bluuebunny/crossref_metadata_2025 huggingface dataset:
247. Catching CAPA: The Healthcare Impact of COVID-19-Associated Pulmonary Aspergillosis in an Academic Medical Center
Authors: Hamilton Caroline , Tran Sarah , Dinh Judy , Askar Gina , Askar Gina , Askar Gina , Askar Gina
Published: December 2022

Background

COVID-19 associated pulmonary aspergillosis (CAPA) is a known complication of COVID-19 which carries a high mortality rate. While there are proposed diagnostic criteria, CAPA remains likely underdiagnosed. Our objectives are to evaluate markers of disease severity, bacterial coinfections, and outcome measures in order to assess the clinical impact of CAPA in patients admitted with COVID-19.

Methods

A retrospective chart review was performed on all adult patients admitted to a single-center, tertiary hospital from March 1, 2020 to May 1, 2022 with a positive COVID-19 PCR and probable or proven CAPA based on ECMM/ISHAM consensus criteria. Admission data, ICU status, time to CAPA diagnosis, respiratory cultures, and 90-day mortality were identified.

Results

14 patients met criteria for probable CAPA. 10 of 14 patients (71.4%) were immediately admitted to the ICU. By day 14, 13 patients (92.9%) were intubated.

The average time from admission to CAPA diagnosis was 31.3 days. 12 patients were diagnosed by BAL galactomannan, while 2 patients were diagnosed by growth on respiratory culture. 12 patients (85.7%) also had bacterial growth on respiratory cultures. The most common pathogen was Staphylococcus aureus, which was seen in 6 patients.

All-cause mortality was 42.8%, or 6 of 14 patients, at day 90. In patients with a CAPA diagnosis, the average length of ICU stay was 36.4 days and average total hospital length of stay was 43.6 days, compared to 6.3 and 12.5 days, respectively, for all patients admitted with COVID-19 disease.

Conclusion

CAPA is a rare complication of COVID-19 but had substantial negative impacts on affected patients. The late onset of CAPA may be a result from longer hospitalizations and increased healthcare-associated infections. The association of CAPA with bacterial coinfections is consistent with literature on other viral infections such as influenza predisposing to secondary pneumonias. As the majority of cases were diagnosed by galactomannan rather than culture, providers should have a low threshold for testing in patients with protracted hospitalization for COVID-19. This case series emphasizes the poor outcomes associated with CAPA and its burden on already strained hospital resources, highlighting the need for improved disease awareness and further study.

Disclosures

All Authors: No reported disclosures.
250. Clinical Disease in Pediatric Long Covid
Authors: Wells Taylor , Gillen Sarah , Sharon Bazak
Published: December 2022

Background

Even weeks and months after initial infection, full recovery from a Covid-19 infection is elusive for some pediatric patients. Long Covid is now recognized as a chronic condition with a constellation of lingering health problems. As the long term sequala of Covid-19 continue to become apparent, it is imperative to study this emerging disease in the pediatric population.

Methods

The University of Minnesota Pediatric Covid Clinic has been receiving referrals since April 2020. The clinic is participating in a national registry (PIDTRAN-6_Covid-19), facilitating IRB approved collection of anonymized clinical data from children diagnosed with Long Covid syndrome.

Results

We have identified 47 children (female 28, male 19) who were diagnosed with Long Covid at the University of Minnesota Covid Clinic. The majority were previously healthy (40) and the average age was 14.7 years (4-18yr). Acute symptomatic infection preceded the diagnosis in 41 children and 6 children were asymptomatic. Common symptoms reported by the patients included: fatigue (35), dizziness and/or lightheadedness and/or palpitation (16), abnormal taste/smell (15), headache (14), difficulty concentrating/focusing [brain fog] (13), myalgia/arthralgia (15), dyspnea (12), abdominal pain (10), and sleep disturbance (6).

Clinical Symptoms of Long Covid

The nine most common clinical symptoms of Long Covid are shown in the chart above with the numbers corresponding to the number of patients who reported experiencing each symptom.

Demographics of Long Covid

The above graphic depicts the demographics of patients seen at the University of Minnesota Pediatric Long Covid Clinic.

Conclusion

Pediatric populations, like adult populations, have patients who suffer from the lingering health effects of what is now termed Long Covid. The majority of patients presenting with Long Covid are teenagers, with females being more commonly affected than males. These patients often suffer from fatigue and are experiencing a constellation of symptoms that are reminiscent of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and positional orthostatic tachycardia syndrome (POTS). This suggests a post-viral autoimmune injury as the likely pathophysiology for Long Covid syndrome. Further population based studies are needed to better understand the extent and prevalence of this debilitating disease.

Disclosures

All Authors: No reported disclosures.
255. Clinical, echocardiographic and electrocardiographic manifestations of COVID-19 multisystem inflammatory syndrome in children in the Dominican Republic
Authors: Roque Yori A , Luna David De , Mena Lora Alfredo J , Espinal Kelvin , Peralta Franzory , Maria Hilario
Published: December 2022

Background

The COVID-19 pandemic has spread globally and millions of infections have occurred. As cases mount, atypical manifestations of COVID-19 and post-infectious complications such as multisystem inflammatory syndrome in children (MIS-C) become more likely. MIS-C is a life threatening post-infectious complication of COVID-19. There is a paucity of data of MIS-C in the Dominican Republic (DR). We seek to understand the clinical manifestations of MISC-C in the DR.

Methods

This is a retrospective review of cases admitted to a pediatric hospital in the Dominican Republic from March 2020 to December 2021. Patients with clinical findings and a diagnosis of MIS-C were included. Echocardiographic (Echo) and electrocardiographic (ECG) changes were reviewed.

Results

A total of 16 patients were included in our study, of which 68.75 were male. Ages were 12.5% < 1 years old, 12.5% between 1-4, 62.5% 5-12 and 12.5% over 12. Fever and rash were the most common clinical findings (Figure 1), while 69% had a new abnormality on echo and 50% had new ECG abnormalities. Echocardiographic findings are listed in Figure 2.

Clinical findings in patients admitted with MIS-C

Echo findings

ECG findings

Conclusion

The clinical manifestation of MIS-C are primarily fever, conjunctivitis, rash and hypotension. Because these findings can be non-specific, a high level of suspicion is needed. With over two thirds of patients with MIS-C showing echocardiographic changes and more than 50% showing ECG changes, these two tests can add significant diagnostic value in the right clinical setting. Clinicians should consider early echocardiography and ECG in patients with possible or suspected MIS-C.

Disclosures

All Authors: No reported disclosures.
258. Comparison of Different COVID Waves during COVID-19 Pandemic: A Retrospective Study from a Dedicated COVID-19 Facility of Karachi Pakistan
Authors: Sayeed Muneeba A
Published: December 2022

Background

In Pakistan, the first case of COVID-19 was reported in February2020. To date Pakistan has experienced 5 waves of COVID-19 and each COVID-19 wave is driven by a unique SARS CoV2 strain. In this study we have compared the clinical spectrum and outcome of different COVID-19 waves in a dedicated COVID-19 facility of Karachi.

Methods

We conducted a retrospective study at the Sindh Infectious Diseases Hospital and Research Centre (SIDH &RC), a 175 bedded dedicated first Infectious Diseases Hospital of Karachi, Pakistan. The hospital was established in July 2020. All patients >16 years of age who were admitted with a positive COVID PCR from July 2020–Mar 2022 were included. First COVID wave in Pakistan lasted from Mar-July 2020, second wave from Oct 2020 to Jan 2021, third wave from Mar-May 2021, fourth from July to Sept 2021 while fifth from Jan 2022 to Mar 2022. Demographic and clinical data was collected of patients from each wave and analyzed by SPSS to compare the difference amongst different COVID waves. Chi-square and t-test were used for analysis.

Results

From July 2020-Mar 2022, 2900 COVID-19 patients were admitted. The total number of patients in each wave (from second to fifth waves) were 1217,783,590 and 310 respectively. The mean age in years was 60 in 2nd and 3rdwaves while it was 58 in 4th and 66 in 5th wave with 64.5%, 62.5%, 51.8%and 54% of males in each wave. On comparison majority 42% had moderate COVID in 2nd wave, 37% and 48.5% had severe COVID in 3rd and 4th waves respectively while the disease was mild (31%) in 5th wave (p-value of < 0.001).Cytokine releasing syndrome (CRS) was common in 3rd wave (33%). Most intubations were done in 4thwave (21%). Compared to other waves mortality rate was also highest in 4thwave (35%, with p-valve of 0.03).

Conclusion

Based on our data fourth wave which was mostly driven by delta variant was the deadliest in terms of disease category and outcome.

Disclosures

All Authors: No reported disclosures.
259. Comparison of the causes of death in patients with delta variant versus omicron variant infections
Authors: Reum Kim A , Lee Jiyoung , Park Somi , Kang Sung Woon , Lee Yun Woo , Lim So Yun , Jang Euijin , Bae SeongMan , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Kim Yang Soo , Kim Sung-Han
Published: December 2022

Background

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) variant strain B.1.1.529 (omicron) has been less virulent than SARS-CoV-2 B.1.617.2 variant (delta), but there are limited data on the comparison of the cause of death between delta variant and omicron variant infections. We thus compared the causes of death in COVID-19 patients with the delta variant and omicron variant.

Methods

We retrospectively reviewed the medical records of adult patients with COVID-19 who were admitted at Asan Medical Center, Seoul, South Korea, between July 2021 and March 2022. We divided into delta-variant dominant period (from July 2021 to December 2021) and omicron-dominant period (from February 2022 to March 2022) with the exclusion of January 2022 because this period was overlapping of delta and omicron variant. The causes of death were classified into COVID-19-associated pneumonia, other causes, and indeterminate cause.

Results

A total of 654 patients with COVID-19 were admitted and 42 (6.4%) died during the omicron dominant period (between February and March 2022), while a total of 366 patients with COVID-19 were hospitalized and 42 (11.5%) died during the delta dominant period (between July and December 2021). The primary cause of death was COVID-19-associated pneumonia in 64% (27/42) during the omicron era whereas that was COVID-19-associated pneumonia in 88% (37/42) during the delta era (p value=0.01) (Table 1).

Conclusion

We found that about two thirds of patients with omicron variant infection died due to COVID-19, while the majority of patients with delta variant infection died due to COVID-19.

Disclosures

All Authors: No reported disclosures.
260. Corticosteroid treatment in influenza virus and SARS-CoV-2 co-infected patients
Authors: Swets Maaike C , Russell Clark , Harrison Ewen , Docherty Annemarie , Lone Nazir , Girvan Michelle , Hardwick Hayley , Visser Leonardus , Openshaw Peter , Groeneveld Geert , Semple Calum , Baillie Kenneth
Published: December 2022

Background

Co-infections with SARS-CoV-2 and influenza virus may become more prevalent now that many countries are easing restrictions to reduce the spread of SARS-CoV-2. Co-infected patients are more likely to receive invasive mechanical ventilation (IMV) and have higher odds of in-hospital mortality. In the RECOVERY trial, dexamethasone was found to reduce the risk of 28-day mortality in hospitalised COVID-19 patients. On June 16, 2020, corticosteroids were included in clinical guidelines for the treatment of COVID-19 patients requiring supplemental oxygen. However, corticosteroid treatment in severe influenza virus infection may increase mortality. The effect of steroids in influenza and COVID-19 co-infected patients is unknown.

Methods

Adult patients with RT-PCR confirmed SARS-CoV-2 and influenza virus co-infection were evaluated. Patients without supplemental oxygen during admission were excluded. Patients who were hospitalised prior to June 16, 2020 were included in the ‘early’ group and patients who were hospitalised on or after June 16, 2020 were included in the ‘late’ group.

Results

171 co-infected patients were included, 123 patients in the early group (table 1) and 48 in the late group (table 2).

In the early group, 25 patients received steroids. In the late group, 40 patients received steroids.

In the early group, the proportion of patients who were admitted to critical care was slightly lower in the group that received steroids. IMV was similar in both groups. In-hospital mortality was slightly higher in the group treated with steroids.

In the late group, critical care admission and receipt of IMV were higher in the group not treated with corticosteroids than the group with corticosteroid treatment. In-hospital mortality was slightly lower in the group not treated with steroids.

Conclusion

There are differences between co-infected patients who were treated and not treated with corticosteroids and differences between the early and late groups.

A limitation is that no dates were collected for the start of steroid treatment, making it impossible to draw conclusions on the causality of the need for IMV and treatment with steroids in this analysis. Future research should focus on the effect of steroids in COVID-19 and influenza co-infected patients.

Disclosures

Peter Openshaw, PhD, Bavarian Nordic: Advisor/Consultant|Cepheid: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|Janssen: Advisor/Consultant|Pfizer: Advisor/Consultant Calum Semple, PhD, Integrum Scientific: Scientific Advisory Board|Integrum Scientific: Stocks/Bonds.
262. COVID-19 associated fungal co-infections in Solid Organ Transplant Recipients: A single center case series
Authors: Khatri Akshay M , Simkins Jacques , Sinha Neeraj , Phancao Anita , Ciancio Gaetano , Abbo Lilian M , Guerra Giselle , Natori Yoichiro , Anjan Shweta
Published: December 2022

Background

During the ongoing Coronavirus disease of 2019 (COVID-19) pandemic, there have been increasing reports of viral, bacterial and fungal co-infections. Two COVID-19-associated fungal infections (CFIs) have been identified – COVID-19 associated pulmonary aspergillosis (CAPA) and COVID-19 associated mucormycosis (CAM), but incidence and occurrence in solid organ transplant recipients (SOTRs) is limited. We describe our experience with CFIs in SOTRs with COVID-19.

Methods

In a single center retrospective study at a large volume transplant center in South Florida, USA, we included adult SOTRs (≥18 years) diagnosed with COVID-19 between March 1st 2020 and January 31st 2022, with subsequent diagnosis of CFI. We collected information related to demographics, comorbidities, COVID-19 diagnosis and therapeutics, and CFI diagnostics and management. Data obtained was analyzed descriptively.

Results

We identified 612 SOTRs with COVID-19, of which 23 (3.8%) were diagnosed with CFIs.

The patients were predominantly male (17/23, 73.9%), with median age of 59 years (range 43-79) [Table 1]. Twenty (86.9%) were kidney transplant recipients. Majority of SOTRs had lymphopenia (18/23, 78.3%) with elevated inflammatory markers at time of COVID-19 diagnosis. They received most commonly remdesivir and corticosteroids for COVID-19, with 22 (95.6%) needing intensive care unit admission and 19 (82.6%) needing continuous renal replacement therapy.

CFIs were diagnosed at median 21 days (range, 3-161) after initial COVID-19 diagnosis. Probable CAPA was diagnosed in most patients (16/23, 69.6%), with CAM noted in 1 patient [Table 2]. 34.8% (8/23) had specific fungal species identified, with elevated fungal markers noted in 95.6% (22/23). Concurrent or prior cytomegalovirus DNAemia was noted in 26.1% (6/23). Patients were followed for median 70 days (range, 19-572), with median hospitalization duration 56 days (range, 7-204). Mortality was noted in 73.9% (17/23). Table 1:COVID-19 related clinical characteristics in study patients (N=23)Table 2:CFI-related clinical characteristics in study patients (N=23)

Conclusion

Fungal co-infections were noted in a small proportion of our SOTRs, with poor outcomes. Transplant physicians should have a high suspicion for early diagnosis and treatment of CFI. Further studies are needed to determine predictors for CFI and role for anti-fungal prophylaxis.

Disclosures

All Authors: No reported disclosures.
263. COVID-19 Associated Pulmonary Aspergillosis (CAPA) at a Hospital in Nicaragua: Prevalence and Risk Factors for Mortality.
Authors: López-Gaitán Armando J , Marenco-Avilés Sunaya V , Castillo-Cano Maikelyn A , Porras-Cortés Guillermo D
Published: December 2022

Background

COVID-19 associated pulmonary aspergillosis (CAPA) is a newly recognized clinical entity. Alterations in the mucociliary clearance, epithelial damage, lymphopenia, and the use of steroids and monoclonal antibodies could be contributing factors for the development of CAPA. The aim of this study was to detemine the prevalence of probable CAPA and risk factors for mortality in patients with COVID-19 admitted in one of the main hospitals in Nicaragua.

Methods

This is a retrospective cohort study of patients admitted with the diagnosis of COVID-19 in the Hospital Dr. Fernando Vélez Paiz of Managua, Nicaragua. The criteria of probable CAPA was established using the consensus of ECMM/ISHAM. Serum Aspergillus galactomannan lateral flow assay (IMMY) was determined in patients with suspect of CAPA. An optical index > 0.5 was considered positive. Different clinical and laboratory variables, and clinical outcomes were evaluated.

Results

A total of 325 patients were included in the study. Ninety-one patients were diagnosed with probable CAPA that means a prevalence of 28%. The mean age was 56.6 ± 15.0 years old. The most important identified comorbidities were arterial hypertension (44.2%), diabetes mellitus (29.4%), and COPD (14.8%). Lymphopenia was a remarkable finding (56% of the patients). The most frequent radiological pattern in the chest CT scan were: "crazy paving" (56.0%), ground glass opacities (28.5%), and diffuse reticulonodular infiltrates (10.9%). The mortality rate in the patients with CAPA was 42.9%. The risk factors associated with mortality in the patients with CAPA were: admission to Intensive Care Unit (ICU) (OR: 17.3; CI95%: 3.6-81.9), any chronic medical condition (OR: 9.28; CI95%: 1.13-75.90), COPD (OR: 6.41; CI95%: 1.64-24.90), use of steroids (OR: 5.03, CI95%: 1.55-16.30), lymphopenia < 1,500/mL (OR: 4.92; CI95%: 1.94-12.40), "crazy paving" pattern in CT (OR: 4.92; CI95%: 1.94-12.40), and diabetes mellitus (OR: 3.60, CI95%: 1.41-9.15).

Risk factors identified for mortality in patients with COVID-19 associated pulmonary aspergillosis (CAPA).

Conclusion

The prevalence of probable CAPA in this study is relatively high. The mortality was of 42.9%. Risk factors for mortality were admission to ICU, chronic medical conditions (COPD and diabetes mellitus), use of steroids, lymphopenia, and radiological "crazy paving" pattern in the chest CT-scan.

Disclosures

All Authors: No reported disclosures.
268. Dengue - SARS-CoV-2 co-infection: Experience in hospitalized patients during COVID-19 pandemic
Authors: Rosso Fernando , Zapata-Vasquez Isabel L , Rodriguez Sarita , Martinez Diana M , Agudelo Olga , Robles-Castillo Sebastián , Tejada Alejandro
Published: December 2022

Background

Dengue fever and COVID-19 co-infection constitute a significant public health concern in Latin America, becoming a clinical challenge to distinguish these two entities in early stages of the disease. Clinical outcomes of coinfected hospitalized patients have not been well established.

Methods

A cross-sectional study was conducted. We included suspected patients diagnosed with COVID-19/dengue co-infection admitted at Hospital Fundación Valle del Lili, Cali – Colombia, from March 2020 to March 2021. All dengue patients had positive NS1 and/or IgM dengue antibodies. SARS-CoV-2 infection was confirmed by RT-PCR or antigen rapid test from nasopharyngeal swab. Laboratory and clinical data were recollected from the clinical laboratory database, clinical charts, and institutional COVID-19 registry.

Results

A total of 90 COVID-19 patients were included. 72 patients were confirmed only with COVID-19, and 18 with dengue co-infection. Most patients were male: 46 (63.9%) vs. 13 (72.2%). None of these study patients were vaccinated against COVID-19 or dengue. The median time from symptoms onset and the diagnosis was five days, and fever was the most common symptom for both groups. There were significant differences between COVID-19 patients and coinfected patients regarding presence of dyspnea (22.2% vs. 61.1%; p=0.003), desaturation (13.4% vs. 53.3%; p=0.002) and a higher neutrophil/lymphocyte ratio (NLR) (3.84 vs. 5.59; p = 0.038). The co-infection was associated with a worse presentation of the COVID-19 infection (p=0.002), an increased requirement of initial supplemental oxygen therapy (p=0.007), mechanical ventilation (p=0.0004), ICU management at the admission (p=0.002), and ICU final management (p=0.002). Overall mortality in patients with co-infection was 44.4% vs. 6.9% in only COVID-19 infected patients (p< 0.001).

Conclusion

Despite the pandemic era, the possibility of co-infection of these two entities must be considered. Admitted coinfected patients were associated with worse clinical outcomes and higher mortality. According to our results, patients with co-infection present with severe respiratory symptoms and an elevated NLR. The impact of the Covid 19 vaccination on this coinfection is unknown.

Disclosures

Olga Agudelo, n/a, Fundación valle del lili: Board Member.
270. Secondary bacterial infection in hospitalized COVID-19 patients. Experience in Colombia, South America
Authors: Rosso Fernando , Rodriguez Sarita , Zapata-Vasquez Isabel L , Tafur Eric , Martinez Diana M , Guzmán Tania , Ramírez-Pérez Daniela , Franky-Ortiz Isabella
Published: December 2022

Background

Secondary infections are common among severe COVID-19 patients, increasing complications and mortality risk. These infections are not well characterized in Latin America and the Caribbean.

Methods

A cross-sectional observational study of adult patients with COVID-19 admitted to the hospital Fundación Valle del Lili in Cali-Colombia from March 2020 to March 2021. Demographic data, clinical characteristics, laboratory parameters, and clinical outcomes were collected. We describe secondary infection, antibiotic therapy, and antibiotic resistance profiles. Secondary infection was defined if the diagnosis occurred ≥48 hours after hospital admission for COVID-19.

Results

A total of 2138 patients with COVID-19 were analyzed; 350 (16.3%) presented secondary infection. 60% were male; the median age was 65 years [IQR: 55-72]. Glucocorticoid therapy was indicated in 335 patients (96.3%). 281 received high doses and 54 low doses. Bacterial infections were the most common, affecting 81.3 % of patients, followed by fungal (14.4%) and viral (4.3%) infections. Most bacterial isolates were orotracheal secretion, blood, urine, and bronchoalveolar lavage fluid culture. The three most frequently identified bacteria were Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. Most of the initial isolates were not antibiotic-resistant (75-89.7%). Empiric antibiotic therapy was indicated in 346 patients (98.9%), 268 received carbapenems (76.6%), 267 Vancomycin (76.3%), and 233 cefepime (66.6%). Of the 350 patients, 327 (93.4%) required management in the intensive care unit, and overall mortality was 35.4% (124/350).

Conclusion

Our results showed a lower frequency of secondary infection than previous reports; However, a high frequency of broad-spectrum antibiotics usage was found despite a high prevalence of non-resistant bacteria. Further studies are needed to establish the best approach for antibiotics therapy.

Disclosures

All Authors: No reported disclosures.
272. Do Empiric Antibiotics Improve Outcomes in Clinically Stable Patients Admitted with COVID-19 Pneumonia? Retrospective Cohort Study of 221 U.S. Hospitals, March 1st, 2020-December 31st, 2020
Authors: Lawandi Alexander , Strich Jeffrey R , Li Xioabai , Yek Christina , Warner Sarah , Kadri Sameer S
Published: December 2022

Background

Patients admitted with COVID19 pneumonia often receive initial empiric antibacterial therapy (IEAT) despite a known low probability of bacterial co-infection. However, evidence supporting this practice is lacking. We studied the impact of IEAT on the risk of in-hospital mortality, clinical deterioration and antibiotic-associated risks in stable inpatients with COVID-19.

Methods

Adult inpatients coded for COVID-19 pneumonia stable (no mechanical ventilation or vasopressors) on admission (+1 day) without a clear indication for antibiotics, were identified at hospitals in the Premier Healthcare Database. Patients who received IEAT, defined as the receipt of ≥ 1 antibacterial agent on admission (+1 day), were compared to a control group, using binomial regression with overlap weight matching and downstream adjustment for baseline characteristics (age, gender, race, admission month, surge index, Elixhauser score, any AOFS organ failure POA, ICU admission on day 0 to +2, receipt of remdesivir, corticosteroids, and tocilizumab). The primary outcome was in-hospital mortality or discharge to hospice; secondary outcomes included need for mechanical ventilation on day2+, and rates of non-POA-acute kidney injury (AKI).

Results

At 221 hospitals between March–December 2020, 39,517 (74%) of 53,431 stable COVID-19 admits received IEAT. Patient and encounter characteristics are shown in Table 1. The crude mortality rates were 12.2% in IEAT recipients and 10.9% in controls. In adjusted analysis of patients who survived beyond admission day, mortality was 11.57% (95% CI 11.24-11.90%) in IEAT recipients and 11.23% (95% CI 10.72-11.74) in controls, for a difference of 0.34% (95% CI -0.23-0.91%, p = 0.24). Subsequent mechanical ventilation occurred similarly between groups (5.72% vs. 5.77%, p=0.83). The adjusted rate of AKI was 2.47% (95% CI 2.31-2.64%) in IEAT recipients, and 3.04% (95% CI 2.74-3.35%) in controls, for a difference of -0.57% (95% CI -0.92-0.22%, p = 0.0014). Table 1.Demographics, clinical and hospital characteristics for patients treated with initial empiric antibiotic therapy (intervention) versus those not treated (control).Figure 1.Standardized mean differences in included covariates before and after several matching strategies comparing covariate values for patients treated and not treated empirically with antibiotics

Conclusion

In patients with COVID19 initially admitted to the ward, IEAT was not associated with a reduction in mortality or deterioration requiring mechanical ventilation, but with a clinically insignificant reduction in AKI. Empiric antibiotics can likely be safely withheld in this population.

Disclosures

All Authors: No reported disclosures.
274. Epidemiology and Antimicrobial Treatment Impact of Procalcitonin in Patients with COVID-19
Authors: Conlon Anna , Rao Krishna , Cinti Sandro , Chopra Zoey , Cahalan Shannon E
Published: December 2022

Background

Procalcitonin (PCT) is often measured in patients with signs of bacterial infection. PCT is often elevated in bacterial pneumonia and septic shock and usually low in viral infections. Recent studies have found a correlation between PCT and disease severity in COVID-19, and most patients receive antibiotics despite bacterial co-infection being rare. We sought to characterize PCT trends in COVID-19, assess its relation to bacterial pneumonia, and assess its relation to clinical decision making around antimicrobial use.

Methods

We included patients ≥18 hospitalized at Michigan Medicine (3/1/20–10/31/21), positive for COVID-19, with ≥ 1 PCT measurement. Structured query was used to retrospectively extract data. Patients started on an antibiotic underwent retrospective chart review by 2 reviewers for presence of bacterial pneumonia (bPNA), and were classified as having proven, probable, possible, or no bPNA (Figure 1). Multivariable models controlling for time from start of the pandemic, demographics, and comorbidities were used to determine associations of PCT and bPNA with antimicrobial use. Figure 1:Flow diagram of patients included in analyses

Results

793 patients met inclusion criteria, with 224 (28.2%) initiated on antibiotics. Of these 224, 33 (14.7%) had proven/probable bPNA, 125 (55.8%) had possible bPNA, and 66 (29.5%) had no bPNA. On average, patients had 2.6 ±3.7 (mean ±SD) PCT measurements, with 4.1 ±5.2 if on antibiotics vs. 2.0 ±2.6 if not. Initial PCT was higher in those on antibiotics and highest in those with proven/probable bPNA (Table 1). After adjustment for confounders, initial PCT was associated with antibiotic initiation (OR 1.68, 95% CI 1.47-1.91, p < 0.0001) (Table 2). Initial PCT (RR 1.11, 95% CI 1.03-1.20, p=0.008), change in PCT over time (RR 1.03, 95% CI 1.01-1.05, p=0.007), and bPNA category (RR 1.51, 95% CI 1.23-1.84, p < 0.0001) were associated with antibiotic duration (Table 3). Table 1:Number of PCT measures by antibiotic and bPNA statusTable 2:Multivariable logistic regression model results for covariate associations with antibiotic initiation (n=793)Table 3:Multivariable negative binomial model results for covariate associations with antibiotic duration (n=224)

Conclusion

PCT was elevated in patients with COVID-19, but more pronounced with bPNA. Antibiotics were started in > 25% of patients, regardless of bPNA. PCT trends associate with the decision to initiate antibiotics and treatment duration, independent of bPNA and comorbidities. Future prospective studies should determine if PCT can be used to safely make decisions around antibiotic treatment for bacterial infection during COVID-19.

Disclosures

Krishna Rao, MD, MS, Merck & Co., Inc.: Grant/Research Support|Seres Therapeutics: Advisor/Consultant|Summit Therapeutics: Advisor/Consultant.
278. Long-term impact of pulmonary function among patients recovered from SARS-CoV-2 infection in Lima, Peru: a preliminary analysis of the FUNCTION cohort study
Authors: Cachay Figueroa Rodrigo Antonio A , Watanabe Takashi , Cuno Katiuska , Coombes Carolina , Mejia Fernando , Medina Felix , Gayoso Oscar , Seas Carlos , Otero Larissa , Gotuzzo Eduardo
Published: December 2022

Background

Longitudinal assessment and reversibility of changes in the pulmonary function tests in the post-acute phase of COVID-19 across the whole spectrum of severity of infection is needed to understand the long-term burden of the disease.

Methods

This was a prospective cohort of symptomatic patients with a positive SARS-CoV-2 (molecular or antigenic) test. Participants were divided based on infection severity at baseline as mildly-ill (B1), moderately-ill (B2), severely-ill (B3), critically-ill (B4) (Fig.1). Follow-up consisted of 4 visits: within 7 days from discharge (BL), and at months 1 (M1), 3 (M3), and 6(M6). We report findings up to M3 for participants enrolled August 2021- March 2022. Pulmonary function capacity was assessed with carbon monoxide diffusing capacity (DLCO), spirometry, and 6-minute walk test (6MWT). A DLCO< 80% was considered abnormal and reverted if >80% at follow-up visits.

Study population divided by severity of infection

Results

Out of 206 eligible participants, 110 were enrolled, of which 96 (87%%), 79 (72%), and 52(47.2%) were evaluated at BL, M1, and M3, respectively (Fig.2). Most (67%) participants were male, median age was 37.5 years old (IQR: 28-46.3) and median body mass index was 26.7 (IQR:23.7-30.4). Regarding severity, 39 (41%) participants were classified as critically-ill (B4) at BL. No underlying comorbidities were reported among 63 (66%) participants, while diabetes type 2 (11%), asthma (7%) prior pulmonary tuberculosis (6%) and hypertension (5%) where the most frequent comorbidities overall; 17 (18%) reported smoking exposure. There were significant differences accross severity groups for sex, age, absence of comorbidities, and dyspnea during the acute phase of COVID-19 (Tab.1). At Of the 88 (92%) participants that underwent the pulmonary function tests at BL: 49 (56%) had DLCO < 80% with a tendency to revert across B1-B4 groups at month 3 (Fig.3). Spirometry parameters (Forced Vital Capacity, Forced Expiratory Volume 1, Peak Expiratory Flow) and distance walked on 6MWT were different across groups.

Flowchart of the study population

Demographics of study population stratified by groups of severity

Median DLCO adjusted for hemoglobin value at baseline, month 1 and month 3 visits stratified by groups of severity of infection.

Conclusion

Abnormal DLCO tended to increase and revert to values greater than 80% in the 3-month follow-up period of patients recovered from SARS-CoV-2 infection across severity groups.

Disclosures

All Authors: No reported disclosures.
289. Prolonged Corticosteroid Usage, Associated Infectious Complications, and High Mortality in Adult Patients with COVID-19
Authors: Chu Rebecca , Zafonte Veronica B , Cervellione Kelly L , Miele Andrew S , Bagheri Farshad , Shakil Javeria
Published: December 2022

Background

Based on the RECOVERY trial, the NIH strongly recommends systemic corticosteroids for COVID-19 pneumonia with hypoxia. The study demonstrated reduced 28-day mortality after dexamethasone 6mg daily for up to 10 days compared to SOC alone. In practice, physicians may continue therapy for longer periods if potential benefit outweighs potential risk. Little is known about adverse events associated with prolonged corticosteroid use in patients with COVID-19; however, in general, this can increase risk for bacterial or fungal infections. This study aimed to explore the incidence of secondary infections during extended corticosteroid use for COVID-19.

Methods

A retrospective study was performed in adults at two community hospitals between September 2020 and May 2021 with a diagnosis of respiratory failure secondary to COVID-19 infection. Those with at least one new, laboratory-confirmed secondary infection during hospitalization after at least 10 cumulative days of corticosteroids were included. Demographic characteristics, clinical data and outcomes were extracted from the medical records. Quantitative analyses was performed using SPSS v27.0 and R.

Results

Of over 1,500 COVID-19 admissions within the timeframe, 73 patients met inclusion criteria (Table 1). No patient received immunomodulators for COVID-19 treatment. Patients had a median of 18 days on corticosteroids (range 10-65 days) prior to first positive culture. There were 130 positive cultures identified in blood, urine, and sputum samples (Figure 1), including polymicrobical cultures, yielding 34 clinically relevant organisms (Table 2). Hospital course was complicated by septic shock (68.5%), worsening of lung function (76.7%), and acute organ damage (57.5%); 55 (75%) patients expired during index admission.

Conclusion

Patients with COVID-19 on extended courses of corticosteroids have relatively higher rates of clinically significant invasive secondary infections and associated poor outcomes. Given there is limited information suggesting improved outcomes with these prolonged courses, risk to benefit analysis must be considered when deciding whether to extend corticosteroid treatment for more than 10 days for COVID-19.

Disclosures

All Authors: No reported disclosures.
297. Secondary Bacterial Blood Stream Infections in Patients Hospitalized with COVID-19
Authors: Adnan Fareeha , Khan Mariam A , Umer Amna , Khursheed Nazia
Published: December 2022

Background

Nosocomial Bloodstream infection (nBSI) in COVID 19 patients is an emerging clinical concern for physicians. In this study, we aimed to assess the prevalence of BSI in COVID-19 patients admitted to our hospital, The Indus Hospital, Karachi, Pakistan.

Methods

This retrospective study included the RT-PCR confirmed COVID-19 patients admitted to our hospital from March 2020 to December 2021. Demographics, the incidence of BSI, frequency of pathogens from the positive blood cultures, antibiotics resistance pattern, and frequency of Multidrug-Resistant Organisms (MDROs) were obtained from the hospital’s electronic medical record. Blood cultures were performed using BD BACTEC. Bacterial identification was done by using Analytical Profile Index(API) whereas antimicrobial susceptibility testing of isolates was performed by the Kirby-Baur disk diffusion method and VITEK® 2 COMPACT.

Results

Our data showed that 25% of the patients admitted to our hospital developed BSI. The incidence of BSI was higher in males than in females (62.6% vs 37.4%) and most of the patients were in the age group of 46-60 years (n=93). Gram-negative pathogens were pre-dominantly identified, (50.67%), followed by yeast (12.9%), and Gram-positive pathogens (11.8%). Among these isolates, Acinetobacter sp. was the most commonly identified pathogen. Figure 1 shows the incidence of BSI and Figure 2 shows the distribution of all the pathogens identified from the positive blood cultures. Antibiotics resistance pattern showed a higher prevalence of MDROs. Among the MDROs, Acinetobacter sp. was highest in number (97.6%), followed by 66.6% of Pseudomonas, 63% of E.coli, 62% of S. aureus, 61.5% of Enterococcus, and 50% of Klebsiella sp.

Conclusion

Our findings indicated the incidence of BSI in 25% of COVID-19 in-patients. There is a significant prevalence of MDROs among which compelling prevalence of Acinetobacter sp. was observed. The COVID-19 pandemic overburdened the already vulnerable health care systems and made it difficult to adhere to infection control practices leading to the emergence of MDROs. Moreover, timely initiation of empirical antibiotics could also reduce the incidence of BSI in patients. Lastly, further multi-centered studies are needed for the evaluation of the incidence of BSI in our region.

Disclosures

All Authors: No reported disclosures.
308. Do lung ultrasound abnormalities change during hospitalization for COVID-19?
Authors: Hwang Jimin , Blair Paul W , Siddarthan Trishul , Liu Gigi , Cui Erjia , Bai Jiawei , East Joshua , Herrara Phabiola , Fong Tiffany , Mahadevan Varun , Hossen Shakir , Seo Stefanie , Sonuga Olamide , Lawrence Joshua , Anova Lalaine , Fenstermacher Katherine , Shea Sophia , Rothman Richard E , Hansoti Bhakti , Sauer Laruen , Crainiceanu Ciprian , Clark Danielle , Clark Danielle , Clark Danielle
Published: December 2022

Background

While point-of-care ultrasound (POCUS) has been used to track disease resolution, temporal trends in lung ultrasound (LUS) findings among hospitalized patients with COVID-19 is not well-characterized.

Methods

We studied 413 LUS scans in 244 participants ≥ 18 years of age hospitalized for COVID-19 pneumonia within 28 days of symptom onset from April, 2020 until September, 2021 at the Johns Hopkins Hospital, Baltimore Maryland. All patients were scanned using a 12-lung zone protocol and repeat scans were obtained in 3 days (N=114), 7 days (N=53), and weekly (N=9) from the initial scan. Participants were followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung artifacts, and the composite mean LUS score (ranging from 0 to 3) across lung zones was determined. Trends of mean LUS scores and % lung fields with A-lines (indicating proportion of normal lung fields) were plotted by peak severity (mild, moderate, and severe defined by the World Health Organization Ordinal Scale) over time from symptom onset. Differences in mean LUS score or % A-lines changes over time between peak severity levels were evaluated using a Kruskal-Wallis test and linear mixed-effected models with an exchangeable correlation structure.

Results

Among 244 patients in our cohort (mean age of 58.2 (SD 15.0) years, and 55.7% female) (Table 1), there was no change in average mean LUS scores between the first two visits by severity groups (Figure 1; Kruskal-Wallis p=0.63). Mean LUS scores were elevated by 0.22 (p< 0.001) in a dose-response manner regardless of duration of illness, but there was no change over time associated with peak severity (p=0.73). Similarly, percentage of A-lines were in 13.9% less lung fields for each increase in peak severity (p< 0.001; Figure 2) regardless of duration of illness. However, a change in mean LUS score did not differ significantly among peak severity levels (p=0.36).

Conclusion

Mean LUS scores correlated with clinical severity among hospitalized adults when assessed cross-sectionally, however mean LUS score did not change or differ between peak severity levels over the time course of hospitalization. These results do not support serial LUS scans to monitor disease progression.

Disclosures

All Authors: No reported disclosures.
313. Performance of Rapid Diagnostic Testing at Days 4-6 from Diagnosis: Implications for Discharge from Isolation on a University Campus
Authors: Atarere Joseph , Zhou Zhenwei , Turcinovic Jacquelyn , Seitz Scott , Sher-Jan Cole , Gilbert Madison , White Laura F , Hossain Mohammad , Overbeck Victoria , Mistry Roxanne M , Doucette-Stamm Lynn , Platt Judy T , Nichols Hannah E , Hamer Davidson H , Klapperich Catherine M , Jacobson Karen R , Connor John , Bouton Tara C
Published: December 2022

Background

Omicron rapidly replaced delta as the predominant strain causing COVID-19 related illness in the United States (US) in December 2021, the same month the US CDC reduced the recommended isolation period from 10 to 5 days for asymptomatic individuals or those with resolving symptoms. New evidence suggests some asymptomatic individuals with omicron remain culture positive beyond 5 days from diagnosis. We sought to evaluate the performance of a SARS-CoV-2 antigen rapid diagnostic test (RDT) in predicting persistent potential for transmission at the end of a five-day isolation period among young, fully vaccinated individuals in a university community setting.

Methods

A subgroup of participants enrolled in a longitudinal COVID-19 cohort were asked to self-perform RDTs on days 4 to 6 from diagnostic test date in addition to a separate self-collected anterior nasal swab used for culture and RT-PCR, and a daily symptom screen (15 COVID-19 symptom questions on a 4-point scale). We calculated the daily and overall sensitivity and specificity of the RDTs in comparison to SARS-CoV-2 culture result. We also compared the N1 cycle threshold (CT) values and symptom score on each day of the study by RDT results.

Results

Of 23 participants, the mean age was 20 years, all had completed their primary COVID-19 vaccine series, and 13 (65.0%) had received a booster vaccine (Table 1). Compared to culture, sensitivity and specificity of the RDTs were 100% and 62% respectively (Table 2). Compared to participants with negative RDTs, median CT values were lower in those with positive RDTs on each day of the study (Figure 1). Participants who had positive RDTs on all three days had higher symptom scores (Figure 2) than those without.

Conclusion

RDTs have a high sensitivity in detecting culture positive SARS-CoV-2 on Days 4 to 6 from initial diagnostic test. However, the high false positive rate of 38% means that over a third of culture negative individuals will stay in isolation longer than necessary if RDTs are used in test to release from isolation protocols. Viral loads (CT values) and symptom scores were higher for participants with persistently positive RDT result. An approach that uses a combination of RDTs, CT values and symptom score may prove useful in guiding isolation duration.

Disclosures

Davidson H. Hamer, MD, Trinity Biotech: Advisor/Consultant Catherine M. Klapperich, Ph.D., BioSens8, LLC: Ownership Interest.
325. Molecular Characterization of Antimicrobial Resistance Genes in Neisseria gonorrhoeae in Southeast Michigan
Authors: Shallal Anita , Suleyman Geehan , Gurdziel Katherine , Perri Mary , Zervos Marcus , Tibbetts Robert
Published: December 2022

Background

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) is a public health crisis. Diagnosis of infection is primarily established using nucleic acid amplification technologies (NAATs) without susceptibility testing; thus rapid identification of resistance determinants is crucial. Whole-genome sequencing (WGS) is a promising alternative to current susceptibility methods. The purpose of this study was to describe AMR genes in a subset of isolates using WGS from Southeast Michigan.

Methods

Isolates, demographic data, and minimum inhibitory concentrations (MIC) via E-test (ceftriaxone/CRO) and broth microdilution (azithromycin/AZM) were obtained from the Michigan Department of Health and Human Services. Libraries from isolates were generated using QIAseq FX DNA library kit before sequencing on NovaSeq 6000. Reads were trimmed [Trimmomatic] and aligned to the NG genome [Burroughs-Wheeler Aligner] before processing with Samtools suite for variant detection and consensus WGS determination. AMRFinderPlus was used to categorize AMR genes and resistance-associated point mutations.

Results

Total of 38 isolates were analyzed. The majority were from males (63%) and Blacks (44.7%) living in Detroit City proper (47.3%) with median age 25 (range 13-56), unknown HIV status (55.2%) and sexual orientation (47.3%) (Table 1). Urine (47.3%) was the most common specimen source, followed by cervix/vagina (28.9%). More than a third had prior NG and other sexually transmitted infections. Eight resistance genes were found among the 38 isolates (Figure 1). The penA gene associated with cephalosporin resistance was found in all isolates; however, all isolates were susceptible to CRO (CLSI susceptible breakpoint MIC < 0.25). The mtrR gene associated with macrolide resistance was noted in 86.8% isolates. Among 33 isolates where AZM susceptibility was available, resistance was noted in 9 (27%) (CLSI resistance breakpoint MIC > 1).

Conclusion

We describe a potential utility for WGS to identify AMR genes in NG. Although numerous β-lactam resistance genes were detected in all isolates, all remained susceptible to CRO. Further research is needed to determine the extent to which genetic diversity affects phenotypic susceptibilities in NG.

Disclosures

All Authors: No reported disclosures.