bluuebunny/crossref_metadata_2025 huggingface dataset:
930. Weakening the waves: Impact of a syndrome-based antimicrobial stewardship intervention during COVID-19
Authors: Mena Lora Alfredo J , Herald Fischer , Lindsey Brenna , Echeverria Stephanie , Ali Mirza , Burgos Rodrigo M
Published: December 2022

Background

Lower respiratory tract infections (LRTIs) from SARS-CoV-2 are difficult to distinguish from other viral or bacterial etiologies. This has led to increased antimicrobial use (AU) during the pandemic and concerns for concomitant rise in antimicrobial resistance (AMR). It is crucial for antimicrobial stewardship (ASP) to develop strategies to mitigate excess AU and curve AMR. We leveraged a syndrome-based ASP intervention targeting LRTIs and the use of anti-Pseudomonal beta lactams (APBL) during the COVID-19 pandemic.

Methods

We incorporated COVID-19 elements into a syndrome-based prospective audit and feedback (PAF) at an urban community hospital. Elements included EMR order sets (Figure 1) that discouraged routine AU for COVID-19 and PAF targeting LRTIs and COVID-19 therapies. Empiric selection discouraging APBL was incorporated during the first COVID-19 wave. Order sets and PAF were then modified to reflect novel COVID-19 therapeutics and AU was strongly discouraged in subsequent waves. Data on AU and AMR from 2018-2022 was reviewed. Figure 1.Electronic medical records COVID-19 antimicrobial order set

Results

Average quarterly AU increased during the first pandemic year by 8.7%, from 359.5 to 391 days of therapy per 1000 patient days (DOT/1000), with peaks 22.5% above the pre-pandemic average during COVID-19 surges. AU increased each COVID-19 surge, with smaller peaks each subsequent wave. DOT/1000 declined 29% from the first wave to the Omicron wave. AU decreased the second year to 318, an 18.6% decrease from the first pandemic year. Ceftriaxone use increased during surges, reflecting our LRTI guidelines (Figure 2). Peaks declined each subsequent wave, from a peak of 239 in the first wave to 75 during Omicron, a 68% decrease. The average monthly DOT/1000 for APBL decreased from 73.51 to 63.21 (Figure 3). Incidence rate of ESBL and CRE initially rose and then declined (Figure 4). Figure 2.Antimicrobial use (DOT/1000) before and during the COVID-19 pandemicFigure 4.Antipseudomonal beta lactam use before and during the COVID-19 pandemic

Figure 5. Incidence of multidrug resistance organisms before and during the COVID-19 pandemic

Conclusion

ASP successfully incorporated COVID-19 elements and steered AU during the pandemic. Though total AU increased, APBL use declined and AU peaks decreased with each COVID-19 wave, reflecting adherence with ASP recommendations. AMR increased during the first year and subsequently declined. ASP can play a vital role guiding AU during respiratory pandemics.

Disclosures

All Authors: No reported disclosures.
971. Antibiotic Prophylaxis for Grade III Open Fractures: A Retrospective Comparison of Ceftriaxone plus Vancomycin versus Cefazolin plus Gentamicin
Authors: Shifko Carlee R , Bremmer Derek N , Jenniches Daniel , Holmberg Kyle , Andreini Derek , Philp Allan , Altman Daniel T
Published: December 2022

Background

Owing to the established path of bacterial entry and contamination-associated mechanisms, grade III open orthopedic fractures represent a substantial infection risk. Historically, the EAST Guidelines recommended covering Staphylococcus aureus and adding aminoglycoside gram negative coverage. Incorporating newer evidence, the Allegheny Health Network local guidelines rely on ceftriaxone to cover gram-negatives and add methicillin-resistant S. aureus coverage with vancomycin.

Methods

The electronic health records of adults admitted for a grade III open fracture between January 1, 2016, and October 31, 2021 were retrospectively reviewed. Patients who received cefazolin and gentamicin (CZ+GM) or ceftriaxone and vancomycin (CRO+VA) as their prophylaxis were included. We recorded rate of a composite treatment failure outcome of receipt of antibiotics for suspected infection, infection-related hospitalization, or subsequent debridement for injury site skin and soft tissue infection or osteomyelitis. Presence of acute kidney injury (AKI) within 7 days was also evaluated. Categorical variables were compared using the Chi-square or Fisher’s exact tests, and continuous variables by t-test or Wilcoxon Rank Sum.

Results

Patients in the CZ+GM group were younger, with a mean age of 42.6 years compared to 50.6 years in the CRO+VA group (p = 0.02). Otherwise, there were no significant differences between groups in demographics, mechanism and site of injury, timeline of care, or total number of surgical interventions. More patients in the CZ+GM arm met the composite primary treatment failure outcome, but it was not statistically significant (45% vs 32%, p = 0.2). There were similar rates of treatment failure at 30 days (21% vs 26%, p = 0.5) and for only osteomyelitis (8% vs 9%, p = 1). Patients receiving CZ+GM trended towards higher rates of AKI, but this was not statistically significant (26% vs 19%, p = 0.4).

Conclusion

The trend in numerically lower treatment failure rates in the CRO+VA group across all outcomes studied supports the current recommendations in the local institutional guidelines. Given our sample size, type II error may have occurred, and larger studies with greater power should analyze this question.

Disclosures

Derek N. Bremmer, PharmD, BCPS-AQ ID, Thermo Fisher Scientific: Honoraria.
972. Bone and Joint Infections : Looking Beyond Gram Positive Bugs, A Case Series from Mumbai, India
Authors: Kaneria Mala V , Kothari Manish , Vishwanath Jashan , Jain Reetu , Raut Indraneel , Mashru Puneet , Gohel Tejash , Bhabhor Anand , Nagral Aabha , Wadia Pettarusp , Savardekar Abhijeet , Pispati Ameet , Palekar Gaurav , Goleria Dhimant , Ladkat Kiran , Tandon Shruti , Bhandare Sonal , Narula Sonar , Shah Samir , Bhat Ganapathi , Afzal Fahad
Published: December 2022

Background

Bone and joint infection (BJI) is a dreadful complication of arthroplasties and orthopaedic trauma. Infection with non traditional organisms is a trade off for medical advances such as newer immunosuppressants and implants.

Complex BJIs, may be complicated by longer hospitalizations and higher costs due to the virulence of organisms, growing resistance to antibiotics and patient comorbidities, especially immunocompromised status. The purpose of this study was to analyse the various characteristics of BJIs with emphasis on the organisms cultured.

Methods

21 consecutive patients of BJIs were prospectively included from June 2021 to March 2022. Demographic features, comorbidities, anatomic site involved, previous surgical intervention, presence of implant, infecting organism, their susceptibility patterns, inflammatory markers, surgical procedure performed, antibiotics given , their route, duration and the outcome were noted.

Results

12/21 (57.14 %) had spondylodiscitis ; 4/21 (19.04 %) knee joint involvement ; 3/21 (14.29 %) orthopaedic trauma ; 3/21 (14.29 %) hip involvement ; 1 ankle joint involvement (diabetic foot) and 1 sternal osteomyelitis. 17/21 (80.95 %) had comorbidities. 7/21 (33.33 %) were immunosuppressed . 14/21 (66.67 %) had undergone recent surgery.

11 gram positive, 8 gram negative organisms and 3 fungi were isolated . 2 were culture negative and 4 had mycobacterial infection. Histopathology revealed pyogenic inflammation in bacterial and granulomatous inflammation in fungal and mycobacterial infections. CRP and ESR were elevated in all bacterial infections and were used to guide antibiotic route switchover. All bacterial infections were treated with 6 weeks of antibiotics .14/21 (66.67 %) underwent surgery, whereas the rest underwent diagnostic aspiration and biopsy only. 3/21 (14.29 %) had relapse on stopping antibiotics and responded after restarting.

Conclusion

Though staphylococcus is thought to be the culprit in most cases of BJIs, gram negative organisms, mycobacteria and fungi are gaining centrestage. Histopathology can give important clues in the absence of positive cultures. Surgical interventions, implant presence and immunosuppressed states are implicated in a majority of the infections. CRP guided therapy is a valuable strategy.

Disclosures

All Authors: No reported disclosures.
979. Eligibility for and Use of Oral Antibiotic Therapy among Veterans with Osteo-articular Infections: A Retrospective Study across Eight Medical Centers
Authors: Mareau Jacquelyn , Alexander Bruce , Egge Jason , Heintz Brett , Suzuki Hiroyuki , Livorsi Daniel J
Published: December 2022

Background

Osteoarticular infections are commonly treated with intravenous antibiotics even though oral antibiotics may be as effective. In this multicenter study, we evaluated how often patients with osteoarticular infections qualified for oral antibiotic therapy and how often oral antibiotics were prescribed.

Methods

We randomly selected 2 high-complexity Veterans Affairs (VA) hospitals from each of the 4 US Census regions. Next, we randomly selected patients admitted to these 8 facilities during 2018-2020 who had a discharge diagnosis of an osteoarticular infection, received ≥5 days of inpatient antibiotics, and had an Infectious Disease consult. Manual chart reviews were performed to confirm the diagnosis and to exclude patients who received < 4 weeks of total antibiotics or had infection of the skull, sacrum or pelvis. Eligibility for oral therapy was defined by the inclusion criteria used in a recent randomized controlled non-inferiority trial. Oral antibiotic stepdown was defined as starting an exclusively oral regimen within 2 weeks of antibiotic initiation. The chi-square test was used to compare categorical variables.

Results

After excluding 76 cases, the final cohort included 145 patients (median age 65, 98% male, 72% white). The most common types of osteo-articular infections were peripheral osteomyelitis (66%) and septic arthritis (14%). The most common isolated pathogen was Staphylococcus aureus (53%). Surgical debridement was performed in 104 (72%) patients, and the median antibiotic duration was 47 days (IQR 43-72). One hundred eight (74%) patients were eligible for oral step-down, but only 18 (17%) of these patients received it (Figure 1). Fourteen (78%) patients treated with oral step-down were from the same hospital. Among patients eligible for oral stepdown therapy, peripheral osteomyelitis was present in 15 (83%) of those who received oral therapy versus 58 (64%) of those who were eligible but did not receive it (p=0.12).

Conclusion

In this retrospective study across 8 geographically-diverse VA hospitals, three-quarters of patients with osteoarticular infections qualified for oral antibiotics but only 1 of 6 eligible patients actually received them. Oral antibiotics may be under-utilized for treating osteoarticular infections in routine practice.

Disclosures

Daniel J. Livorsi, MD, Merck & Co.: Grant/Research Support.
980. Enterobacter: An Early-Onset Pathogen of Prosthetic Hip and Knee Infections with Poor Prognoses
Authors: Prado Isabel P , Kim Billy I , Schwartz Andrew , Wixted Colleen M , Polascik Breanna , Hendershot Edward , Jiranek William A , Seidelman Jessica , Seyler Thorsten M
Published: December 2022

Background

Enterobacter sp. is a gram-negative, often drug-resistant bacillus that is classically identified from mucosal surfaces, such as pulmonary or urinary tracts. Despite its virulence, Enterobacter represents a less common pathogen in prosthetic joint infections (PJI). This study aims to resolve the current paucity of described clinical characteristics and treatment success of Enterobacter PJI.

Methods

Thirty-three patients with Enterobacter aerogenes-, cloaecae/asburiae-, or hormachei-positive PJIs were identified at a single institution. Infection clearance was defined as absence of infection or repeat surgery at one year and off all adjunct antibiotic therapy. Patient demographics, PJI characteristics, treatments, and clinical outcomes were compared between patients with and without clearance.

Results

In this cohort, mean age was 66.8 years (SD: 11.6), mean BMI was 31.0 (SD: 7.1), and mean Elixhauser Comorbidity Score was 9.1 (SD: 4.5). 54.5% had a prior PJI in the same joint, and 87.9% had more than one prior surgery in that joint. Median time of PJI diagnosis after surgery was 22 days [IQR: 18-60]. Patients initially treated with debridement antibiotics and implant retention (n=11) had a 45.5% clearance rate, compared to 23.1% for 2-stage exchange (n=13) and 44.4% for those requiring resection arthroplasty or amputation (n=9). With a median follow-up of 2.9 years, final joint outcomes included resection arthroplasty in 9 (27.3%), above-knee amputation in 7 (21.2%), definitive treatment with an articulating spacer in 6 (18.2%), and arthrodesis in 2 (6.1%) patients.

Conclusion

Enterobacter PJI often presents acutely and is a difficult pathogen to treat. The outcomes of our cohort reflect the virulence of Enterobacter, with high rates of failure and ultimate joint- or limb-sacrificing procedure. Despite being a less common cause of PJI, prognosis is exceptionally poor with traditional treatment algorithms when compared to historical cohorts of more common pathogens.

Disclosures

William A. Jiranek, MD, Biomech Holdings LLC: Stocks/Bonds|DePuy, A Johnson & Johnson Company: IP royalties Thorsten M. Seyler, MD, PhD, Heraeus: Paid consultant|Pattern Health: IP royalties|Restor3d: IP royalties|Smith & Nephew: Paid consultant|Total Joint Orthopedics: Paid consultant|Zimmer: research.
1005. Financial and clinical impact of ceftolozane/tazobactam global recall on the treatment of multi-drug resistant Pseudomonas in a large health system
Authors: Carpio Brandon Del , Dillon Michelle , Hurtado Dahlia , VanDenberg Taylor , Hayes Jillian E , Carr Amy L , Minor Sarah B
Published: December 2022

Background

In December 2020, ceftolozane/tazobactam (CT) was voluntarily recalled due to failed sterility tests. With this recall, clinicians were forced to utilize alternatives for multi-drug resistant (MDR) Pseudomonas (PSA) infections until CT returned in late December, 2021. While many studies have examined the impact of medication shortages, few have evaluated the impact of antimicrobial shortages. We evaluated the impact of the CT recall by assessing cost, clinical outcomes, and utilization of novel alternative agents.

Methods

This multi-site retrospective cohort study compared patients treated for MDR PSA prior to the CT recall (Jan-Jul 2020) to patients treated during the CT recall (Jan-Jul 2021) across seven AdventHealth Central Florida (AHCF) adult hospitals. The primary outcome was percentage of patients treated with novel therapies (CT, ceftazidime/avibactam, or cefiderocol). Secondary outcomes included length of therapy (LOT), inpatient mortality, 30-day readmissions, length of say (LOS), pharmacy expenditures, and average cost per case.

Results

A total of 203 patients with MDR PSA were evaluated: 100 in the pre-recall cohort and 103 in the post-recall cohort. The majority (58%) of patients were male with an average age of 64 years. The most common source of infection in both cohorts was pneumonia, followed by complicated urinary tract infection. Significantly more patients were treated with novel agents as definitive therapy in the post-recall cohort (65% vs. 29%, p< 0.0001). Average LOT for all anti-PSA therapy was 12 days in the pre-recall cohort compared to 14 days in the post-recall cohort (p=0.1753). Inpatient mortality and 30-day readmissions were not statistically different between groups. Hospital LOS was significantly different between the two groups (18 days vs. 25 days, p=0.006). Significantly higher pharmacy expenditures were found in the post recall cohort (Figure 1) and the average cost per case was significantly higher in the post-recall cohort ($125,254 vs. $62,249). Figure 1:Pharmacy Expenditures for Novel Agents

Novel agents: cefiderocol, ceftazidime/avibactam, ceftolozane/tazobactam

Conclusion

The CT recall had a significant impact on both economic and clinical outcomes, particularly increased length of stay, length of therapy, and cost to both the patient and health system. Higher utilization of novel agents is concerning given rising rates of PSA resistance.

Disclosures

Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board.
1010. Metronidazole-associated neurologic adverse events: risk factors analysis
Authors: Lee Se Ju , Kim Jinnam , Lee Ki Hyun , Lee Jung Ah , Hyup Kim Chang , Yeom Joon-sup , Choi Jun Yong , Ku Nam Su , Jeong Su Jin , Ahn Jin Young , Kim Jung Ho
Published: December 2022

Background

Metronidazole is a widely used antibiotic to treat anaerobic and protozoal infections. However, neurologic adverse events associated with metronidazole have been reported in case series and case reports. Previous publications implicated that long-term usage and cumulative dose are risk factors for this adverse event. Still, little is known about the risk factor of the metronidazole-associated neurologic adverse events. Therefore, we conducted a retrospective study to investigate the risk factors for the metronidazole-associated neurologic adverse events through a matched case-control study.

Methods

This retrospective study enrolled patients prescribed metronidazole from January 2006 to July 2021 at Severance Hospital, a tertiary hospital in South Korea. Case patients were defined as those who developed central nervous system (CNS) adverse events or peripheral nervous system (PNS) adverse events during the study period with causality assessment. In a 1 to 3 ratio, case patients were compared to a control group of the patients without neurologic adverse events, matched on age and cumulative dose of metronidazole.

Results

92838 patients were prescribed metronidazole during the study period. Among them, 52 patients showed metronidazole-associated neurologic adverse events (39 patients with CNS, 27 patients with PNS adverse events, and 14 patients with both). The proportion of chronic kidney disease (CKD), solid organ transplantation, liver cirrhosis (LC), intravenous (IV) administration of metronidazole, and concomitant use of a proton pump inhibitor was significantly higher in the case group. The body weight, hemoglobin, and serum albumin levels were lower, and Sequential Organ Failure Assessment scores were higher in the case group. Multivariate conditional logistic regression analysis demonstrated LC, CKD, IV administration, and lower body weight as risk factors for metronidazole-associated neurologic adverse events.

Conclusion

In this case-control study, LC, CKD, IV administration, and lower body weight were associated with the metronidazole-associated neurologic adverse events. Prolonged metronidazole treatment in patients with the risk factors requires careful examination for these adverse events.

Disclosures

All Authors: No reported disclosures.
1031. Impact of Meningitis-Encephalitis PCR Panel Testing on Antimicrobial Use in Patients with Suspected Meningoencephalitis
Authors: Rodriguez Julieta , Ahuja Monica , Moore Franklin , Marie Peter St , Lindsey Kristy , Paez Armando
Published: December 2022

Background

Meningoencephalitis continues to be a source of morbidity and mortality in the US despite vaccine development. Traditional culture-based diagnosis is time-consuming and less sensitive than molecular methods. Meningitis-encephalitis PCR panel (MEP) testing of CSF allows for rapid detection of 14 culprit microorganisms.

Methods

A retrospective cohort study was performed at University of Massachusetts Chan Medical School-Baystate in Springfield, MA between May 15, 2015 and May 14, 2017 on encounters among 163 individuals ranging in age from neonates to geriatric patients before and after MEP introduction for clinical practice. One cohort reflected pre-MEP availability and relied on culture and gram stain while another cohort had the MEP available and gram stain/culture. The primary outcomes were (1) MEP effect on antimicrobial de-escalation and (2) total antimicrobial days defined as sum of days on antimicrobial therapy counting each antimicrobial agent separately. Secondary outcomes were (1) length of hospital stay, (2) rate of adverse events associated with antimicrobial use, and (3) determination if adult or pediatric age interplayed with interpretation of MEP results.

Results

Fifty-two percent of the population was 18 years-old or younger. The most common organisms identified were parechovirus and enterovirus. There were 26 positive MEP panels and nine encounters did not de-escalate antimicrobials. Seven of the nine did not de-escalate because there was concern for sepsis or blood culture was positive. The remaining two either started or continued acyclovir for a positive MEP of HSV-2 or VZV. When the MEP resulted positive for bacteria, antimicrobials were modified. Mean time antimicrobial use was less when MEP was available (3.1 vs. 4.8 days) and length of hospitalization was similar (6.1 vs. 6.9 days). Adverse events were minimal in both groups.

Identified Organisms

Microorganisms identified by MEP overall, pediatric, and adult.

Total Antimicrobial Days and Length of Stay by Cohort

Pre-MEP and MEP available cohort distribution on total antimicrobial days and length of stay in pediatric and adult populations.

Conclusion

The data did identify difference in management with interpretation of the MEP for pediatrics (≤ 18 y/o) when compared to adults. Fever in a neonate, or severely ill child led to a 48 hour blood culture rule out prior to any change in antibiotics. Overall, our study showed association of MEP use with early antimicrobial de-escalation that can potentially lead to decreased length of stay and savings in healthcare costs.

Disclosures

All Authors: No reported disclosures.
1034. Risk Score for the Need of Mechanical Ventilation in Adults Presenting with Encephalitis.
Authors: Heck Ashley N , Ramirez Denisse , Ibanez Alejandro Granillo , Hasbun Rodrigo
Published: December 2022

Background

The purpose of this study was to stratify risk subgroups for mechanical ventilation in adults presenting with encephalitis.

Methods

A retrospective observational study of 271 adults ( > 18 years old) admitted with an encephalitis diagnosis according to International Encephalitis Consortium guidelines were enrolled from sixteen hospitals in Houston, Texas between the years of 2005 and 2015.

Results

Mechanical ventilation (MV) was utilized in 91/271 (33.6%) adults with encephalitis and it was associated in hospital mortality (24.2% vs 3.9%, P< 0.001). There were no significant differences in age, race, gender, underlying comorbidities or immunosuppressive conditions, fever, symptoms on presentation, focal neurological deficits, Glasgow coma scale, CSF profile, and abnormal cranial imaging including cerebral edema between patients with or without MV (P >0.05). Risk factors associated with the need for MV included seizures, serum white blood cell (WBC) counts >11,000/mm3, a Sequential Organ Failure Assessment (SOFA) score >3 and abnormal Electroencephalogram (EEG) (P< 0.05). A risk model was created using 3 baseline variables independently associated with MV (P< 0.05): serum WBC count >11,000/mm3, a

SOFA >3 and abnormal EEG. The risk score classified patients into 3 subgroups for the need for MV: low risk [none of the three variables, 1/32 (3.1%)], intermediate risk [1 of the 3 variables, 19/106 (17.9%], and high risk [2 or 3 of the 3 variables, 71/136 (52.2%)].

Risk Classification for Mechanical Ventilation in Patients with Encephalitis.

a Predictors include white blood cell count > 11, Sequential Organ Failure Assessment (SOFA) scores > 3 or abnormal Electroencephalogram (EEG)

Receiver Operating Characteristic (ROC) curve of risk score (Low =0 variables seen in the patients, Intermediate = 1 variable seen, and High = 2 or 3 variables seen).

Area under the curve = 0.728.

Conclusion

This risk score can be utilized by clinicians to assess the need for MV in adults presenting with encephalitis to help stratify patients that require intensive care unit admissions.

Disclosures

Rodrigo Hasbun, MD MPH FIDSA, Biofire: Grant/Research Support|Biofire: Honoraria.
1036. Timing and Use of Adjunctive Steroids in Adults with Bacterial Meningitis: Compliance with International Guidelines.
Authors: Ramirez Denisse , Nigo Masayuki , Hasbun Rodrigo
Published: December 2022

Background

Adjunctive steroids decrease mortality in adults with bacterial meningitis with the exception of Listeria monocytogenes. Steroids given within 20 minutes, 4 hours and 12 hours after the first dose of antibiotic are advocated by the Infectious Diseases Society of America (IDSA), European, and United Kingdom (UK) guidelines, respectively. Compliance with these guidelines in the US is unknown.

Methods

Retrospective observational study of 195 adults with community-acquired bacterial meningitis at 16 hospitals in Houston area from December 2004-May 2019.

Results

Adjunctive steroids were given to 146/195 (75%) of patients and were more likely used in patients with a positive Gram stain, those with pneumococcal etiology, comorbidities, a higher CSF protein and with lower CSF glucose (P >0.05). The percentage of patients with pneumococcal etiology 77%. There was no association between the use of steroids and history of immunosuppression, fever, headache, stiff neck, Glasgow coma scale, seizures, focal neurological exam or serum WBC counts (P >0.05). Out of the 146 patients that received steroids, 28 (14%), 68 (35%), and 106 (54%) received them within 20 minutes, 4 hours or 12 hours after the first dose of antibiotics as per IDSA, European and UK guidelines, respectively. Use of steroids in this study by any timeline was not associated with improved clinical outcomes.

Conclusion

Timing and use adjunctive steroids in adults with bacterial meningitis remain suboptimal in the US and could account for the lack of impact on clinical outcomes.

Disclosures

Rodrigo Hasbun, MD MPH FIDSA, Biofire: Grant/Research Support|Biofire: Honoraria.
1037. Access to hospitalization for patients with severe COVID-19 during the first wave of the pandemic in Caracas, Venezuela.
Authors: Orejas Jose , Forero David , Mendoza Daniela , Omana Oscar , Carrión-Nessi Fhabián S , Landaeta Maria , Diaz Alejandro
Published: December 2022

Background

The COVID-19 pandemic has overwhelmed health systems around the world, causing access problems. The patient referral system in Caracas, Venezuela has no interinstitutional coordination, patients are given a note by the referring center and thereafter seeking care relies on themselves. We studied primarily to what extent the Caracas healthcare system satisfied the demand for hospitalization of severe COVID-19 during periods of congestion, measured in proportion of patients not hospitalized; and secondly how difficult it was for patients with severe COVID-19 to meet their need of hospitalization, measured in number of days and visits made to health centers until hospitalization or desisting from further searching.

Methods

This study was approved by national bioethics committee. We included all symptomatic patients who attended the University Hospital of Caracas COVID-19 testing center, whose nasopharyngeal swab PCR was positive for SARS-CoV-2, and whose SpO2 was 93% or less between 07/01/2020 and 07/24/2020, the period in which we referred patients due to unavailability of beds in our center.

Results

Ninety-four patients were included, 66 (70%) were men, the mean age was 58 years (range, 25-87 years), the median number of comorbidities was 1 (range, 0-3), and the median SpO2 was 90% (range, 30%-93%). Fourty-three (46%) patients were never admitted following referral from our center. Referred patients required a median of 1 day (range, 1-15 days) and 2 visits (range, 1-41 visits) to being admitted, or a median of 2 days (range, 1-17 days) and 5 visits (range, 1-31 visits) to desisting from further searching for admission.

Conclusion

These data show that the healthcare system did not meet the hospitalization needs of half of the patients with severe COVID-19 during the peak of the first wave of the pandemic in Caracas. The data also show that referred patients faced a major delay in being hospitalized, and that referred patients had to perform multiple visits to healthcare centers accross the city as a consequence of insufficient system capacity, increasing their urban mobility and therefore their probabilities of transmitting SARS-CoV-2 to others.

Disclosures

All Authors: No reported disclosures.
1041. Association of SARS-CoV-2 Viral load in COVID-19 at the hospital representation
Authors: Bhargava Ashish , Patel Hemang , Salaytah Natali , Akagi Elisa , Saravolatz Louis , Sharma Mamta
Published: December 2022

Background

The SARS-CoV-2 viral load and its association with COVID-19 severity remain a widely discussed topic with a little or no consensus. With these considerations we aimed to investigate SARS-CoV-2 viral load in the saliva/sputum in COVID-19 patients with varying severity levels.

Methods

A single-center prospective cohort study at Ascension St John Hospital, Detroit, MIchigan was conducted during early January 2021 and September 2021. We recruited 200 subjects with a PCR-confirmed COVID-19 and 18 year of age and older. Further these subjects were divided into mild, moderate, severe and critical cohorts based on WHO defined criteria. Further we collected sputum/saliva samples and measured them for SARS-CoV-2 viral load. .

Results

We recruited 50 patients in each cohort totaling to 200 patients.Our study cohort was made up of 104 (52%) males and 96 (48%) females. We note severity level differences matching with the COVID-19 severity at the hospital presentation.

Conclusion

These results were interesting to provide an insight into COVID-19 severity and clinical representation.

Disclosures

All Authors: No reported disclosures.
1070. Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes
Authors: Guaraldi Giovanni , Milic Jovana , Barbieri Sara , Marchio’ Tommaso , Caselgrandi Agnese , Motta Federico , Beghe’ Bianca , Verduri Alessia , Belli Michela , Gozzi Licia , Iadisernia Vittorio , Faltoni Matteo , Burastero Giulia , Dessilani Andrea , Monte Martina Del , Bacca Erica , Franceschi Giacomo , Yaacoub Dina , Volpi Sara , Mazzochi Alice , Clini Enrico , Mussini Cristina
Published: December 2022

Background

The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC).

Methods

This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: “fit/resilient”, “fit/non-resilient”, “frail/resilient” and “frail/non-resilient”. Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions.

Results

232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Table 1 shows demographic, anthropometric and clinical characteristics, comorbidities and patient-reported outcomes according to four frailty-resilience phenotypes. With regards to study outcomes, Figure 1 depicts in radar graphs, mean scores of each domain of SF-36 (1A), EQ-5D5L (1B) and IC (1C). Figures shows polygon areas for each frailty/resilience phenotypes. Progressive increase of mean scores of each domain are plotted in the vertices of polygons, from the lowest (near the center) in frail and non-resilient, to highest (towards periphery) in fit and resilient. Multivariate logistic analyses were used to identify predictors of the total scores of SF-36 (Figure 2A), EQ-5D5L (Figure 2B) and IC (Figure 2C).

Conclusion

Resilience is complementary to frailty in the identification of clinical phenotypes with different impact on wellness and QoL. Frailty and resilience should be evaluated in hospitalized COVID-19 patients to identify vulnerable individuals to prioritize urgent health interventions in people with PACS.

Funding

This study is supported by a Gilead Sciences Inc. unrestricted grant.

Disclosures

All Authors: No reported disclosures.
1084. Comparison of Pediatric SARS-CoV-2 Infections During Spring 2020 and Spring 2021
Authors: Ngo Lynda , Ericson Jessica E , Gavigan Patrick , Williams Amanda , Kwon Michelle , Musser Leah
Published: December 2022

Background

Data is lacking regarding the clinical manifestations of children with SARS-CoV-2 infection during Spring 2021 and how that clinical presentation compares to children who presented during the early months of the pandemic. We sought to compare the presentation and severity of illness among children with a positive PCR test result for SARS-CoV-2 who presented during the Spring 2020 to those who presented for testing during Spring 2021.

Methods

We identified all patients < 18 years old who had a positive nasopharyngeal polymerase chain reaction (PCR) result for SARS-CoV-2 from 4/1/2020-6/30/2020 and from 4/1/2021-6/30/2021 through a laboratory-based database at a rural academic tertiary care medical center. Data collected included demographics; underlying medical comorbidities; symptoms at the time of SARS-CoV-2 testing; results of SARS-CoV-2 testing and other tests performed at the same time; treatments administered; imaging studies performed; need for hospitalization; and, for those requiring hospitalization, hospital length of stay, and respiratory support. We excluded patients who were hospitalized for reasons other than COVID-19 infection in our hospitalization statistics.

Results

We identified 331 children with a positive SARS-CoV-2 PCR result who met our inclusion criteria. Among children presenting during the Spring 2021 time period, upper respiratory tract infection (URI) symptoms were much less common than those presenting in Spring 2020 (2% vs 19%, p< 0.001). Additionally, fever and cough were more common among children presenting in Spring 2021 (34% vs 22%, p=0.01) (Table 1). Hospitalization for COVID-19 care occurred in 4% of children overall: 3% of children during the Spring 2020 era and 5% of children during Spring 2021, P=0.587 (Table 2).

Self-reported symptoms among children with a positive SARS-CoV-2 polymerase chain reaction test, Spring 2020 vs. Spring 2021.

Association of year, patient, and clinical characteristics with hospital admission for care of COVID-19.

Conclusion

Our study offers insights into the differences in the clinical presentation and outcomes of pediatric patients infected with SARS-CoV-2 during Spring 2020 and Spring 2021, respectively. We found that children infected during Spring 2021 had fever and cough more often and rhinorrhea and nasal congestion less often than children infected during the Spring 2020. Hospitalization was uncommon and was similar in both time periods. Most children requiring hospital admission had an underlying medical comorbidity.

Disclosures

Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant.
1086. COVID-19 in a Comprehensive Cancer Center: 2020-2022
Authors: Mulanovich Patricia , Chemaly Roy F , Granwehr Bruno , McConn Kelly , Assistant Physician , Patel Nina , Assistant Physician , Raad Issam I , Adachi Javier
Published: December 2022

Background

Patients with COVID-19 and underlying malignancies, particularly those receiving immunosuppressive therapy, are at higher risk of severe COVID-19 disease.

Our retrospective cohort study examines the outcomes of COVID-19 infection in patients with different underlying malignancies admitted to a 710- beds comprehensive cancer center during the first 2 years of the pandemic.

Methods

All patients with cancer admitted to MD Anderson Cancer Center with a positive PCR test for SARS-CoV-2 were included in a clinical case registry from 3/22/20 (first hospitalized COVID-19 patient) to 3/31/22. This clinical registry was approved at the beginning of the COVID-19 pandemic by the Quality Improvement Assessment Board at MDACC. Clinical information including type of malignancy, date of admission, length of stay, need for invasive mechanical ventilation (IMV), and in-hospital mortality was obtained from their electronic medical records. Statistical analysis was performed using a two-proportion z-test where p< 0.05 was considered significant.

Results

A total of 1748 patients with cancer and COVID-19 infection were admitted over a 2-year period (3.2% of total hospital admissions during the same period), 49% had hematological malignancies (HM) (see table). Patients with HM had significantly higher readmission rates (17.3% vs 9.1%, p< 0.0001), IMV rates (7.8% vs 4.4%, p=0.0029), and inpatient mortality rates (13.6% vs 7.1%, p< 0.0001). compared to patients with solid tumors (ST). Total mortality rate was 8.8% (154 patients), even higher in patients with different types of HM, such as lymphoma 18.1%, AML 14.2%, MM 8.4%, CML 7.1% while the mortality for ST was 7.1%.

COVID-19 Hospitalized Patients at UT-MDACC (3/22/20-3/31/22)

UT-MDACC: The University of Texas MD Anderson Cancer Center

*p-value <0.01 for z-test of 2 proportions (one-tailed)

Conclusion

HM patients hospitalized with COVID-19 infection had more severe disease and worse outcomes based on readmissions, IMV, and mortality rates. Preventive measures, prompt diagnosis and early treatments should be considered on this patient population.

Disclosures

Roy F. Chemaly, MD/MPH, Karius: Advisor/Consultant|Karius: Grant/Research Support.
1091. HIV Does Not Increase Risk of Disease Severity in Patients with COVID-19 Infection
Authors: Bangash Salman , Betancourth Adriana , Khan Ayesha , Hsiao Chiu-Bin , Oehler Cassandra , Abalos Charmaine Clarisse D
Published: December 2022

Background

Limited literature on the impact of COVID-19 infection in persons living with HIV infection (PLWHIV) has shown conflicting results, especially on the degree of disease severity and morbidity/mortality risk impact. The advent of vaccinations against COVID-19 infection helped combat this horrific pandemic. However, their efficacy in immunocompromised hosts is understudied. The measurement of anti-spike antibody levels makes them an ideal surrogate to study the efficacy of the immune response conferred after vaccination.

Methods

A quality improvement project was conducted between 03/2020 and 03/2022 at Positive Health Clinic (PHC), a Pittsburgh urban Ryan White-funded HIV clinic, where approximately 930 PLWHIV receive care. PHC patients who tested positive for COVID-19 were followed up for their clinical presentations and outcomes. Goals were to observe longitudinal clinical impact with or without vaccinations; the COVID-19 vaccination acceptance and its serum anti-spike antibody response (AS-Ab); and COVID-19 variants impact on protection by vaccination.

Results

By 02/21, a 70% vaccination rate was achieved for PHC PLWHIV. 136 serum AS-Ab tests were collected at least 28 days after completing the primary vaccination series. Five non-responders were noted (2 renal transplant recipients, 2 with advanced AIDS with uncontrolled HIV, and 1 with liver cirrhosis). Low AS-Ab titers were observed in patients with CD4 < 200 or HIV VL > 200. A total of 109 COVID-19 infections in 105 patients were seen. From 03/20 – 11/21, there were 53 infections noted (45 unvaccinated: 5 with severe disease; 8 vaccinated: 0 severe disease). 58 infections (8 unvaccinated, 2 severe, 50 vaccinated (including four 2nd infections: 0 severe) were observed during 11/221 – 03/22. No mortality was noted. Figure 1.Figure 2.Figure 3Demographics of PHC

Conclusion

This report did not show mortality directly associated with COVID-19 infection in PLWHIV. Moreover, COVID-19 vaccination is known to reduce the risk and severity of COVID-19 infection in the general population, which was consistent across our study. Interestingly, there were very few COVID-19 infections diagnosed in PLWHIV who had low CD4 count and uncontrolled HIV (CD4 < 200 & HIV VL > 500 copies) even after the surge of the Omicron variant.

Disclosures

All Authors: No reported disclosures.
1105. A Matched-Group Comparison of Interventions for COVID-19 During the First and Second Waves of the COVID-19 Pandemic in a County Hospital in Chicago.
Authors: Hernandez Acosta Ruben A , Corpuz Carlos , Gonakoti Sriram , Patel Palak , Chang Hillary , Akaho Elikplim , Skaathun Britt , Hoffman Michael , Rezai Katayoun
Published: December 2022

Background

The COVID-19 pandemic continually challenges the scientific community to develop and evaluate viable treatments. In May 2020, remdesivir became the first medication to receive emergency use authorization for the treatment of COVID-19, while dexamethasone became standard of care for patients requiring supplementary oxygen in late 2020.

Methods

This was a retrospective observational study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19) admitted in the first wave (3/2020-7/2020) and second wave (10/2020-1/2021) at Cook County Hospital. Variables on demographic, clinical data and outcomes were extracted from the EMR. The measured intervention was use of dexamethasone with remdesivir during the second wave; patients were matched by age and diabetic status to patients in the first wave who had received only remdesivir. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. Conditional logistic regression was used to examine associations between use of dexamethasone and each outcome, controlling for glucose levels, use of remdesivir and severity of disease.

Results

621 patients were admitted in the first wave (3/2020-7/2020) versus 355 in the second wave (12/2020-1/2021). Median age was 55 years and 56 years, respectively. Most patients were Hispanic and Black. In the first wave, 296 patients (48%) were admitted with severe COVID-19 (defined as oxygen saturation on room air at or below 94%) versus 163 patients (46%) in the second wave. Logistic regression showed no association between use of dexamethasone and ICU admission, mortality or intubation. Use of remdesivir showed no association with any of the outcomes. Glucose and severe/critical disease were strongly associated with ICU admission (p=0.01 and p=0.003) and mortality (p=0.06 for both).

Conclusion

Despite promising medications, in this study the mortality and disease severity of COVID-19 was very similar to that seen in the first wave. This could be due to patients presenting with more advanced disease and undiagnosed or poorly-controlled comorbidities that may offset the potential benefit of these treatments. Enhancing access to care and decreasing health inequalities may be more worthwhile than finding a “miracle drug”.

Disclosures

All Authors: No reported disclosures.
1106. A Retrospective Assessment of the Effects of Baricitinib and Tocilizumab on COVID-19 Patients requiring High Flow Oxygen
Authors: Tin Kathy , Fernandes Annamarie , Njoroge Alexander , Go Roderick
Published: December 2022

Background

SARS-CoV-2 has been a leading cause of mortality worldwide for over two years. It continues to be a group effort to discover treatment to prevent further deterioration during the disease course. Positive outcomes have been observed in select patients with immune modulator therapy. Although large randomized controlled trials have investigated the use of immunomodulators in COVID-19 therapy, few have compared the differences in safety profiles and clinical outcomes between the different drugs. We studied the differences in outcomes in hospitalized patients with COVID-19 pneumonia treated with baricitinib versus tocilizumab.

Methods

Adult patients admitted to Stony Brook University Hospital between April 2020 and April 2021 with high flow oxygen requirements due to severe COVID-19 pneumonia were retrospectively analyzed. The primary endpoint was the time to reduction of highest oxygen requirement 14 days after immune modulator therapy was administered or hospital discharge, whichever came first. Secondary endpoints include length of hospital stay (LOS), 28-day mortality, and serious adverse events.

Results

132 patients with COVID-19 pneumonia were treated with immune modulators. One patient was excluded from primary and secondary analysis due to having received both tocilizumab and baricitinib. All patients received steroids and remdesivir. 73 received baricitinib and 58 received tocilizumab. Oxygen requirements at the initiation of either baricitnib or tocilizumab had a mean of 5.84±0.6 and 5.9±0.7, respectively using the WHO ordinal scale. The mean time to oxygen down titration in the baricitinib group was similar (5.7±2.6 and 6.07±2.7 days). In continuous variable analysis, patients who received baricitinib had a longer duration of fever (6.0 days vs 3.6 days, p=0.04) and lower serum ferritin (909.9 ng/ml vs. 1331.8 ng/ml, p=0.09). LOS was not similar between the groups (mean 24.4 vs. 25.8, p=0.89). Hospital mortality was not statistically significant between the two groups (32.9% vs. 27.6%, p=0.514).

Conclusion

This study suggests similar outcomes for oxygen requirements, hospital length of stay, and mortality between baricitinib and tocilizumab when given in conjunction with remdesivir and steroids for severe COVID-19 pneumonia.

Disclosures

Kathy Tin, D.O., Merck: Stocks/Bonds|Novavax: Stocks/Bonds|Pfizer: Stocks/Bonds Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support.