bluuebunny/crossref_metadata_2025 huggingface dataset:
372. Comparing the Outcome of COVID-19 in Cancer and Non-Cancer Patients: an International Multicenter Study
Authors: Hachem Ray Y , Datoguia Tarcila , Siddiqui Bilal , Cruz Ana Fernandez , Mori Nobuyoshi , Fakhreddine Suha , Lee Dong-Gun , Gorak Edward , Somer Robert , Bhinder Arvinder , Shelanski Samuel , Dragivich Tomislav , Bayle Arnaud , Chemaly Roy F , Mulonovich Victor , Adachi Javier , Malek Alexandre , Slavin Monica , Jiang Ying , Chaftari Anne-Marie , Raad Issam I , Raad Issam I
Published: January 2021

Background

Our objective was to describe the clinical course, risk factors and outcomes of patients infected with COVID-19 around the globe comparing cancer to non-cancer patients.

Methods

We conducted a retrospective cohort study of COVID-19 confirmed cases through an international multicenter collaboration including 17 centers around the world including the United States of America, Brazil, Europe, Far East, Middle East and Australia from January to date. We evaluated the patients’ clinical characteristics, clinical course of the disease, hospitalization and outcome. Death was considered to be COVID-associated if it occurred within 30 days from the time of diagnosis.

Results

Preliminary data on 571 patients included 186 cancer patients and 385 non-cancer patients.

Cancer patients were more likely to have COPD and received steroids but were less likely to have COVID-related symptoms compared to non-cancer patients (84% vs 97%, p< 0.0001). The rate of pneumonia with hypoxia, non-invasive ventilation and mechanical ventilation were similar in both groups. Despite the fact that hospital admissions were significantly higher in non-cancer patients (70% vs 56%, p< 0.001), promising antiviral and immune-related therapy including remdesivir, convalescent plasma and immunomodulators were more commonly used in cancer patients compared to non-cancer patients (P=0.04). Cancer patients had a higher COVID-associated mortality rate compared to non-cancer patients (20% vs 11%, p=0.006).

Conclusion

Despite the fact that cancer patients received more frequent antiviral and immune-related therapy, the mortality rate among cancer patients was significantly higher than non-cancer patients.

Disclosures

Roy F. Chemaly, MD, MPH, FACP, FIDSA, Chimerix (Consultant, Research Grant or Support)Clinigen (Consultant)Merck (Consultant, Research Grant or Support)Novartis (Research Grant or Support)Oxford Immunotec (Consultant, Research Grant or Support)Shire/Takeda (Research Grant or Support)Viracor (Research Grant or Support) Issam I. Raad, MD, Citius (Other Financial or Material Support, Ownership interest)Cook Medical (Grant/Research Support)Inventive Protocol (Other Financial or Material Support, Ownership interest)Novel Anti-Infective Technologies (Shareholder, Other Financial or Material Support, Ownership interest)
375. COVID 19 infection in a Massachusetts community hospital
Authors: Davaro Raul , rapose alwyn
Published: January 2021

Background

The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16.

Methods

The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included.

Results

A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma.

Conclusion

In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %.

Disclosures

All Authors: No reported disclosures
378. E-cigarette or Vaping Associated Lung Injury in the Time of COVID-19
Authors: Downey Rachel D , Murphey Donald , Fernandez Marisol , Sapozhnikov Julia , Hauger Sarmistha Bhaduri
Published: January 2021

Background

Pediatric providers have been caring for two new and similar respiratory illnesses: E-cigarette or vaping use associated lung injury (EVALI) beginning in 2019 and Coronavirus Disease 19 (COVID-19) in 2020. Similarities include prodrome, presentation, imaging, and laboratory testing. While EVALI often improves with steroid treatment, steroids can be detrimental early in the course of COVID-19.

Although a positive SARS CoV-2 polymerase chain reaction (PCR) test is helpful, this result does not definitively identify SARS CoV-2 as the primary cause of symptoms in patients with a history of vaping, as both processes may be coexistent. Coinfection with other infectious agents is commonly found in children with COVID-19 infection, and the majority of children with PCR positive SARS CoV-2 are asymptomatic or mildly symptomatic.

Methods

In hopes of better defining EVALI versus COVID-19 clinical syndromes, we reviewed charts of pediatric patients admitted to a freestanding children’s hospital in Texas diagnosed with EVALI over a year period from June 1, 2019 and June 1, 2020. Cases were identified through a local patient registry. We compared findings in these cases with literature regarding pediatric patients with acute COVID-19 and EVALI. Variables included presenting symptoms, timing of symptoms, vital signs, imaging, and laboratory results.

Results

Twelve patients with EVALI diagnosis were included. Clinical presentation, imaging, and laboratory findings were similar to those described with acute COVID-19 and are included in figures 1 and 2. Repeated interviewing regarding vaping revealed a history of vaping in all EVALI cases; frequency reported varied from multiple times daily to remote use. Some cases with EVALI also had a significant psychiatric history, positive urine drug screen, or significant weight loss prior to hospitalization. Cases with EVALI and steroid treatment improved within days of treatment. In a review of literature, BAL sampling often reveals lipoid pneumonia in EVALI cases, which would not be expected in COVID-19. Of note, the single case in our group tested did not have lipoid pneumonia on bronchoalveolar lavage (BAL) cytology.

Conclusion

Presence of prolonged preceding weight loss, or BAL cytology could help differentiate these clinical states.

Disclosures

All Authors: No reported disclosures
380. First Reports of Salivary Gland Involvement in Corona Virus Disease 2019
Authors: Anmolsingh Roopa , Keenan Elizabeth , Kannangara Don
Published: January 2021

Background

Many viruses infect salivary glands. These include mumps, Epstein-Barr, herpes virus 6, parainfluenza, influenza, adeno virus, boca virus and others. Almost all coronavirus disease 2019 (COVID -19) infected patients carry the virus in saliva. Salivary duct epithelium were the early target cells in macaque monkeys infected with severe acute respiratory syndrome corona virus (SARS-COV). Here we present 2 COVID-19 cases with the involvement of salivary glands. Salivary gland involvement has not been reported in COVID-19.

Methods

We followed the COVID 19 clinical findings in a Pennsylvania long term care facility with 190 residents. Thirty tested polymerase chain reaction (PCR) positive. However, 48 were presumed infected. Eighteen likely cases were not tested due to shortage of swabs. Thirty four employees also tested positive. Two out of 48 patients aged 78 and 88 developed unilateral sialadenitis during the course of the illness. Both were Hispanic females. We studied the Clinical presentations, co-morbidities, lab and imaging results and the outcome.

Results

Case 1: Two days after the first confirmed case, a 88 year old Hispanic female developed fever and fatigue and tested COVID-19 positive. Fever lasted 5 days. Twenty days later the patient developed a 5x3 cm tender left parotid mass and hypoxia treated with oxygen via nasal cannula. (Table 1)

Case 2: A 78 year old Hispanic female developed high fever and cough 7 days after the index case. Six days later she had persistent fever and presented with a tender 8.5x3.5 cm right submandibular mass. The patient was intubated for 3 days to protect the airway due to the size of the mass. Both made an uneventful recovery. (Table 1 and Figure 1)

Conclusion

New clinical findings of COVID -19 have been gradually added during the course of the pandemic. The virus is almost universally present in the saliva. In experimental Chinese macaques with SARS-COV early target cells were the salivary duct epithelium. Salivary gland inflammation and swelling should be included amongst the clinical features of COVID-19.

Disclosures

All Authors: No reported disclosures
382. Incidence of Hospital-Acquired and Ventilator-Associated Pneumonia in Patients with Severe COVID 19 on High Flow Oxygen
Authors: Papamanoli Aikaterini , Nakamura Jacquelyn , Fung Jenny , Abata Joshua , Karkala Nikitha , Tsui Stella T , Yoo Jeanwoo , Grewal Prabhjot , Mojahedi Azad , Dhaliwal Simrat , Jacob Robin , Hotelling Jessica , Rawal Sahil , Coritsidis Alexandra , Psevdos George , Kalogeropoulos Andreas , Marcos Luis
Published: January 2021

Background

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) can be serious complications of coronavirus disease 19 (COVID-19). Co-infections may worsen outcomes and prolong hospitalization. This risk may be exacerbated by systemic corticosteroids (steroids) and other adjunctive therapies.

Methods

We reviewed the records of all adults admitted to Stony Brook University Hospital, NY, from 3/1 to 4/15, 2020 with severe COVID-19 pneumonia, requiring high-ﬂow O2 (non-rebreather mask, Venturi mask with FiO2 >50%, or high-ﬂow nasal cannula). We excluded patients who received mechanical ventilation (MV) or died within 24h. Patients were followed until death or hospital discharge. We reviewed positive sputum cultures (PSC) for pathogenic microorganisms and calculated the incidence of HAP and VAP (nosocomial pneumonia, [NP]), rates of MV and impact on mortality. Fungi isolated from sputum, were considered colonization unless associated with fungemia. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on HAP or VAP.

Results

A total of 469 patients were included (Table 1). Of these, 199 (42.4%) required intensive care and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 105 (22.4%) had PSC. Of these, 59 were considered true pathogens (HAP: 11, VAP: 48), with predominance of S. aureus (MSSA) 38.9%, Enterobacteriaceae 33.8% and Pseudomonas species 18.6%. 39 isolates were considered colonization (Table 2); Patients with PSC < 48h (N=7) from admission, were not considered NP. The incidence of NP was 7.0 per 1000 patient-days (95%CI 5.5–8.5). Of 11 patients with HAP, 9 needed MV. NP was more frequent among patients receiving steroids (9.0 vs 5.7 per 1000 patient-days; P=0.023). Use of tocilizumab was not associated with NP (6.2 vs 8.4 per 1000 patient-days; P=0.11). Mortality was nonsignificantly higher in patients with (20/59, 33.9%) vs. without (103/410, 25.1%) NP (P=0.16). Intubation and length of stay were the strongest predictors of NP in multivariable models.

Cohort Characteristics of Patients with Severe COVID -19 Pneumonia on High Flow Oxygen (N= 469)

All Microbes Isolated from Sputum Cultures

Conclusion

Among high risk COVID-19 patients, NP is a common complication. MSSA and Enterobacteriaceae were the most frequent isolates. The risk increases with intubation, longer hospital stay and use of steroids but not tocilizumab.

Disclosures

All Authors: No reported disclosures
383. Increased Need for Antimicrobial Stewardship during a COVID-19 Outbreak in New York City
Authors: Policar Maurice , Barber Peter , Malik Yesha
Published: January 2021

Background

The impact of COVID-19 on the health care system in New York City (NYC) cannot be overstated. The first documented cases of COVID-19 in Queens NYC occurred in early March of 2020. The total number of patients with proven or suspected COVID-19 at Elmhurst Hospital peaked in early April. A dramatic increase in the use of antimicrobials occurred in April, and correlated with the increased number of intubated COVID-19 patients at Elmhurst Hospital.

Methods

Antimicrobial Stewardship Committee activities and meetings had been suspended for the months of March and April due to the increased clinical demands associated with the COVID-19 outbreak. In preparation for the May meeting, a retrospective analysis of antimicrobial use for March and April of 2020 was performed.

Results

The analysis revealed a 30% increase in the use of antimicrobials. The average total days of antimicrobials per 1000 patient days (TDA/TPD) was 445 for January through March of 2020. In April, this number climbed to 580. TDA/TPD increased from 57 to 90 (58%) for vancomycin, 25 to 35 (40%) for meropenem, and 31 to 89 (187%) for cefepime. The number of intervention by the Antibiotic Stewardship team remained low during this time period.

Total Days of Antimicrobials per 1000 Patient Days (TDA/TPD)

Conclusion

A dramatic increase in the use of antimicrobials correlated with an increase in the number of intubated patients at Elmhurst Hospital during a COVID-19 outbreak. It is likely that the frequent appearance of fever and leukocytosis in intubated patients with COVID-19 prompted an increase in empiric antimicrobial use. The 48 hour time outs and prospective review of antimicrobial use may be necessary to maintain stewardship efforts during the COVID-19 epidemic. Further review of antibiotic usage in critically ill COVID-19 patients is needed to help define stewardship practices as we go forward in this pandemic.

Disclosures

All Authors: No reported disclosures
385. Kawasaki’s Disease and Sars-Cov-2: an Unexpected Pediatric Global Crisis?
Authors: Giarola Lucca G , Couto Braulio Roberto Gonçalves Marinho , Starling Carlos Ernesto Ferreira , de Carvalho Handerson Dias Duarte
Published: January 2021

Background

Infection by SARS-CoV-2 can lead to dyspnea, edema, deposition of intra alveolar fibrin, thrombosis and hemorrhages. During the COVID-19.

outbreak, several questions were raised about the risks for the pediatric population. Pediatric patients appeared to be relatively safe, with only minor symptoms and a quick recovery. However,

there have been reports of a relationship between COVID 19 and a Kawasaki-like inflammatory disease in this population. Kawasaki’s disease (KD) is a rheumatological vasculitis prevalent in childhood characterized mainly by diffuse inflammation of the arteries associated with skin rash, changes in the mucosa and its main complication is coronary aneurysms.

Methods

A systematic literature review was performed in the PubMED database using the keywords “Kawasaki disease”, “COVID-19” and “Pediatrics”. The selected filters were “Case reports”, “Multicenter study”, “Clinical Study”, “Observational study”, “Human” and “English”. A total of 18 articles were seleted.

Results

There seems to be a convergence between the literature published so far, pointing to a greater propensity for pediatric patients infected with Sars-Cov-2 to develop KD. The number of patients with KD symptoms seen at a specific center increased from 2 to 17 in 11 days (MOREIRA, 2020). In a sample space of 21 patients diagnosed with KD, 91% had previous contact with SARS-CoV-2 (TOUBIANA, 2020) whereas other studies point to a 30-fold increase in the prevalence of KD since the beginning of 2020 (VERDONI, 2020).

There is already an established relationship between DK and HCoV-NH, describing that 4.5% of patients with this infection develop KD. Therefore, it was suggested that infection with another Coronavirus strain could have a similar relationship.

Conclusion

Despite the relationship described between pediatric patients infected with COVID-19 being more likely to develop KD, further studies are needed to prove a statistical relationship between both condition.

Disclosures

All Authors: No reported disclosures
386. Long-term Complications Associated with COVID-19 Infection
Authors: Gudipati Smitha , Ranger Judith L , Vahia Amit T , Acosta Tommy J Parraga , Hanna Zachary W , Nair Sashi N , Yared Nicholas F , Suleyman Geehan , Brar Indira
Published: January 2021

Background

In Michigan, 44,964 (68%) of the 66,269 COVID-19 patients have recovered. However, there is concern that COVID-19 infection may lead to long-term sequelae, including pulmonary defects, cardiac complications, blood clots, and neurocognitive impairment. This study describes the 30-day outcomes of patients who had recovered.

Methods

From 3/16/2020 to 5/19/2020, a follow-up was attempted for patients who were discharged alive from Henry Ford Hospital in Detroit and had recovered. Recovery was defined as being alive 30 days post symptom-onset. A telephone survey was conducted 30 days post-index admission and recorded in electronic medical records. Oxygen (O2) requirements, symptoms, readmissions and the need for antibiotics for secondary bacterial infections were evaluated.

Results

585 patients met inclusion criteria and were contacted by phone; 303 answered their phone (Table 1), but only 266 (45%) completed a full telephone encounter and were included in the final analysis (Table 2). The majority were female (53%), black (80%), and discharged to home (84%). The clinical characteristics of those who completed the survey were as follows: 11% presented with O2 saturation < 90%, 16% had underlying lung pathology, and 57% had a BMI above 30. Patients’ average age was 61 ± 14.3 years. At 30 days post-index admission, 49% were still symptomatic. Of the symptomatic patients, 86% had dyspnea on exertion and 15% required O2 supplementation. 18% of patients were readmitted within 30 days, and 9% developed a secondary infection prior to the phone encounter. No statistically significant differences in demographics or comorbidities were found between symptomatic and asymptomatic cohorts (Tables 1, 2).

Conclusion

In our study, almost half of the discharged patients remained symptomatic after 30 days with a substantial proportion experiencing pulmonary symptoms. A better understanding of the long-term pulmonary sequelae following COVID-19 infection is needed to design interventions to reduce post-infectious morbidity.

Disclosures

Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)
387. Markers for Mortality in COVID-19 Patients with Atrial Fibrillation or Flutter
Authors: Chan Kok Hoe , Patel Bhavik , Farouji Iyad , Suleiman Addi , Slim Jihad
Published: January 2021

Background

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter).

Methods

A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter

Results

The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%).

New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired.

In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93).

Conclusion

This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter.

Disclosures

Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
389. Neutrophil-lymphocyte index, platelet-lymphocyte index and systemic inflammation-immunity index in patients with Covid-19 pneumonia in Veracruz, Mexico
Authors: Del Carpio-Orantes Luis , García-Méndez Sergio , Hernández-Hernández Sara Nohemi , Rosas-Lozano Ada Lili , Munguia-Sereno Alvaro Efren , Guerrero-Mancinas Zeltzin Olivia , Aparicio-Sánchez Elisa Estefanía , Segura-Rodríguez Orlando Israel , García-Hernández Omar , Escobar-Huerta Alejandro
Published: January 2021

Background

Different indices have been devised that attempt to correlate the severity of the symptoms and predict mortality mainly in septic states and inflammation, with important results that validate their usefulness. In the present pandemic, to date, no indices have been used in severe cases of Covid- 19 that can predict the outcome.

Result of the measurement of demographic and clinical variables

Comparative analysis of the variables studied stratified by hospital outcome

Methods

It includes a cohort of patients with pneumonia confirmed by Sars Cov 2 PCR-RT, treated at the Veracruz Norte branch of the Instituto Mexicano del Seguro Social from April to May 2020, analyzing the neutrophil-lymphocyte, platelet-lymphocyte and immunity-systemic inflammation indices.

Correlation analysis of severity hematological variables with hospital outcome

Results

We included 100 patients, 54 (54%) women and 46 (46%) men, with a mean age of 49.4 ± 19.3 years. The mean of leukocytes was 10,103.0 ± 4,289.0 cel / mm3, neutrophils 8,509.3 ± 4,216.0 cel / mm3 and lymphocytes of 1,112.7 ± 585.4 cel / mm3; Regarding the hematological indices used to measure severity, we found that the mean of the INL was 10.7 ± 10.9, that of the IPL was 290.1 ± 229.2 and that of the IIIS was 2.6 ± 3.4 x 109. Regarding the type of pneumonia, 54 (54%) had mild pneumonia and 46 (46%) had severe pneumonia. Regarding hospital outcomes, 75 (75%) of the patients were discharged due to clinical improvement and 25 (25%) of the patients died during the hospital stay. The mean age was significantly higher in the group of patients who died during the hospital stay (45.9 ± 18.6 VS 60.0 ± 17.5 years, p = 0.001), the proportion of women who died was higher and tended to be statistically significant. The mean INL was 20.4 ± 16.9 in patients who died VS 7.5 ± 4.9 in patients who improved (p = 0.001). The mean IPL was 417.1 ± 379.7 in patients who died VS 247.7 ± 127.4 in patients who had improvement; p = 0.038. Finally, the mean IIIS was significantly higher in patients who died VS patients who had clinical improvement (4.8 ± 6.1 VS 1.9 ± 1.2; p = 0.030, respectively). In the correlation analysis, high and significant r were found in the three indices.

Conclusion

Neutrophil-lymphocyte, platelet-lymphocyte and systemic immunity-inflammation indices in patients with Covid-19 pneumonia can be used as predictors of severity and predict hospital outcome.

Disclosures

All Authors: No reported disclosures
390. Non-invasive Detection of Co-infections in Hospitalized Patients with COVID-19 using the Karius Test, A Plasma-based Next-Generation Sequencing Test for Microbial Cell-free DNA
Authors: Via William V La , Dalai Sudeb , de Vries Christiaan R , Macintyre Ann , Ahmed Asim A
Published: January 2021

Background

Patients hospitalized with SARS-CoV2 infections (Covid-19) are frequently febrile and can become critically ill quickly often leading to intervention with antimicrobial therapy. An etiologic diagnosis of superinfections can be difficult to obtain through the usual invasive procedures because of patient instability and the desire to avoid them because they may not be tolerated by the patient. Providers may also be hesitant to embark on such interventions in order to avoid healthcare personnel (HCP) exposure to aerosols.

Methods

Karius Test (KT) results are presented from 30 patients who presented with Covid-19. The KT is a CLIA certified/CAP-accredited next-generation sequencing (NGS) plasma test that detects pathogen cell free DNA (cfDNA). After cfDNA is extracted and NGS performed, human reads are removed and remaining sequences are aligned to a curated database of > 1400 organisms. Organisms present above a statistical threshold are reported.

Results

The KT detected pathogens in the majority of patients (n=20) with COVID-19. The most common infections were herpesviruses in 60% of patients. The most common bacterial pathogen was E. coli seen in 25% of patients. 15 out of 20 patients had more than one pathogen detected. 15% of patients had fungal pathogens, including one detection of Lichtheimia ramosa, in an immunocompromised patient. The results are summarized in the table.

Co-infections detected by the Karius Test in patients hospitalized with COVID-19

Conclusion

Open-ended, plasma-based NGS for mcfDNA provides a non-invasive method to assess for co-infections in critically ill patients with COVID-19. This report highlights the potential to increase diagnostic yield as well as to decrease the need for invasive procedures – and their attendant risks to patients and HCP – to obtain etiologic diagnoses to better inform antimicrobial therapy for superinfection. It also serves to highlight the variety of pathogens affecting these patients during the COVID-19 pandemic.

Disclosures

William V. La Via, MD, Karius (Employee) Sudeb Dalai, MD, Karius (Employee) Christiaan R. de Vries, MD, PhD, Karius (Consultant, Independent Contractor)Stanford University (Employee) Ann Macintyre, DO, Karius (Employee) Asim A. Ahmed, MD, Karius (Employee)
391. Outcomes of Empiric Antimicrobial Therapy in COVID-19 Positive Patients
Authors: Medler Corey J , Jakupovic Lejla , Weinmann Allison J , Kenney Rachel , Davis Susan L , Davis Susan L
Published: January 2021

Background

The COVID-19 pandemic has revealed new challenges for antimicrobial stewardship. Optimal medical treatment is not completely understood at this time. The epidemiology and outcomes of bacterial co-infections are not well-established; however, empiric antibiotic (abx) use is anecdotally common. The purpose of this study is to characterize empiric antimicrobial drug selection and timing in COVID-19 and evaluate the impact on patient outcomes.

Methods

Cross-sectional cohort study for COVID-19 positive inpatients from March 1, 2020 to June 1, 2020 at an academic medical center and 4 community hospitals. Inclusion: patients with a documented positive COVID-19 PCR nasopharyngeal swab. Exclusion: patients less than 18 years; deceased or transitioned to hospice within 24 hours of admission. Primary endpoint: empiric abx drug, initiation, duration and indication. Additional data collected: severity of illness, co-infection diagnosis, microbiology, and adverse drug effects (ADE). Clinical outcomes included time to recovery by COVID-19 ordinal outcome, clinical status at day 15, and readmission.

Results

400 patients were included with 27% from the ICU. COVID symptom category included mild (23.8%), moderate (53%), severe (15%), and critical (8.3%). 322 (80.5%) received abx at any time during hospital stay, 301 (93.5%) started within 1 day of admission. Most common documented indication community-acquired pneumonia (69%). Identified 43 (10.8%) microbiologically confirmed co-infections, including 5 MRSA and 7 Pseudomonas. Median duration of initial abx 4 days. 54/322 (16.8%) had abx restarted after discontinuation. Median days to recovery without abx was 10 days (7 – 14) and 14 days (9 – 20) with abx. Patient characteristics and outcomes described in table 1. 74 abx related ADE were identified: gastrointestinal 37 and renal 22.

Conclusion

It’s difficult to distinguish bacterial and Covid-19 in coinfections in patients ill enough to be hospitalized. Longer courses of empiric abx therapy were prevalent as the severity of illness increased. However, the low frequency of microbiologically confirmed bacterial co-infections results in potentially unnecessary abx exposure. This exposure increases risk of abx ADE and may not improve clinical outcome.

Disclosures

All Authors: No reported disclosures
392. Predictors of Mortality in Hospitalized Patients with COVID-19; A Single Centered Retrospective Analysis
Authors: Harmouch Farah N , Shah Kashyap , Goel Harsh
Published: January 2021

Background

The Coronavirus disease-2019 (COVID-19) has been responsible for the death of over 400,000 people with a continuous rise in prevalence and mortality globally. Identifying hospitalized patients at high mortality risk is critical for triage and health-care resource management regionally, nationally, and globally. We present a retrospective analysis of predictors of mortality in hospitalized COVID-19 patients.

Methods

Electronic health records (EHR) of patients admitted between March 1 and April 18, 2020 to St. Luke’s University Hospital with a primary diagnosis of COVID-19 were reviewed for medical co-morbidities and initial biochemical/inflammatory markers. Survivors vs non-survivors were compared using χ 2 test, Student’s t-test, and Mann-Whitney U-test as appropriate. Univariate logistic regression was used to identify candidate variables for multivariate analysis, which were then included in stepwise backward logistic regression. Statistical analyses were done on SPSS v26 software (IBM, Armonk, NY).

Results

Clinical characteristics, biochemical abnormalities and results of univariate regression in our cohort of 560 patients are noted in table 1. Multivariate regression revealed age, congestive heart failure (CHF), and creatinine≥ 1.5 mg/dl as significant predictors of mortality while race (Caucasian), vascular disease, lymphopenia, and elevated ferritin approached significance (Table 2).

Table 1: Baseline clinical characteristics, overall and by mortality. Continuous variables are presented as median (25th-75th percentile), and categorical variables as n (%) Significance of difference between subgroups (survivors versus non-survivors) *p≤0.05, **p≤0.01, ***p≤0.001

Table 2: Results of stepwise backward conditional logistic regression for predicting mortality among hospitalized COVID-19 patients. (n=334, 287 survivors and 47 non-survivors). ALC – Absolute lymphocyte count, S.E. – Standard error of B.

Conclusion

We present one of the largest cohorts to date of hospitalized COVID-19 patients. Age, CHF, and renal disease were significant independent predictors of mortality. Though several inflammatory markers (d-dimer, CRP, procalcitonin) initially predicted mortality, they failed in multivariate analysis, questioning their role in risk-stratifying COVID-19 hospitalized patients. Interestingly, IL-6 used in those severely ill patients to assess candidacy for IL-6 inhibitor therapy (Tocilizumab) failed to predict mortality in our study. Our analysis was limited due to its retrospective nature and unfortunately large amounts of data were missing for some variables (ESR, BNP, IL-6 levels). The missing data was due to rapidly evolving institutional protocols early during the pandemic, leading to non-uniform assessment of these markers.

Disclosures

All Authors: No reported disclosures
393. Prevalence of HIV in Patients Hospitalized for COVID-19 and Associated Mortality Outcomes: A Systematic Review and Meta-analysis
Authors: Ssentongo Paddy , Ssentongo Anna E , Heilbrunn Emily S , Du Ping
Published: January 2021

Background

As of June 3rd, 2020, the number of confirmed cases of novel SARS-CoV-2, the causative agent of COVID-19, was approximately 6,538,456, with 386,503 deaths globally. Individuals with pre-existing conditions are particularly susceptible to and more likely to die from Covid-19. However, individuals with human immunodeficiency virus (HIV) are unique due to their use of antiretroviral therapy, including protease inhibitors, which have been used to treat COVID-19. We aimed to conduct a systematic review and meta-analysis exploring the prevalence and prevalence of HIV in patients hospitalized for COVID-19 and delineating the mortality rates.

Methods

MEDLINE, SCOPUS, and Cochrane Library databases and medrxiv.org were searched from January 1st, 2020, to June 15th, 2020. Studies reporting on the prevalence of HIV among hospitalized COVID-19 patients among and outcome of mortality were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed proportions and risk ratio estimates, and heterogeneity was quantified.

Results

A total of 144,795 hospitalized COVID-19 patients were identified from 14 studies (United States 8, Spain 3, China 1, Italy1, and Germany 1). The pooled prevalence of HIV in COVID-19 patients was 1.22 % [95% confidence interval (CI): 0.61%-2.43%)] translating to a 2-fold increase compared to the respective local-level pooled HIV prevalence in the general population of 0.65% (95% CI: 0.48%-0.89%. When we stratified the analysis by country, pooled HIV prevalence among COVID-19 patients in United States (1.43%, 95% CI: 0.98% -2.07%) was significantly higher compared to Spain (0.26%, 95% CI: 0.23%-0.29%) but not different from China (0.99 %, 95% CI: 0.25 %-3.85%). The pooled mortality rates in HIV-positive patients hospitalized for COVID-19 was 14.1 % 95% CI: 5.78%-30.50% and was substantially higher in the United States compared to other countries.

Conclusion

The prevalence of HIV among COVID-19 patients may be higher compared to the general population, suggesting higher susceptibility to COVID-19. The mortality rates are high but vary significantly across countries.

Disclosures

All Authors: No reported disclosures
396. Relationship Between Patient Characteristics and Critical Illness in Patients Admitted for CoVID-19
Authors: Windham Samuel L , Wilson Melissa P , Fling Connor , Sheneman David W , Wand Taylor , Babcock Lyndsey , Delson Samantha , Erlandson Kristine M
Published: January 2021

Background

While several studies have explored hospitalization risk factors with the novel coronavirus (COVID-19) infection, the risk of poor outcomes during hospitalization has primarily relied upon laboratory or hospital-acquired data. Our goal was to identify clinical characteristics associated with intubation or death within 7 days of admission.

Methods

The first 436 patients admitted to the University of Colorado Hospital (Denver metropolitan area) with confirmed CoVID-19 were included. Demographics, comorbidities, and select medications were collected by chart abstraction. Missing height for calculating body mass index (BMI) was imputed using the median height for patients’ sex and race/ethnicity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression and a minimax concave penalty (MCP) regularized logistic regression explored prediction.

Results

Participants had a mean(SD) age 55(17), BMI 30.9(8.2), 55% were male and 80% were ethnic/racial minorities. Unadjusted comparisons by outcome are shown (Table 1). Male sex (aOR: 1.60, 95% CI (1.02, 2.54)), increasing age (aOR: 1.25(1.08, 1.47); per 10 years), higher BMI (aOR 1.03(1.00, 1.06) and poorly controlled diabetes (hemoglobin A1C ≥8) (aOR 2.33(1.27, 4.27) were significantly (p< 0.05) associated with greater odds of intubation or death. Minority status tended to be associated with higher odds (aOR:1.8(1.01,3.36); p=0.052). Surprisingly, need for hospital interpreter was associated with decreased odds (OR: 0.58(0.35, 0.95)) of intubation/death. Our final MCP model included indicators of A1C≥8, age >65, sex and minority status, but predicted intubation/death only slightly better than random chance (AUC= 0.61(0.56, 0.67)).

Table 1. Patient Characteristics Stratified by Intubation and/or Death Within One Week of Admission (n=436)

Conclusion

In a hospitalized patient cohort with COVID-19, male sex, poorly controlled diabetes, increasing age and BMI were significantly associated with early intubation or death. These results complement larger cohort studies, and highlight risk differences across metropolitan areas with varying COVID-19 prevalence, demographics, and comorbid disease burden. Notably, our predictive model had limited success, which may suggest unmeasured factors also contribute to disease severity differences.

Disclosures

All Authors: No reported disclosures
397. Respiratory Coinfections with COVID-19 in Veterans Health Administration (VA), 2020
Authors: Schirmer Patricia , Lucero-Obusan Cynthia , Sharma Aditya , Sohoni Pooja , Oda Gina , Holodniy Mark
Published: January 2021

Background

The first US cases occurred in the COVID-19 pandemic in Jan. 2020. Initially, some states required patients be screened for other respiratory pathogens before COVID-19. Information on COVID-19 coinfections with other respiratory pathogens is limited. We investigated prevalence of COVID-19 coinfections with other respiratory pathogens in VA.

Methods

Molecular and viral culture test results from 9/29/2019-5/31/2020 for respiratory pathogens (Adenovirus, Bordetella pertussis/parapertussis, Chlamydia pneumoniae, COVID-19 and other Coronaviruses, Influenza, human Metapneumovirus (hMPV), human parainfluenza viruses (HPIV), Mycoplasma pneumoniae, Rhino-Enterovirus, and Respiratory Syncytial Virus (RSV)) were identified from VA data sources. COVID-19 tested patients were evaluated within 7 days for respiratory pathogen coinfections from 2/1/2020–5/31/2020. Patient demographics were obtained for patients with coinfections.

Results

A total of 825,282 respiratory pathogen tests (including COVID-19) were performed from Sept. 2019 with percent positive shown in Figure 1. Of these, 617,541 tests were performed starting in Feb. 2020 (Table 1). There were 14,839 (6.5%) positive COVID-19 tests (10,223 unique patients) of 227,111 tests performed (174,747 unique patients). 30,066/174,747 (17%) of patients with COVID-19 were tested for another respiratory pathogen. Fifty-six (0.55%) unique COVID-19 patients were detected with coinfection including 3 COVID-19 positive patients with > 1 other respiratory pathogen (2 with Coronavirus and Adenovirus and 1 with Coronavirus and Rhino-Enterovirus). Other coinfections included 18 Rhino-Enterovirus, 15 Influenza, 10 with another Coronavirus, 4 RSV, 3 hMPV, 2 HPIV, and 1 C. pneumoniae. Demographics of coinfected patients are shown in Table 2.

Figure 1: Percent Positive of Respiratory Pathogens in VA, 9/29/2020–5/31/2020

Table 1: Respiratory Pathogens in VA, 2/1/2020–5/31/2020

Table 2: Co-infection patients with COVID-19 and other Respiratory Pathogens, 2/1/2020–5/31/2020

Conclusion

In VA, coinfection with COVID-19 and other respiratory pathogens was rare. Detection was limited since not all COVID-19 patients were tested for other respiratory pathogens and respiratory pathogens were declining when COVID-19 emerged. Coinfections were detected with different respiratory pathogens. Further comparisons of coinfected vs. non-coinfected patients to assess outcome or actionable results will be important as we enter the next influenza season.

Disclosures

All Authors: No reported disclosures
398. Risk Factors Associated with Requiring Invasive Mechanical Ventilation in Patients with SARS-CoV-2 Infection: Experience in a Tertiary Care Hospital in Mexico City
Authors: Garibay-Vega Brian Ricardo , Castañeda-Mendez Paulo F , Castillo-Álvarez José Luis , Barragán-Reyes Armando , Bay-Sansores Daniela , Pulido-Enríquez Jessica Isabel , Cabrera-Ruiz Maria Lorena , Aguilar-Zapata Daniel , Reyes-Mar Javier , Soto-Ramírez Luis Enrique
Published: January 2021

Background

The clinical presentation of SARS-CoV-2 disease ranges from asymptomatic respiratory infection to acute respiratory distress syndrome. Risk factors upon hospital admission associated with the need for invasive mechanical ventilation are not well documented.

Methods

185 hospitalized patients with confirmed COVID-19 were enrolled in this study, and they were classified as patients who required invasive mechanical ventilation and patients who did not require it. Comorbidities such as diabetes, high blood pressure, obesity, chronic lung disease and immunodeficiency were recorded. Laboratory studies were requested upon admission such as C-reactive protein, leukocyte and lymphocyte levels, D-dimer, troponin, serum ferritin and procalcitonin.

Results

Of the patients who entered the study, 65 patients (35%) required invasive mechanical ventilation (IMV), while 120 (65%) did not require advanced airway management. Of the patients with invasive mechanical ventilation, age > 65 years, male sex, obesity (BMI > 30) and high blood pressure were the most frequent characteristics, presenting the latter two in 26% and 27% respectively. Regarding laboratory studies, the parameters most associated with the requirement for mechanical ventilation were a D-dimer (> 1000) and troponin (> 1), with 26% and 18%, respectively.

Conclusion

This study showed the high proportion of obesity, hypertension and advanced age among patients who required invasive mechanical ventilation associated with SARS-CoV2 infection. The presence of elevated D-dimer and troponin on admission are associated with more severe presentations and a requirement for invasive mechanical ventilation.

Disclosures

All Authors: No reported disclosures
399. Risk Factors for Mortality in COVID-19 Patients in a Community Teaching Hospital
Authors: Andrade Justin A , Muzykovsky Karina , Truong James
Published: January 2021

Background

As of May 2020, there were over 190,000 confirmed COVID-19 cases in New York City (NYC) with approximately 13,000 deaths. Previously published literature identified risk factors (advanced age, higher severity of illness and elevated d-dimer) for mortality in a cohort of patients from Wuhan, China and mechanical ventilation in a case series from NYC. Another case series from NYC evaluated clinical outcomes only. There are limited published studies assessing clinical characteristics, outcomes and risk factors for mortality in COVID-19 patients in NYC. The objective of this study was to assess the risk factors for mortality in patients with confirmed COVID-19 infections.

Methods

This study was a single center retrospective case-control at The Brooklyn Hospital Center, a 464-bed community teaching hospital. Adult patients with confirmed COVID-19 infection, who received at least 24 hours of COVID-19 therapy were included. Endpoints assessed were risk factors for mortality in COVID-19 patients, increase in QTc, renal failure or renal replacement therapy, ventricular fibrillation or ventricular tachycardia. Baseline characteristics between survivor and non-survivors were analyzed utilizing Mann-Whitney U test/two-tailed t-tests for continuous data and Chi-square/Fisher’s exact test for categorical data. Univariable and multivariable logistic regression analyses were conducted to identify the risk factors for in-hospital mortality.

Results

Two-hundred and eighty six patients were included in this analysis, of whom 97 (33.9%) were non-survivors and 189 (66.1%) patients were survivors. Diabetes and coronary artery disease were more common in non-survivors compared to survivors (p = 0.003 and p < 0.001, respectively). Multivariable logistic regression showed higher in-hospital mortality in patients with advanced age (odds ratio 5.779, 95 % confidence interval 1.369–24.407), vasopressor initiation (OR 28.301, 95 % CI 3.307–242.176), and development of renal failure (OR 30.927, 95 % CI 1.871–511.201).

Conclusion

Risk factors associated with mortality for COVID-19 patients in a community teaching hospital include advanced age, vasopressor therapy, and development of renal failure.

Disclosures

All Authors: No reported disclosures
402. Spontaneous pneumothorax in COVID-19
Authors: Tariq Zain , Doeing Diana , Nauriyal Varidhi , Chaudhry Zohra Sarfraz , Shallal Anita , Bhargava Pallavi , Chen Anne , Ramesh Mayur , Herc Erica
Published: January 2021

Background

Pneumothorax has been reported with the use of positive pressure ventilation in COVID-19 pneumonia. Literature on spontaneous pneumothorax (PTX) in COVID-19 patients is scant. We present a case series of 7 patients with COVID-19 pneumonia, who developed spontaneous pneumothorax without prior mechanical ventilation.

Methods

A retrospective chart review of 7 cases was performed from two different hospitals in the US between 4/6/2020–5/15/2020. Hospitalized patients with confirmed COVID-19 by nasopharyngeal RT-PCR who developed spontaneous pneumothorax were included. Collected data included demographics, co-morbidities, inflammatory biomarkers, chest imaging and management strategies. Length of stay, transfer to intensive care unit and death were the assessed outcomes. A descriptive analysis was done.

Results

There were 3 patients from Henry Ford Health System, Michigan and 4 patients from Silver Cross Hospital, Illinois. Median age was 75 years and 6 out of 7 (85.7%) were males (Table 1). There were no co-morbidities associated with spontaneous pneumothorax except for one patient with COPD. None of the patients’ imaging prior to diagnosis of pneumothorax revealed any underlying blebs. Median time from symptom onset to diagnosis of pneumothorax was 17 days. One of the patients had tension pneumothorax, two had bilateral pneumothorax and three had pneumomediastinum (Figure 1). Four patients required chest tube placement, three required escalation to ICU, of which two died.

Table 1. Demographics and Clinical Characteristics of Patients with Spontaneous Pneumothorax

Figure 1. CT imaging before (left) and after (right) Spontaneous Pneumothorax

Conclusion

Spontaneous pneumothorax may be an unrecognized late complication of COVID-19 pneumonia. In hospitalized patients with acute respiratory decompensation, spontaneous pneumothorax should be considered as part of the differential diagnosis. Repeat chest imaging should be considered in these cases.

Disclosures

All Authors: No reported disclosures