bluuebunny/crossref_metadata_2025 huggingface dataset:
273. Neurological Involvement Caused by Intracellular Bacteria
Authors: Hammami Fatma , Koubaa Makram , Chakroun Amal , Rekik Khaoula , Marrakchi Chakib , Smaoui Fatma , Jemaa Mounir Ben
Published: December 2021

Background

Infection of the central nervous system is a severe and fatal disease. Causative agents include bacteria, viruses or fungi. Intracellular bacteria are not only overlooked, but also underdiagnosed. We aimed to study the clinical, laboratory and evolutionary features of neurological involvement caused by intracellular bacteria.

Methods

We conducted a retrospective study including all patients hospitalized in the infectious disease department for neurological involvement caused by intracellular bacteria between 1995 and 2020. The diagnosis was confirmed by serology.

Results

We encountered 76 cases among which 43 were males (56.6%). The mean age was 32±18 years. The revealing symptoms included fever (97.4%), cephalalgia (73.7%), vomiting (64.5%) and arthralgia (51.3%). Lumbar puncture revealed a median white blood cell count of 120[56-340]/mm3. Lymphocytic pleocytosis was noted in 62% of the cases. Elevated cerebrospinal fluid (CSF) protein level was noted in 37 cases (48.7%) with a median of 0.84[0.6-1.37] g/L. Low CSF fluid glucose level was noted in 14 cases (18.4%). There were 70 cases (92.1%) of meningitis and 6 cases of meningoencephalitis (7.9%). The causative agent included Rickettsia species in 47 cases (61.8%), Brucella species in 17 cases (22.4%) and Mycoplasma species in 12 cases (15.8%). Laboratory investigations included elevated C-reactive protein levels (40.7%), thrombocytopenia (32.8%) and increase in hepatic enzyme levels (21%). Anemia was noted in 27 cases (35.5%), leukocytosis in 24 cases (31.5%) and leucopoenia in 6 cases (7.8%). Blood and CSF cultures were positive for Brucella in 2 cases (2.6%) and 5 cases (6.5%), respectively. The mean duration of treatment was 156±94 days for brucellosis cases, 9±4 days for rickettsiosis cases and 10±6 days for Mycoplasma cases. The disease evolution was favorable in 72 cases (94.7%). Four patients were dead (5.3%). Complications were noted in 5 cases (6.5%) and sequelae in 2 cases (2.6%).

Conclusion

Intracellular bacteria including Brucella, Rickettsia and Mycoplasma species should be considered in front of neurological symptoms. Meningitis with lymphocytic pleocytosis was the most common clinical presentation. An early diagnosis followed by the adequate treatment might avoid complications and death.

Disclosures

All Authors: No reported disclosures
274. Legionella bozemanii (Fluoribacter bozemanae) Brain Abscess in a Renal Transplant Recipient
Authors: Khan Abrar , Kruthiventi Sreechandra L , Mahapatra Rahul , Sanyal Soma , Kufel Wesley
Published: December 2021

Background

Legionnaires’ disease is a potentially fatal multi-system disease caused by Legionella species. However, extra-pulmonary Legionella disease is rare and is typically associated with Legionella species other than L. pneumophila in immunocompromised patients.

Methods

We present a 55-year-old immunocompromised male with history of living-related renal transplant secondary to IgA nephropathy (day 0) which was complicated by T-cell mediated rejection requiring anti-thymocyte globulin and elotuzumab (day 130).

Results

Patient was hospitalized on day 184 with community-acquired pneumonia and treated with piperacillin-tazobactam and azithromycin. Three weeks later (day 214), he presented with new-onset seizures and was found to have a frontal brain abscess on MRI. His clinical course and brain imaging worsened despite undergoing multiple operative drainage procedures, placement of an extra ventricular drain, and receiving broad-spectrum antimicrobials. L. bozemanii was first identified from cerebrospinal fluid (CSF) on buffered charcoal yeast extract (BCYE) agar from day 240 and was also later confirmed by 16S rRNA sequencing. Susceptibilities were unavailable due to poor organism growth. Of note, his allergy history was significant for rash with ciprofloxacin and levofloxacin. Based on the low severity of the allergic reaction and need for central nervous system penetration, moxifloxacin 400 mg intravenously every 24 hours was initiated on day 244 in addition to broad-spectrum antibiotics. Subsequent CSF cultures were positive for L. bozemanii until the CSF culture on day 250. Due to poor clinical response, azithromycin and intrathecal polymyxin B were added for salvage therapy on day 255. His neurological status continued to worsen and he eventually succumbed to his illness on day 262.

08/31/20 MRI Brain

New solitary ring-enhancing lesion with significant surrounding vasogenic edema within the anterior right frontal lobe.

09/23/20 MRI Brain

Post-Surgical right frontal lobe with edema, persistent cerebritis, and mass effect on the lateral ventricles.

Fluoribacter Bozemanae

Formerly known as Legionella bozemanii, an intracellular GNR grown on BCYE.

Conclusion

We present a diagnostically challenging case of L. bozemanii brain abscess in an immunocompromised patient. To our knowledge, this is the first case of culture proven L. bozemanii brain abscess in the literature. Considering the fastidious growth of the organism, fatal nature of the infection, and narrow therapeutic profile, Legionella infection should be considered in a multi-system disease in immunocompromised patients.

Disclosures

Wesley Kufel, PharmD, Melinta (Grant/Research Support)Merck (Grant/Research Support)Theratechnologies, Inc. (Advisor or Review Panel member)
275. Clinical and Laboratory Predictors of Stroke Associated with COVID-19 Disease
Authors: Bromberg Valerie R , Cressman Leigh , Tolomeo Pam C , Abdallah Hatem , Holmes Alexis , Garcia Jay , Patel Ashini , Ziegler Matthew J , Omorogbe Jacqueline , Hamilton Keith W , Lautenbach Ebbing , David Michael Z , Kelly Brendan
Published: December 2021

Background

Although SARS-CoV-2 predominantly targets the respiratory system, it has also been associated with vascular complications including stroke. Identifying COVID-19 patients at elevated risk for stroke can help inform target anticoagulation strategies. We sought to understand how symptoms and laboratory markers at presentation with COVID-19 relate to stroke risk.

Methods

We enrolled a cohort of 1324 subjects who were hospitalized with COVID-19 across six PennMedicine hospitals between April and August 2020 and performed retrospective, manual chart review to measure exposures including presenting symptoms and admission inflammatory markers. Data were organized with a REDCap database, and analyses were performed using R statistical software, with Bayesian binomial regression models fit using Stan Hamiltonian Monte Carlo via the “brms” package.

Results

Among 1324 subjects, 19 stroke events were observed within 30 days of COVID-19 diagnosis. Admission inflammatory markers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin, and D-dimer, were poor predictors of stroke risk. Among presenting symptoms, including respiratory, gastrointestinal, dermatologic, and neurologic features of COVID-19 disease, only altered mental status documented on presentation (in 529 subjects) was significantly associated with stroke risk (odds ratio 6.06, 95% credible interval 2.16 - 18.7).

Conclusion

Inflammatory markers associated with COVID-19 disease severity did not discriminate patients at high versus low risk of stroke in this cohort. Altered mental status documented on presentation was significantly associated with incident stroke during COVID-19 disease.

Disclosures

Ebbing Lautenbach, MD, MPH, MSCE, Merck (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB)) Michael Z. David, MD PhD, GSK (Board Member)
277. Low Rates of Bacterial Co-infection in Hospitalized Patients with COVID-19
Authors: Spivack Stephanie , Kludjian Geena , Gallucci Stefania , Kilpatrick Laurie , Mishkin Aaron D , Sajjan Umadevi , Tam Vincent , Gallagher Jason C , Gallagher Jason C
Published: December 2021

Background

The rate of bacterial co-infection in inpatients with COVID-19 is unknown, however, patients who are hospitalized with COVID-19 often receive antibiotics for community-acquired bacterial pneumonia (CABP). Reducing unnecessary antibiotic usage in this population is important to prevent adverse effects and slow the development of antimicrobial resistance.

Methods

We performed a retrospective chart review on patients admitted to our health system between March and May 2020 with confirmed COVID-19 by nasopharyngeal PCR. We reviewed patients with positive cultures from urine, blood, sputum, and sterile sites. Positive cultures were reviewed to determine if they represented a true infection versus a contaminant or colonization. Patients with true infections were categorized as having a co-infection (CI) if the positive culture was collected within 48 hours of initial positive SARS-CoV-2 PCR test. Additional data was collected on patient demographics, types of infections, organisms grown, and antibiotic usage.

Results

902 patients were admitted with positive SARS-CoV-2 tests during the study period. Of these, 47 patients (5.2%) had a bacterial CI. Some patients had more than one CI, with 53 total CIs identified. The median age of patients with CI was 66 years old (39 – 90). Tables 1 and 2 describe patient characteristics and infections. A subgroup analysis on types of bacteria was done on the 20 patients with a respiratory CI, who accounted for 2.2% of all COVID-positive patients admitted during the study period. In these infections, Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae were the most common organisms, accounting for 60%, 15%, and 10% infections, respectively.

Table 1. Patient Characteristics

Table 2. Co-infections

Conclusion

The overall rate of CIs in patients admitted with COVID-19 was low. Some of these CIs may represent an “incidentally positive” COVID-19 test if a patient presented with one infection and had asymptomatic carriage of SARS-CoV-2 when community prevalence was high. Further analysis is needed to evaluate specific risk factors for co-infection.

Disclosures

Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Consultant, Speaker’s Bureau)Merck (Consultant, Grant/Research Support, Speaker’s Bureau)Qpex (Consultant)scPharmaceuticals (Consultant)Shionogi (Consultant) Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Individual(s) Involved: Self): Speakers' bureau; Merck (Individual(s) Involved: Self): Consultant, Grant/Research Support; Nabriva: Consultant; Qpex (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant
279. Clinical Characteristics of Critically Ill Patients with COVID-19 and Invasive Pulmonary Aspergillosis: A Case Series From Mexico City
Authors: Galindo-Lopez Patricia , Valente-Acosta Benjamin , Moreno-Sanchez Francisco , Espinosa-Aguilar Luis , Hoyo-Ulloa Irma , Mendoza-Aguilar Raquel , Garcia-Guerrero Javier , Ontañon-Zurita Diego , Gomez-Gomez Brenda
Published: December 2021

Background

COVID-19 has emerged as a global public health emergency and has been the main cause of intensive care admission during the pandemic. COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in case series of critically ill patients. However, the criteria for CAPA diagnosis has been inconsistent among most of the reports. Mexico has been widely affected by SARS-CoV-2. We present a series of CAPA cases at a teaching hospital in Mexico City.

Methods

We performed a retrospective analysis of COVID-19 patients admitted to the ABC Medical Center from May 1st, 2020, to May 1st, 2021. Including only those with critical COVID-19 who required invasive mechanical ventilation (IMV). Patients with a diagnosis of CAPA were analyzed. We followed the 2020 ECMM/ISHAM consensus criteria for CAPA diagnosis. Aspergillus antigen testing in tracheal aspirate and serum was done with Aspergillus-specific galactomannoprotein (GP) ELISA (Euroimmun Medizinische Labordiagnostika).

Results

Among the 230 admitted patients who required IMV, we identified 49 (21.3%) cases of CAPA, 46 probable CAPA and 3 proven CAPA. Nineteen (38%) of those died in the hospital. The mean age was 64.5 ± 12.6 years and 11 were female. Proven CAPA was diagnosed with culture in three cases (one A. niger, one A. terreus and one A. fumigatus). Probable CAPA was diagnosed by a positive serum GP in 27 (55.1%) patients and by a positive bronchoalveolar lavage (BAL) GP in 29 (59.2%) cases. Seven patients had both serum and BAL positive GP. Forty-six (93.9%) patients received corticosteroids, and 22 (49.9%) were treated with tocilizumab before CAPA diagnosis. All but one received isavuconazole as CAPA treatment. We detected 35 (71.4%) patients who had a bacterial co-infection. Eighteen of those died (51.4%) compared to only one dead in the subgroup without coinfections (7.1%). The mean time from hospital admission to CAPA diagnosis was 6.2 days (SD 7.1) among those who survived compared to 13.2 (SD 6.3) days in those who died p< 0.01.

Conclusion

CAPA had a lower prevalence than previously reported in other series. However, it appears to be linked to high mortality when it occurs with other bacterial coinfections and when it is diagnosed late from admission.

Disclosures

All Authors: No reported disclosures
280. Burden of Hyperglycemia in Patients Receiving Dexamethasone for Severe COVID-19
Authors: Fetters Kirk B , Judge Stephen , Hatlen Timothy , Daar Eric
Published: December 2021

Background

Previous studies demonstrated the adverse impact corticosteroids can have on blood glucose homeostasis in both diabetics and non-diabetics. This raises concern for corticosteroid use in severe COVID-19 where the population is enriched for those at highest risk of severe disease, such as diabetics and patients with obesity. Previous studies of dexamethasone in COVID-19 were limited by the inability to assess steroid-induced hyperglycemia or the impact of hyperglycemia on hospital resources.

Objective

The study aimed to describe the clinical characteristics, management, and outcomes related to hyperglycemia, before and after dexamethasone therapy was used as the standard of care in patients with severe COVID-19.

Methods

We performed a pre/post retrospective study of patients with severe COVID-19 pneumonia admitted from May to July 2020 to Harbor-UCLA Medical Center. 126 patients were evaluated. 64 received dexamethasone and 62 did not. To quantify the effect of dexamethasone on diabetic vs. non-diabetic patients, we documented the average blood glucoses and frequency of correctional insulin doses required by each patient group (diabetic with and without dexamethasone, non-diabetic with and without dexamethasone).

Results

While dexamethasone was associated with higher median blood glucose and more frequent correctional insulin dosing in diabetic patients, there was minimal effect of dexamethasone on hyperglycemia in non-diabetic patients. Furthermore, while non-diabetic patients receiving dexamethasone required more doses of correctional insulin per day vs non-diabetic patients not receiving dexamethasone (0.3 doses per day vs 0.1 doses per day), the frequency of correctional insulin doses required by non-diabetics on dexamethasone remained low at 0.3 doses per day.

Conclusion

NIH COVID-19 guidelines recommend administering dexamethasone only if the patient is in a monitored setting. Our data support the NIH concerns that outpatients with diabetes receiving steroids are at risk for hyperglycemic complications. However, contrary to the NIH guidelines, our data suggest that patients without diabetes receiving steroids are at low risk for complications due to hyperglycemia and a majority do not require monitoring.

Disclosures

Eric Daar, MD, Gilead (Consultant)Gilead (Research Grant or Support)Merck (Research Grant or Support)Merck (Consultant)ViiV (Research Grant or Support)
281. Prevalence of Influenza Co-infection in a Real-world Cohort of COVID-19 Patients in the U.S
Authors: Chawla Devika , Chen Xin , Kuhlbusch Klaus , Zalocusky Kelly , Rizzo Shemra
Published: December 2021

Background

Over 29 million people have been infected with COVID-19 in the U.S. alone. While COVID-19 carries serious morbidity and mortality, potential for co-infection with other respiratory infections remains unclear. We aimed to: (1) estimate co-infection prevalence of COVID-19 and influenza, and (2) compare demographics and clinical outcomes of co-infected patients to those of COVID-19 singly-infected patients using U.S. electronic health records (EHR).

Methods

Patients in the Optum De-identified COVID-19 EHR database diagnosed with COVID-19 (lab-confirmed or ICD code) between February 2020 and January 2021 were eligible. Influenza co-infection was defined as an influenza diagnosis (lab-confirmed or ICD code) within ±10 days of COVID-19 diagnosis. We report co-infection prevalence for all COVID-19 patients and for a subset of hospitalized COVID-19 patients.

Results

Among all COVID-19 patients (N = 549,532), 1,794 (0.3%) were co-infected with influenza. Among the hospitalized subset (N = 80,192), 242 (0.3%) were co-infected with influenza. In sensitivity analyses restricting to lab-confirmed influenza, co-infection prevalence was 0.1% overall and 0.2% among hospitalized patients. No meaningful differences were observed in baseline demographics between co-infected and singly-infected patients. Among hospitalized patients, univariate analysis suggested higher likelihood of invasive ventilation (12.8% vs. 9.8%; p=0.14), respiratory failure (56.2% vs. 46.6%, p< 0.01), and ICU stay (27.3% vs. 23.1%, p=0.13), but no meaningful difference in mortality (13.3% vs. 13.0%, p=0.97), for co-infected as compared to singly-infected COVID-19 patients.

Conclusion

In a real-world cohort, we observed a low proportion (0.3%) of COVID-19 patients co-infected with influenza. Co-infected patients had similar baseline characteristics but higher likelihood of hospitalization severity as compared to singly-infected COVID-19 patients. Limitations include low prevalence of circulating influenza and potential missing data bias.

Disclosures

Devika Chawla, PhD MSPH, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Xin Chen, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Klaus Kuhlbusch, PhD MD, F. Hoffmann-La Roche Ltd. (Employee) Kelly Zalocusky, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Shemra Rizzo, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee)
283. Population-Based Co-infection of Carbapenem-Resistant Organisms and SARS-CoV-2 in Massachusetts
Authors: Geoghegan Ashley , Leaf Jessica , Klevens Monina , Troppy Scott
Published: December 2021

Background

Concerns about antibiotic resistance are exacerbated in COVID-19 patients due to frequent antibiotic use, increase in mechanical ventilation and reusable equipment, conservation of PPE, and strain on hospital staff. We described cases with co-infection of carbapenem-resistant organisms (CRO) and SARS-CoV-2 and compared rates in the Massachusetts population.

Methods

All providers and hospitals are required to report CROs and SARS-CoV-2 to the Massachusetts Virtual Epidemiologic Network (MAVEN). We selected cases with both a positive SARS-CoV-2 test and a laboratory confirmed CRO from January through July 2020. We classified by which result occurred first and described demographic and clinical characteristics. We standardized the CRO case definition by excluding CR-Pseudomonas aeruginosa and calculated rates per 100,000 to assess the impact of SARS-CoV-2 on the population-based frequency of CROs. Analyses were conducted in SAS 9.4.

Results

28 confirmed cases of SARS-CoV-2 infection were also diagnosed with a CRO. They were an average age of 71.8, 60.7% male, 67.9% white, and 64.3% were in congregate care prior to their diagnoses. Mortality was 5/28 (17.9%). The 23 (82.1%) with a positive SARS-CoV-2 result first were all hospitalized at least once compared to 40% in the CRO first group (p=0.003). 11 (47.8%) of the SARS-CoV-2 first were already admitted when they tested CRO positive; 7 (30.4%) were admitted for the CRO separately from COVID-19 treatment. None of the CRO first group were admitted for CRO infection. Average length of stay for the SARS-CoV-2 first group was higher than the CRO first group (62.3 days vs 11.0 days; p=0.049). Cases positive for CRO first were all infected with CR-Escherichia coli whereas those positive for SARS-CoV-2 first were infected with CRAB, CRPA, or a CRE (Klebsiella oxytoca or Klebsiella pneumoniae) (p< 0.0001). The rate of CRO/COVID coinfection was 0.203 per 100,000 population; the rates for January through July of CRO alone were 2.5 per 100,000 in 2020 and 2.4 per 100,000 in 2019.

Conclusion

Characteristics of individuals co-infected with CRO and SARS-CoV-2 differed by which diagnosis was made first; however, the SARS-CoV-2 pandemic did not impact the CRO population rate during the time frame studied.

Disclosures

All Authors: No reported disclosures
285. Outcomes and Antibiotic Use in Patients with COVID-19 Admitted to an Intensive Care Unit
Authors: Petteys Megan , Medaris Leigh Ann , Williamson Julie E , Denmeade Travis , Soman Rohit , Anderson William E , Leonard Michael , Polk Christopher
Published: December 2021

Background

Studies have shown the proportion of critically ill patients with COVID-19 receiving empiric antibiotics (ABX) greatly exceeds those with culture-proven bacterial co-infections. However, the benefits of continuing ABX in culture-negative (CxN) cases is unknown; this practice may increase the risks associated with ABX overuse. The purpose of this study was to evaluate outcomes and antibiotic use (AU) in intensive care unit (ICU) patients with COVID-19 based on culture results.

Methods

This was a multicenter, retrospective cohort study evaluating adults in an ICU for the first episode of ABX initiated following a confirmed COVID-19 diagnosis between September to December 2020. Blood and/or respiratory cultures must have been obtained within 24 hours (h) of ABX initiation. Patients were categorized into three groups: 1) CxN, ABX discontinued ≤ 72 h, 2) CxN, ABX continued > 72 h, or 3) Culture-positive (CxP). Data on AU was obtained from electronic medication administration records. The primary outcome was clinical success, defined as being discharged alive or > 2-point decrease in the World Health Organization Clinical Progression Scale score from day of ABX initiation to day 30.

Results

A total of 65 patients were included with 35.4% being CxP. ABX were discontinued ≤ 72 h in 23.8% of CxN patients. Methicillin-susceptible Staphylococcus aureus was the most common organism in 52.2% of CxP patients (66.7% respiratory; 16.7% blood; 16.7% both). Anti-methicillin-resistant Staphylococcus aureus and anti-pseudomonal antibiotics were the most prescribed for the initial regimen (Table 1). ABX de-escalation occurred in 58.5% of patients. Initial ABX duration was significantly longer in the CxP group (P < 0.01). No significant difference in clinical success was observed (Table 2). Although not significantly different, the highest rate of adverse events occurred in the CxN and ABX continued > 72 h group (40.6%).

Table 1. Antibiotic Use in ICU Patients with COVID-19

Table 2. Clinical Outcomes and Adverse Events in ICU Patients with COVID-19

Conclusion

In ICU patients with COVID-19, empiric broad-spectrum ABX are often overutilized with an inertia to de-escalate despite negative culture results, potentially increasing the risk of adverse events. This remains an important area for focused antimicrobial stewardship efforts to mitigate the development of multidrug resistance.

Disclosures

Christopher Polk, MD, Atea (Research Grant or Support)Gilead (Advisor or Review Panel member, Research Grant or Support)Humanigen (Research Grant or Support)Regeneron (Research Grant or Support)
287. Characteristics and Outcomes of COVID-19 Patients with Candidemia at a Community Hospital in Chicago
Authors: Adeyemi Oluwadamilola A , Gonzaga Gregg , Cariño Sean , Kalish Steve B
Published: December 2021

Background

1,416 patients with acute COVID-19 infection were admitted to our hospital in 2020. During that year we noticed an alarming increase in cases of nosocomial Candidemia: 26 versus an average of 2.8 cases per year over the previous 5 years. 19 of the 26 episodes (73%) of Candidemia occurred in patients who were admitted with acute COVID-19 infection. Recent reports suggest that hospitalized patients with COVID-19 are at increased risk for developing Candidemia, however their clinical characteristics, risk factors and outcomes have not been well described. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with Candidemia.

Methods

We performed a retrospective chart review of 19 patients with Candidemia and confirmed COVID-19 infection at a 292-bed community teaching hospital in Chicago, Illinois from January through December 2020. We report a descriptive analysis of the demographic characteristics, comorbidities, complications, and outcomes of these patients.

Results

The average age of our study population was 65 years; 68% were male. The average hospital length of stay (LOS) was 34 days. The mean time from admission to the development of Candidemia was 16 days. Associated co-morbidities included cardiovascular diseases (CVD) in 79%, diabetes mellitus (DM), in 68%, and obesity in 50%. Underlying kidney disease was present in 10%. Treatments for COVID-19 included convalescent plasma (53%), remdesivir (53%), steroids (52%) and tocilizumab (19%). All patients were managed in the intensive care unit (ICU) and 95% required multiple central line (CL) placements. Most of the patients (58%) required hemodialysis (HD); all patients were treated with multiple antibiotics. The average LOS in the ICU was 25 days. Despite anti-fungal treatment, 68% expired. The 28-day mortality was 50%.

Conclusion

The occurrence of Candidemia in our hospitalized patients with acute COVID-19 infection was associated with a history of CVD, DM, obesity, prolonged hospital LOS, requirement for multiple CL, HD, treatment with multiple antibiotics and a long stay in the ICU. The mortality of COVID-19 patients with Candidemia is high. The development of strategies to mitigate the occurrence of nosocomial Candidemia in this population of patients is urgently needed.

Disclosures

All Authors: No reported disclosures
288. Clinical Variables Associated with COVID-19 Mortality and ICU Admission in a Public Safety-net Hospital in Chicago
Authors: Hernandez-Acosta Ruben A , Sarmiento Juan , Patel Palak , Hoffman Michael , Rezai Katayoun
Published: December 2021

Background

The COVID-19 pandemic has disproportionately impacted minorities in the United States. John H. Stroger Jr. Hospital (JSH) is a tertiary care hospital within the safety-net system for Cook County in Chicago, Illinois. In this study we report demographics, clinical characteristics and outcomes of patients admitted with COVID-19 in our hospital during the spring surge of 2020.

Methods

A retrospective study was done including patients > 18 years of age admitted to JSH with positive PCR for SARS-CoV2 from March 18 to May 30th, 2020. Outcomes, clinical and demographic characteristics were extracted from the electronic medical record. Moderate and severe disease were defined as radiographic evidence of pulmonary infiltrates and SpO2 > 94% on room air or SpO2< 94% on room air, respectively. Bivariate analysis and logistic regression were performed to assess for risk factors for admission to the intensive care unit and mortality.

Results

625 patients were included, 424 (68%) were male. Median age was 44 years (44,63). 364 (58%) were Hispanic and 222 (36%) non-Hispanic Blacks. 113 (18%) of patients presented with mild disease, 204 (33%) with moderate disease, 298 (48%) with severe disease. 73 patients (12%) died. 153 (24%) required ICU admission, 84 (13%) required intubation [Table 1]. In bivariate analysis, increasing age and diabetes (DM) were associated with increased mortality and ICU admission (p=0.001, Tables 2 and 3). Race/ethnicity was not associated with increased mortality or ICU admission. In the multivariate analysis, elevated glucose on admission regardless of DM and CKD were associated with mortality (p < 0.001).

Conclusion

JSH is a safety net hospital that provides care for the most vulnerable population of Chicago. The proportion of Hispanic patients increased in the later weeks of the pandemic until they represented most of the inpatient population and presented with more severe disease (Figure 1). Although race was not associated with mortality or ICU admission, the high prevalence of chronic diseases such as hypertension and DM in our population may explain the higher rate of admissions. Strengthening of preventive medicine and social engagement with minorities must be a crucial effort to decrease the burden of COVID-19 in this population.

Graph showing disease severity on admission by Race/Ethnicity (upper). Notice the predominance of severe disease (orange) in Hispanic patients. Graph showing Race/Ethnicity Distribution by Week (lower). Notice the gradual increase and predominance of Hispanic patients (orange) in the later weeks of the study period compared to Black (blue) and White (green) patients.

Disclosures

All Authors: No reported disclosures
291. Epidemiology of Candidemia Rates during COVID-19 and Comparison of Outcomes in Candidemia Between COVID-19 and Non-COVID-19 Patients
Authors: Cruz Angela Beatriz , LeRose Jennifer , Evans Kenisha J , Meyer Monica , Chopra Teena , Chopra Teena
Published: December 2021

Background

Fungemia is associated with high rates of morbidity, mortality and increase in length of hospital stay. Several studies have recognized increased rates of candidemia since the COVID-19 pandemic.

Methods

A retrospective cohort study was conducted at a tertiary healthcare system in Detroit, Michigan to evaluate the impact of the COVID-19 pandemic on incidence of candidemia. The “pre COVID-19” timeframe was defined as January – May 2019 while the “during COVID-19” timeframe was January – May 2020. To compare incidence and patient characteristics between cohorts, t-tests and chi-square analysis was used. Additional sub-analysis was performed in candidemia patients during COVID-19 timeframe comparing outcomes of patients based on COVID-19 status. A Fisher Exact and Satterthwaite Test were used for analysis of categorical and continuous variables, respectively.

Results

Overall, 46 cases of candidemia were identified in both the pre COVID-19 and during COVID-19 periods. Pre COVID-19, the average number of cases was 3.0 ± 1.2 per month. The incidence more than doubled during COVID-19 to 6.2 ± 4.2 cases per month (p = 0.14) (Figure 1). No significant differences in patient demographics were detected between cohorts, however, patients in the COVID-19 cohort had higher rates of corticosteroid use, mechanical ventilation and vasopressors (Table 1). In the 2020 period, 31 patients developed candidemia and 12 (38.7%) patients tested SARS-CoV-2 positive. On average, COVID-19 patients developed candidemia 12.1 days from admission, compared to 17.8 days in the COVID-19 negative cohort (p = 0.340). Additionally, COVID-19 patients with candidemia coinfection were significantly more likely to expire; 83.3% (n=10) COVID-19 patients expired compared to 36.8 (n=7) in the COVID-19 negative cohort (p = 0.025) (Table 2).

Figure 1. Incidence of Candidemia in the Pre-COVID-19 (January 2019 – May 2019) and During COVID-19 (January 2020-May 2020) periods

Table 1. Characteristics of Candidemia patients in the pre-COVID (January 2019-May 2019) and during-COVID periods (January 2020-May 2020)

Table 2. Characteristics of Candidemia patients in the SARS-COV-2 negative and SARS-COV-2 positive cohorts from January 2020-May 2020

Conclusion

The prevalence of fungemia markedly increased during the COVID-19 surge. Increased use of corticosteroids and broad spectrum antimicrobials, prolonged use of central venous catheters and prolonged ICU length of stay likely contributed to this increase. Patients who developed candidemia co-infection with COVID-19 were found to have poorer outcomes as compared to those who were SARS-CoV-2 negative or untested.

Disclosures

All Authors: No reported disclosures
292. Antibiotic Use Is Increased in Patients with Acute Respiratory Distress Syndrome (ARDS) Requiring Extracorporeal Membrane Oxygenation (ECMO) due to COVID-19 Compared with Influenza
Authors: Alex Viehman J , Thorngren Christina K , Nguyen M Hong , Samanta Palash , Clancy Cornelius J , Murray Holt , Rivosecchi Ryan
Published: December 2021

Background

During the COVID-19 pandemic, >50% of hospitalized patients (pts) received an antimicrobial. ECMO is increasingly used in COVID-19 pts with severe ARDS. ECMO has been used for ARDS due to influenza at our center in prior years. Pts on ECMO are at high risk for infections. We compared the rates of antibiotic (Ab) and antifungal (AF) use in pts on ECMO for COVID-19 vs influenza ARDS.

Methods

This was a retrospective review of pts on ECMO for COVID-19 (2020-2021) or influenza (2013-2019). Antimicrobials (Abs and AFs) were categorized as anti-MRSA, anti-pseudomonal β-lactams (AP-BL), carbapenems, and new broader spectrum β-lactams. We calculated total Ab and AF utilization, adjusted for ECMO duration.

Results

Seventy-one pts (36 COVID-19 and 35 influenza) were included. COVID-19 pts had longer ECMO duration (median: 25 vs 11 days, p=.03). 100% and 97% of pts with COVID-19 and influenza received ≥1 Ab, respectively, and 42% and 33% an AF, respectively. COVID-19 pts received longer duration of Abs (26 vs 10 days, p< 0.001) and but not AF. COVID-19 group (gp) were more likely to receive anti-MRSA Ab (69% vs 33%, p=.004); otherwise, there were no differences between gps in types of Abs used. When adjusted for ECMO days, COVID-19 gp received higher median number of Abs (1.23 vs 1, p=.06). Specifically, COVID-19 gp received higher median number of anti-MRSA Ab (0.2 vs 0, p=.007) and AP-BL (0.44 vs 0.28, p=.08). There was no difference in Ab-free days between gps, though the proportion of Ab-free days was lower (0.2 vs 0.36) in COVID-19 pts (p=.08). More COVID-19 pts had pathogens recovered from clinical cultures, especially S. aureus and Enterobacterales (Figure).

Pathogens recovered from clinical cultures

Patients recovered from clinical cultures of patients with COVID-19 and Influenza ARDS requiring ECMO

Conclusion

Among pts on ECMO, those with COVID-19 received significantly longer courses of Abs than those with influenza, even after adjusting for longer durations of ECMO. Differences were driven by receipt of anti-MRSA and AP-BLs. Recovery of pathogenic bacteria was greater in COVID-19 pts than influenza pts. Given difficulties in distinguishing pneumonia from airway colonization among ARDS pts on ECMO, development of diagnostic criteria for pt care, rational antimicrobial stewardship and further research are needed.

Disclosures

Cornelius J. Clancy, MD, Merck (Grant/Research Support)
293. Lung Cancer and Hematologic Malignancy ( HM) Patients Are Associated with the Highest Risk of Progressing to Severe Disease and Mortality in Cancer Patients with COVID-19
Authors: Chaftari Anne-Marie , Malek Alexandre , Dagher Hiba , Jiang Ying , Bayle Arnaud , Bhinder Arvinder , Cruz Ana Fernandez , Siddiqui Bilal , Somer Robert , Datoguia Tarcila , Slavin Monica , Dragvich Tomislav , Gorak Edward , Mori Nobuyoshi , Hachem Ray Y , Raad Issam I
Published: December 2021

Background

Several studies have shown that underlying cancer is a risk factor for progression of COVID-19 to severe illness and fatal outcome but there is very little data that specifies which underlying cancer puts this patient population at the highest risk.

Methods

We retrospectively collected de-identified data on 1115 cancer patients diagnosed with COVID-19 between January and November 2020, at 12 centers in Asia, Australia, Europe, North America, and South America. Patient characteristics including age, type of malignancy (hematologic malignancy [HM], lung cancer, and non-lung cancer were determined in association with severe illness as well as all-cause mortality within 30 days after COVID-19 diagnosis.

Results

By multivariable logistic regression analysis, independent risk factors for 30-day mortality in cancer patients included age > 65 (OR 6.64; 95% CI 3.351to 12.55; p< 0.0001), ALC < 0.5 K/microliter (OR 2.10; 95% CI 1.16 to 3.79; p=0.014), and anemia at < 10g/dl (OR 2.41; 95% CI 1.30 to 4.44; p=0.005). Among cancer patients, the 30-day mortality rate was significantly higher in patients with lung cancer than in patients with non-lung cancer solid tumors, including those with lung metastases (22% vs 9%; p=0.001). Patients with HM tended to have higher 30-day mortality than patients with non-lung cancer solid tumors (13% vs 9% p=0.07) and tended to have a lower mortality rate than patients with lung cancer (p=0.07). Furthermore, HM patients were more likely to be lymphopenic and anemic at diagnosis as well as progress to LRTI and be placed on ventilatory support compared to non-lung cancer solid tumor patients ( p= or < 0.01). In addition, lung cancer and HM patients were more likely to develop hypoxia and require hospital admission than non-lung cancer solid tumor patients ( p=0.01).

Conclusion

Lung cancer and HM patients are associated with the highest risk of progressing to severe disease and mortality in cancer patients with COVID-19. Hence, cancer patient population should be given the highest priority as far as prevention [vaccination with boosters if needed] as well as preemptive early therapy with monoclonal antibodies right after the onset of COVID-19.

Disclosures

Monica Slavin, MBBS,MD, F2G (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Pfizer (Advisor or Review Panel member)
295. SARS-CoV-2 Infection in a Referral Cancer Center in Mexico City During the First Year of the COVID-19 Pandemic
Authors: Vilar-Compte Diana , De La Rosa Martinez Daniel , Martín-Onraet Alexandra , Pérez-Jiménez Carolina , Islas-Muñoz Beda , Alatorre-Fernández Pamela , Cornejo-Juarez Patricia , Aranda-Audelo Mercedes , Zinser-Peniche Paola , Nuñez-Luna Luis , Ruíz-García Erika
Published: December 2021

Background

Literature on SARS-CoV-2 infection in cancer patients is scarce in Latin America. This population seems to have a higher risk for adverse outcomes. This study aims to correlate clinical characteristics with outcomes in patients with cancer in a referral center in Mexico.

Methods

We included patients with cancer and confirmed SARS-CoV-2 infection, from April, 19 to December 30, 2020, at the Instituto Nacional de Cancerología, Mexico. Clinical information was obtained from medical and epidemiological records. We conducted a descriptive analysis. For the association between variables with hospitalization, invasive mechanical ventilation (IMV), and mortality; univariate and multivariate logistic regression was performed; odds ratios and 95% confidence intervals were calculated.

Results

Four hundred thirty-three patients were included; 268 (62%) were female, the median age was 55 years. One hundred thirty-five (31%), 130 (30%), and 93 (21%) patients had obesity, hypertension, and diabetes mellitus (DM), respectively. Three hundred forty-one (79%) had solid cancer; 82 (19%) hematological malignancy (HM), and 10 (2%) were under evaluation for cancer diagnosis. One hundred seventy (39%) had advanced or metastatic cancer. One hundred ninety-eight (46%) patients were hospitalized. Risk factors were: age (p= 0.001); woman (p=0.019); HM (p=0.050) and advanced or metastatic cancer (p= 0.041). Fourty-five (10%) patients required IMV. Age (p=0.018); DM (p=0.041); C-Reactive Protein (p= 0.002), and LDH (p= 0.033) were associated with invasive mechanical ventilation. Mortality within 30-days after diagnosis was 19% (82 cases). Associated characteristics were: age (p=0.041); lymphocytes (p=0.049); creatinine (p=0.005) and albumin (p=0.001).

Conclusion

In this study, patients with cancer showed higher mortality, need of hospitalization, and invasive mechanical ventilation compared with groups of patients without cancer. We did not find an increased risk in mortality for hematological malignancies. Although our cohort was younger than others previously reported, age was a strong predictor of adverse outcomes. Variables associated with IMV and death were similar to those previously described in cancer patients with COVID-19.

Disclosures

All Authors: No reported disclosures
297. Infectious Complications Associated with Tocilizumab Use in Patients Infected with SARS-CoV-2 at a Mid-Atlantic Hospital Consortium
Authors: Kent Kristen R , Darling Nellie , Geng Xue , Clark Gavin , Kazanas Marybeth , Kumar Princy N , Timpone Joseph G
Published: December 2021

Background

The IL-6 inhibitor Tocilizumab (TOCI) has been associated with infections in 5-8% of patients with Rheumatoid Arthritis. TOCI has now been recommended as a treatment option for select patients with COVID-19; however, the risk of infection in this patient population is yet to be determined.

Methods

We performed a retrospective chart review of patients diagnosed with COVID-19 and admitted to MedStar hospitals within the D.C./Baltimore corridor from 03/01/2020 to 12/31/2020. We identified patients who had positive culture data within 30 days of administration of TOCI-based regimens and analyzed clinical characteristics and outcomes. Univariate analyses (Wilcoxon, T-test, Chi-Square, Fisher’s Exact) were used to compare these outcome variables between patients who had post-treatment infections and those who did not.

Results

A total of 220 patients received TOCI-based regimens; 16% (N=36) of patients developed positive cultures within 30 days of treatment. Of the 99 cultures, 50% were gram positive (N=49), 38% were gram negative (N=38), 10% were Candida spp. (N=10), and 2% were anaerobic organisms (N=2). Only 9% (8/87) of the gram positive and gram negative organisms were MDROs. Bloodstream infections were the most common and accounted for 58.4% of all infections. Length of stay (LOS) was approximately twice as long in those with post-treatment infections (26 days) compared to those without infections (14 days, p< 0.001). Although the mortality rate was higher in patients with infections after TOCI-based treatment compared to patients with no post-treatment infection (47% vs 31% respectively), this did not reach statistical significance (p=0.09). Moreover, there was no significant difference in the infection rate of patients treated with TOCI alone compared to TOCI and Dexamethasone (16.6% vs. 13.3%, p=0.99). No cases of invasive Aspergillosis were observed.

Conclusion

Tocilizumab treatment in patients with COVID-19 may predispose patients to an increased risk of infection which is associated with a prolonged LOS and possibly higher mortality. We observed a two-fold increase in infections in COVID-19 patients compared to other patient groups receiving this treatment.

Disclosures

Princy N. Kumar, MD, AMGEN (Other Financial or Material Support, Honoraria)Eli Lilly (Grant/Research Support)Gilead (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)GSK (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)Merck & Co., Inc. (Grant/Research Support, Shareholder, Other Financial or Material Support, Honoraria)
298. Examining the Relationship Between Excess Weight and In-Hospital Mortality in COVID-19 Patients in Southwest Georgia, U.S
Authors: Dykes Austin C , Chastain Daniel B , Thomas Geren , Young Henry N , Martínez Andrés F Henao , Franco-Paredes Carlos , Osae Sharmon P
Published: December 2021

Background

There are multiple mechanisms for the interconnection between obesity and adverse outcomes in COVID-19. Body mass index (BMI) has historically been used to delineate body fatness, but does not include age, which could influence the relationship between body fat and BMI. Ideal body weight (IBW) equations predict a single IBW, which could allow improved recognition of adults with excess weight at increased risk of death from COVID-19. The purpose of our study was to determine whether an association exists between excess weight and in-hospital mortality in COVID-19 patients.

Methods

This was a multicenter, retrospective chart review of hospitalized patients with COVID-19. Patients were separated in two groups based on the difference between actual body weight (ABW) and IBW (ABW/IBW ≤ 120% and ABW/IBW > 120%) to compare rates of in-hospital mortality and length of stay (LOS). A subgroup analysis of patients with ABW/IBW > 120% was conducted to compare in-hospital mortality between patients with ABW/IBW 121-149%, ABW/IBW 150-199%, and ABW/IBW ≥ 200%.

Results

A total of 445 patients were included of which 71% were in the ABW/IBW > 120% group. Patients in the ABW/IBW ≤ 120% group had higher median age (71 [IQR 64-80.5] vs 60 [IQR 50-70] years) compared to those in the ABW/IBW > 120% group. Fewer African Americans and females were in the ABW/IBW ≤ 120% than in the ABW/IBW > 120% group (65% vs 86% and 35% vs 64%, respectively). There was no difference in the rate of in-hospital mortality between patients in the ABW/IBW ≤ 120% and ABW/IBW > 120% group (26% vs 20%, p=0.174). Average LOS was 10.5 days (SD 9.2) for patients in the ABW/IBW ≤ 120% and 9.3 days (SD 9.5) for those in the ABW/IBW > 120% group (p=0.227). Among those in the ABW/IBW > 120% group, in-hospital mortality was 14%, 23%, and 22% in patients with ABW/IBW 121-149%, ABW/IBW 150-199%, and ABW/IBW ≥ 200%, respectively (p=0.192).

Conclusion

In-hospital mortality and LOS were not significantly higher among COVID-19 patients with excess weight, defined by ABW/IBW > 120%, when compared to those with ABW/IBW ≤ 120%. Further research is needed to compare COVID-19 outcomes when BMI and ABW/IBW are used to define excess weight.

Disclosures

All Authors: No reported disclosures