2314. Burden of Respiratory Syncytial Virus (RSV) Infection Among Hospitalized Older Adults and Those with Underlying Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF)

Background

Data are limited about the burden of respiratory syncytial virus (RSV)-related hospitalizations in older adults and those with COPD or CHF.

Methods

We conducted prospective surveillance at two hospitals from October 2018 to March 2019 for adults ≥50 years of age admitted with acute respiratory infections (ARI) and adults of any age with COPD or CHF-related admissions. Adults were eligible if they were residents of an 8 county region in Atlanta, Georgia. Asymptomatic adults ≥50 years of age were enrolled as controls. Nasopharyngeal and oropharyngeal swabs were tested for RSV and influenza (Flu) using BioFire® FilmArray® Respiratory Viral Panel (RVP) and acute/convalescent serology was obtained for RSV antibodies detection by enzyme immunoassay against RSV lysate. Standard of care results were included for enrollees. We compare the number of RSV+, Flu+ and RSV−/Flu− cases along with demographic features and outcomes.

Results

We screened 12,453 patients to identify 1,515 eligible adults of which 617 (41%) were enrolled. The most common reasons for failing to enroll were refusal (676, 75%) and inability to obtain informed consent (221, 25%). Of the 617, 36 (6%) were RSV+ and 41 (7%) were Flu+. RSV was detected in 1/126 (0.8%) and Flu in 0/126 healthy controls. RSV+ occurred earlier in surveillance and peaked at a higher frequency (figure). Clinical characteristics and outcomes are in the table. In a convenience sample, a four-fold rise in RSV antibody titer was detected among 8/15 RSV+, 0/42 RSV−/Flu−, and 0/42 healthy controls.

Conclusion

The burden and outcomes for RSV are similar to Flu in adults admitted to the hospital with ARI, CHF, or COPD. A vaccine for RSV would be beneficial.

Disclosures

Nadine Rouphael, MD, Merck: I conduct as Emory PI the PNEUMO MERCK study at Emory, Research Grant; Pfizer: I conduct as co-PI the RSV PFIZER study at Emory, Research Grant; Sanofi-Pasteur: I conducted as Emory PI the CDIFFENSE trial at Emory, Research Grant.

Goldspotted spinefoot Siganus punctatus (Siganidae) age-based reproductive life history and fisheries vulnerability

Between February 2015 and 2016, samples of the Indo-Pacific goldspotted spinefoot Siganus punctatus were taken from local fish markets, feeding sites and nursery grounds on the main island of Pohnpei, Micronesia, to ascertain sexual pattern, reproductive seasonality, age, growth and mortality. Microscopic examinations of gonads identified two seasonal peaks in reproduction: February to May and September to December, with evidence of some spawning activity in most months. Ripe females were observed 4 days on either side of the new moon. Females first matured at c. 180 mm fork length (L_F ) and 1 year of age, which coincides with their entry into the fishery. Ninety five per cent of individuals were less than 3 years and the oldest fish were 8 years. To examine the species vulnerability to fishing, a tag-and-recapture study was conducted over 4 months in 2015 in a locally managed marine area and at an unprotected site. Findings suggest high residency and high vulnerability to fishing at shallow-water feeding sites and restricted migration overall. The placement of marine protected areas within critical habitat appears to be an effective conservation strategy for this species, particularly when combined with gear and seasonal market restrictions during vulnerable life-history phases.

What is the rate of methicillin-resistant Staphylococcus aureus and Gram-negative infections in open fractures?

BACKGROUND

There have been increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) infections in the community, but it is unclear whether infectious organisms in open fracture infections have changed and if our current regimen of antibiotic prophylaxis is therefore obsolete.

QUESTIONS/PURPOSES

We determined the recent incidence of MRSA and Gram-negative organism infections after open fractures.

METHODS

We performed a retrospective cohort study on 189 patients with 202 open fractures treated from 2009 to 2010. During the followup, patients were evaluated for signs of infection using the Centers for Disease Control and Prevention criteria. We determined the organisms using routine microbiology culture. The minimum followup was 3 months (median, 47 months; range, 3-108 months).

RESULTS

Of the 202 open fractures, 20 (10%) developed infections. The most common organism was Staphylococcus, whereas five (25%) of those infected were positive for MRSA, and 11 (55%) of those with infection were cultured for at least one Gram-negative organism. Six (30%) open fractures had infections that grew out multiple organisms. The incidence of MRSA infections in our open fracture population was 2.5%.

CONCLUSIONS

There is a high incidence of MRSA and Gram-negative infections after open fractures, which may indicate that current antibiotic regimens need to be changed.

LEVEL OF EVIDENCE

Level IV, retrospective case-series. See the Guidelines for Authors for a complete description of levels of evidence.

Ultrasound estimation of amniotic fluid volume using the largest vertical pocket containing umbilical cord: measure to or through the cord?

OBJECTIVES

The purpose of this investigation was to determine the preferable method, either measuring to the umbilical cord or through the umbilical cord to the base of the pocket, of ultrasonically estimating amniotic fluid volume.

SUBJECT AND METHODS

This was a prospective study carried out in singleton pregnancies undergoing a third-trimester amniocentesis. The amniotic fluid index (AFI) and single deepest pocket (SDP) were measured prior to amniocentesis. If measured spaces contained umbilical cord, measurements were made to and through the cord. Actual amniotic fluid volume was determined by the dye-dilution technique.

RESULTS

One-hundred pregnancies were evaluated. Low dye-determined volume was identified in a significantly greater number of pregnancies using the AFI to the cord (7/28, 25%) compared to through the cord (2/28, 7%) (P = 0.025). The SDP technique to the cord was superior in low volumes (2/28, 7%) vs. (0/28, 0%) through the cord (although statistical significance could not be determined because there were no low through-the-cord measurements).

CONCLUSIONS

For the detection of low amniotic fluid volumes, the AFI to the cord is better than through the cord. Measurement to the cord and through the cord had similar accuracy for both the AFI and SDP techniques in normal and high dye-determined amniotic fluid volumes.

Bisphenol a binds to the low-affinity estrogen binding site

Environmental estrogens are suspected of being involved in the current increase in the incidence of human reproductive malfunctions, such as a decrease in male reproductive capacity and an increased incidence of breast cancer in women. The influences of these compounds have been proposed to be mediated through binding to macromolecules, such as estrogen receptor alpha or beta. In this study we examined whether the low-affinity Type II estrogen binding site (Type II EBS), originally identified in the rat uterus, is a possible mediator of environmental estrogens such as bisphenol A (BPA). Analysis of BPA's binding to an enriched fraction of Type II EBS, using a competition assay, indicated that BPA was able to compete with estradiol in binding to this site. At a concentration of 10-15 microM (comparable to that required to induce uterine proliferation), BPA inhibited the binding of estradiol to Type II EBS by greater than 50%. The binding affinity of BPA for the Type II EBS was only 8-10-fold lower than that of the synthetic estrogen diethylstilbestrol. The binding of BPA to Type II EBS appeared specific to BPA, in that endosulfan, another environmental estrogen, failed to displace estradiol from the site. A comparison of the relative binding affinities of BPA for rat uterine estrogen receptor alpha to that of the Type II EBS implies that BPA preferentially binds to the Type II EBS.

Laboratory evaluation of a multitest system for identification of gram-negative organisms

Seventy-two oxidase-positive or nonfermentative organisms, or both, all of which could be identified with reasonable certainty by alternative means, were used to challenge the OXI/FERM tube. There was 91% concurrence of identification between the two methods. Three observers, working independently, agreed upon the interpretation of each of the tests in the OXI/FERM system from 91% to 100% of the time. Duplicate OXI/FERM tubes inoculated with the same strain yielded identical interpretations 95% of the time for all tests except citrate utilization (89%). The OXI/FERM tube thus appeared to be an accurate identification method and yielded test results that were easily interpreted and adequately reproducible.

Comparison of methods for rapid immunofluroescent staining of group A streptococci and Neisseria gonorrhoeae

Immunofluorescent staining reactions for group A streptococci and Neisseria gonorrhoeae were equivalent to those of standard "slow" methods when slides were heated on a serological water bath at 50 C for periods one to four minutes. No false negative reactions occurred when this method was used. False negative reactions occasionally occurred when previously described rapid methods which employed a slide warmer were used.