bluuebunny/crossref_metadata_2025 huggingface dataset:
538. Percent Positivity of COVID-19 Testing in Children of Racial/Ethnic Minority Groups in Mississippi
Authors: Inagaki Kengo , Hobbs Charlotte V
Published: January 2021

Background

COVID-19 testing data in children from different backgrounds such as race/ethnicity can guide the strategies for controlling the pandemic. In this study, we aimed to characterize the percent positivity of real time reverse transcriptase polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children with different race/ethnicity in Mississippi, a state with historic racial health disparity.

Methods

We performed a retrospective study using a deidentified COVID-19 registry abstracted from the electronic health record at the University of Mississippi Medical Center, the only academic institution in the state encompassing the main university hospitals and ambulatory sites statewide. Children aged 18 years or younger who underwent RT-PCR for SARS-CoV-2 between 11 March 2020 and 31 May 2020 were included in the study. The primary outcome of interest was positive SARS-CoV-2 RT-PCR test, and the primary exposure of interest was race/ethnicity. Multivariable analysis was performed by developing a logistic regression model.

Results

Of 1838 children who underwent SARS-CoV-2 RT-PCR testing, 162 tested positive, corresponding to percent positivity of 8.8%. Non-Hispanic white children had percent positivity of 2.4%, which was substantially lower than that of non-white children (9.7%, 28.6%, and 11.5% for non-Hispanic black, Hispanic, and other race/ethnicity children, respectively) (Table). Older children (particularly those aged 10–18 years) also had higher percent positivity (Table, Figure). The risks associated with non-white race/ethnicity remained substantial after adjusting for insurance status, which was used as a surrogate for socioeconomic status (Figure).

Table

Figure

Conclusion

We found a striking difference in percent positivity by race/ethnicity among children, suggesting inadequate allocation of testing resources to this population. Higher percent positivity among school age children may also have particular public health implications, considering their school attendance. We argue that minority children should not be left behind in data analysis, research, targeted testing and transmission reduction measures.

Disclosures

All Authors: No reported disclosures
539. Prevalence of Symptomatic and Asymptomatic COVID-19 Infection in Pregnant Women and Their Infants in an Urban Hospital
Authors: Woods Krystina L , Gabasan Angela , Schwing Deborah , Wagner Brian , Eiland Lisa , Camins Bernard
Published: January 2021

Background

COVID-19 is an emerging pathogen that has caused a global pandemic, with New York City as one of its epicenters. Data are still forthcoming if pregnant women are more vulnerable to COVID-19, as they are with influenza. Additionally, it is not known if infants born to COVID-19 positive women are at risk of being infected at birth.

Methods

In March 2020, our hospital instituted a policy of testing all pregnant women presenting for active labor and scheduled C-section or induction of labor, with a nasopharyngeal swab that was sent for RT-PCR qualitative SARS-CoV-2 assay (Roche Cobas® 6800). Upon birth, infants were also tested, unless the parent did not give consent. We retrospectively reviewed the COVID-19 test results of all pregnant women and their infants, from March 23 through May 31, 2020 using our infection control surveillance system (VigiLanz®). We also reviewed the electronic medical record (EPIC®) for documentation of any symptoms consistent with COVID-19 infection either prior to hospitalization or during the hospital stay.

Results

A total of 415 women and 72 infants were tested for SARS-CoV-2. Of the 415 women tested, 41 (9.9%) were positive. Of the 72 infants tested, 2 (2.8%) were positive and concordant with their birth parent. Only 1 (2.4%) of the women who tested positive was symptomatic. The remaining 40 (97.6%) women did not report any symptoms of COVID-19 during labor. Neither of the two positive infants displayed any signs or symptoms of COVID-19. Of the 41 women who were positive, 5 did not consent to have their infant tested. The one symptomatic woman who tested positive for COVID-19 had an infant who tested negative by PCR.

Conclusion

During the first wave of the COVID-19 pandemic, we found 9.9% (41/415) of pregnant women presenting for labor tested positive for SARS-CoV-2. Among the 41 women who tested positive, only 1 (2.4%) had symptoms on presentation and only 2 newborn infants tested positive. Our data suggests that pregnant women may not be at increased risk for complications from COVID-19 disease and are not likely to transmit the disease to their infants during labor.

Disclosures

All Authors: No reported disclosures
540. Prolonged Viral Shedding of SARS-CoV-2 In Solid Organ Transplant Recipients
Authors: Nam Hannah , Roberts Scott C , Tanna Sajal D , Ison Michael G
Published: January 2021

Background

Solid organ transplant (SOT) recipients are more susceptible to viral infection and present with differing viral kinetics when compared to non-immunocompromised cohorts. The duration of viral shedding in SOT recipients with SARS-CoV-2 infection is unknown.

Methods

All SOT recipients with a diagnosed of SARS-CoV-2 by nasopharyngeal of bronchoalveolar lavage RT-qPCR from March 06, 2020 to May 31, 2020 were identified. Viral shedding duration was obtained by evaluating all subsequent SARS-CoV-2 PCR results following initial positivity over time. Severity classification was defined as mild (outpatient), moderate (hospitalized), and severe (ICU level care). Data were obtained from electronic medical record case review and analyzed with Stata 16.

Results

71 patients with a positive SARS-CoV-2 PCR test were identified. 50 (70.4%) were classified as mild/moderate disease, while 21 (29.5%) had severe disease. Median age was 56.5 (IQR 45 – 61.3) years, and 56.9% (n = 41) were male. Older age was significantly associated with severe disease. A disproportionate number of patients were African American/Black or Hispanic at 72.2% (n=52). Interestingly, Caucasian race was significantly associated with less severe outcomes (p=0.038). The majority of patients were kidney transplant recipients (46, 63.9%), followed by liver (13, 18.1%), heart (6, 8.3%), lung (3, 4.2%), and pancreas (9, 12.5%) with a median duration from transplantation at 5 (IQR 3 – 17) years. Overall mortality was 5.6% (n=4), with all deaths occurring only in those with severe disease (19.1%, n=4). Prolonged viral shedding was observed in few patients, with median duration of SARS-CoV-2 PCR positivity at 32 (IQR 18.5 – 41.0) days. One kidney recipient was observed with up to 64 days of positive SARS-CoV-2 RT-PCR from initial diagnosis despite not developing severe disease.

Demographics and Outcomes

Duration of Viral Shedding in SOT Patients with COVID-19

Conclusion

COVID-19 can lead to significant outcomes in SOT with increased mortality in those with severe disease, as well as prolonged viral shedding. Further studies are needed to elucidate the full duration of viral shedding in this population.

Disclosures

Michael G. Ison, MD MS, AlloVir (Consultant)
543. SARS-CoV-2 Viral Dynamics For Symptomatic People Living with HIV Requiring Hospitalization For COVID-19
Authors: Virata Michael D , Villanueva Merceditas , Shenoi Sheela , Ladines-Lim Joseph B , Aoun-Barakat Lydia
Published: January 2021

Background

Over 8 million people have been infected with severe acute respiratory syndrome 2 (SARS-CoV-2). People living with HIV (PWH) affected by SARS-CoV-2 represent a small proportion of patients admitted to the hospital for COVID-19 disease. Viral dynamics in this subpopulation are still unknown.

Methods

We conducted a retrospective cohort study from a large, urban academic center in New Haven, CT of patients consecutively admitted with laboratory confirmed SARS-CoV-2 infection through May 31, 2020. Main outcome measure was the ribonucleic acid (RNA) viral load (VL) detected in respiratory samples by cycle threshold (Ct) values and trend over time as a measure of nucleic acid concentration and replication. Epidemiological, clinical, laboratory results, ART treatment, COVID treatment and outcomes were abstracted from patient records. We evaluated the relationship between virologic data and disease severity.

Results

Among 19 PWH hospitalized with covid19, 84% were >50 years of age, 53% were women, 63% were black, 95% were on antiretrovirals, 95% with undetectable HIV VL (< 50 copies/ml), and median CD4 count of 827.9 cells/mm3. Symptom duration was 2–14 days. Median length of stay was 12 days. There was no in-hospital mortality. A total of 62 respiratory samples were collected at various time points and evaluated for SARS-CoV-2 RNA viral load. Eight patients had 1 specimen. Patient with more severe disease had higher baseline SARS-CoV-2 viral loads. Mean Ct values for N1 and N2 on admission were 21.6 and 23.7, respectively.

Conclusion

PWH with COVID19 represents only a small percentage of hospitalized patients and viral dynamics are not well defined. SARS-CoV-2 VL was higher among PWH with advanced disease at the presentation of illness. Overall, PWH with COVID-19 had favorable outcomes.

Disclosures

All Authors: No reported disclosures
549. Clinical Characteristics and Outcomes of Patients with COVID-19 treated with Convalescent Plasma in Miami, Florida
Authors: Anjan Shweta , Skiada Dimitra , Cuartas Miriam Andrea Duque , Salguero Douglas , Serota David P , Gonzales-Zamora Jose , Ayoade Folusakin , Beauchamps Laura , Quiroz Tanya R , Bertran-Lopez Jovanna , Raccamarich Patricia , Montgomerie Emily K , Barreto Irma , Abbo Lilian M , Abbo Lilian M , Doblecki-Lewis Susanne , Wu Yanyun , Alcaide Maria L
Published: January 2021

Background

The Coronavirus disease of 2019 (COVID-19) global health crisis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in unprecedented mortality, impacted society, and strained healthcare systems, yet sufficient data regarding treatment options are lacking. Convalescent plasma, used since 1895 for infectious disease outbreaks, offers promise as a treatment option for COVID-19.

Methods

This is a retrospective study of patients diagnosed by a nasopharyngeal swab SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT-PCR), who received convalescent plasma between April to June 2020 at two large hospitals in Miami, Florida, as part of the US FDA Expanded Access Program for COVID-19 convalescent plasma (CCP).

Results

A total of 23 patients received CCP, 13 (57%) had severe COVID-19 disease, while 8 (35%) had critical or critical with multiorgan dysfunction. Median time of follow up was 26 (range, 7–79) days. Overall, 11 (48%) survived to discharge, 6 (26%) died, while 6 (26%) are currently hospitalized. All deaths reported were due to septic shock from secondary infections. 15 (65%) showed improvement in oxygen requirements 7 days post CCP transfusion. Measured inflammatory markers, c-reactive protein, lactate dehydrogenase, ferritin and d-dimer improved 7 days post transfusion in 13 (57%) patients. No adverse events due to the transfusion were reported. 10 (43.4%) patients had a negative SARS-CoV-2 RT-PCR at a median of 14.5 (range, 4–31) days after receiving convalescent plasma.

Conclusion

Administration of convalescent plasma was found to be safe, with favorable outcomes in this small cohort of relatively high acuity patients. Larger studies including control arms are needed to establish the efficacy of convalescent plasma on clinical and virologic outcomes for patients with COVID-19.

Table

Disclosures

All Authors: No reported disclosures
552. Could Anticoagulant Use Prior to Infection with COVID-19 Decrease Mortality?
Authors: Natali Kayla M , Chan Kok Hoe , Atallah Liana , Nagarakanti Sindhu , Slim Jihad
Published: January 2021

Background

The novel coronavirus (COVID-19) has resulted in substantial morbidity and mortality worldwide. Infection with COVID-19 has been associated with coagulopathy and inflammation. This prothrombotic state has been identified in the literature as an indicator of poor prognosis and those with COVID-19 who receive anticoagulation therapy may have better outcomes. Due to this prothrombotic state, patients who are currently receiving anticoagulation therapy for other indications prior to infection with COVID-19 may have better outcomes.

Methods

This was a retrospective case control study conducted at an inner city hospital. Patients were eligible if they were hospitalized between March 15, 2020 and May 15, 2020 and had confirmed infection due to COVID-19. Patients were matched by age, sex, body mass index (BMI), diabetes mellitus (DM), hypertension (HTN) and estimated glomerular filtration rate (eGFR) by chronic kidney disease (CKD) state. This study evaluated morality in patients who were receiving long term anticoagulation therapy prior to infection with COVID-19 compared to those who were not.

Results

Of the 436 patients hospitalized with confirmed infection due to COVID-19, 400 were eligible for analysis. Twenty-two were on anticoagulation therapy prior to admission. Among those patients, 68% were male and 32% were female. The majority of the patients were greater than 60 years of age (82%). Comorbidities were present in 21 patients and were as follows: HTN (95%), CKD (67%), DM (57%), obesity (36%). Of the 22 patients, five expired due to COVID-19 infection compared to 52 patients from the 149-patient matched cohort [z-score 1.13, p = 0.26; odds ratio (OR) 1.82; 95% confidence interval [CI], 0.69–4.71].

Conclusion

Prior long-term anticoagulation use does not appear to have a protective effect in patients with COVID-19 infection. Studies with larger sample size will be needed to answer this important question.

Disclosures

Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
553. Critically Ill patients Receiving Tocilizumab Compared With Those Not Receiving Tocilizumab for Treatment of COVID-19
Authors: Leonard Michael , Asher anthony , Kooken Banks , Donahue Erin , Symanowski james , Roshdy Danya , onsrud jennifer , Umani Saad , Copelan edward , shahid zainab
Published: January 2021

Background

Background::

Immune modulation in patients with clinical features suggestive of a cytokine release syndrome (CRS) has become a pharmacologic target for potential treatment of COVID-19 and prevention of ARDS. Tocilizumab is an IL-6 receptor blocker FDA-approved for chimeric antigen receptor (CAR) T cell-induced severe or life-threatening CRS. The objective of this study was to describe clinical outcomes associated with tocilizumab compared with those not receiving tocilizumab in critically ill patients with severe COVID-19.

Methods

Methods:

Retrospective case series of 49 adult patients admitted to an intensive care unit with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients receiving tocilizumab were compared with those not receiving tocilizumab. The primary outcome was clinical improvement (decrease in supplemental oxygen requirement, discharge from ICU, or live discharge from hospital). Secondary endpoints included mortality and frequency of extubation. All comparative endpoints were assessed at 2 weeks after ICU admission.

Results

Results:

49 patients were identified with SARS-CoV-2 who were admitted to an ICU, 16 received tocilizumab. Baseline characteristics were similar; most were African American males with comorbidities such as obesity, cardiovascular disease, and diabetes. The time from symptom onset to positive test and subsequent intubation were similar (4 and 7 days, respectively). 75% received one dose (all received 8 mg/kg). The median time from symptom onset to tocilizumab administration was 11 days.

In patients receiving tocilizumab compared with those not receiving tocilizumab, there were similar rates of clinical improvement (44% versus 61%, p=0.27), extubation (31% versus 45%, p=0.60), and mortality (18% versus 19%, p >0.99, respectively). 81% of the tocilizumab group had resolution of fever and 75% had improvement in C-reactive protein levels.

Conclusion

Conclusion:

In this study of patients with progressed disease, outcomes were similar regardless of receipt of tocilizumab. Randomized controlled trials are needed to assess the impact of earlier administration and identify clinical characteristics to assist with selection of appropriate patients who may benefit from tocilizumab.

Disclosures

All Authors: No reported disclosures
559. Outcomes of Convalescent Plasma Transfusion for SARS-CoV2 Patients in the Intensive Care Unit
Authors: Khalid Rabeeya , Thomas Alvin G , Zhu Daisy , Minga Iva , Desai Nirmit , Kaplan Leonard
Published: January 2021

Background

SARS-CoV2 is a grave illness and few therapeutic agents have yielded benefit or reduced mortality. Administration of convalescent plasma (CP) in viral illnesses in the past, including SARS, before day 14, has been associated with a shorter hospital course. In the present study, we are interested in determining the benefit of administering CP to critically ill patients in the intensive care unit, and the impact on mortality and other clinical markers.

Methods

5 critically ill patients with confirmed SARS-CoV2 infection were observed in the uncontrolled case series study. Mechanically ventilated patients with severe ARDS (PaO2/FiO2 < 100) were eligible to receive CP transfusion. We reviewed daily vital signs, inflammatory markers, PaO2/FiO2 ratio and SOFA scores before and after CP transfusions. SARS-CoV2 PCR viral load testing was completed on day 0 of transfusion and repeated on day 3 and 6. Complications during the hospitalization and 30-day mortality were assessed.

Results

All 5 patients were mechanically ventilated at the time of transfusion and between day 7 to 31 of their illness. Following plasma transfusion, body temperature and inflammatory markers remained elevated in four patients (figure 1). SOFA score and PaO2/FiO2 ratios continued to worsen in three and four patients respectively (figure 2). SARS-CoV2 PCR remained positive in 4 patients. 4 of the 5 patients had died at the end of the follow up period. One patient was successfully extubated on day 29 (table 1) and discharged after a long hospital course.

Fever curve and trends of inflammatory markers

Trends of SOFA socre and PaO2:FiO2 ratio

Patient characteristics

Conclusion

In our patient cohort, the administration of CP did not improve laboratory markers or clinical outcomes. Some notable limitations of this study are the small sample size, and that the patients received CP late in their disease course. Further investigation is necessary to draw definitive conclusions about the utility of CP in the treatment of SARS-CoV2.

Disclosures

All Authors: No reported disclosures
571. “Real world” Impact of Letermovir for Prevention of Cytomegalovirus Infection in Hematopoietic-Cell Transplantation
Authors: Loecher Alyssa M , Yum Kendra , Park Daniel , Kim Sara , Saunders-Hao Patricia , Jakubowski Rita , Keyzner Alla , Steinberg Amir , Rana Meenakshi , Jacobs Samantha E
Published: January 2021

Background

Letermovir (LTM) was FDA-approved in 2017 for cytomegalovirus (CMV) prophylaxis in allogeneic hematopoietic cell transplant (HCT) patients. We evaluated the “real-world” impact of LTM in adult HCT recipients at the Mount Sinai Hospital in New York following addition of LTM to our formulary in June 2018.

Methods

In this retrospective study, we compared 31 consecutive allogeneic HCT recipients from June 2018-June 2019 who received LTM prophylaxis from Day +10–100 to 36 consecutive CMV-seropositive patients who underwent allogeneic HCT June 2017-June 2018 and did not receive LTM. Clinical and laboratory data were abstracted from the existing electronic medical record. The primary outcome was development of clinically significant CMV infection (CS-CMV) through 6 months post-HCT, defined as CMV viremia or disease requiring antiviral therapy.

Results

There were no baseline differences in patient demographics or transplant characteristics between patients who did and did not receive LTM prophylaxis. The median duration of LTM prophylaxis was 96 days (IQR, 66–116). At 6-months post-HCT, the cumulative incidence of CS-CMV was lower in patients receiving LTM prophylaxis vs no prophylaxis (29% vs 61%, respectively; p=0.004, Figure 1). Patients who received LTM developed CS-CMV at a later time post-HCT than those who did not receive prophylaxis (median 160 vs 39 days, respectively; p < 0.01). Among patients with CS-CMV, the median duration of antiviral therapy was 39 vs 70 days in the LTM prophylaxis vs no prophylaxis groups, respectively (p< 0.01). While there was no difference in the incidence of graft-versus-host disease (GVHD), the median time to GVHD diagnosis was longer in the LTM group (63 days vs 27 days in the no prophylaxis group; p=0.02). Between patients who did and did not receive LTM prophylaxis no statistically significant difference was observed, respectively, in incidence of CMV disease (3% vs 14%), hospital re-admission (68% vs 67%), or mortality (26% vs 14%) at 6 months post-HCT.

Conclusion

We demonstrated the “real-world” utility of LTM for CMV prevention in HCT recipients. Future studies should further evaluate the impact of LTM on antiviral drug usage, GVHD, and other transplant-related outcomes in this population.

Disclosures

All Authors: No reported disclosures
587. Equity in academic advancement: findings from an IDSA-sponsored survey of infectious disease physicians
Authors: Manne-Goehler Jennifer , Krakower Douglas , Marcelin Jasmine R , Del Rio Carlos , Stead Wendy
Published: January 2021

Background

Recent evidence has shown substantial disparities in the rate of advancement to full professorship among women as compared to men faculty in academic infectious diseases (ID). We sought to identify barriers to academic advancement overall and by gender among faculty physicians in this field.

Methods

We conducted a web-based survey of academic faculty in ID. The survey was made available to the IDWeek2019 attendees and digitally via email and social media to the IDSA membership at large from 9/18/19 – 11/8/2019. The survey assessed demographic characteristics and barriers to faculty advancement and achievement, building on prior research. Survey themes included faculty promotion track, part-time work history and a suite of questions about workplace atmosphere and policies related to career advancement. Multivariable Poisson regression models were used to evaluate the association between these factors and full professorship.

Results

Of 1,036 respondents, 790 were retained in the final dataset [Men: 322 (40.7%), Women: 458 (58.0%), Other: 10 (1.3%)]. 352 respondents were Instructors or Assistant Professors (38.5%), 198 were Associate Professors (25.1%) and 240 were Full Professors (30.4%). Fewer women reported that their promotion process was transparent (57.4% v. 67.6%, p=0.004) and more women Full Professors felt they had been “sponsored” compared to men at their same rank (73.3% v. 53.6%, p=0.002). In regression analyses (Table 1), gender, publications and clinical trial leadership were significantly associated with full professor rank and promotion transparency and NIH grants emerged as possible correlates of this outcome. Salary support, part-time work, women in leadership, faculty promotion track and sponsorship were not associated with this outcome.

Table 1. Results of Poisson regression analysis

Conclusion

Sponsorship and transparency of promotion criteria differed by gender and emerged as potentially important factors associated with full professorship in academic ID. Future policies to promote equity in advancement should address these issues.

Disclosures

All Authors: No reported disclosures
596. Clinical outcomes and healthcare utilization in uninsured patients requiring long-term antibiotic therapy
Authors: Vo Daniel , Hamad Yasir
Published: January 2021

Background

Outpatient parenteral antimicrobial therapy (OPAT) is frequently indicated in the management of severe bacterial infections. Uninsured patients may more have difficulties accessing OPAT services (compared to those with a payer source) which can lead to prolonged hospitalizations or early discharge with potentially suboptimal therapy. We sought to assess disparities in the care of hospitalized, uninsured patients who had an OPAT indication and to examine subsequent clinical outcomes.

Methods

We performed a retrospective analysis of consecutive patients admitted to an academic hospital from 09/01/2018-12/31/2018 who received an infectious diseases consultation and had an index diagnosis of endocarditis (IE), Staphylococcus aureus BSI, or bone and joint infection including osteomyelitis, prosthetic joint infection, and septic arthritis identified by ICD-10 code. Clinical data were collected during index admission; outcomes were followed for up to 30 days after discharge. We examined differences in length of stay (LOS), discharge against medical advice (AMA), and composite outcome of death and readmission at 30 days in uninsured and privately insured patients.

Results

Of 104 patients, 66 (63.5%) were privately insured and 38 (36.5%) were uninsured. Baseline clinical characteristics are presented in Table 1. Uninsured patients were younger (40.9 versus 51.4 years, p< 0.001) and more likely to be African American (55.3% versus 19.7%, p< 0.001). Uninsured patients were more likely to leave AMA (18.4% versus 0%, p=0.001), complete shorter duration of IV antibiotics (p=0.001), and receive oral antibiotics at discharge (15.8% versus 3.0%, p=0.049). Length of stay was numerically longer in this group although not significant (15.5 days versus 10 days, p=0.053). Composite outcome of readmission or death from all cause at 30 days was lower in the uninsured group; however, after adjusting for age, the results were not significant (aOR 0.372, 95% CI 0.106-1.297, p=0.121).

Table 1. Demographic and clinical characteristics of privately insured and uninsured patients

Conclusion

Uninsured patients were more likely to leave AMA, complete shorter duration of IV antibiotics, and receive oral antibiotics at discharge compared with privately insured patients. Thirty-day readmission and death rates were not significantly different among the two groups.

Disclosures

All Authors: No reported disclosures
612. In-Person vs Tele-Infectious Disease Care: Is One Better?
Authors: Gupta Nupur , Sanghvi Adit B , Bariola J Ryan , Mellors John , Abdel-Massih Rima
Published: January 2021

Background

Telemedicine (TM) has allowed physicians to expand beyond traditional in-person practice to provide care at remote locations. Initial performance of TM programs in ID has been reported, including favorable outcomes, but limited data exists on how inpatient Tele-ID compares to in-person.1,2 To address this gap, we analyzed data from hospitals that transitioned from in-person ID care to Tele-ID.

References

Methods

Travel time between the 3 rural Pennsylvania hospitals (total 432 inpatient beds) by car is 1 hour 40 minutes. All in-person consults were provided by an independent ID physician who traveled daily between sites. Starting July 2018, all consults were provided by Tele-ID consisting of one full-time equivalent physician. This included live audio-video visits and e-consults. Data were extracted from electronic health record; between 1/1/2018-6/30/2018 for in-person and 7/1/2018-12/30/2018 for Tele-ID. Key outcomes assessed were number of initial encounters, length of stay (LOS) after ID consult, proportions of patients discharged home, transferred to tertiary centers, and ID related readmission at 30 days.

Results

Study population consisted of 642 encounters with majority being Caucasian, female and average age 67 years (Table 1). Tele-ID had higher comorbidity scores vs in-person ID (Table 1). Total encounters were significantly greater for Tele-ID than in-person ID (Table 2; p=0.018). LOS after ID consult, transfers to tertiary centers, readmissions at 30 days, and discharges home were similar between the two groups (Table 2). Most common diagnosis was “bacteremia;” notably Tele-ID made a broader range of diagnosis (Figure 1). Limitations include a small sample size and possibility of a temporal bias, although the patient characteristics were similar except for higher co-morbidity for the Tele-ID service.

Conclusion

This comparative study shows that patient outcomes are similar between in-person and Tele-ID, despite higher volume and complexity encountered by Tele-ID. The greater number of consults and broader range of diagnosis made by Tele-ID suggests greater productivity, possibly related to travel time elimination. Tele-ID appears to be a good alternative solution for rural locations that lack in-person access to ID care.

Disclosures

J. Ryan Bariola, MD, Infectious Disease Connect (Employee)Mayne Pharma (Advisor or Review Panel member)Merck (Research Grant or Support) John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer)
616. Patients Experiencing Homelessness and Opioid Use Disorder with Infectious Complications Treated with OPAT at Medical Respite: Evaluation of Retention in Care at 30 days and Role of Addictions Consultation
Authors: Beieler Alison M , Beieler Alison M , Klein Jared W , Bhatraju Elenore , Iles-Shih Matthew , Enzian Leslie , Dhanireddy Shireesha , Dhanireddy Shireesha
Published: January 2021

Background

Patients experiencing homelessness and opioid use disorder (OUD) admitted for severe infections often require prolonged hospital stays. These patients, typically evaluated by Infectious Disease (ID) providers, are often excluded from Outpatient Parenteral Antimicrobial Therapy (OPAT) due to social risk factors. Medical respite, near Harborview Medical Center (HMC), offers a supportive environment for patients to receive OPAT with daily nurse administered antibiotics. For further support, our institution created a dedicated Addiction medicine consult service March 1, 2019 to assist with initiation of medications for opioid use disorder (MOUD) and linkage to outpatient care for interested patients.

Methods

We performed retrospective review of all patients > 18 years with OUD admitted for procedure/inpatient stay from 1/31/2018 – 1/31/2020 who discharged to medical respite for OPAT. The minimum follow up period was 90 days. We recorded demographics, OUD history, diagnosis, discharges against medical advice (AMA), and total readmissions. We evaluated outcomes of 4 care interventions (ID consult, Addiction consult, linkage to case management and/or mental health, linkage to MOUD) in relation to successful OPAT completion, clinical cure, and retention in MOUD at 30 days.

Results

Fifty-three patients had 63 OPAT episodes of care (Table 1). Median length of stay (LOS) was 19 days inpatient, and 33 days at medical respite. Common diagnosis included, osteomyelitis 46 (73%), bacteremia 27 (43%), septic joint 17 (27%), epidural abscess 10 (16%), and endocarditis 10 (16%). There were 24 OPAT episodes which received all 4 interventions (Table 2). Episodes during which 4 interventions occurred were more likely to result in clinical cure (p = 0.03) and retention in MOUD treatment at 30 days (p = 0.003) compared to episodes where 3 or fewer interventions occurred (Table 3).

Table 1. Demographics

Table 2. OPAT Care Interventions, n =63

Table 3. Summary of Outcomes, n =63

Conclusion

Patients discharged to medical respite who received the combination of ID consult, Addiction consult, case management and/or mental health, and MOUD had higher rates of clinical cure compared to those who did not receive all four interventions. Developing a patient-centered comprehensive care plan, including ongoing support and access to MOUD should be a priority to ensure successful treatment of infections.

Disclosures

All Authors: No reported disclosures
621. Reporting Behaviors and Perceptions Towards the National Healthcare Safety Network Antimicrobial Use (AU) and Antimicrobial Resistance (AR) Options
Authors: Werth Brian J , Werth Brian J , Dilworth Thomas J , Escobar Zahra Kassamali , Gross Alan E , Suda Katie , McGregor Jessina C , Morris Andrew M , LaPlante Kerry , Kuper Kristi
Published: January 2021

Background

Antibiotic use (AU) and antibiotic resistance (AR; AUR) reporting to National Healthcare Safety Network (NHSN) is suboptimal by US hospitals. The Society of Infectious Diseases Pharmacists (SIDP) and the Society for Healthcare Epidemiology of America (SHEA) conducted a survey of their membership to 1) Identify characteristics of US health systems that report AUR data 2) Determine how NHSN AUR data are used by health systems and 3) Identify barriers to AUR reporting.

Methods

An anonymous survey was posted on SurveyMonkey from 1/21- 2/21/2020 and links were emailed to SIDP and SHEA Research Network members. Data were analyzed in Excel and RStudio. Respondent and hospital data were reported as frequencies and percentages. Fisher’s Exact test was used to compare survey responses from NHSN AUR reporters to non-reporters.

Results

A total of 238 individuals from 43 states responded to our survey. Respondents were primarily pharmacists (84%), from urban (45%), non-profit medical centers (80%) with >250 beds (65%). 62% of respondents reported to the AU option while 19% reported to the AR option. Respondents not using software for local AU or AR tracking were less likely than those using any software for local tracking to report to AU (19% vs 64%) and AR (2% vs 30%) options (P< 0.0001). Among AU and AR reporters 41% and 54% used clinical decision support software to aggregate compile data for upload while 54% and 38% used their electronic health record, and 5% and 8% used another method. Over half of AU (56%) and AR (51%) reporters upload data manually. Regular use of the NHSN data analysis tools was reported by 36% and 9% of those reporting AU and AR data respectively. The most common barriers to reporting were related to technical issues (software, IT support, data formatting) and time/salary support. Among non-reporters, increased expectations to report and better software solutions were most commonly identified as the best ways to increase reporting.

Conclusion

Efforts to improve AUR reporting should focus on software solutions and increasing the utility of AUR analytical tools. Increasing expectations to report may also help to improve reporting rates. The lower rate of AR vs AU reporting suggests that interventions should also target the AR option.

Disclosures

Brian J. Werth, PharmD, Shionogi Inc. (Grant/Research Support) Kerry LaPlante, PharmD, Merck (Advisor or Review Panel member, Research Grant or Support)Ocean Spray Cranberries, Inc. (Research Grant or Support)Pfizer Pharmaceuticals (Research Grant or Support)Shionogi, Inc. (Research Grant or Support)
641. Carriage and Genetics of Haemophilus influenzae Serotype A (Hia) in Alaska, 2018
Authors: Nolen Leisha , Tifffany Amanda , DeByle Carolynn , Bruden Dana , Reasonover Alisa , Simons Brenna , Castrodale Louisa , McLaughlin Joseph , Klejka Joseph , Wang Xin , Topaz Nadav , Bruce Michael
Published: January 2021

Background

Haemophilus influenzae serotype a (Hia) is an important cause of infection among Alaska Native children. In 2018, 4 invasive Hia cases (iHia) occurred in an Alaska community. Our response aimed to prevent more iHia and evaluate Hia carriage in the community. Whole genome sequencing (WGS) was performed to compare Hia from iHia patients across Alaska in 2018, and from healthy outbreak community members.

Methods

We collected oropharyngeal (OP) samples from outbreak community members. Children aged < 10 years and people in close contact with cases (contacts) were offered rifampin prophylaxis. A second set of OP samples was collected 8 weeks later. Isolates from iHia from across the state were collected as part of the state surveillance. Hia was detected by PCR and culture, then characterized by antimicrobial susceptibility and WGS.

Results

At baseline, contacts had a higher prevalence of Hia carriage than non-contacts (4/27(14.8%) vs 7/364(1.9%), p=0.0043). Eight weeks after rifampin prophylaxis, carriage prevalence did not significantly change among contacts (5/42(11.9%) to 6/25(24%), p=0.18) or non-contacts (7/368(1.9%) to 2/114(1.8%), p=0.47). Phylogenetic analysis of 19 iHia isolates and 15 isolates from healthy outbreak community members, revealed two major clades that differed by an average of 300 core single nucleotide polymorphisms (SNPs). Invasive and carriage isolates from the outbreak community were clustered in one clade, along with 3 non-outbreak iHia isolates. Isolates from this community differed from each other by an average of 1.2 core SNPs. Comparative genomics did not reveal any genetic mutations that distinguished carriage from invasive isolates. Three (20%) community isolates were rifampin-resistant and had a previously unreported mutation in the rpoB gene.

Conclusion

We found Hia carriage prevalence was highest among persons in contact with iHia cases. Long-term community carriage was not affected by rifampin prophylaxis, possibly due to staggered prophylaxis. In the outbreak community, Hia isolates from carriers were nearly genetically identical to iHia isolates. Overall, iHia isolates from Alaska in 2018 were genetically similar. The mutation conferring rifampin resistance is concerning, as rifampin is used to prophylax contacts of iHia cases.

Disclosures

All Authors: No reported disclosures
653. Comparison of Yeasts identification by Biofire, Culture and ePlex for Quality Assurance purpose
Authors: lin jeffrey , Myint Thein , Arora Vaneet , Ribes Julie A
Published: January 2021

Background

At the University of Kentucky Medical center (UKMC), positive fungal blood cultures are concurrently run through the Biofire Blood Culture Identification (BCID) panel which detects 5 Candida species. The newer platform, the GenMarkDx ePlex BCID-FP (fungal panel) is designed to detect 16 fungal targets. Our study compares the performance of the Biofire BCID panel’s with culture as the gold standard method. We examine the percentage of agreement by both testing methods and predict the performance of the GenMarkDx ePlex BCID-FP panel based on culture results. We also look at the number of other yeasts not included in Biofire BCID panel that could be picked up by the GenMarkDx ePlex BCID-FP panel.

Methods

Positive fungal blood cultures from July 1, 2018 to June 30, 2019 were run through the Biofire BCID panel. Culture results were used to extrapolate whether the GenMarkDx ePlex FP would provide any additional diagnostic benefit. Results were categorized as true or false positives and negatives as compared to culture as the gold standard.

Results

A total of 141 blood cultures were tested via the Biofire BCID panel for the identification of yeasts. Of these, 123 (87%) yielded Biofire results in concordance with culture results. We would expect these also to be positive on the GenMarkDx ePlex BCID-FP panel. In addition, 18 specimens (13%) would have tested positive on the GenMarkDx ePlex BCID-FP panel and not the Biofire BCID panel. These organisms were noted to be Candida lusitaniae (n=6), Cryptococcus neoformans (n=3), Candida dublinensis (n=2), and Candida keyfr (n=1). Organisms that were found on culture that were not detected by both GenMarkDx ePlex BCID-FP panel and Biofire BCID panel were Candida nivariensis (n=2), Pichia ohmeri (n=1), Trichospon species (n=2).

Conclusion

Based on these data, we expect that the ePlex would have correctly identified 95.9% of the yeasts in this patient population. This represents an additional 18 (13%) of specimens that could be detected rapidly from the positive blood culture if the GenMarkDx ePlex BCID-FP panel were used instead of the Biofire BCID panel. Early identification can influence the choice of antifungal agent. Less than 5 % of the yeasts would have remained unidentified by ePLex compared to 13% for Biofire.

Disclosures

All Authors: No reported disclosures
667. Multicenter Assessment of Enterobacterales, Salmonella spp. and Pseudomonas aeruginosa Using Updated CLSI Levofloxacin Breakpoints on MicroScan Dried Gram Negative MIC Panels
Authors: Garner Omai , Traczewski Maria M , Beasley Denise , Harrington Amanda , DesJarlais Sharon , Hastey Christine , Brookman Regina , Lockett Zabrina , Chau Jennifer
Published: January 2021

Background

Data from a multicenter clinical study with Enterobacterales, Salmonella spp. and P. aeruginosa on a MicroScan Dried Gram-negative MIC (MSDGN) Panel was evaluated with updated US FDA/CLSI levofloxacin breakpoints. MIC results were compared to results obtained with frozen broth microdilution panels prepared according to CLSI methodology.

Methods

A total of 839 Enterobacterales, Salmonella spp. and P. aeruginosa clinical isolates were tested at three clinical sites in efficacy and challenge combined. MSDGN panels were evaluated with turbidity and Prompt® methods of inoculation. MIC values obtained from the MSDGN panels were compared to MICs utilizing a CLSI broth microdilution reference panel. To assess reproducibility, a subset of 15 organisms were tested on MSDGN panels at each site. MSDGN panels were incubated at 35 ± 1ºC and read on the WalkAway System, the autoSCAN-4 instrument, and visually. Read times for the MSDGN panels were at 16-20 hours. Frozen reference panels were prepared and read according to CLSI methodology. FDA and CLSI breakpoints (µg/mL) used for interpretation of MIC results were: Enterobacterales ≤ 0. 5 S, 1 I, ≥ 2 R; Salmonella spp. ≤ 0.12 S, 0.25-1 I, ≥ 2 R; P. aeruginosa ≤ 1 S, 2 I, ≥ 4 R.

Results

Essential and categorical agreement were calculated compared to frozen reference panel results. Results for isolates tested during efficacy and challenge with Prompt inoculation and manual read are as follows:

Conclusion

Levofloxacin MIC results for Enterobacterales, Salmonella spp., and P. aeruginosa obtained with the MSDGN panel correlate well with MICs obtained using frozen reference panels using updated FDA/CLSI interpretive criteria in this multicenter study.

* PROMPT® is a registered trademark of 3M Company, St. Paul, MN USA.

BEC, the stylized logo and the BEC product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the US and other countries.

Disclosures

Omai Garner, PhD, D(ABMM), Beckman Coulter (Scientific Research Study Investigator) Maria M. Traczewski, BS MT (ASCP), Beckman Coulter (Scientific Research Study Investigator) Denise Beasley, BS, Beckman Coulter (Other Financial or Material Support, Research personnel) Amanda Harrington, PhD, Beckman Coulter (Scientific Research Study Investigator) Sharon DesJarlais, BS, Beckman Coulter (Other Financial or Material Support, Research personnel) Christine Hastey, PhD, Beckman Coulter (Employee) Regina Brookman, BS, Beckman Coulter (Employee) Zabrina Lockett, MS, Beckman Coulter (Employee) Jennifer Chau, PhD, Beckman Coulter (Employee)
682. Is There a Role for the Early Use of Tocilizumab and Interleukin-6 Levels in the Management of SARS-CoV-2 Patients with Early Respiratory Failure?
Authors: Antony Suresh J , Almaghlouth Nouf K , Davis Monique G , Davis Michelle A , Guevara Roberto , Antony Nishaal , Fahad Omar , Prakash Bharat , Del Rey Fernando , Hassan Ali , Arian Muhammad
Published: January 2021

Background

The severity of respiratory failure in SARS-CoV-2 infection appears to be related to cytokine release syndrome (CRS), resulting in mechanical ventilation (MV). In this observational study, we investigated tocilizumab’s role in the treatment of SARS-CoV-2 and the use of interleukin-6 (IL-6) levels in the management of these patients.

Methods

Patients with positive SARS-CoV-2 PCR were prospectively observed from February 1, 2020 to May 31, 2020. Data on demographics, medical history, and clinical outcomes were collected. Tocilizumab (TCZ) 4 mg/kg/day q12h was given for 24 hours, followed by methylprednisolone 60 mg q8h for 72 hours to patients with oxygen requirement of 3 L and above. IL-6, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimers were monitored on days: 0, 3, and 6 following the initiation of therapy. Statistical analyses were performed using a Wilcoxon signed-rank test with significance (α) less than or equal to 0.05 (P ≤ 0.05).

Results

A total of eighty patients (45 males, 56.96%) and (34 females, 43.04%) with positive SARS-CoV-2 PCR were included in this study. The median age was 63 (51 - 72) years. Seven patients expired (8.75%), and nine patients required mechanical ventilation (11.25%). The median of IL-6 levels before administration of TCZ was 342.50 (78.25 – 666.25) pg/mL compared to after administration of TCZ on day 3, 563 (162-783) pg/mL (P < 0.00001). On day 6, the median dropped to 545 (333.50 - 678.50) pg/mL as compared to day 3 (P = 0.709). Moreover, CRP, ferritin, LDH, and D-dimers levels were reduced following the administration of TCZ.

TABLE 1: IL-6 of SARS-CoV-2 patients at before and after Tocilizumab treatment

TABLE 2: Laboratory findings of SARS-CoV-2 patients at before and after Tocilizumab treatment

Conclusion

Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels, which may be useful inflammatory indices in the management of SARS-CoV-2 patients. Furthermore, the sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. The use of IL-6 levels may be helpful as a prognostic tool and in the management of acutely ill SARS-CoV-2 patients.

Disclosures

All Authors: No reported disclosures