bluuebunny/crossref_metadata_2025 huggingface dataset:
1000. Clinical significance and antimicrobial susceptibilities of Roseomonas species infections
Authors: Kim Chang Hyup , Lee Se Ju , Kim Jinnam , Lee Ki Hyun , Lee Jung Ah , Yeom Joon-sup , Choi Jun Yong , Ku Nam Su , Jeong Su Jin , Ahn Jin Young , Kim Jung Ho
Published: December 2022

Background

Roseomonas species are slow-growing Gram-negative cocobacillus, and were first reported in 1993. Roseomonas have been isolated from environmental sources and can cause bacteremia in humans, especially in immunocompromised patients. Since these species were difficult to isolate and infections with these species are not common, there are only a few studies on their characteristics. Therefore, we aim to expand our knowledge of clinical features, antimicrobial susceptibility patterns, and treatment outcomes for Roseomonas human infections.

Methods

From January 2006 to March 2022, patients with Roseomonas isolated from blood and other aseptic sources were extracted from three tertiary hospitals in South Korea. Underlying conditions, clinical manifestations, antimicrobial susceptibility patterns, and outcomes were reviewed through the medical records.

Results

During the study period, a total of 39 patients (46.2% were male) with Roseomonas infections were included. The median age was 50 (interquartile range, 33.5-62.5) years old, and seven patients (17.9%) were under age 18. Of the 39 patients, 13 patients (33.3%) had malignancies, five patients (12.8%) had neutropenia with an absolute neutrophil count of fewer than 1000 cells/mm3. Blood isolates were the most common (26 cases), followed by catheter blood (3 cases), and soft tissue (3 cases). Twenty-one cases (53.8%) were cultured after 48 hours of incubation, and co-infection with other bacteria was identified in nine cases (23.1%). Twenty-eight patients (71.8%) were symptomatic, with fever (30.8%) being the most common symptom. Amikacin showed a high susceptible rate (95.7%) to isolated Roseomonas. Tigecycline also showed high susceptible rates (92.9% , respectively). The susceptible rate of levofloxacin was 85.0%. On the other hand, the susceptible rate of piperacillin-tazobactam (5.9%) and meropenem (47.6%) were below 50%. There were two cases (5.1%) of in-hospital mortality.

Conclusion

Although not common, Roseomonas species can cause bacteremia and even death, especially in immunocompromised individuals. Since Roseomonas are challenging to isolate and generally show resistance to antibiotics commonly used for Gram-negative bacterial infections, careful attention is warranted in selecting antibiotics.

Disclosures

All Authors: No reported disclosures.
1004. Dalbavancin Use and Associated Cost-Savings: An Update
Authors: Streifel Amber C , Sikka Monica K , Lewis James S
Published: December 2022

Background

Dalbavancin provides an alternative to standard of care intravenous (IV) antibiotics for the treatment of complicated infections, although clinical data continues to evolve In the United States, the use of dalbavancin as an alternative for patients requiring long courses of IV therapy can result in reduction of hospital days, and thus significant cost-savings to health systems.

Methods

We conducted a retrospective review of dalbavancin use at our institution and resulting cost avoidance from 2015 to 2021. We identified all patients age 18 years or older who received > one dose of dalbavancin via medication records. Cost calculation was based on the number of outpatient dalbavancin days as a measure of avoided inpatient days.

Results

189 patients received at least one dose of dalbavancin over the study period. The mean age 47.6 years and the most common infections were non-vertebral bone and joint infections (85; 45%), vertebral osteomyelitis (28; 14.8%) and skin and soft tissue infections (27; 14.3%). The most commonly isolated organism was Staphylococcus aureus (109; 57.6%), MRSA (60; 31.7%) and MSSA (49; 25.9%). Dalbavancin dosing regimens varied over the study period. Reasons for selection of dalbavancin included history of injection drug use (67; 35.4%), lack of a safe home environment to receive daily IV antibiotics (26; 13.8%), and patient declining PICC or daily outpatient IV antibiotics (26; 13.8%). 84 patients (44%) received at least one dose of dalbavancin in the inpatient setting. Adverse effects were documented for 21 (11%) of patients. Readmission within 30 days of dalbavancin dose occurred for 27 (14.2%) patients, 14 (7.4%) of which were related to either infection or dalbavancin adverse effect. Relapse or recurrence of infection at 30 days was documented for 9 patients (4.8%). A total of 4,273 out-of-hospital dalbavancin days were identified, resulting in a cost savings of $10,464,382 or a mean of $55,367.10 per patient.

Conclusion

As the use of dalbavancin for complicated infections continues to increase, the potential for health system cost-savings increases, driven by reduction in length of hospital stay. Prospective cost-analysis research is needed to further describe the cost benefits associated with dalbavancin use to patients and health systems in the United States.

Disclosures

Monica K. Sikka, MD, F2G: Site research investigator James S. Lewis, PharmD, FIDSA, Cidara: Advisor/Consultant|Merck: Advisor/Consultant|SeLux Diagnostics: Advisor/Consultant.
1006. High Adherence and Cost Savings with Home OPAT Provided through Infectious Disease Physician Office Infusion Centers
Authors: Martin Clifford P , Sleweon Thomas K , Luu Quyen , Prokesch Richard C , Dretler Robin H , Statner Barry , Stock Kent J , Schroeder Claudia P , Van Anglen Lucinda J
Published: December 2022

Background

Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be safe and effective for self-administration but can lead to non-adherence without supervision. A physician office infusion center (POIC) with pharmacy services provides a unique opportunity to impact adherence and OPAT management. Patients (pts) typically come to the POIC weekly for catheter care, laboratory collection, medication pick-up and as needed provider visits. Often, close provider oversight allows for de-escalation of OPAT. We evaluated adherence to therapy, visits and associated cost saving in pts receiving self-administered OPAT through POICs.

Methods

Pts receiving home OPAT in 2021 were randomly selected from participating sites based on annual pt volume. Adherence was assessed as % of OPAT doses dispensed vs. doses missed. Frequency of office visits for routine catheter care and labs along with OPAT completion were collected. Cost savings were calculated in days of OPAT saved due to therapy de-escalation and response to therapy, based upon published daily costs of OPAT. Pt characteristics, OPAT duration, infection type and regimen were captured.

Results

A total of 125 of 2180 pts from 13 POICs nationally were included (mean age 50±18 years, 52% male). Mean OPAT duration was 38±9 days. Predominant infections were bone and joint (38%), complicated skin (18%), intra-abdominal (15%) and bacteremia (14%). The most common antimicrobials were cephalosporins (54%) with 20 pts self-administering ≥2 drugs. Pts had a mean of 6±3 POIC visits during the therapy course with completion as scheduled in 703/706 visits (99.6%). OPAT was completed as planned in 118 pts (94%), with discontinuations for adverse events (n=3), hospitalization (n=2), or non-adherence (n=2). Overall adherence rate was 99.3% with 51 missed of 7315 doses dispensed. De-escalation during OPAT saved 533 doses equating to 307 days of OPAT (2.4 days/pt). Based on an average daily OPAT cost of $140, this saved $42,980 in the randomized cohort and an estimated $749,571 annually in the entire population.

Conclusion

Home OPAT through an ID POIC was associated with a very high rate of adherence and compliance to scheduled visits in pts. ID oversight resulted in healthcare cost savings through onsite antimicrobial stewardship and therapy management.

Disclosures

Lucinda J. Van Anglen, PharmD, Merck & Co.: Grant/Research Support|Paratek: Grant/Research Support.
1025. Utility of a Risk Assessment Model in Predicting 30-day Unplanned Hospital Readmission in Adult Patients Receiving Outpatient Parenteral Antimicrobial Therapy
Authors: Brenneman Ethan , Funaro Jason , Dicks Kristen , Yarrington Michael E , Drew Richard H
Published: December 2022

Background

Outpatient parenteral antimicrobial therapy (OPAT) is used for patients that require prolonged durations of intravenous (IV) antimicrobials and who are healthy enough to receive the medications in the outpatient setting. While OPAT is both efficacious and cost-effective, hospital readmission rates are high. Durojaiye and colleagues in the UK developed a 30-day unplanned readmission risk prediction model for OPAT patients. Given differences in patient mix and methods of OPAT delivery, we validated the established risk assessment model for Duke University Health System (DUHS) patients receiving OPAT.

Methods

A retrospective review of 606 OPAT episodes of adult patients who were enrolled in the DUHS OPAT program between July 1, 2019 and February 1, 2020 was conducted. The review captured the 6 risk predictors of the established model: age, Charlson Comorbidity Score, number of admissions in the preceding 12 months, concurrent receipt of more than one IV antimicrobial agent, type of infection, and mode of OPAT delivery. Additional risk predictors were captured: aminoglycoside use, vancomycin use, OPAT delivery in a skilled nursing facility, and history of IV drug abuse. The discriminative ability of the model to predict 30-day unplanned readmission as well as 30-day OPAT-related unplanned readmission was validated with the collected data using scaled Brier score, Hosmer-Lemeshow goodness-of-fit, and area under the receiver operating curve. A logistic regression model fitted with the additional risk factors was conducted to determine their impact on the model.

Results

When comparing DUHS OPAT patients with those of the UK model, DUHS patients were sicker (mean Charlson Comorbidity Score 3 vs 1), were treated for deeper seated infections, and received OPAT through different modes. Overall the 30-day unplanned readmission rate was 20.0% (94/470), with 59.5% of those being OPAT-related. The UK model was unable to discriminate between patients with readmission and those without, both overall and OPAT-related. The additional risk factors were also non-significant between the groups and the updated model could not predict 30-day readmission risk.

Conclusion

The UK 30-day unplanned hospital readmission model did not predict patient risk of readmission for the Duke OPAT population.

Disclosures

Richard H. Drew, PharmD MS, American College of Clinical Pharmacists: Publication royalties|Takeda: Advisor/Consultant|UpToDate: publication royalties.
1028. Clinical and radiologic characteristics of calcified parenchymal neurocysticercosis: A large series of a non-endemic region
Authors: Berto Moreano Cesar G , Machiavello Francisco J , Mazzini Jorge , Sacchi Robert , Coyle Christina
Published: December 2022

Background

Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system and a common cause of seizures. Approximately, one-third of patients with epilepsy in endemic regions have NCC. Calcified parenchymal cysticercosis (CaNCC) was previously referred to as an inactive form of NCC, however, recent data suggests that the antigenic parasitic material within this lesion can intermittently elicit a host inflammatory response. The clinical and radiologic characteristics associated with calcified lesions have not yet been well characterized.

Methods

We describe the clinical, radiologic, and serologic characteristics of a large series of patients with calcified parenchymal NCC who presented to Jacobi Medical Center, New York.

Results

Of 302 cases of NCC, 87 patients (32.5%) had exclusively CaNCC. Most individuals were female (50.7%) and born in Mexico (32.2%); the mean age was 38.4 ± 15.3 years and the median time from migration was 12 years [IQR 4-20 years]. The most common presentation was seizures (52.9%); among these patients, 23 individuals (53.5%) had perilesional edema on imaging which was always associated with enhancement on MR T1 image after gadolinium injection. Thirty-seven patients (42.5%) presented with headaches; among these, only 6 patients (16.2%) had perilesional edema at presentation. Nine patients (10.3%) were diagnosed incidentally. The Western blot was positive in 19 patients (21.8%) and the cysticercosis antigen in serum was negative in all cases.

Conclusion

This large series of patients with CaNCC in a non-endemic area highlights the clinical spectrum of this form of NCC. Seizures were the most common symptom. Perilesional edema around calcified lesions was seen in 50% of individuals presenting with seizures, similar to findings in endemic regions. Headaches also were frequent; the pathophysiology is yet not well understood. Unlike extraparenchymal disease, serum antigen is not positive in CaNCC. Enhancement of the corresponding calcifications after gadolinium was frequently seen on MRI. More research on individuals with CaNCC is needed to better understand why certain calcified lesions develop perilesional edema. It is clear that CaNCC is not inactive and the etiology of both headaches and seizures is probably multifactorial.

Disclosures

All Authors: No reported disclosures.
1030. Epidemiology and Microbiologic Characteristics of Post-operative Central Nervous System Infections following Endoscopic Endonasal Surgery
Authors: Shah Sunish , Durkin Joseph , Byers Karin E , Snyderman Carl H , Gardner Paul A , Shields Ryan K
Published: December 2022

Background

Endoscopic Endonasal Surgery (EES) is an innovative surgical technique to remove brain tumors and lesions. Post-operative central nervous system (CNS) infections following EES are poorly described. The objective of this study was to define the epidemiology and characteristics of post-EES CNS infections.

Methods

Adult patients who underwent EES between 1/2010 and 7/2021 were evaluated and included if microbiologically confirmed CNS infection occurred within 30 days of EES. Suspected contaminants, ventricular drain colonization, and pre-EES CNS infections were excluded.

Results

Overall, 2005 patients underwent EES; 1.8% (37/2005) developed CNS infection. The median [IQR] age was 51 [42-60] years, 32.4% (12/37) were female, and 54% (20/37) had a prior EES. The most common indications for EES were tumor resection [67.6% (25/37)] and cerebrospinal fluid (CSF) leak repair [24.3% (9/37)]. Post-operative CSF leaks were documented in 70.3% (26/37) of patients and 24.3% (9/37) had an extra-ventricular drain or shunt in place for >48 hours at the time of infection. Ceftriaxone prophylaxis was prescribed in 64.9% (24/37) of cases and other regimens varied. The median [IQR] time from EES to diagnosis of CNS infection was 12 [6-19] days. The most common pathogens were S. aureus, Enterobacterales, and P. aeruginosa(Fig 1). Among 20 patients with prior EES, pathogens included S. aureus (5/20), Enterobacterales (3/20), Enterococcus spp. (3/20) and polymicrobic infections (3/20). Overall, 35.1% (13/37) of patients developed CNS infection due to a pathogen susceptible to pre-EES prophylaxis. Among those colonized with MRSA at time of EES, 75% (3/4) developed MRSA CNS infection compared to 6.1% (2/33) of non-colonized MRSA patients (P=0.005). The overall 30-day mortality rate was 2.7% (1/37). Figure:Microbiology

A polymicrobic case was defined as >1 pathogen isolated from CSF (n=1) or from rhinocerebral tissue if CSF cultures were negative (n=11). Among polymicrobic cases (n=12), P. aeruginosa (n=5), Enterococcus spp. (n=4). and S. aureus (n=3) were predominant. Cases labeled as other consisted of Trichoderma spp, A. xylosoxidans, P. acnes, S. epidermidis, Peptostreptococcus spp.

Conclusion

CNS infection post-EES is rare and causative pathogens vary. Given the predominance of S. aureus, antimicrobial prophylaxis should ensure adequate coverage of this pathogen in addition to sinus flora, and programs may benefit from screening patients for MRSA colonization pre-EES. Our data also suggest that prophylaxis should target Gram-negative and other colonizing bacteria among patients with prior EES.

Disclosures

Ryan K. Shields, PharmD, MS, Infectious Disease Connect: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Roche: Grant/Research Support.
1035. The Microbiological Pattern and Outcome of Community Acquired Brain Abscess: A Single Centre Study from Pakistan
Authors: Sayeed Muneeba A
Published: December 2022

Background

Brain abscess is a potentially life-threatening infection. Streptococci and bacteroides are considered the predominant causative organisms in community acquired brain abscesses. Recommended empirical therapy is therefore ceftriaxone and metronidazole. Our objective was to assess the microbiological pattern and outcome in patients admitted with brain abscess in the neurosurgery unit of a tertiary care hospital in Karachi, Pakistan.

Methods

A retrospective study was conducted on all patients admitted with community acquired brain abscess at the Neurosurgery Department of Shaheed Mohtarma Benazir Bhutto Institute of Trauma from Jun 2018- Nov 2019. Demographic, microbiological, management and outcome data was gathered from medical records.

Results

Twenty-three patients were identified of which 13 were males (56.5%). Mean age was 18 (2-65) years. Predisposing factor was an otogenic focus in 17 (73.9%), and head trauma in 3 (13%). Of 23 patients, site of abscess was frontal in 7 (30.4%), occipital in 8 (34.7%), parietal in 4 (17.3%), and temporal in 3 (13%). Single brain abscess was seen in 18 (78.2%). Abscess was drained in all 23 patients (100%) patients and pus culture positive in 16, of which 8 (50%) were poly-microbial. Isolates were 6 (%) Bacteroides, 6 Streptococci, 5 Enterobacteriace, 3 Staphylococcus aureus, 3 Enterococci, 1 Hemophilus, 1 Acinetobacter and 1 Brevibacterium. Of 6 bacteroides isolates, 2 were resistant to metronidazole while only 3 of 10 aerobes isolated were susceptible to ceftriaxone. All patients did well with resolution of abscess/es after an average of 41.2 days of therapy.

Conclusion

The microbiological spectrum and antimicrobial susceptibility pattern of community acquired brain abscess is changing. Ceftriaxone and metronidazole may no longer be appropriate empirical therapy in these patients.

Disclosures

All Authors: No reported disclosures.
1042. Inflammatory Representation of COVID-19 at the Time of Hospitalization: An Insight into the Mild, Moderate, Severe and Critical COVID-19 Disease
Authors: Bhargava Ashish , Patel Hemang , Akagi Elisa , Sharma Mamta , Santos Claudia V , Zhao Wei , Salaytah Natali , Kondapi Goutham , Mangukia Nilamben , Coyle Meredith M , Riederer Kathleen M , Johnson Leonard B , Saravolatz Louis
Published: December 2022

Background

The ongoing state of the COVID-19 pandemic necessitates the characterization of the biological basis of disease severity. We aimed to correlate the clinical severity of illness upon hospitalization with inflammatory sero-biomarker levels.

Methods

A single-center prospective cohort study was conducted at a 776-bed tertiary care urban academic medical center in Detroit, Michigan. Adults with confirmed reverse-transcriptase-polymerase-chain-reaction assay for COVID-19 were recruited in equal numbers into four disease severity categories, as defined by the WHO, upon hospital admission from January 8th, 2021 to September 1st, 2021. Electronic medical charts were reviewed. In addition to clinical markers, cytokines and chemokines were assessed to gain detailed understanding of COVID-19 pathology.

Results

We included 200 patients with 50 patients each in the mild, moderate, severe and critical illness. The mean age of the cohort was 58.6.±15.9 yrs, 104 (52%) were males, and 135(67.5%) were blacks. The common comorbidities were hypertension (67.5%), diabetes (37%) and chronic lung diseases (26.5%). At the time of admission, oxygen therapy was needed in 49.5% but intubation in only 0.5%.

Conclusion

We noted COVID-19 severity dependent changes in the clinical representation as well as the biomarker profiles. Clinical markers such as CRP, LDH, D-dimer and Ferritin were relatable to COVID-19 severity. Inflammatory cytokines and chemokines such as CCL-2, CXCL-10, IL-1ra, IL-6 and TNF-alpha also varied with the severity of disease. Our results provide a system level insight into the inflammatory state of COVID-19 at the time of hospital representation.

Disclosures

All Authors: No reported disclosures.
1050. Breath Sample Collection from Individuals Infected with SARS-CoV-2: Biosafety Methodology
Authors: Lopez Marcela , Lopez Marcela , Stainton Emma , Chun Leanne X , Tam Grace K , Thiessen Rosita , Carrington Yuan J , Idziak Luke , Hannon Ami M , Duanmu Youyou , Trounce Milana Boukhman , Altamirano Jonathan , Ricco Antonio J , Li Jing , Li Jing , Maldonado Yvonne A , Govindarajan Prasanthi
Published: December 2022

Background

Breath samples collected from patients infected with respiratory viruses are necessary for viral detection using breath analyzer devices. Given the highly transmissible nature of many of these illnesses, sample collection requires a multi-layered approach to ensure the safety of the research staff responsible for obtaining and transporting these samples. Our team established a protocol to minimize exposure to and transmission of COVID-19 when collecting breath samples.

Methods

We collected breath samples from 64 participants, of which 31 (48.4%) were positive for SARS-CoV-2 at the time of their visit. Before we started sample collection, biosafety inspection was conducted. We used a five-pronged approach to enhance safety and minimize transmission. First, we collected specimens in an outdoor space while the patients were seated in their vehicles. Second, we used a disposable mouthpiece and a one-way valve to fill a 1L TEDLAR bag. Third, patients were instructed to close the valve tightly before returning it to the staff. Fourth, we placed the bag in secondary containers which were placed in tertiary containers to minimize any contact with aerosols in the TEDLAR bag. In the last step, we placed a portable HEPA filter near the indoor sample processing unit to minimize exposure and air contamination with the samples. Study staff donned all forms of necessary personal protective equipment, including gloves, gowns, N95 respirators, and protective eyewear, during sample collection and transportation.

Results

A total of 64 breath samples were collected from 64 adult participants from February to March 2022. A total of 30 participants (46.9%) were within 7 days of their initial diagnosis. All participants were able to successfully collect samples without additional resources or attempts. All samples were able to be transported successfully into the lab. No staff contracted COVID-19 during the study period.

Conclusion

Layered safety measures, including protective equipment, physical barriers, and well-ventilated environments mitigated the risks associated with breath sample collections from infected participants.

Disclosures

Yvonne A. Maldonado, MD, Pfizer: Grant/Research Support|Pfizer: Member, DSMB, Pfizer Meningococcal Vaccine clinical trial.
1051. Cardiac Assessment in Children with MIS-C: Late Magnetic Resonance Imaging Features
Authors: Arslan Sema Yıldırım , Bal Zümrüt Şahbudak , Bayraktaroğlu Selen , Özenen Gizem Güner , Bilen Nimet Melis , Levent Ertürk , Ay Oğuzhan , Özkaya Pınar Yazıcı , Özkınay Feriştah Ferda , Çiçek Candan , Çinkooğlu Akın , Aksu Güzide , Ak Güneş , Kurugöl Nuri Zafer
Published: December 2022

Background

Multisystem Inflammatory Syndrome (MIS-C), a new entity in children which developed 2-4 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is a severe condition. It can affect the multisystem, while the most severe manifestation is cardiac involvement. Left ventricular dysfunction, cardiogenic shock, coronary artery dilatation/aneurysm, valvulitis, pericardial effusion, arrhythmia, and conduction abnormalities were reported in approximately 80% of children with cardiovascular system involvement. It is still unclear the duration of the cardiac symptoms, and even they are permanent or persistent. Few studies evaluated persistent cardiac abnormalities by cardiac magnetic resonance imaging (MRI). Therefore, we aimed to assess persisting cardiac abnormalities with MIS-C by cardiac MRI and compare them with echocardiograms.

Methods

A retrospective study was conducted at a tertiary-level University Hospital between June 2020-July 2021. Thirty-four children diagnosed with MIS-C according to the criteria defined by the Centers for Disease Control and Prevention were retrospectively evaluated.

Results

The study included 17 males and 17 females with a mean age of 9.31±4.72 years. Initial echocardiographic evaluation showed cardiac abnormality in 18 (52.9%) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, 5 (14.7%) LV fractional shortening < 30%, 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients at follow-up; coronary dilatation persisted in 2 of 5 (40 %) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients. We didn’t detect abnormal T1 levels, whereas 9 (29%) had isolated elevated T2 values. 19 (61.3%) of 31 patients had at least one of the following findings: pericardial effusion, right ventricular dysfunction, LVEF abnormality.

Conclusion

Cardiac involvement persisted at a higher rate which was shown by cardiac MRI in the late period, particularly pericardial effusion. Cardiac MRI may be suggested for all MIS-C patients at a later phase. Prospective studies with larger sample sizes are needed to determine long-term cardiac effects.

Disclosures

All Authors: No reported disclosures.
1054. Comparison of Post-Acute COVID-19 Symptoms in Infected Individuals Pre- and Post-Vaccination
Authors: McDonald Dylan , Logue Jennifer , Franko Nicholas M , Kemp Megan M , McCulloch Denise J , Chow Eric J , Chu Helen Y
Published: December 2022

Background

A constellation of debilitating symptoms, known as post-acute sequelae of COVID-19 (PASC), has been described in those in those with prior SARS-CoV-2 infection. While SARS-CoV-2 vaccination remains an effective way to prevent severe illness, PASC in individuals infected after vaccination is not well characterized.

Methods

A cohort of adults with laboratory confirmed SARS-CoV-2 infection were enrolled as cases and longitudinally followed between March 2020-March 2022 in the greater Seattle region. Demographic and acute illness surveys capturing baseline symptoms, infection severity and medical care were administered at enrollment (Table). Controls with no history of SARS-CoV-2 infection were concurrently followed.

Symptom surveys were given at 6 months post-infection. Vaccination status was self-reported. We defined PASC as the presence of one or more symptoms that persisted for at least 4 weeks after acute SARS-CoV-2 infection. Table.Demographic and Illness Characteristics of Study Participants*Days since illness onset refers to the days passed since infection date. **Comorbidities included hypertension, diabetes mellitus, chronic obstructive pulmonary disease, cardiovascular disease, chronic liver disease, chronic kidney disease, HIV, current use of immunosuppressants or diagnosis of cancer.

Results

Of 369 cases and 93 controls 57% (median age 44.7 years; 59.3% female) and 30% (median age 50.0 years; 50.0% female), completed the 6-month survey, respectively (Table). A total of 174 cases were infected prior to vaccination and 35 were post-vaccination.

A total of 58 (28%) cases reported symptoms at 6 months, compared to 5 (18%) controls (Figure). In participants infected pre-vaccination, 32% reported PASC symptoms, compared to 6% of those infected post-vaccination (Figure; P=0.001).

Conclusion

Our study found that the proportion of individuals reporting PASC at 6 months after infection was significantly higher among those infected before SARS-CoV-2 vaccination than those who were infected after. This suggests that timing of vaccination relative to SARS-CoV-2 infection may be associated with the development of PASC symptoms. Symptoms were still reported among many individuals with PASC who were vaccinated after their infection. Further research is required to understand the underlying mechanisms of PASC, and to characterize PASC in those infected after vaccination and with variant of concerns.

Disclosures

Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.
1065. Patient-Reported Reasons for Non-Participation in Inpatient COVID-19 Clinical Research: Results from a Multi-Center VA Embedded Randomized Trial
Authors: Reyes Dassum Samira , Ferguson Ryan , Woods Patricia , Flynn Maura , Visnaw Karen , Schiller Sara J , Monach Paul , Leatherman Sarah , Branch-Elliman Westyn
Published: December 2022

Background

Early in the COVID-19 pandemic, no evidence-proven therapeutics were approved, and thus participation in a clinical trial was often the only way to access experimental medications. However, in the US, participation in medical research is low. Patient-stated factors impacting enrollment decisions are poorly characterized. Thus, the aim of this study was to identify patient-reported reasons for declining enrollment in a COVID-19 clinical trial.

Methods

As part of an open-label, pragmatic randomized trial across five VAs from 4/10/20 – 2/3/21, SARS-COV-2 positive inpatients with moderate to severe disease were screened for eligibility. Potentially eligible patients received an informed consent packet with a letter explaining the study and were then contacted remotely to assess willingness to participate. If eligible patients declined to participate, if willing, they were asked an open-ended question about the reasons behind their decision. If they were not able to provide a specific answer, then general categories were offered. Qualitative responses were analyzed using a directed content analysis approach; responses were categorized using previously defined factors that have contributed to decisions not to enroll in other clinical therapeutics trials, primarily conducted in oncology.

Results

Among 417 patients screened, 162 met eligibility criteria. Of these, 53 consented (32.7%), 102 declined to participate (62.9%), and 7 were unable to give consent. Themes and examples of reasons for declining participation are presented in Table 1. Among the patients who declined to participate, the four most cited factors were limited perceived benefit, competing priorities, physician or family influence and presence of comorbidities. Several patients reported that their decision was influenced by physician or family recommendation to decline, which was reported as physician lack of support for participation due to the presence of comorbidities or physician perceived lack of benefit given clinical improvement prior to study enrollment.

Conclusion

Understanding reasons and attitudes driving enrollment may help investigators address them during the recruitment process and increase participation in clinical trials in the US.

Disclosures

Karen Visnaw, RN, Hologic Inc: Stocks/Bonds|Liquidia Corporation: Stocks/Bonds Paul Monach, MD, PhD, Celgene / Bristol-Myers Squibb: Advisor/Consultant|ChemoCentryx: Advisor/Consultant|Gilead: Grant/Research Support|Kiniksa: Advisor/Consultant Westyn Branch-Elliman, MD, MMSc, DLA Piper,LLC/Medtronic: Advisor/Consultant|Gilead Pharmaceuticals: Grant/Research Support.
1071. Retrospective study evaluating the cytokine dynamics in COVID-19 patients who were treated with casirivimab/imdevimab
Authors: Sugita Akiho , Ishikane Masahiro , Iwamoto Noriko , Sugiyama Masaya , Teruya Katsuji , Hojo Masayuki , Mizokami Masashi , Ohmagari Norio
Published: December 2022

Background

Neutralizing antibody therapy such as casirivimab/imdevimab is known to significantly reduce the viral load of SARS-CoV-2, but there is limited study on the clinical prognosis of neutralizing antibody therapy, especially in Asia, and the dynamics of cytokines is unknown worldwide. Several cytokines have been investigated as biomarkers to predict oxygen demand, among which CCL17 and INF3 have received approved and covered by the national health insurance in Japan.

Methods

Between July 2021 - December 2021, patient’s demographic, laboratory, radiological findings, prognosis, and cytokine kinetics (IFN-λ3, CCL17) at National Center for Global Health and Medicine, Tokyo, Japan, were analyzed using medical charts and serum samples. Univariate analysis was performed using Fisher's exact probability test and Mann-Whitney U test to evaluate the clinical characteristics of the group with oxygen demand compared with those of the group without oxygen demand.

Results

Thirty-four patients were analyzed. The median age of the cohort was 57.5 years (IQR 52.8-67.3), and 25 (73.5%) were male. Eight patients (23.5%) had been fully vaccinated and three patients (8.8%) had been vaccinated once. The severity of disease before casirivimab/imdevimab was asymptomatic in two (5.9%), mild in 12 (35.3%), moderate in 20 (58.8%) cases. Of the 17 cases in which mutant strains were identified, 16 were delta strains. The IFN-λ3 level (pg/mL) before casirivimab/imdevimab was significantly higher (7.6 vs. 17.2, p = 0.005), while the CCL17 level (pg/mL) was significantly lower (148.8 vs. 64.2, p = 0.036) in the group with oxygen demand during the therapeutic course compared to those in the group without oxygen demand. After casirivimab/imdevimab was administered, the IFN-λ3 level decreased to a median of 0.0 (IQR 0.0-0.3), while the CCL17 level increased to median of 220.3 (IQR 135.8-304.8), with no statistically significant differences between both groups (Figure 1). None of the patients became seriously ill.

Figure 1A and 1B show the changing of the cytokine dynamics in COVID-19 patients who were treated with casirivimab/imdevimab on IFN-λ3 level and CCL17 level, respectively.

Conclusion

There was a statistically significant difference between IFN-λ3 and CCL17 levels before casirivimab/imdevimab in both groups. Our results suggest that casirivimab/immudevimab may improve the clinical prognosis for COVID-19 patients with delta strains.

Disclosures

All Authors: No reported disclosures.
1076. The Role of Bronchoalveolar Lavage in COVID-19 Diagnoses and Management
Authors: Zhang Edie , Liu Shuman , She Rosemary
Published: December 2022

Background

In the diagnosis of SARS-COV-2, upper respiratory tract specimens are primarily used for PCR testing. This study aims to evaluate the clinical and diagnostic role of bronchoalveolar lavage (BAL) in diagnosing and managing COVID-19.

Methods

Patients admitted to Keck Medical Center (Los Angeles, CA) during March 2020-May 2021 who had SARS-CoV-2 PCR tested on both nasopharyngeal swab (NPS) and BAL specimens (QIAGEN QIAstat-Dx RP) were included. Four patient groups were designated by PCR results: (A) NPS+/BAL+ (n=34), (B) NPS+/BAL- (n=26), (C) NPS-/BAL+ (n=5), (D) NPS-/BAL- (n=89). Clinical and laboratory data were retrospectively reviewed. Statistical analysis included the use of one-way ANOVA with Tukey HSD and Fisher’s exact test.

Results

154 inpatients had NPS and BAL tested for SARS-CoV-2 RNA (mean age 55.1 y, 59.6% male). BAL was performed mainly to further assess abnormal respiratory function (n=43) or chest imaging findings (n=27), or for COVID-19 work-up (n=17). Mean turnaround time for BAL PCR was 4 h 5 min. Ct values, available on 28 BAL+ samples, did not significantly differ between patients who died (mean Ct 29.9, n=18) vs. survived (mean Ct 28.7, n=10). Time from symptom onset to BAL was significantly longer in Group B (34.2 d) vs. D (13.7 d, p< 0.01) or C (12.8 d, p< 0.05) but not vs. A (23.9 d). Groups did not differ significantly in patient comorbidities, mortality, length of hospital stay, or immunosuppressive status. SARS-CoV-2 NPS+/BAL+ patients were more likely to have diffuse or bilateral chest radiographic opacities (p< 0.01), respiratory culture with Aspergillus spp. (p< 0.05), and ARDS diagnosis than those who were NPS+/BAL- (p< 0.01).

Conclusion

BALs were an important specimen source for the detection of SARS-CoV-2 in the lower respiratory tract particularly when NPS at admission was PCR-negative and for ruling out COVID-19 pneumonia as a cause of abnormal pulmonary findings or declining respiratory status. BAL positivity for SARS-CoV-2 RNA was associated with higher frequency of diffuse or bilateral opacities on CXR, culture recovery of Aspergillus spp., and ARDS. Ct values of BAL+ samples did not predict mortality though sample size was limited. Further studies on the role of viral detection in BALs in patient management and prognosis are warranted.

Disclosures

All Authors: No reported disclosures.
1077. Understanding the Psychosocial Burden Associated with Hospitalization Among Adults Diagnosed with COVID-19 in the United States
Authors: Ansari Wajeeha , Draica Florin , Atkinson Joanna , Annunziata Kathy , Maculaitis Martine C , Scott Amie
Published: December 2022

Background

Due to the coronavirus disease 2019 (COVID-19) pandemic in the United States (US), public health officials sought to reduce transmission. However, the psychosocial impact associated with COVID-19 has received less attention. This study describes psychosocial burden among adults diagnosed with COVID-19 and assesses the unique impact on those who had a COVID-19 hospitalization.

Methods

This cross-sectional retrospective study used 2021 US National Health and Wellness Survey (NHWS; N=75,098) data. NHWS is an annual web-based self-report survey of the US general adult population (aged ≥ 18 years). Results were weighted to reflect the population on age, gender, race/ethnicity, and education based on US Census. Among adults who self-reported a COVID-19 diagnosis, those with COVID-related hospitalization, emergency room (ER) visit/no hospitalization, and no hospitalization/no ER visit were descriptively compared on demographics, health characteristics, and psychosocial burden measures.

Results

Almost 16 million adults had a COVID-19 diagnosis in the past year; of these, 8% had a COVID-related hospitalization, and 6% had a COVID-related ER visit/no hospitalization. Compared to adults with no ER visit/no hospitalization or ER visit/no hospitalization, those with a hospitalization were more often male, college educated, and employed. Relative to those with no ER visit/no hospitalization, adults with a hospitalization were more often diagnosed, either pre- or post-COVID-19 diagnosis, with allergies (47% vs 38%), asthma (20% vs 11%), pain (37% vs. 25%), headache (25% vs 16%), migraine (27% vs 15%), type 2 diabetes (16% vs 10%), dry eye (25% vs 12%), and sleep apnea (15% vs 11%). Adults with a hospitalization had lower mental, physical, and general health-related quality of life, 2-3.4 times higher work/non-work impairment, and 2 times higher positive depression screen rate than those with no ER visit/no hospitalization.

Conclusion

US adults with a COVID-related hospitalization had higher psychosocial burden than those without a hospitalization on several domains. Accordingly, reducing COVID-related hospitalizations, particularly among the employed and those with comorbidities, will be vital to help mitigate this burden.

Disclosures

Wajeeha Ansari, MPH, Pfizer Inc.: Stocks/Bonds Florin Draica, MD, Pfizer Inc.: Stocks/Bonds Joanna Atkinson, MD, Pfizer Inc.: Stocks/Bonds Kathy Annunziata, MA, Pfizer: Advisor/Consultant|Pfizer: Employee of Cerner Enviza, which received funding from Pfizer to conduct and report on the study Martine C. Maculaitis, PhD, Cerner Enviza: Employee of Cerner Enviza, which received funding from Pfizer to conduct and report on the study. Amie Scott, MPH, Pfizer Inc.: Stocks/Bonds.
1080. Clinical Characteristics and Outcomes of 104 Pregnant Women with Coronavirus Disease 2019 during delta wave; single-center observational study
Authors: Hong Shin Hee , Shi Hye Jin , Park Yoonseon , Eom Joong Sik
Published: December 2022

Background

Pregnancy is one of the risk factor associated with the severity of Coronavirus Disease 2019 (COVID-19). The perinatal complications also known to be increased when pregnant women become infected with COVID-19. However, there were not enough studies involving pregnant women with severe COVID-19, especially in Korea. The purpose of this study was to analyze the cases of pregnant women with COVID-19 infection with various severities, and to compare and describe the clinical course and the effects on pregnancy and perinatal prognosis according to severity.

Methods

We retrospectively analyzed the medical records of adults 18 years of age or older who were PCR-confirmed COVID-19 and proved pregnancy, from February 1, 2020 to January 31, 2022. Through the epidemiological investigation report, the patient's medical history, obstetric history, date of diagnosis and variants of COVID-19, and vaccination history were collected. Clinical symptoms, oxygen demand, chest imagings, treatment, perinatal complications, fetal conditions, delivery results, and complications were collected through medical records.

Results

A total of 104 pregnant women with PCR-confirmed COVID-19 were hospitalized. The age at the time of diagnosis was 33 ±4.24 (Mean ± SD) years, and 4 patients (3.8%) were vaccinated with the COVID-19 vaccine. During hospital stay, the most common complaints were cough (99 patients, 95.2%) and fever (85 patients, 81.7%). Oxygen was applied in 40 patients (38.5%), and in 19 patients (18.3%) in severe cases. Thirty-seven patients (35.6%) delivered during isolation treatment. Critical COVID-19 patients group has statisticaly significant higher rate of preterm delivery compared with mild COVID-19 patient group (31.6 % versus 6.3 %, p=0.009). One patient died from septic shock caused by multidrug-resistant Acinetobacter baumannii during treatment. A total of 39 babies were born, of which 4 received postnatal oxygen therapy.

Conclusion

Pregnant women with COVID-19 had higher mortality rates, aggravation rates, and premature birth rates compared to non-pregnant patients of the same age. In a situation where effective and safe COVID-19 treatments for pregnant women are limited, it is necessary to increase the vaccination rate to prevent undesired outcomes in both mother and child.

Disclosures

All Authors: No reported disclosures.
1082. Clinical Characteristics and Vertical Transmission of Pregnant Women with SARS-CoV-2 Infection and Their Neonates
Authors: Lee Jiyoung , Lee Mi-Young , Jung Euiseok , Lee Ji-Na , Bae SeongMan , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Kim Sung-Han
Published: December 2022

Background

Pregnant women with SARS-CoV-2 infection are known to have a poor prognosis. In addition, the previous meta-analysis revealed that SARS-CoV-2 infection in neonates born from pregnant women with SARS-CoV-2 infection is about 2%. However, there are limited data on the clinical characteristics of pregnant women with SARS-CoV-2 infection and their neonates and the vertical transmission rate in South Korea.

Methods

Pregnant women confirmed as SARS-CoV-2 infection were retrospectively reviewed in Asan Medical Center from September 1 2020 to April 26 2022. All neonates from SARS-CoV-2-infected women underwent SARS-CoV-2 PCR within 24 hours after the birth and 48-hour interval if he or she stayed in the hospital.

Results

A total of 60 pregnant women gave birth by cesarean section (n=40, 67%) or vaginal delivery (n=20, 33%). Among them, three women gave birth to twins (63 neonates). Delivery was carried out at the average gestational age of 268 days (± 14.0), and 9 patients (15%) had underlying diseases. Of these 60 patients, 11 (18%) received COVID-19 vaccination. Pneumonia was confirmed by chest radiograph in 7 patients (12%), and 2 patient (3%) required supplemental oxygen therapy who eventually recovered. The mean weight of 63 newborns was 3137 g (± 558), and 8 neonate (13%) was a low-birth weight (< 2500 g), and 12 neonate (19%) was premature (< gestational age 37 weeks). Apgar score was 8.1 points (± 1.2) at 1 minute and 9.1 points (± 0.8) at 5 minutes. Five neonates (8%) required mechanical ventilation, who eventually recovered. All 63 neonates revealed negative SARS-CoV-2 PCR results with 24 hours after the birth. After 48 hours, 45 newborns exhibited negative SARS-CoV-2 PCR results. So, there was no vertical transmission among 63 neonates (0%, 95% CI 0-6).

Conclusion

Our experiences about pregnant women with SARS-CoV-2 infection revealed that obstetric outcomes were favorable and the vertical transmission risk was low. Balancing risks about the infection control of pregnant women and their neonates during the COVID-19 pandemic are needed.

Disclosures

All Authors: No reported disclosures.
1089. Evaluation of breakthrough infections in solid organ transplant recipients: the prospective CONTRAST cohort
Authors: Tazza Beatrice , Bonazzetti Cecilia , Caroccia Natascia , Gibertoni Dino , Morelli Maria Cristina , Tamé Mariarosa , Busutti Marco , Potena Luciano , Salvaterra Elena , Gamberini Chiara , Viale Pierluigi , Lazzarotto Tiziana , Giannella Maddalena
Published: December 2022

Background

Solid organ transplant (SOT) recipients are at higher risk than general population for complicated COVID-19 course. Moreover COVID-19 vaccination in this setting is associated with a suboptimal immune response. However, the impact of this finding on the risk of breakthrough infection (BI) in SOT recipients has to be yet determined.

Methods

Single-center prospective longitudinal cohort of adult SOT recipients who received three doses of mRNA COVID-19 vaccine between February and December 2021 and were followed up to March 30 2022. Patients were tested for antibody response at several timepoints (1 st dose, 2 nd dose, 3±1 month after 1 st dose, and 1 month after 3 rd dose). Main endpoints were: i) BI defined as laboratory confirmed SARS-CoV2 infection diagnosed ≥14 day after 2 nd dose; ii) positive antibody response (AbR) defined as anti-rapid binding domain titer ≥5 U/ml determined by Elecsys Anti-SARS-CoV-2 ECLIA assay (Roche Diagnostics, CH), the last available determination before BI was considered.

Results

Study cohort consists of 642 SOT (277 kidney, 191 liver, 144 heart, 37 lung) recipients: 63.9% males, median age 54 ± 14.5 years. Of them, 111 (17.8%) developed BI, BI rates were 19.9%, 18.1%, 15.2% and 10.8% among liver, heart, kidney and lung transplant recipients, respectively. Positive-AbR was observed in 60% of all patients, but rates varied from 8.7% to 91.3% among patients with BI and without BI, respectively. Predictors of BI infection at multivariable analysis were liver (vs. other grafts) transplant (OR 2.98, 95%CI 1.47-6.03), mycophenolate (1.63, 0.92-2.88) and steroids (1.8, 1.05- 3.33), while positive-AbR (0.61, 0.35-1.04) and age (0.97, 0.95-0.99) were protective. On the other hand, liver transplant (1.94, 1.02-3.69), time from transplant (1.09, 1.05-1.21), and Moderna vaccine (2.32, 1.46-3.70) were associated with positive-AbR, while age (0.97, 0.95-0.98), heart transplant (0.56, 0.33-0.96), mycophenolate (0.65, 0.39-1.06) and steroids (0.39, 0.23-0.65) with lower probability of positive-AbR.

Conclusion

Although associated with positive-AbR, liver transplant and younger age were also BI predictors, suggesting the importance of social factors and the controversial role of immune monitoring.

Disclosures

All Authors: No reported disclosures.