)Valanbio (Consultant, Other Financial or Material Support, Stock options)xBiotech (Consultant)
Abstract
Background
Clinical outcomes and host immune response in solid-organ transplant recipients (Tx) with Staphylococcus aureus bacteremia (SAB) and Gram-negative bacteremia (GNB) are poorly ...understood. The aims of this study were to describe (1) clinical characteristics and outcomes and (2) acute-phase cytokine response in Tx recipients with SAB and GNB as compared with matched non-transplant subjects (Non-Tx).
Methods
Thirty-two Tx recipients who were prospectively enrolled in the Blood Stream Infection Biorepository (BSIB) were matched 1:1 with Non-Tx patients on age, race, gender and bacteria using a perfect matching algorithm (Tx-SAB n = 16, Non-Tx SAB n = 16; Tx GNB n = 16, Non-Tx GNB n = 16). GNB included Escherichia coli (n = 16) and Klebsiella pneumoniae (n = 16). Multiplex cytokine testing was performed (Luminex) to evaluate acute-phase serum cytokines levels. Baseline characteristics were summarized using mean with standard deviation (SD), median with interquartile range (IQR), and ranges (min and max), or frequency with %. Differences between the Tx and Non-Tx SAB and GNB were compared using either the equal or unequal variance version of the Student’s t-test or Wilcoxon rank-sum test for continuous variables. Fisher’s exact test was used for categorical variables.
Results
An endovascular source was more common in Tx SAB vs. Non-Tx SAB (75.0% vs. 0.0%; P = 0.0003) and Tx-GNB (42.9% vs. 18.8%; P = 0.006). Fewer SAB cases were attributed to a skin/soft tissue/osteoarticular in Tx vs. Non-Tx (8.3% vs. 91.7%; P = 0.0001). APACHE II scores were higher in Tx SAB vs. Non-Tx SAB (14.0 IQR: 11.0, 17.5 vs. 10.0 IQR: 7.0, 12.5 P = 0.02), but not between Tx GNB vs. Non-Tx GNB (14 IQR: 12.0, 15.5 vs. 13.5 12.0, 15.0 P = 0.54). No significant difference length of stay, recurrent bacteremia or mortality were noted among or between groups. Patients with SAB had significantly higher levels of IL-10, CCL5, eotaxin vs. GNB in both Tx and Non-Tx. Conversely, IL-5, IL-13 and IL-17 levels were significantly lower in SAB compared with GNB in both Tx and Non-Tx. Within Tx alone, IL-8 and IL-15 were significantly higher in SAB as compared with GNB.
Conclusion
Significant differences exist in etiology and host immune response in Tx and Non-Tx with SAB and GNB. Further research is needed to understand the host immune response to BSI in these patients.
Disclosures
All authors: No reported disclosures.
Abstract
Background
Hematopoietic stem cell transplants (HSCT) recipients are at increased risk of respiratory viral infections and their associated complications. Although the epidemiology of many ...respiratory viruses has been well characterized in this population, little is known about the epidemiology of human coronavirus (HoCV) infection.
Methods
We identified HSCT recipients with symptoms of a respiratory tract infection who tested positive for HoCV by nasopharyngeal (NP) swab from January 2013 to December 2016 at our hospital. NP swabs were analyzed by the FilmArray® Respiratory Panel, which detects 17 respiratory viruses, including 4 coronavirus serotypes. We reviewed the demographics, transplant type, comorbidities, smoking status, respiratory symptoms, co-pathogens, and radiographic findings of infected patients. We then assessed the incidence of developing a lower respiratory tract infection (LRTI), defined as new pulmonary infiltrates or detection of HoCV in bronchoalveolar lavage fluid, within 30 days of initial diagnosis.
Results
We identified 58 HSCT recipients who tested positive for HoCV. The median patient age was 54 years, 29 (50%) were men, and 24 (41%) were current or prior smokers. Fifty (86%) patients had received an allogeneic HSCT and 8 (14%) had received an autologous HSCT. The coronavirus serotypes were: OC43 (n = 19, 33%), NL63 (n = 18, 31%), HKU1 (n = 16, 28%), and 229E (n = 5, 9%). The median time from transplant until detection of HoCV infection was 135 days (IQR=256). Seventeen (29%) patients were lymphopenic at the time of diagnosis and 17 (29%) were receiving corticosteroids. The most common initial symptoms were cough (n = 41, 71%), rhinorrhea (n = 31, 53%), and dyspnea (n = 17, 29%), and 19 (33%) and 16 (28%) patients had fever and hypoxia, respectively. Seventeen patients (29%) developed a LRTI within 30 days of diagnosis and 43% harbored a co-pathogen in the blood or respiratory tract. Three patients (5%) were intubated for respiratory failure and 1 (2%) died within 30 days.
Conclusion
HoCV infection is common in HSCT recipients and is caused by multiple serotypes. Nearly one-third of patients have fever and hypoxia upon initial diagnosis or progress to LRTI. Further research is needed to identify risk factors for HoCV LRTI in this population.
Disclosures
All authors: No reported disclosures.
Background Accelerometers were traditionally worn on the hip to estimate energy expenditure (EE) during physical activity but are increasingly replaced by products worn on the wrist to enhance wear ...compliance, despite potential compromises in EE estimation accuracy. In the older population, where the prevalence of hearing loss is higher, a new, integrated option may arise. Thus, this study aimed to investigate the accuracy and precision of EE estimates using an accelerometer integrated into a hearing aid and compare its performance with sensors simultaneously worn on the wrist and hip. Methods Sixty middle-aged to older adults (average age 64.0 ± 8.0 years, 48% female) participated. They performed a 20-min resting energy expenditure measurement (after overnight fast) followed by a standardized breakfast and 13 different activities of daily living, 12 of them were individually selected from a set of 35 activities, ranging from sedentary and low intensity to more dynamic and physically demanding activities. Using indirect calorimetry as a reference for the metabolic equivalent of task (MET), we compared the EE estimations made using a hearing aid integrated device (Audéo) against those of a research device worn on the hip (ZurichMove) and consumer devices positioned on the wrist (Garmin and Fitbit). Class-estimated and class-known models were used to evaluate the accuracy and precision of EE estimates via Bland-Altman analyses. Results The findings reveal a mean bias and 95% limit of agreement for Audéo (class-estimated model) of −0.23 ± 3.33 METs, indicating a slight advantage over wrist-worn consumer devices (Garmin: −0.64 ± 3.53 METs and Fitbit: −0.67 ± 3.40 METs). Class-know models reveal a comparable performance between Audéo (−0.21 ± 2.51 METs) and ZurichMove (−0.13 ± 2.49 METs). Sub-analyses show substantial variability in accuracy for different activities and good accuracy when activities are averaged over a typical day's usage of 10 h (+61 ± 302 kcal). Discussion This study shows the potential of hearing aid-integrated accelerometers in accurately estimating EE across a wide range of activities in the target demographic, while also highlighting the necessity for ongoing optimization efforts considering precision limitations observed across both consumer and research devices.
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