bluuebunny/crossref_metadata_2025 huggingface dataset:
242. Association Between Procalcitonin and Antimicrobial Usage in Patients with COVID-19
Authors: Aly Mahmoud H , Cani Eris , Raymond Lendelle , Zeana Cosmina
Published: December 2022

Background

Patients with COVID-19 disease often receive antibiotics to treat suspected bacterial coinfections. Procalcitonin (PCT) is a biomarker used for suspected bacterial infections. The objective of this study is to evaluate the association between PCT and the use of antimicrobials in COVID-19 patients.

Methods

This was a retrospective, cohort study of adult patients admitted with confirmed COVID-19 from March 30, 2020 to March 30, 2021. Data collected included demographics, baseline inflammatory markers including initial PCT and C-reactive protein (CRP) values, past medical history, initiation of empiric antibiotics, mechanical ventilation, in-hospital mortality, days of antibiotic therapy, and length of hospital stay (LOS). Univariate analyses were utilized to assess for any significant differences in demographics based on predefined initial PCT groupings (< 0.25 ng/ml (group 1), 0.25-0.49 ng/ml (group 2), and ≥ 0.5 ng/ml (group 3)). Multivariate analyses were performed to evaluate for any differences between initial PCT values and in-hospital mortality, LOS, and days of antibiotic therapy.

Results

Out of 149 patients, 61.7% had an initial PCT value < 0.25 ng/ml, 17.45% had an initial value of 0.25-0.49 ng/ml, and 20.8% had an initial value ≥ 0.5 ng/ml. A total of 145 patients (97%) received empiric antibiotics. Univariate analysis among the three groups displayed a difference in the initial CRP value, which was higher in groups 2 and 3 versus group 1 (p < 0.001). Regression analysis controlling for initial CRP value found that patients in groups 2 and 3 had a higher duration of antibiotic therapy compared to group 1 (12 and 11 versus 8 days) (p < 0.001) and a longer LOS (17 and 15 vs 12 days) (p = 0.009). More patients (34.6%) were mechanically ventilated in group 2 compared to group 1 (14.1%) and group 3 (22.6%) with a trend toward significance (p = 0.059). Multivariate analysis found no significant association between PCT levels and mortality. The rate of in-hospital mortality in patients receiving invasive ventilation was higher in groups 2 and 3 (78% and 86%, respectively) compared to group 1 (54%, p < 0.001).

Conclusion

When controlling for CRP, an initial PCT value > 0.25 ng/ml was associated with increased days of antibiotic therapy and longer duration of hospital stay in COVID-19 patients.

Disclosures

All Authors: No reported disclosures.
244. Bacterial co-infection in COVID-19: an analysis of a National Cohort of Hospitalized U.S. Veterans
Authors: Khader Karim , Li Haojia , Jones Barbara E , Rubin Michael , Haroldsen Candace , Willson Tina M , Effiong Atim , Cole Jessica , Zhang Yue
Published: December 2022

Background

Bacterial co-infection has been reported with COVID-19, but the extent of co-infection nationally is unclear. We sought to describe the temporal and spatial trends in bacterial co-infection across the US among COVID-19 positive admissions to Veterans Affairs (VA) hospitals.

Methods

This retrospective cohort study included patients admitted to VA hospitals from March 1, 2020 through May 31, 2022 with a positive COVID-19 test within the previous 14 days and up to 2 days after admission. We summarized temporal and spatial patterns of bacterial co-infection, defined as a positive clinical microbiology culture for the bacterial pathogens listed in Table 1, defined as either community-onset (COI, within 2 calendar days of admission), or hospital-onset (HOI, > 2 calendar days after admission). We performed a univariate analysis including facility and patient factors and generated descriptive statistics to describe the frequency of occurrence over time and space overall, and within each organism.

Organisms Table 1:List of organisms included in our study

Results

By the end of June 2021, there were 35,299 hospitalizations observed from 33,383 patients admitted with positive COVID-19 tests in VA. Co-infection was detected among 7.4% of hospitalizations (2.9% for COI and 4.7% for HOI). VA patients older than 70, Asian or unknown race, higher Charlson Comorbidity Index were more likely to experience HOI and COI. Facility-level rates of HOI and COI over the study period presented substantial geographic variability, ranging from 0 to 45.5 per 1000 patient days and from 0 to 6.98 per 100 hospitalizations for HOI and COI, respectively [Fig 1]. Between March 2020 and June 2021, monthly facility-level rates of HOI and COI also varied substantially within and between facilities [Fig 2]. Average monthly co-infection rates increased in the first three months of the pandemic, with HOIs subsequently declining gradually and COIs remaining stable across VA. The correlation coefficients between hospital mortality and facility-level co-infection rates for HOI and COI ranged from –0.5 to 0.7 [Fig 3].

Spatial variation Fig 1:Plot for spatial distribution across VA facilities of HOIs and COIs, measured as Co-Infections per 100 patient hospitalizations

Temporal variation Fig 2:Plot for temporal distribution across VA facilities of HOI and COI, measured as Co-Infections per 100 patient hospitalizations

Mortality correlation Fig 3:Plot for spatial distribution of the correlation coefficients between hospital mortality and HOI and COI

Conclusion

Bacterial co-infection was infrequent during hospitalization with COVID-19 in the VA healthcare system, and has mild to moderate association with hospital mortality. However, substantial geographic and temporal variation was observed.

Disclosures

Karim Khader, PhD, BioFire Diagnostics: Grant/Research Support.
246. Cardiac involvement in children with multisystem inflammatory syndrome (MIS-C) following infection with different SARS-CoV-2 variants
Authors: Pinninti Swetha , Hebson Camden , Trieu Connie , Boppana Sushma , Buchfellner Markus , Yarbrough April , Poole Claudette , Ross Shannon , James Scott H , Hutto Cecelia , Boppana Suresh
Published: December 2022

Background

MIS-C is a hyper inflammatory condition following SARS-CoV-2 infection. Although COVID-19 infection rates and severity have varied based on circulating SARS-CoV-2 variants, it is unclear if cardiac involvement in MIS-C varies following infection with different SARS-CoV-2 variants. The objective of this study is to describe the severity of cardiac involvement in children with MIS-C following three different waves of SARS-CoV-2 infections.

Methods

Children hospitalized with a diagnosis of MIS-C were enrolled in a prospective observational study. Demographic, clinical, laboratory (troponin I and B-type natriuretic peptide (BNP)), electrocardiogram (EKG) and echocardiogram (ECHO) data for children diagnosed between 4/20 and 12/21 and followed at 1- and 6-months was analyzed. The cohort was divided into 3 groups to represent cases that followed infection with the Wuhan (4/20-10/20, group 1), Alpha (B.1.1.7, 11/20-7/21, group 2) and Delta (B.1. 617.2, 8/21-12/21, group 3) variants. Cardiac involvement during hospitalization and follow-up was compared between the groups.

Results

The cohort includes 131 children with MIS-C (32, 61 and 38 in groups 1, 2 and 3, respectively) with a median age of 10 years. Two-thirds were male (66.4%) and 49.6% were Black. Elevated BNP and troponin I levels were seen in 82% and 52.7% of children at initial diagnosis. A third of the cohort had at least one abnormal EKG finding. The proportion of children with abnormal laboratory and EKG findings was not different between the groups. Decreased left ventricular function on ECHO was seen in 25% (33/131) of the cohort with similar distribution among the three groups (p = 0.79). Trivial-small pericardial effusions were detected in 22% (29/131). Coronary artery abnormalities were detected in 11.45% (15/131), a majority in group 1 (25%; 8/32). At 1- and 6-monthfollow-up visits, BNP and Troponin I were normal in all children. At the 6-month follow-up visit, EKG was normal in all and ECHO was normal in 37/41 children with trivial to mild valvular regurgitation in four children.

Conclusion

In this single center prospective study, while a significant proportion of children with MIS-C had evidence of cardiac involvement at diagnosis, most resolved on follow-up demonstrating good outcomes.

Disclosures

Claudette Poole, MD, Therapy Brands: Stocks/Bonds Scott H. James, MD, Bayer: Advisor/Consultant|Pantheon Biosciences: Grant/Research Support Suresh Boppana, MD, Merck, Inc: Advisor/Consultant|Merck, Inc: Grant/Research Support|Pfizer: Grant/Research Support.
252. Clinical Outcomes and Risk Factor of Severe Disease in Young Adult Patients Compared with Middle-Aged Patients Who Infected with COVID-19: A Large Cohort Study in Tertiary Hospital
Authors: Noopetch Preudtipong , Benchamanon Rutporn , Kongsuwan Samerjan , Chai-adisaksopha Chatree
Published: December 2022

Background

Coronavirus disease 2019 (COVID-19) is increasing rapidly among young adults in worldwide. Our knowledge, COVID-19 was more severe in elderly patients. Only few studies described clinical and outcome of young adults with COVID-19 infection. A recent large retrospective data in US found increasing severity of COVID-19 in young adults due to obesity, hypertension, and diabetes, however there is lacking Asian ethnicity in this study. We aimed to evaluate clinical outcome of COVID-19 infection in young adult and middle-aged group.

Methods

A cohort study was carried out in 10,072 patients with confirmed COVID-19 infection were admitted to Hatyai hospital, Songkhla, Thailand from 1 April 2021 to 31 December 2021. We collected data directly from patient and medical record. The results of primary objective were compared young adults and middle-aged patients and secondary objective were analyzed risk factor of severe COVID-19 among young adult patients by multivariable logistic regression analysis.

Results

The preexisting disorders were significant more observed in middle-aged group. Obesity was the most common in both group, 540 [(11.66%) and 800 (14.17%) patients; p< 0.001] in young adult and middle-aged group respectively. Diabetes and hypertension were frequently observed in middle-aged group. Severe pneumonia was found [500 (9.19%) compared with 99 (2.14%); (adjusted odd ratios (aORs) 2.75; 95% confident interval (CI) 2.18 – 3.49) p< 0.001] patients in middle-aged group and young adult group. mortality rate was more in middle-aged group [91 (1.67%) and 11 patients (0.24%); [aORs 4.08 (95%CI 2.12 – 7.87) p< 0.001]. The risk of severe pneumonia among young adults group. Diabetes was the most increased risk (9 (9.09%) patients in severe pneumonia [aOR 16.27 (95%CI 5.82 – 45.5; p-value< 0.001)].

Conclusion

Data from our study was different than another. In US or Europe young adult was increased severity of COVID-19 due to their pre-existing disease (obesity, diabetes, and hypertension). But in Asian population co-morbidity not much as in US or Europe therefore middle-aged group still had more severe COVID-19 than young adults. The factor contributing to the severe COVID-19 among young adult group, diabetes was the most common and followed by cardiovascular disease and HIV infection.

Disclosures

All Authors: No reported disclosures.
256. Coinfection and Secondary Bacterial Infection in Hospitalized Patients with COVID 19 in a Fourth Reference Level Institution in Colombia: Incidence, Microbiology and Bacterial Resistance.
Authors: Pabon Patricia Reyes , Pabon Patricia Reyes , Pulido Natalia Cordoba , Alvarez luisa Jimenez , Sierra Claudia
Published: December 2022

Background

The presence of coinfection and superinfection in hospitalized patients with COVID 19 varies, ranging between 3-14% in case of bacterial coinfection and 3 - 58% for superinfection. The objective of the study is to describe the incidence, type of infection and etiology in a cohort of patients with COVID 19 who required hospitalization.

Methods

A retrospective series of adult patients with a confirmed diagnosis of COVID 19 who required hospitalization in the general ward or ICU and who presented coinfection or superinfection, between March and November 2020. The clinical and microbiological characteristics of patients who presented coinfection or superinfection are described

Results

During the study period, 788 patients with COVID 19 who required hospitalization were evaluated. 6.2% presented coinfection, 49 coinfections were documented, 84% detected in patients who required admission to the ICU.

The coinfections detected were pneumonia 74%, tracheitis 11%, urinary tract infection 2% and soft tissue infection 2%. Gram negative bacilli were isolated in 58% of cases (K. pneumoniae, H. influenzae, E. cloacae, E. coli), 29% were gram positive (S aureus. S pneumoniae, S. agalactiae). Among gram negative bacilli, 12% showed resistance to 3 generation cephalosporins (3GCephR), no resistance to carbapenems (CR) was found.

Superinfection was detected in 18%, with 142 documented infectious events. 98% were hospitalized in the ICU with a mean hospitalization time of 9 days at the time of infection diagnosis.

The most frequent infections were tracheitis 49%, pneumonia associated with mechanical ventilation 21%, bloodstream infections 17%, pneumonia 8%, catheter-associated bacteremia 3.6%, urinary tract infection 0.7% and others 0.7%.

80% were gram negative (K. pneumoniae, E. coli, E. cloacae, P. aeruginosa), 16% gram positive and fungi 4% Among the isolated gram negative bacilli, 3% showed 3GCephR and 9% were CR. Table 1.Types of superinfection and microbiological isolation

Conclusion

The incidence of coinfection in patients with COVID 19 in this series is similar to that reported in the literature. Superinfection occurred in 18% of hospitalized patients, the majority hospitalized in the ICU. 78% of superinfections were from the respiratory tract. Gram-negative bacilli are the most frequently isolated germs in superinfection, with CR of the 9%.

Disclosures

All Authors: No reported disclosures.
265. Cryptococcal disease in Covid-19 infection: Case series from South Texas
Authors: Babar Sumbal , Restrepo Marcos I , Ford Delvina , Cadena-Zuluaga Jose
Published: December 2022

Background

Covid-19 infection is associated with a lack of immune resilience that may be magnified using immunomodulators to suppress the cytokine storm, facilitating the emergence of opportunistic infections. We describe five cases of cryptococcal infection complications among Covid-19 hospitalized patients.

Methods

This was a retrospective cohort study based on chart review performed at the Audie Murphy Veteran Affairs Hospital from 8/2020 to 8/2021; a level 1A facility with 232 beds and an active bone marrow transplantation program. We included patients aged ≥ 18 with a diagnosis of Covid-19 and subsequent Cryptococcal infection based on cultures or antigen testing.

Results

Our patients were all male with ages ranging between 64 to 80 years. Three had underlying type II diabetes, hypertension, and two had end-stage renal disease. Only one had underlying immunosuppression with hydroxychloroquine for rheumatoid arthritis and one had underlying cirrhosis. Four patients had disseminated disease/fungemia while one had localized pulmonary disease. All the cases had low CD4 counts (158-300) and low CD8 counts (92-290). Two of the fungemia cases were diagnosed by blood culture and the other two by serum cryptococcus antigen test. All the patients had received corticosteroids with or without remdesivir, while one received additional tocilizumab, one baricitinib and one convalescent plasma infusion. Four cases of fungemia received liposomal amphotericin B and three of them received additional flucytosine. The patient with cryptococcal pulmonary disease received only fluconazole. Four patients expired at 28 days after diagnosis, only one recovered and is still alive at 1-year follow up. Table 1.Case details.

ESRD: end stage renal disease; DM-2: diabetes mellitus type ; HTN: hypertension; A-fib: Atrial Fibrillation; HFpEF: heart failure with preserved ejection fraction; PVD: peripheral vascular disease; RA: rheumatoid arthritis; PTSD: post traumatic stress disorder; BPH: benign prostatic hyperplasia; CAD: coronary artery disease; HLD: hyperlipidemia; CVA: cerebrovascular accident.

Conclusion

Cryptococcus infection has been described among patients with Covid-19 during the pandemic. This may be due to immunosuppression caused by the Covid-19 infection and its related-treatments. Most of our patients presented with disseminated cryptococcus infection complicating covid-19 with resulting high mortality rates. Low CD4/CD8 counts and corticosteroid use were documented in all cases. Further studies are needed to better characterize at-risk patients for cryptococcal infection that may benefit from cryptococcal prophylaxis.

Disclosures

All Authors: No reported disclosures.
281. Not the sharpest of tools: Procalcitonin and bacterial co-infections in patients admitted with COVID-19
Authors: Mena Lora Alfredo J , Herald Fischer , Lindsey Brenna , Echeverria Stephanie , Lira Sorel , Burgos Rodrigo M
Published: December 2022

Background

The COVID-19 pandemic has caused record breaking hospitalizations due to respiratory failure. A major challenge in the management of COVID-19 is the difficulty distinguishing COVID-19 from other causes of lower respiratory tract infections (LRTIs) that may require antimicrobial use (AU). Procalcitonin (PCT) has been used to differentiate viral from bacterial causes of LRTIs and clinicians have relied on PCT to use or withhold antimicrobials. However, the utility of PCT in the setting of COVID-19 remains unclear. We seek to define the role of PCT in patients admitted with COVID-19.

Methods

Retrospective cohort study of COVID-19 inpatients with PCT ordered at a 151-bed urban community hospital from March 2020-March 2022. Ranges of PCT were categorized as high ( >5 µg/L), medium (0.25-5 µg/L), and low (< 0.25 µg/L) risk of infection. Co-infection was defined as presence of clinical and microbiological evidence of infection in blood (BSI) or in sputum within 7 days of admission. Late infections were excluded

Results

Of a total 262 cases, 154 (58%) were low-risk, 43 (16%) medium-risk, and 63 (24%) high-risk (Figure 1). AU in the low-risk category was 29% (45), followed by 29% in the moderate and 36% in high-risk categories. 1 BSI caused by Klebsiella pneumoniae in the low-risk category and 1 LRTI caused by Streptococcus pneumoniae in the high-risk category were found, representing 0.6% and 1.5% of samples in those categories. Total documented infection was 0.7% for all cases. Figure 1.Procalcitonin levels and co-infections in patients admitted with COVID-19 pneumonia.

Conclusion

PCT has limited utility in COVID-19. Co-infection rates on admission are exceedingly rare, representing < 1% of our cohort. Only 2 documented infections were found, 1 of which was in the low-risk category. Thus, PCT was commonly elevated without documented infection. Though rare, a co-infection can occur without elevation of PCT. As described in the 2019 IDSA Community Acquired Pneumonia Guidelines, the use of PCT is of limited utility and may confound providers towards using or deferring antimicrobials inappropriately. This remains true in COVID-19. Antimicrobial stewardship programs should advise against its routine use.

Disclosures

All Authors: No reported disclosures.
283. Post COVID-19 syndrome and quality of life impairment in a cohort of severe COVID-19
Authors: Roman-Montes Carla M , Guaracha-Basañez Guillermo A , Flores-Soto Yesenia C , Gonzalez Maria Fernanda , Ponce-de-leon Luis Alfredo , Tamez-Torres Karla M , Sifuentes-Osornio José
Published: December 2022

Background

Post-COVID-19 syndrome occurs usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis (WHO definition, 2021). Our objective was to describe the prevalence, type, and duration of symptoms and their impact on the quality of life of patients hospitalized for COVID-19.

Methods

A cross-sectional descriptive study was done, digital informed consent was obtained. Patients with a history of hospitalization for COVID-19 between March 2020 and October 2021 were invited to answer electronically an adaptation of the questionnaire for the identification of post-COVID-19 syndrome and the instrument EuroQol-5D (quality of life). Both were performed at 3, 6, 9 and 12 months after the initial evaluation for COVID-19.

Results

We included 246 patients, of whom 76% (187/246) met the definition of post-COVID-19 syndrome, 54% were men, with a median age of 50 years (IQR 41-63). Sixty-three percent (117/187) of post-COVID-19 syndrome patients described a worse health status (OR 9.2, 95% CI 4.1-22.6, p=< 0.0001). The median time to symptoms onset after hospital discharge was 1 day (IQR 1-20), and the median duration of symptoms was 150 days (IQR 90-225). The most frequent symptoms were dyspnea 75% (141), arthralgia 71% (132), fatigue 68% (127), hair loss 60% (112), myalgia 53% (99), sleep disturbances 52% (97), dizziness 47% (88), and palpitations 41% (76) (Figure 1).

Regarding quality of life, the post-COVID-19 syndrome patients presented a lower visual analog scale of the EQ-5D versus the group without syndrome (80mm [IQR 70-90] vs. 89.5mm [IQR 75-90], p=0.05). All five dimensions of the quality of life were affected in the post-COVID-19 syndrome group; and dimensions of pain/discomfort, usual activities, and anxiety/depression showed a statistical difference (Fig 2). Figure 1.Frequency of symptoms in Post-COVID-19 syndrome.Figure 2.Distribution of the EQ-5D dimensions affected.

Euroqol (EQ)-5D:Specific instrument to describe and value health-related quality of life.

Conclusion

Post-COVID-19 syndrome occurred in 76% of hospitalized patients, with prolonged duration and quality of life impairment. Dyspnea was the most frequent symptom. Timely diagnostic and therapeutic intervention is required.

Disclosures

All Authors: No reported disclosures.
291. Retrospective Study on Bacteremia in COVID-19 Patients in the Delta and Omicron Era
Authors: Park Sunghee , Kim Tark , Choo Eun Ju
Published: December 2022

Background

The coronavirus disease 2019 (COVID-19) outbreak reached peak levels in South Korea as the Delta variant, dominant from late August until the end of 2021, was rapidly overtaken by the Omicron variant at the start of 2022. In studies conducted near the start of the pandemic, the occurrence of bacteremia in COVID-19 patients was relatively low. We aimed to determine if there was a change in the rate of bacteremia in COVID-19 patients with the progression of the pandemic.

Methods

We performed a retrospective study of patients who were diagnosed with COVID-19 at a referral hospital between September 2021 and March 2022. Blood culture results were recorded, along with demographic characteristics and clinical outcomes. Contamination was considered when a single blood culture was positive for coagulase-negative staphylococci (CoNS), Corynebacterium species, or Bacillus species. Clinically relevant bacteremia was defined as bacteremia due to clinically significant pathogens between 7 days before COVID-19 diagnosis to 14 days after diagnosis.

Results

Among the 360 patients included in the study, 46 cases from 43 (11.9%) patients were considered to be clinically relevant bacteremia. Enterococcus faecalis (17.4%) and CoNS (17.4%) were the most common pathogens, followed by Acinetobacter baumannii (15.2%), Staphylococcus aureus (10.7%) and Escherichia coli (10.7%). The median number of days from COVID-19 diagnosis to identification of bacteremia was 2 days. There was no significant difference in the rate of bacteremia between the Delta (September-December 2021) and Omicron variant eras (January-March 2022) (12.2% vs. 11.7%, P = .88). In the subgroup analysis of patients who received more than 2 days of intensive care, there was no statistical difference in the rate of bacteremia (14.5% [9/62] in the Delta variant era vs. 16.9% [14/83] in the Omicron variant era; P = .70). Mortality was significantly higher in patients with clinically relevant bacteremia (48.8% vs. 19.2%, P < .001).

Conclusion

Many COVID-19 patients had bacteremia in the Omicron variant era, especially in the intensive care unit. Clinicians should suspect bacterial co-infection when a COVID-19 patient is clinically aggravated.

Disclosures

All Authors: No reported disclosures.
294. Risk factors of COVID-19 associated pulmonary aspergillosis in a high endemic setting and development of a bedside clinical risk prediction score.
Authors: Moni Merlin , John Teny M M , Moosa Abdul Razak , Kulirankal Kiran G , Edathadathil Fabia , Dipu T S
Published: December 2022

Background

India has a high burden of invasive fungal infections. Although invasive aspergillosis was also reported during the COVID-19 pandemic, the real world data on the risk factors and outcome of CAPA are limited. Our aim is to determine risk factors and clinical outcomes of CAPA and develop a prediction model for patient stratification.

Methods

A retrospective, case-control study was conducted at a 1300-bedded South Indian tertiary care academic centre from June 1st, 2020 to May 31st, 2021. CAPA cases were defined by 2020 ECMM/ISHAM consensus criteria as possible, probable, and proven infection. Age and admission period matched control group with COVID-19 but without aspergillosis was selected in a 1:1 ratio. A risk scoring stratification for CAPA was developed based on the significant CAPA risk factors using logistic regression model. Figure 1:Receiving operating characteristic curve of CAPA incidence score for predicting CAPA in the study cohort

Results

95 CAPA cases, of which 75(79%) were probable and 20(21%) possible, were diagnosed during the study period. 84(88.4%) patients had moderate to severe COVID-19, and 75(78.9%) were treated with steroids, most commonly dexamethasone (Table 1). The time from COVID-19 diagnosis to CAPA was 13 days (IQR 12). 40(42.1%) of patients were on mechanical ventilation at CAPA diagnosis. Outcome measures (MV, NIV and hospital/ICU stay) were significantly higher in CAPA patients compared to controls(Table 2). Neutropenia, use of steroids, broad spectrum antibiotic use, fluconazole prophylaxis and absence of co-infecting pathogen were found to be significant factors associated with CAPA(p< 0.05) (Table 3). An optimal risk score of ≥10.00 predicted CAPA with a sensitivity of 84.2% and a specificity of 59% with an area under the curve of 0.77 (PPV=67.23%, NPV=78.87%)(Fig 1). 75(78.9%) patients had positive serum aspergillus galactomannan with an average value of 1.89±1.65. 28-day (41.1% vs 33.7%, p=0.13) and 6-week all cause-mortality (48.4% vs 37.9%, p=0.07) were higher, but not statistically significant, for CAPA. Table 1:Baseline characteristics and risk factorsTable 2:Primary and secondary outcomesTable 3:CAPA incidence scoring table

Significant univariate variables were included in the multivariate logistic regression model and predicted probabilities based on the beta co-efficients of the significant variables in the model were transformed to generate CAPA incidence score for patients.

Conclusion

Risk factors of CAPA in Indian were similar to those reported previously in other countries. CAPA can be seen in severe COVID-19 patients who are not mechanically ventilated. A CAPA risk scoring system, that needs external validation, is a simple and feasible tool that could be useful in stratification of patients suspected of CAPA.

Disclosures

All Authors: No reported disclosures.
305. Clinical scoring system to predict viable viral shedding in patients with COVID-19
Authors: Kang Sung Woon , Kim Ji Yeon , Park Heedo , Park Sunghee , Lim So Yun , Bae SeongMan , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Choi Sang-Ho , Lee Sang-Oh , Kim Yang Soo , Park Man-Seong , Yun Sung-Cheol , Kim Sung-Han
Published: December 2022

Background

Centers for Disease Control and Prevention (CDC) recommends 5 to 20 days of isolation for COVID-19 patients depending on symptom duration and severity regardless of genomic PCR results or vaccination history. However, in real clinical practice, more individualized approach is required. We thus developed clinical scoring system to predict viable viral shedding in a given patient by using various factors affecting viable viral shedding.

Methods

We prospectively enrolled adult patients with SARS-CoV-2 infection admitted to tertiary hospital and day care center between February 2020 and January 2022. The daily dense respiratory sampling (i.e. saliva, sputum, or nasopharyngeal swabs) during the hospital and day care center stay were obtained. Genomic RNA viral load and viral culture were performed for these samples. Clinical predictors of negative viral culture results were identified using survival analysis and multivariable analysis.

Results

A total of 612 samples from 121 patients of varying degrees of severity were obtained. Of these, 494 (81%) samples were saliva, 63 (10%) were nasopharyngeal swab, and the remaining 55 (9%) were sputum. Of these 612 specimens, 154 (25%) samples revealed positive viral culture results. Univariate and multivariable Cox's time varying proportional hazard model revealed that symptom onset day, viral copy number, disease severity, organ transplant recipient, gender, and vaccination status were independently associated with viral culture results. We thus developed the 5-factor model from -3 to 3 points: viral copy number (-3 to 3 points depending on copy number), disease severity (1 point to moderate to critical diseases), organ transplant recipient (2 points), gender (-1 points to male), and vaccination status (-2 points to fully vaccinated status). The predictive culture-negative rates were calculated through the symptom onset day and the score of the day the sample was collected. Table 1.Prediction scores for negative viral culture resultsTable 2.Predicted Culture-negative Rates

Values in the table expressed as percentages.

Conclusion

Our clinical scoring system can provide objective probability of negative culture results in a given COVID-19 patient with genomic viral load, and appears to be useful to decide de-isolation policy depending on individualized factors associated with viable viral shedding beyond simple symptom-based isolation strategy by CDC.

Disclosures

All Authors: No reported disclosures.
314. Performance of Saliva Compared to Nasopharyngeal Swab in Detection of SARS-CoV-2 at a Field Site in Rural Guatemala Using the Roche Cobas® Liat® Point-of-Care Assay
Authors: Arias Kareen , Díaz Eliceo , Paiz Claudia , Rojop Neudy , Lamb Molly , Barrios Edgar , Mejía Wanda , Mejía Wanda , Gomez Melissa , Asturias Edwin J , Calvimontes Diva , Olson Daniel
Published: December 2022

Background

Saliva samples are less invasive but not considered the gold standard for detecting SARS-CoV-2, and they are not validated for the Roche Cobas® Liat® platform. We aimed to evaluate the performance of a saliva sample compared to nasopharyngeal (NP) swab in the detection of SARS-CoV-2 on the Roche Cobas® Liat® platform at a research site in rural Guatemala.

Methods

Adults in an existing cohort study with influenza-like illness (ILI) provided clinical data and underwent NP swab (Copan) collection by trained nurses. Swabs were immediately placed into universal transport media (UTM), stored at 2-8 °C for less than 30 minutes and then tested on the Cobas Liat platform for SARS-CoV-2. Consenting subjects who had not eaten or drank in the last 2 hours were asked to provide a 5-mL saliva sample directly into an RNAse free container. The saliva sample remained at 2-8 °C for 24 hours, then diluted 1:2 with 0.85% saline (to reduce viscosity) and run on the same assay. We used descriptive statistics to compare the performance of saliva to NP swabs.

Results

Of the 28 subjects screened (1/10/22 - 4/26/22), 23 (82%) were consented and enrolled. The majority of subjects were male (78.3%) with a mean age of 31 years (range: 18-59 years). Of the 23 subjects enrolled, 14 (30.4%) reported fever and cough, 16 (34.8%) reported cough only, 14 (30.4%) reported fever only, and 2 (4.3%) reported cough and nasal congestion. The median symptom duration was 3.0 days (IQR: 1.5-5 days). Of the 23 subjects, 5 (23.7%) tested positive for SARS-CoV-2 in both sample types (NP swab and saliva); 3 (13%) were discordant, including 1 (4.3%) saliva-positive only and 2 (8.7%) NP-positive only. Compared to NP swab, preliminary performance of saliva in detection of SARS-CoV-2 included a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 71.4%, 93.7%, 87%, 83.3%, and 88.2%, respectively. The Fisher’s exact test p-value (0.003) shows concordance between both tests.

Conclusion

Our preliminary results show good precision between NP and saliva samples in detection of SARS-CoV-2 on the Roche Cobas® Liat® platform. Ongoing data collection will provide greater insight on the discordant results, but our findings support the continued use of saliva in the detection of SARS-CoV-2 in this population.

Disclosures

Molly Lamb, PhD, Pfizer: Grant/Research Support Edwin J. Asturias, MD, Curevac: DSMB Member|Fundacion para la Salud Integral de los Guatemaltecos: Board Member|Inovio: DSMB Member|Merck: Honoraria|Pfizer: Grant/Research Support Diva Calvimontes, n/a, Pfizer: Grant/Research Support Daniel Olson, MD, Fundacion para la Salud Integral de los Guatemaltecos: Board Member|Pfizer: Grant/Research Support|Roche: Grant/Research Support.
316. The Value of Monocyte-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Predicting COVID-19 Mortality: A Single-Center Retrospective Study
Authors: Nanas Denise Marie J , Nolasco Marjorie A , Samin Divina Cristy R
Published: December 2022

Background

The quest for an easy yet effective and affordable tool in predicting mortality among COVID 19 patients is one of the major health concerns that should be addressed. In this study, we investigated the role of these hemogram derived ratios- Monocyte-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio and Platelet-LymphocyteRatio in predicting in-hospital COVID 19 Mortality. Objectives of this study aimed to determine the optimal cut-off value of each ratio and compare the values of each ratio in predicting mortality.

Methods

A cross sectional retrospective study utilizing chart review of adult, COVID 19 confirmed patients admitted at Dr. Paulino J. Garcia Memorial Research and Medical Center from July 2020 to July 2021 were analyzed. Complete blood count taken within 24 hours of admission were recorded. The primary outcome was in-hospital mortality. The NLR, MLR and PLR values were computed and were stratified into two groups after determining the optimal cut-off from the receiver operating characteristic curve (ROC) curve.

Results

A total of 226 adult Filipinos with confirmed COVID 19 infection were included. Patients who died had significantly higher mean age (p=0.004), lower mean hospital days (p=< 0.001) and significantly had a higher proportion of diabetes (p=< 0.027) as a co-morbidity. Significantly higher neutrophils (p=< 0.001), lower lymphocytes (p=< 0.001), higher NLR (p=< 0.001), higher MLR (p=0.002) and higher PLR (p=< 0.001) among non-survivors than survivors group. The optimal cutoff value of NLR to predict in-hospital mortality is ≥5.846 with 66.37% sensitivity and 60.18% specificity (AuROC curve of 0.695). The optimal cut off value of MLR is ≥0.4444 and PLR of ≥190.

Conclusion

NLR, MLR and PLR were noted to be consistently high among non-survivors of COVID 19 Infection. These are useful markers in predicting in-hospital mortality. NLR appears to be the best predictor of COVID-19 mortality of the three markers. However, its overall diagnostic accuracy is only considered acceptable at best.

Disclosures

All Authors: No reported disclosures.
324. Detection of Antibiotic Resistance Genes and Associated Genera Direct from Blood Samples by Multiplex PCR and Next Generation Sequencing
Authors: Gamero Daniel , Dabrowski Kelly , DeVito Analisa , Smith Roger , Snyder Jessica L
Published: December 2022

Background

While blood culture and genotypic or phenotypic testing is standard procedure for identification of sepsis pathogens and resistance, blood culture negative sepsis occurs in 40-60% of patients. A culture independent diagnostic can identify pathogens that do not grow in culture and may provide a more sensitive indicator to blood stream infections. Here we discuss an assay that combines multiplex PCR with next generation sequencing (NGS) to detect resistance genes and pathogenic genera directly from whole blood. These genes include mecA, mecC, vanA, vanB, blaKPC, blaOXA-48 family, blaNDM, blaVIM, blaIMP, blaCMY-2, blaDHA, and blaCTX-M-14 and blaCTX-M-15 groups.

Methods

K2EDTA whole blood samples were spiked with low titers of antimicrobial resistant bacterial isolates. Sample processing involved chemical lysis of red blood cells, concentration and mechanical lysis of pathogen cells, and multiplex amplification of resistance genes and 16S rRNA gene. A synthetic DNA oligo was added at a fixed concentration as a read control. Samples were sequenced on Illumina platforms. NGS data was analyzed using a bioinformatics pipeline to process and match sequences to curated databases with BLAST. The number of reads per sequence was normalized by the number of reads for the read control, resulting in a read-control-normalized (RCN) value that could be used to establish positivity cutoffs.

Results

Resistance genes in bacterial pathogen spiked samples were identified at titers ≤ 10 CFU/mL. Owing to a unique dual indexing strategy, cross-reactivity was absent or low enough that cutoffs could be set using RCN values without reducing sensitivity. The expected genus was also detected at ≤ 10 CFU/mL for all samples; however, genera that may be representative of reagent or environmental contamination were observed at levels higher than a universal RCN cutoff in some samples.

Conclusion

We have shown that this NGS assay can detect 13 antimicrobial resistance genes with high sensitivity and specificity direct from blood. Bacterial genera associated with these genes were detected by this assay. As there is a risk of detection of contaminating species with a 16S target, further research into low DNA reagents or environmental controls may be required.

Disclosures

Daniel Gamero, BS, T2 Biosystems, inc: WO2018213641A8, EP3861013A1, WO2020055887A1, WO2020252084A1, WO2020257691A1|T2 Biosystems, inc: Stocks/Bonds Kelly Dabrowski, M.S., T2 Biosystems, Inc: Stocks/Bonds Analisa DeVito, B.S., T2 Biosystems, Inc: Stocks/Bonds Roger Smith, Ph.D., T2 Biosystems, Inc: US20180188195A1, EP3849938A1,WO2020257691A1, WO2020252084A1|T2 Biosystems, Inc: Stocks/Bonds Jessica L. Snyder, Ph.D., T2 Biosystems, Inc: CA3062882A1,US20180171388A1,WO2017180745A1 , EP3861013A1 , AU2020296183A1, WO2020055887A1, WO2020252084A1|T2 Biosystems, Inc: Stocks/Bonds.
338. Epidemiology and Treatment of Invasive Bartonella spp. Infections
Authors: Pizzuti Morgan , Bailey Pamela , Derrick Caroline , Brandon Bookstaver P
Published: December 2022

Background

Serology and PCR testing methods have increased ability to diagnose Bartonella spp. invasive infections. Current treatment recommendations are based primarily on case series and aging data published before newly available diagnostic techniques. These recommendations are limited in safety and effectiveness outcomes. This multicenter, retrospective cohort study describes the epidemiology and treatment outcomes of invasive bartonellosis among patients in the U.S.

Methods

Collaborating sites were selected from SERGE-45 (Southeastern Research Group Endeavor) research network. Data were collected through REDCap. Subjects were screened from adult patients with invasive bartonellosis diagnosis codes, positive Bartonella spp. serologies, PCR, 16/18S tests, cultures, and Karius® tests from blood or tissue between January 1, 2014, and September 1, 2021. Eligible patients had at least one positive test result, evidence of invasive bartonellosis, and received treatment for bartonellosis. Treatment failure was defined as admission or readmission while on treatment, mortality during treatment or within 30 days after end of treatment, required escalation or extended duration of therapy, premature discontinuation of therapy, or necessitated change in regimen. Those not meeting treatment failure criteria were considered treatment success.

Results

Of the 169 patients screened, 32 were included, with 19 having treatment success. Bartonella henselae was the most common causative pathogen (n = 31, 97%). Endocarditis was the most common invasive manifestation (n = 18, 56%). Treatment regimens are displayed in Table 1. Primary reasons for treatment failure included necessitated escalation of therapy during treatment course (n = 4, 30.8%) and discontinuation of therapy due to adverse effect (n = 4, 30.8%).

Conclusion

Doxycycline with rifampin was the most common treatment regimen for invasive bartonellosis, with extended durations used compared to often referenced 6-week courses for invasive infections. It is important to consider adverse drug effects, toxicities, and tolerability in patients being treated for invasive bartonellosis.

Disclosures

P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.
343. Relevance of Use of Anaerobic Blood Culture Bottle for the Diagnosis of Bacteremia
Authors: Noguchi Taro , Shinohara Koh , Tsuchido Yasuhiro , Yukawa Satomi , Yamamoto Masaki , Matsumura Yasufumi , Nagao Miki
Published: December 2022

Background

Blood cultures remain the cornerstone for the diagnosis of bacteremia. Although an anaerobic blood culture bottle can recover facultative and obligate anaerobes, routine use of an anaerobic bottle paired with an aerobic bottle remains controversial. We aimed to evaluate the role of anaerobic bottle for the diagnosis of bacteremia.

Methods

We conducted a retrospective cohort study in a tertial hospital in Japan from January 2019 to September 2021. Blood culture results were collected from microbiology laboratory records. Blood cultures for which simultaneous pairs of aerobic and anaerobic bottles were collected and from which a single organism was recovered were included. Positive blood cultures were considered as a single episode of bacteremia when obtained within 14 consecutive days.

Results

A total of 22677 blood cultures were collected, with 22650 bottles were paired. In 2962 paired blood cultures of which one or both bottles were positive, 1079 episodes of clinically significant monomicrobial bacteremia were observed. In these episodes, 898 had a positive aerobic bottle, while 789 had a positive anaerobic bottle, with 608 had both positive bottles. In 181 episodes (16.8%), clinically significant organisms were isolated in an anaerobic bottle without concomitant positive aerobic bottle. In these anaerobic bottles, 146 facultative and 35 obligate anaerobes were recovered. The most common facultative anaerobe was Escherichia coli (30 isolates), followed by Staphylococcus aureus (27 isolates). Bacteroides fragilis (11 isolates) was the most common obligate anaerobe.

Conclusion

Recovery of clinically significant facultative and obligate anaerobes from anaerobic bottle alone was observed in 17% of episodes, which supports that the routine collection of both aerobic and anaerobic bottles is relevant.

Disclosures

All Authors: No reported disclosures.
350. Clinical impact of positive fungal blood cultures for diagnosis and treatment of fungal infections.
Authors: Chavez Miguel A , Ching Patrick R , Spec Andrej , Hsueh Kevin
Published: December 2022

Background

Fungal blood cultures are usually ordered when sepsis secondary to disseminated fungal infection is suspected. We aimed to analyze whether positive fungal blood cultures had an added clinical impact over other conventional microbiological tests.

Methods

We performed a retrospective study of all patients for whom fungal blood cultures were performed for any indication at our institution from June 2018 to March 2022. We reviewed informatics database and medical records to assess the microbiological and clinical impact of positive fungal blood cultures during the initial admission. Assessment of clinical impact was analyzed using a list of predefined positive, negative, and no impact scenarios (Table 1) based by the treating team’s decisions.

Results

In total, 4447 fungal blood cultures were performed in 3648 admissions during our study period. The overall positivity rate of fungal blood cultures was 6.4% (n=284), of which only 130 (2.9%) were positive for fungi. The most common isolated fungi were Candida spp. (71, 55%), followed by Histoplasma spp. (16, 12%), Cryptococcus spp. (12, 9%), and unidentified mold (9, 7%) (Table 1). The median time to positivity was 106 hours (IQR 79-177). Only 21 (16%) fungal blood cultures resulted in a change in management. Positive fungal blood cultures for fungi led to a positive clinical impact in 17 (13%), negative clinical impact in 4 (3%), and no clinical impact in 109 (84%). Most fungal blood cultures confirmed other conventional microbiological diagnosis (71, 55%) or result was not acted upon (26, 20%). Organisms where fungal blood culture had a positive impact included C. albicans (n=4), and C. parapsilosis (n=3), while Cladosporium spp. (n=2) was the most frequent fungi with a negative clinical impact. Isolated fungi that had no clinical impact because of other confirmatory tests included Candida spp. (n=57), Histoplasma spp. (n=13) and Cryptococcus neoformans (n=10). Table 1.Microbiological characteristics and clinical impact of fungal blood cultures.Abbreviations: h hours; IQR, interquartile range.*Time to positivity was defined as the time from the fungal blood culture collection until growth and preliminary identification of a fungal organism on staining by the microbiology laboratory. **Time to identification was defined as the time from the fungal blood culture collection until identification of the fungal organism by the microbiology laboratory.

Conclusion

Most of positive fungal blood cultures for fungi resulted in no immediate clinical impact due to other microbiological tests available sooner or isolates thought to be non-clinically significant. Further studies should evaluate the long-term impact of fungemia and identify stewardship interventions to optimize clinical utility of fungal blood cultures.

Disclosures

All Authors: No reported disclosures.