bluuebunny/crossref_metadata_2025 huggingface dataset:
1322. Complications and Hospital Resource Utilization among Patients with Bacterial Nosocomial Pneumonia in the US, 2012-2019
Authors: Zilberberg Marya , Nathanson Brian , Puzniak Laura A , Zilberberg Noah , Shorr Andrew F
Published: December 2021

Background

Nosocomial pneumonia (NP) remains a costly complication of hospitalization. Consisting of hospital-acquired ventilated (vHABP) and non-ventilated (nvHABP), and ventilator-associated (VABP) bacterial pneumonia, these conditions themselves are fraught with further complications. We examined hospital resource utilization (HRU) and the rates of important complications in these three groups in a large US database.

Methods

We conducted a multicenter retrospective cohort study within Premier Research database, a source containing administrative, pharmacy, and microbiology data. The three types of NP were identified based on a slightly modified, previously published ICD-9/10-CM algorithm,1 and compared with respect to hospital costs, length of stay (LOS) and development of C. difficile infection (CDI), extubation failure (EF), and reintubation (RT). CDI was identified by its treatment with metronidazole, vancomycin, or fidaxomicin. Marginal effects were derived from multivariable regression analyses.

Results

Among 17,819 patients who met the enrollment criteria, 26.5% had nvHABP, 25.6% vHAPB, and 47.9% VABP. Patients with nvHABP were oldest (mean 66.7+/-15.1 years) and those with VABP were youngest (59.7+/-16.6 years). vHABP was associated with the highest chronic disease burden (mean Charlson score 4.1+/-2.8) and VABP with lowest (3.2+/-2.5). Patients with nvHABP had lowest severity of acute illness (ICU 58.0%, vasopressors 7.7%), and those with vHABP were most likely to require vasopressors (38.8%). The adjusted EF and RT in vHABP and VABP, and CDI rates, and adjusted post-infection onset hospital LOS across all groups were similar. The adjusted marginal post-infection onset ICU LOS and total hospital costs relative to nvHABP were 5.9 (95% CI 5.4, 6.3) days and &6,814 (95% CI &3,637, &9,991) in vHABP, and 6.5 (95% CI 6.0, 6.9) days and &16,782 (95% CI &13,446, &20,118) in VABP.

Conclusion

Both HABP and VABP remain associated with significant morbidity and HRU in the US. VABP was associated with the longest post-infection ICU LOS and highest hospital costs.

Reference

1. Zilberberg et al. Chest 2019;155:1119-30

Disclosures

Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)
1323. Efficacy and Safety of Telavancin Compared to Vancomycin for Cystic Fibrosis Pulmonary Exacerbation in Adults
Authors: Shorman Mahmoud , wadi ghassan , Veve Michael P
Published: December 2021

Background

Telavancin (TLV) is an advanced generation lipoglycopeptide with activity against methicillin-resistant Staphylococcus aureus (MRSA), but there are limited patient outcomes in the setting of cystic fibrosis pulmonary exacerbation (CFPE). The study objective was to compare the efficacy and safety of TLV to vancomycin (VAN) in CFPE.

Methods

Retrospective cohort conducted from 1/2011-6/2020. Inclusion criteria were: i) age ≥16 years, ii) hospitalized for CFPE with documented signs/symptoms of infection, iii) confirmed or suspected MRSA lower respiratory tract infection, iv) receipt of ≥48 hours of TLV or VAN. The primary outcome was 30-day CFPE-related readmission: infection recurrence, clinical worsening on treatment, or ADE requiring readmission. Secondary outcomes included adverse drug events (ADE) on therapy: acute kidney injury (AKI), rash, thrombocytopenias, cardiac abnormalities.

Results

101 patients were included: 52 (52%) TLV, 49 (49%) VAN. The median (IQR) age was 22 (21-27) years, 50% were women, and 86% were Caucasian. The majority (84%) of patients had some federal health insurance; 19% had private health insurance. 93% of patients used a maintenance cystic fibrosis (CF) medication, and 35% had previous CF-therapy compliance concerns. 62% had a previous positive culture for MRSA; 22 (43%) TLV patients had documented MRSA infection on admission compared to 41 (84%) VAN (P< 0.001). The median (IQR) time to TLV initiation from admission was 1 (0.8-1.4) days. 13 patients were readmitted within 30-days due to CFPE; 8 (15)% TLV vs. 5 (10%) VAN (unAdjOR, 0.63; 95%CI, 0.19-2.1). Reasons for 30-day CFPE: TLV: 7 infection recurrence, 1 clinical worsening; VAN: 2 clinical worsening, 2 infection recurrence, 1 treatment-related ADE. When accounting for confounders, TLV was not associated with 30-day CFPE-related readmission (adjOR, 0.34, 95%CI, 0.1-1.2). Patients who received VAN more commonly experienced an ADE while hospitalized (18%), most notably AKI

Conclusion

TLV was associated with similar short-term clinical outcomes compared to VAN for treatment of CFPE due to confirmed or suspected MRSA. Patients who received TLV experienced fewer overall ADEs.

Disclosures

Mahmoud Shorman, MD, Cumberland (Grant/Research Support) ghassan wadi, MD, Cumberland (Grant/Research Support) Michael P. Veve, Pharm.D., Cumberland (Grant/Research Support)Paratek Pharmaceuticals (Research Grant or Support)
1326. Possible Predictors of Coinfection in COVID-19: Making a Difficult Diagnosis
Authors: Lehmann Christopher J , Shah Rohan N , Zhu Mengqi , Pettit Natasha N , Ridgway Jessica , Sherer Renslow
Published: December 2021

Background

Coinfection with COVID-19 and a secondary pathogen contributes to morbidity and mortality. Despite its contribution to outcomes, diagnosing coinfection is challenging and no predictive tools have been established. To better assess risk factors for coinfection, we performed a review of all patients hospitalized for COVID-19 in our institution and evaluated them for candidate predictors of coinfection.

Methods

Medical records were reviewed in all patients admitted with COVID-19 at University of Chicago Medical Center between March 1, 2020 and April 18, 2020. Those identified as having coinfection were compared to those without coinfection. Secondary review was performed for characteristics of the coinfection, including diagnosis, microbiology, drug resistance, and nosocomial acquisition.

Results

401 patients were included in the study, the mean age was 60 years (SD-17), 29% had severe disease, and 13% died. At least one test for coinfection was performed in 99% of patients. Coinfection was identified in 15% (72/401) of patients. Coinfection was associated with older age, disease severity, and hospital complications, such as DVT/PE, AKI, and delirium. [Table 1] No symptom, non-microbiologic test, radiograph, or preexisting condition was associated with coinfection. Dyspnea, chest pain, and obesity were more common in those without coinfection. 74% received antibiotics. The most common sites for coinfection were urinary 33%, lower respiratory 26%, and blood 24%. [Table2] Bacteria were most frequently recovered (82%). The most commonly recovered pathogens were Enterobacterales (42%), Staphylococcus aureus (12%), and Pseudomonas (4%). 42% of the infections were hospital acquired, 16% caused by MDRO, and 13% were catheter or ventilator associated.

Table 1. Clinical Characteristics Associated with Coinfection

Abbreviations: sd, standard deviation; WBC, white blood cell count; CRP, C-reactive protein; COPD, chronic obstructive pulmonary disease; ARDS, acute respiratory distress syndrome; DVT, deep venous thrombosis; PE, pulmonary embolism; MI, myocardial infarction; AKI, acute kidney injury

Table 2. Characteristics of Coinfection

Abbreviations: Cath, catheter; Vent, ventilator; Assoc, Associated; MDRO, Multiple Drug Resistant Organism

Conclusion

Coinfection in COVID-19 was most closely associated with age, COVID-19 disease severity, and complicated hospitalization. No presenting symptoms, non-microbiologic test, or radiograph was associated with coinfection, underscoring the challenge in diagnosing coinfection. A remarkable number of infections were hospital acquired, MDRO, and catheter/ventilator associated. Further prospective study on coinfection in COVID-19 is needed to guide diagnosis and treatment.

Disclosures

Renslow Sherer, MD, Gilead Sciences, Inc (Grant/Research Support)
1327. Human Rhinovirus Infection in Multiple Myeloma Patients: Effect on Morbidity and Mortality
Authors: Hasan Lana , Crescencio Juan Carlos Rico , Jenkins Mitchell , Burgess Mary J
Published: December 2021

Background

Human Rhinovirus (hRV) causes mild, primarily upper respiratory tract symptoms in immunocompetent hosts. However, in immunocompromised patients, it often progresses to a lower respiratory tract infection. Multiple myeloma (MM) patients are immunocompromised due to inherent immunodeficiency and exposure to biologic and chemotherapeutic agents. The complications of hRV infection in MM patients are not well known. In this study, we aim to identify the morbidity and mortality associated with hRV in MM participants.

Methods

This was a retrospective study, using Arkansas Clinical Registry Database, which identified all MM patients diagnosed with hRV infection by nasopharyngeal multiplex polymerase chain reaction (PCR) in January-December 2019. Duplicates within 30 days were excluded. Patients were followed for 30 days after diagnosis. We assessed the need for hospitalization, intensive care unit (ICU) admission, oxygen administration, mechanical ventilation, and death. We collected their absolute neutrophil (ANC) and lymphocyte count (ALC) within three days of diagnosis and compared values using Mann-Whitney U test.

Results

We identified 217 MM patients with hRV. Ninety (41%) had prior autologous stem cell transplant, 148 (68%) had received chemotherapy within 30 days. Ninety (41%) had chest imaging, with 11 (12%) having infiltrates. Out of the 217, 69 (31.9%) were admitted, with a mean length of stay of 3 days. 13% of the admitted patients were transferred to the ICU. 65.5% of the admitted patients needed oxygen, and two required mechanical ventilation. The mean ANC and ALC for the admitted group was 3.88 cells/µL and 1.22 cells/µL respectively, compared to 3.57 cells/µL and 1.07 cells/µL in the outpatient group, p=0.6 and 1. Five participants died.

Conclusion

Human Rhinovirus infection in MM patients was associated with significant morbidity, including hospitalization, ICU care, supplemental oxygen requirement, and even mechanical ventilation in 2 patients. Death was observed within 30 days, although rarely. The mean ALC and ANC were not predictive of the severity of the disease. Recognizing hRV effects on morbidity and mortality could lead to earlier recognition and management of complications in MM patients.

Disclosures

All Authors: No reported disclosures
152. Sharp Decline in Rates of Community Respiratory Viral Infections Among NIH Clinical Center Patients During the COVID-19 Pandemic
Authors: Woolbert Michele , Sinaii Ninet , Spalding Christine , Henderson David K , Palmore Tara N
Published: December 2021

Background

During the first year of the COVID-19 pandemic, nonpharmaceutical interventions had a broad impact on viral transmission apart from SARS-CoV-2. The NIH Clinical Center has used the BioFire FilmArray multiplex PCR respiratory pathogen panel (RPP) for evaluation of upper respiratory symptoms since 2014. Beginning in 3/20, respiratory samples from symptomatic patients were tested by SARS-CoV-2 PCR and the RPP. We performed a retrospective study comparing frequency and rates of community respiratory viruses detected by RPP from 1/14 through 3/21.

Methods

Results of RPPs from nasopharyngeal swabs/washes, bronchoalveolar lavages, and bronchial washes were included. Results from viral challenge studies were excluded. Charts were reviewed to determine whether repeat positives for the same virus within 12 months represented new infections; repeats from the same infection were excluded. A quantitative data analysis was completed using cross tabulations; comparisons were done using mixed models, applying Dunnett’s correction for multiplicity.

Results

A total of 3,329 patients underwent 8,122 RPPs from 1/14 through 3/21. Frequency of all respiratory pathogens declined from an annual range of 0.88-1.97% from 1/14-3/20 to 0.29% in 4/20-3/21 (p < 0.001). Individual viral pathogens declined sharply in frequency during the pandemic, with zero cases of influenza A/B, parainfluenza, or metapneumovirus detected from 4/20-3/21. One case each of adenovirus, RSV, CoV OC43, and CoV HKU1 were detected in 4/20-3/21. Rhino/enterovirus detection continued, but with a substantially lower frequency of 4.27% in 4/20-3/21, compared with an annual range of 8.65-18.28% from 1/14-3/20 (p < 0.001).

Frequency of detection of all respiratory pathogens tested using the Biofire FilmArray multiplex PCR respiratory pathogen panel from January 2014 through March 2021. The frequency of pathogen detection from April 2020 through March 2021 declined substantially in comparison with previous years.

Frequency of detection of influenza A, influenza B, rhinovirus/enterovirus, parainfluenza (1, 2, 3, 4), and respiratory syncytial virus from January 2014 through March 2021. The frequency of detection of these pathogens declined sharply starting in April 2020.

Conclusion

During the pandemic, the burden of viral respiratory infections detected among patients at the NIH Clinical Center improved considerably. This reprieve was likely thanks to the layered COVID-19 prevention and mitigation measures implemented in the community and the hospital: masking, distancing, symptom screening, isolation and testing symptomatic persons. As COVID-19 vaccination allows relaxation of masking, community transmission of respiratory viruses will likely resume; continued mask-wearing in the hospital may provide an enduring benefit by preventing nosocomial transmission.

Disclosures

Tara N. Palmore, MD, Nothing to disclose
1328. Risk Factors for Severe Influenza Outcomes Among Infants Born Between 2011 and 2019
Authors: Chamseddine Sarah , Zaheer Haniah A , Williams John V , Martin Judith M , Rick Anne-Marie , Liu Hui
Published: December 2021

Background

Influenza in infancy can cause significant morbidity and mortality. This study aimed to characterize influenza outcomes in infants < ορ = 12 months and identify risk factors for severe infection.

Methods

A retrospective cohort of infants ≤ 12 months born between 2011-2019 who received longitudinal ambulatory and inpatient care within a multi-facility hospital system and had laboratory-confirmed influenza were included. Perinatal, medical and illness characteristics were described. Risk factors for severe influenza (hospitalization, intensive-care unit (ICU) admission, secondary bacterial infections) were analyzed using Chi-square analysis and multivariate logistic regression.

Results

Among 421 infants with influenza, 134 (32%) were < 6 months (m), 28 (6.5%) were born prematurely (< 35 weeks gestational age), and 41(10%) had chronic medical conditions (CMC). 62 (15%) required hospital admission, 13 (21%) of which required ICU care. No deaths were reported. Secondary bacterial infections were diagnosed in 101 (24%) including acute otitis media (84%), pneumonia (15%) and sinusitis (3%). Prematurity (OR 3.6, 95%CI:1.5-8.3), age < 6m (OR 3.4, 95%CI:1.9-5.9), and CMC (OR 7.6, 95%CI 3.8-15.3) were significantly associated with hospitalization. Prematurity, age < 6m, and CMC were also associated with ICU admission. Infants > 6m (OR 2, 95%CI:1.2-3.5) were more likely to be diagnosed with a secondary bacterial infection than younger infants. Among infants > 6m, complete influenza vaccination (2 doses) was associated with lower rates of antibiotic use (OR 0.5, 95% CI:0.3-0.9) compared to partial or no vaccination, but did not significantly affect hospitalization, ICU admission, or frequency of secondary bacterial infections. Adjusting for prematurity, age < 6m remained associated with hospitalization (aOR 4, 95%CI: 2.1-7.3) as did presence of CMC (aOR 7.3, 95%CI 3.3- 15.7). For ICU admission, age < 6m (aOR 6.3, 95%CI:1.6-24.1) and CMC (aOR 19.7,95%CI:4.9-79.5) were also independent risk factors.

Conclusion

Younger age and chronic medical conditions were independent risk factors for severe influenza infection. Complete influenza vaccination in eligible age groups was associated with decreased antibiotic use.

Disclosures

John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member, Independent Data Monitoring Committee)Quidel (Advisor or Review Panel member, Scientific Advisory Board) Judith M. Martin, MD, Merck Sharp and Dohme (Consultant)
1330. Clinical Associations and Trajectory of “Long COVID”
Authors: Jacobson Karen , Balasubramanian Vidhya , Bonilla Hector F , Madrigal Martina , Hack Isabelle , Purington Natasha , Singh Upinder , Hedlin Haley , Jagannathan Prasanna
Published: December 2021

Background

Persistent symptoms after acute COVID-19 are being increasingly reported. To date, little is known about the cause, clinical associations, and trajectory of “Long COVID”.

Methods

Participants of an outpatient clinical trial of Peginterferon-Lambda as treatment for uncomplicated SARS-CoV-2 infection were invited to long term follow-up visits 4, 7, and 10 months after initial COVID-19 diagnosis. Ongoing symptoms and functional impairment measures (work productivity and activity index (WPAI), NIH toolbox smell test, 6-minute walk test) were assessed and blood samples obtained. “Long COVID” was defined as presence of 2 or more typical symptoms (fatigue, hyposmia/hypogeusia, dyspnea, cough, palpitations, memory problems, joint pain) at follow up. Associations between baseline characteristics, initial COVID-19 clinical course, and presence of “Long COVID” during follow-up were assessed using generalized estimating equations accounting for repeated measurements within individuals.

Results

Eighty-seven participants returned for at least one follow-up visit. At four months, 29 (34.1%) had “Long COVID”; 19 (24.7%) met criteria at 7 months and 18 (23.4%) at 10 months (Figure 1). Presence of “Long COVID” symptoms did not correlate significantly with functional impairment measures. Female gender (OR 3.01, 95% CI 1.37-6.61) and having gastrointestinal symptoms during acute COVID-19 illness (OR 5.37, 95% CI 1.02-28.18) were associated with “Long COVID” during follow-up (Figure 2). No significant associations with baseline immunologic signatures were observed.

Figure 1. Alluvial plot of long term follow-up participants showing outcomes of symptoms at each visit.

Figure 2. Generalized Estimating Equations Model showing associations with “Long COVID” (presence of 2+ symptoms) at month 4, 7, and 10 following acute infection using unstructured correlation matrix.

Conclusion

“Long COVID” was prevalent in this outpatient trial cohort and had low rates of resolution over 10 months of follow up. Female sex and gastrointestinal symptoms during acute illness were associated with “Long COVID”. Identifying modifiable risk factors associated with the development of persistent symptoms following SARS-CoV-2 infection remains a critical need.

Disclosures

All Authors: No reported disclosures
1332. Clinical Indicators for When Bronchoalveolar Lavage (BAL) Is Needed Beyond Nasopharyngeal Swab (NP) Testing for Viral Respiratory Infections
Authors: Ulrich Patrizia , Chen Derrick
Published: December 2021

Background

This study evaluated the yield of testing NP vs BAL specimens using a multiplex PCR respiratory viral panel (RVP).

Methods

A retrospective chart review was conducted on all patients from 10/2017-3/2021 who had both an NP swab and BAL tested by RVP within a 4-week period.

Results

There were 477 cases where patients had both an NP and BAL specimen tested by RVP. Results were NP-/BAL- for 361 (76%) cases, NP+/BAL+ for 58 (12%), NP-/BAL+ for 40 (8%), and NP+/BAL- for 18 (4%). For NP+/BAL+, NP-/BAL+, and NP+/BAL-, respectively, rhinovirus was detected in 23 (40%), 3 (8%), and 16 (89%) cases (p< 0.001); influenza A or B in 9 (16%), 7 (18%), and 0 (0%) (ns); adenovirus in 3 (5%), 10 (25%), and 2 (11%) (p< 0.05); metapneumovirus in 9 (16%), 8 (20%), 2 (11%) (ns); RSV in 8 (14%), 6 (15%), and 1 (6%) (ns); and, parainfluenza in 7 (12%), 6 (15%), and 1 (6%) (ns), respectively. Average ages were 48, 48, and 48 years; numbers of males were 34 (58%), 28 (70%), and 11 (61%); immunocompromised were 56 (97%), 37 (92%), and 17 (94%); and, 16 (28%), 10 (25%), and 6 (33%) had an active malignancy, respectively (all ns). Average symptom durations prior to presentation were 7.0, 13.1, and 9.6 days (ns); pulmonary exams were abnormal in 35 (60%), 24 (60%), and 5 (28%) cases (p< 0.05); shortness of breath (SOB) was present in 40 (69%), 25 (62%), and 8 (44%) (ns); lower respiratory tract infection (LRTI) symptoms were absent in 1 (2%), 12 (30%), and 8 (45%) cases (p< 0.01); when spirometry values were available, they were reduced in 28/31 (90%), 15/19 (79%), and 3/8 (37%) cases (p< 0.05); and, mean SpO2 levels were 91.5%, 93.9%, and 93.7% (ns), respectively. Mean temperatures were 99.0F, 99.0F, and 99.1F (ns); chills, sweats, and malaise were present in 27 (47%), 13 (33%), and 3 (17%) cases (p< 0.05); GI symptoms were present in 20 (34%), 5 (13%), and 10 (56%) cases (p< 0.05); and, acute kidney injury was present in 38 (66%), 13 (33%), and 6 (33%) cases (p< 0.05), respectively.

Conclusion

Most (88%) RVP test results were concordant between NP and BAL. There were significant differences between cases of NP+/BAL+, NP-/BAL+, and NP+/BAL-. Rhinovirus and GI symptoms were more common for NP+/BAL- vs NP-/BAL+. Conversely, pulmonary exams were more often abnormal and spirometry values reduced for NP-/BAL+ vs NP+/BAL-.

Disclosures

All Authors: No reported disclosures
1333. A National Outbreak of Respiratory Syncytial Virus Associated with Emergence of a Genetically Distinct ON1 variant
Authors: Lin Wei Hsuan , Wu Fang-Tzy , Chen Yi-Yin , Tsao Kuo Chien , Hsieh Yu-Chia
Published: December 2021

Background

A national outbreak of respiratory syncytial virus (RSV) has been observed in the community since Fall 2020 in Taiwan.

Methods

We reviewed a national laboratory-based surveillance network established over 20 years by Taiwan Centers for Disease Control (TCDC) for respiratory viral positivity rate and viral pathogen in outpatient department and hospitalized patients. A retrospective study of children younger than 5 years old hospitalized with RSV infections at Chang Gung Memorial Hospital (CGMH) including Lin Kou and Kaohsiung branch between 2018 and 2020 was conducted. Samples positive for RSV A were sequenced. Patients’ clinical data was obtained from medical files and stratified by genotype and year.

Results

2020 showed a 4-fold surge in RSV cases in Taiwan, in which surpassed both 2011 (the appearance of ON1 strain in Taiwan) and 2013 (ON1 strain predominates in Taiwan)(Figure1,Table1). Phylogenetic analysis of G protein sequences showed that most strains in 2020 were clustered apart from 2018, 2019 seasons and other ON1 reference strains between 2011 and 2016, indicating a novel ON1 variant had been circulating in the community(Figure2). The novel ON1 variants carried six amino acid changes, of which T113I,V131D, H258Q,H266L,Y304H located in the mucin domains and N178G in central conserved domain. These changes emerged gradually in 2019 and showed a high consistency in 2020. The unique amino acid substitution E257K in the second mucin domain was noticed in 2020 exclusively. Besides, 10 substitutes in F protein were appeared between 2018 and 2020, of which R213S and N276S were in antigenic sites. Furthermore, substitutes T12I and H514N in F protein were first emerged since 2020. On multivariate analysis, age (OR 0.97; 95% CI 0.94-0.99; p 0.02) and ON1 variant in 2020 (OR 2.52; 95% CI 1.13-5.63; p 0.025) were independently associated with oxygen saturation < 94% during hospitalization (Table 2).

Figure 2. The phylogenetic tree of G protein sequences including ON1 strains in our study from 2018 to 2020 and reference strains from 2011 to 2016

The phylogenetic tree showed that most strains of the 2020 season clustered apart from those of the previous seasons, which indicated there was a novel ON1 variant circulating in the community associated with 2020 RSV epidemic.

Variables with p<0.1 in the univariate analysis were included in the multivariate analysis.

Conclusion

An unprecedented RSV epidemic within the last 10 years caused by a novel ON1 variant has occurred in 2020 (Figure 1), suggesting the sets of mutations may confer fitness advantage. Further studies on viral replication, infectivity and virulence is needed to understand the evolution and spread of RSV.

Disclosures

All Authors: No reported disclosures
1335. High Serum Levels of Interleukin-10 as a Predictor Factor of In-Hospital Mortality in COVID-19 Patients
Authors: Gomez-Duque Salome , Gamboa-Silva Enrique , Bustos-Moya Ingrid G , Fuentes Yuli , Lozada-Arciniegas Julian , Ibañez-Prada Elsa Daniela , Narváez - Ramírez Oriana , Morales-Cely Lina , Bravo-Castelo Laura A , Ramirez Paula , Parra-Tanoux Daniela , Caceres Edar , Santos Ana , Londoño Jhon , Reyes Luis F
Published: December 2021

Background

Since the spread of SARS-CoV-2 worldwide, there has been the need for scores and biomarkers to identify patients at risk of died or requiring admission to the intensive care units (ICU) admission. Interleukin-10 (IL-10) is released as a response to the infection, stimulating inflammatory pathways in the acute phase response. Thus, previous studies have shown that high serum concentrations IL-10 can be identify patients with severe community acquired pneumonia (CAP). Nevertheless, there is a lack of information regarding the capacity of IL-10 to identify severe COVID-19. Thus, the aim of this study was to determine the capacity of IL-10 as a prediction factor for mortality in hospital admitted patients with COVID-19 compared with CAP patients.

Methods

A prospective observational study was carried out at the Clinica Universidad de La Sabana, Colombia. Patients older than 18 years and old, hospitalized due to COVID 19 or CAP, were included. Patients were stratified into COVID-19 and non-COVID-19 patients. IL-10 levels were quantified in serum samples using the LUMINEX technology. Serum samples were collected within the first 24 hours of hospital admission. Afterward, concentrations of interleukinwere statistically compared among groups. ROC curves were calculated.

Results

A total of 88 patients with CAP and 152 patients with COVID-19 were enrolled in the study. The median [with IQR] serum concentration of IL-10 were higher in those patients who died (81.1 [30.7-148.9] vs 18.8 [8.3-48.4] p-value < 0.0001). Then, comparing the study group, the median concentration of IL-10 levels among patients deceased by COVID-19 were higher than patients those who survived (85.1 [40-149.8] vs 32.4 [13.9-56.7] p-value < 0.001). In addition, IL-10 levels were higher in patients who survived COVID-19 compared with those who survived CAP (32.4 [13.9-56.7] vs 10.6 [4.9-18] p-value < 0.0001). The area under curve (AUC) ROC of IL-10 to predict mortality risk was 0.754 for all cohort. DeLong′s test comparing ROC curves in COVID-19 and CAP patients had a p= 0.744.

Conclusion

High serum levels of IL-10 are a good predictor of in-hospital mortality among COVID-19 patients. However, this risk association was not observed in CAP patients. Further studies are needed.

Disclosures

All Authors: No reported disclosures
1336. Outcomes of COVID-19 in Recent Kidney Transplants Recipients at a Large Transplant Center in Miami
Authors: Mendoza Maria A , Coro Ana , Natori Yoichiro , Anjan Shweta , Guerra Giselle , Mattiazzi Adela , Chen Linda , Morsi Mahmoud , Figueiro Jose , Raveh Yehuda , Simkins Jacques
Published: December 2021

Background

Outcomes of COVID-19 have been reported in deceased donor kidney transplant (DDKT) recipients. However, data is limited in patients that underwent recent DDKT.

Methods

This single-center retrospective study evaluated the differences in demographics and post-transplant outcomes between those who tested positive and negative for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by polymerase chain reaction, after undergoing recent DDKT. The treatments and outcomes for the SARS-CoV-2-positive patients were assessed. Patients who underwent DDKT from 3/2020 to 8/2020 were included and followed until 9/2020.

Results

201 DDKT recipients were analyzed [14(7%) SARS-CoV-2-positive and 187(93%) negative]. There was no difference in delayed graft function and biopsy-proven rejection between both groups. The patient survival at the end of the study follow-up was lower among SARS-CoV-2-positive patients (Table 1). The median time from DDKT to COVID-19 diagnosis was 45 (range: 8-90) days; 5(36%) patients required intensive care unit and 4(29%) required mechanical ventilation; steroids were used in all the patients, therapeutic plasma exchange (TPE) and convalescent plasma (CP) in 7(50%) patients each, remdesivir in 6(43%) and tocilizumab in 1(7%); 9(64%) patients recovered, 3(21%) died and two were still requiring mechanical ventilation at the end of the follow-up.

Conclusion

Our cohort demonstrated a lower survival rate among SARS-CoV-2-positive patients, which highlights the vulnerability of the transplant population. Transplant patients must comply with the CDC recommendations to prevent COVID-19.

Disclosures

All Authors: No reported disclosures
153. Gone Are the Other Respiratory Viruses During COVID…but the Rhinovirus/Enterovirus “Cockroach” Persists!
Authors: Singh Jasjit , Huff Beth , Nieves Delma , Gornick Wendi
Published: December 2021

Background

In a typical winter respiratory season, Influenza A, Influenza B, Respiratory Syncytial Virus (RSV) and human Metapneumovirus (hMPV) infections are common in pediatrics. During the COVID-19 pandemic, we noted a marked decrease in all except for Rhinovirus/Enterovirus at our free-standing quaternary level children’s hospital.

Methods

We prospectively reviewed all patients with positive testing for viral respiratory pathogens from October 1, 2018 through May 29, 2021. Testing was done by polymerase chain reaction (PCR) (BioFire® FilmArray® Respiratory 2 Panel, UT) and by SARS-CoV-2 PCR testing (Cepheid®, CA). The latter may have been done for pre-procedure or admission screening. We submitted 74 specimens to the California Department Public Health (CDPH) for definitive identification and serotyping analysis.

Results

The number of Rhinovirus/Enterovirus (RV/EV) infections was compared with Influenza A & B, RSV, and hMPV over the past 3 years. There was a 152% increase in RV/EV from 2018-2019 to 2020-2021 with near absence of other respiratory viruses (Figure 1). In 2020-2021, RV/EV (N=877, 84%) made up a larger percentage of all viral etiologies compared to 2018-2019 (N=348, 11%) (Figure 2). Healthcare acquired infections (HAI) due to respiratory viruses decreased in 2020-2021 compared to both of the prior seasons, though all cases were due to RV/EV (Figure 3). There were no RV/EV associated deaths. Of 74 submitted, CDPH did typing on 24 samples; all were found to be rhinovirus (RV).

Figure 1. High-Risk Winter Viral Infections 2019-2021.

Figure 2. Distribution of Winter Viral Pathogens 2018-2019 Compared to 2020-2021 Season.

Figure 3. Winter Viral Healthcare Associated Infections 2019-2021.

Conclusion

We experienced a marked increase in RV/EV during COVID precautions, despite a near absence of other common respiratory viruses. This was reflected in both our community data and HAI due to respiratory viruses. There was a marked increase in RV/EV starting with week 18 (Figure 4). We hypothesize this is due to schools’ re-opening. Understanding RV epidemiology and transmission is important, as it may inform return to school and work protocols for the upcoming respiratory viral season.

Figure 4. Rhinovirus/Enterovirus by Week for the 2020-2021 Season.

Disclosures

All Authors: No reported disclosures
1338. Before and After: The Impact of the COVID-19 Pandemic on Influenza-Like Illness Trends in PAIVED
Authors: Colombo Rhonda E , Richard Stephanie A , Schofield Christina , Collins Limone , Ganesan Anuradha , Geaney Casey , Hrncir David , Lalani Tahaniyat , Markelz Ana E , Maves Ryan C , Maves Ryan C , McClenathan Bruce , Mende Katrin , Modi Jitu , Montgomery Jay R , Seshadri Srihari , Skerrett Catherine , Spooner Christina , Utz Gregory , Williams Alan , Burgess Timothy , Coles Christian L
Published: December 2021

Background

The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) is a multicenter study assessing influenza vaccine effectiveness in active duty service members, retirees, and dependents. PAIVED recently completed its third year and offers a unique opportunity to examine influenza-like illness (ILI) trends prior to and during the COVID-19 pandemic in a prospective, well-defined cohort.

Methods

During the 2018-19, 2019-20, and 2020-21 influenza seasons, PAIVED enrolled DoD beneficiaries presenting for annual influenza vaccination. After collecting baseline demographic data, participants were randomized to receive egg-based, cell-based, or recombinant-derived influenza vaccine. Weekly throughout the influenza season of enrollment, participants were surveyed electronically for ILI, defined as (1) having cough or sore throat, plus (2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for seven days and submitted a nasal swab for pathogen detection.

Results

Over the three seasons, there were 10,656 PAIVED participants: 1514 (14.2%) in 2018-19, 5876 (55.1%) in 2019-20, and 3266 (30.6%) in 2020-21. The majority were male (68-73% per year) with a mean age of 34±14.8 years at enrollment. 2266 participants reported a total of 2673 unique ILIs. The highest percentage of participants with ILI was in 2019-20 (28.2%), versus 19.6% in 2018-19 and 9.6% in 2020-21. Figure 1 depicts the percent of individuals reporting ILI by week of the season for each of the PAIVED seasons. Notably, after March 21, 2020, the weekly incidence of participants reporting ILI never exceeded 1%.

Figure 1. Percent of PAIVED participants reporting ILI by week of season.

Conclusion

The low incidence of reported ILI in PAIVED participants during the COVID-19 pandemic is consistent with national influenza surveillance reports of influenza and outpatient ILI activity, suggesting that mitigation measures taken to reduce transmission of SARS-CoV-2 reduced the spread of other respiratory viruses.

Disclaimer

Disclosures

Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker’s Bureau)
1341. Relative Vaccine Effectiveness Against Influenza-related Hospitalizations and Respiratory Events During the 2019/20 Influenza seAson in U.S. Children and Adults. A Real-World Evidence Comparison Between Quadrivalent Cell-based and Egg-based Influenza Vaccines
Authors: Pelton Stephen I , Postma Maarten , Divino Victoria , Mould-Quevedo Joaquin F , Anupindi Ruthwik , DeKoven Mitchell , levin myron J
Published: December 2021

Background

Non-egg-based influenza vaccine manufacturing reduces egg adaptation and therefore has the potential to increase vaccine effectiveness. This study evaluated whether the cell-based quadrivalent influenza vaccine (QIVc) improved relative vaccine effectiveness (rVE) compared to standard-dose egg-based quadrivalent influenza vaccine (QIVe-SD) in the reduction of influenza-related and respiratory-related hospitalizations/emergency room (ER) visits among subjects 4-64 years old during the 2019/20 influenza season.

Methods

A retrospective analysis was conducted among subjects 4-64 years old vaccinated with QIVc or QIVe-SD using administrative claims data in the United States of America (U.S.) (IQVIA PharMetrics® Plus). Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounders. Post-IPTW, the number of events and rates (per 1,000 vaccinated subject-seasons) of influenza-related hospitalizations/ER visits, respiratory-related hospitalizations/ER visits and all-cause hospitalizations were assessed. Poisson regression was used to estimate adjusted rVE. To avoid any influenza outcome misclassification with COVID-19 infection, the study period ended March 7,2020. A sub-analysis for a high-risk subgroup was conducted. Urinary tract infection (UTI) hospitalization was assessed as a negative control endpoint.

Results

During the 2019/20 influenza season, 1,150,134 QIVc and 3,924,819 QIVe-SD recipients were identified post-IPTW. Overall adjusted analyses (4-64 years old) found that QIVc was associated with a significantly higher rVE compared to QIVe-SD against influenza-related hospitalizations/ER visits (5.3% [95% CI: 0.5%-9.9%]), all-cause hospitalizations (14.5% [95% CI: 13.1%-15.8%]) and any respiratory-related hospitalization/ER visit (8.2% [95% CI: 6.5%-9.8%]). A similar trend was seen for the high-risk subgroup; for instance, rVE for QIVc compared to QIVe-SD against influenza-related hospitalizations/ER visits was 10.5% [95% CI: 2.9%-17.4%]. No effect was identified for the negative control outcome.

Conclusion

QIVc was significantly more effective in preventing influenza-related and respiratory-related hospitalizations/ER visits, as well as all-cause hospitalizations, compared to QIVe-SD.

Disclosures

Stephen I. Pelton, MD, Seqirus (Consultant) Maarten Postma, Dr., Seqirus (Consultant) Victoria Divino, PhD, Seqirus (Consultant) Joaquin F. Mould-Quevedo, PhD, Seqirus (Employee) Ruthwik Anupindi, PhD, Seqirus (Consultant) Mitchell DeKoven, PhD, Seqirus (Consultant) myron J. levin, MD, GSK group of companies (Employee, Research Grant or Support)
1342. TOSCANA: The Observational Seroepidemiologic Study of COVID-19 at the United States Naval Academy
Authors: Millar Eugene , Laing Eric , Saperstein Adam , Modi Jitu , Heaney Christopher , Fraser Jamie , Shaikh Saira , Pollett Simon , Broder Christopher C , Burgess Timothy , Coles Christian L
Published: December 2021

Background

University students, including those at military service academies, are at increased risk of acute respiratory infection (ARI), including SAR-CoV-2, due to crowded living conditions, frequent social interaction and other factors that facilitate pathogen transmission. Unlike many universities, the United States Naval Academy (USNA) continued in-person instruction in Fall 2020 in the midst of the COVID-19 pandemic. The Observational Seroepidemiologic Study of COVID-19 at the United States Naval Academy (TOSCANA,) a longitudinal cohort characterizes the burden and risk factors of SARS-CoV-2 in USNA midshipmen.

Methods

Midshipmen were enrolled August- October 2020. Participants were queried about their ARI risk factors, COVID-19 history, and recent receipt of medical care for any ARI at enrollment, in December 2020 and again in May 2021. Subjects were also asked to provide blood and saliva samples to assess their SARS-CoV-2 serostatus at the same three timepoints. A saliva sample was collected by a subset of subjects in February 2021. Presence of anti-SARS-CoV-2 serum IgG in dried blood spots and saliva was measured by multiplex magnetic microparticle-based immunoassays.

Results

181 midshipmen consented to the study and completed the baseline survey (Table 1). 17 (17.5%) of the 97 subjects who submitted baseline blood sample were SARS-CoV-2 seropositive. Only 4 (24%) positive individuals reported having been tested for or diagnosed with COVID-19 prior to arrival at USNA. 121 participants completed the midyear survey, of whom 61 (50%) submitted a blood sample. 16 (26%) of the midyear specimens were SARS-CoV-2 positive. Of these, 3 were new infections. 73 subjects completed the May survey, and 63 (100%) of the submitted blood samples were positive. 83 subjects provided baseline saliva samples, and ~55 submitted saliva at each successive time point. 1 (5%) was positive at enrollment, 9 (17%) were positive at midyear and 47 (96%) were positive in May.

Table 1. Key characteristics of TOSCANA participants

Conclusion

SAR-CoV-2 prevalence in a sample of USNA midshipmen was < 20% at enrollment. A small proportion of subjects seroconverted between the September and December visits. SARS-CoV-2 positivity rose in May, following a COVID-19 outbreak in February and COVID-19 vaccination efforts in March at USNA.

Disclosures

Jitu Modi, MD, GSK (Speaker’s Bureau)
1343. Viral and Bacterial Pneumonia Hospitalizations — New York City, 2001–2016
Authors: Huang Chaorui , Foerster Steffen , Iskhakova Faina , Aracena Joaquin
Published: December 2021

Background

This study was to investigate the burden and trend of viral and bacterial pneumonia hospitalization in New York City (NYC) from 2001 to 2016.

Methods

We analyzed hospital discharge data for NYC residents during 2001–2016 using Statewide Planning and Research Cooperative System. Annual crude hospitalization rate and percentage of in-hospital all causes death were calculated, using NYC population as denominator. Poisson regression was performed to assess temporal trends of pneumonia hospitalization rate and percentage of in-hospital death from 2001 to 2016.

Results

During 2001–2016, there were 122,324 pneumonia hospitalizations with identified viral or bacterial pathogen in NYC, of which 7,826 (6.4%) were influenza, 13,059 (10.7%) were other viruses, 11,847 (9.7%) were pneumococcus, and 89,592 (73.2%) were other bacteria. From 2001 to 2016, there was significantly increased viral and bacterial pneumonia hospitalization rate, except for pneumococcal pneumonia, and pneumococcal pneumonia had significantly decreased hospitalization rate (p< 0.0001). From 2001 to 2016, the percentage of in-hospital death for viral pneumonia except influenza significantly increased (p=0.0002), whereas decreased for bacterial pneumonia (p< 0.0001). Patients aged ≥65 years old had the highest percentage of in-hospital death among all ages for both viral and bacterial pneumonia, especially there was 19.5% of in-hospital death for pneumococcal pneumonia and 23.4% for other bacterial pneumonia.

Conclusion

While hospital discharge data are subject to limitations particularly for large amount of un-identified pathogens for pneumonia, our analysis showed increased viral activities considering the changes in hospitalization rate and percentage of in-hospital death in NYC during 2001–2016. There was a reduced pneumococcal pneumonia hospitalization rate and percentage of in-hospital death, likely related to the increased vaccine uptake, and a reduced percentage of in-hospital death for overall bacterial pneumonia, likely related to improved antibiotic treatment management. Further studies are warranted to evaluate the necessity of increasing the pneumococcal vaccine coverage in elderly, as well as reducing antimicrobial resistance to improve the management of bacterial infection.

Disclosures

All Authors: No reported disclosures
1344. Predicting Measles Outbreaks in the United States: Application of Different Modeling Approaches
Authors: Kujawski Stephanie , Ru Boshu , Das Amar K , Afanador Nelson L , baumgartner richard , Liu Zhiwen , Lu Shuang , Pillsbury Matthew , Lewnard Joseph , Conway James H , Pawaskar Manjiri D
Published: December 2021

Background

Although measles is still rare in the United States (U.S.), there have been recent resurgent outbreaks in the U.S. To improve the accuracy of prediction given the rarity of measles events, we used machine learning (ML) algorithms to model measles case predictions at the U.S. county level.

Methods

The main outcome was occurrence of ≥1 measles case at the U.S. county level. Two ML prediction models were developed (HDBSCAN, a clustering algorithm, and XGBoost, a gradient boosting algorithm) and compared with traditional logistic regression. We included 28 predictors in the following categories: sociodemographics, population statistics, measles vaccination coverage, healthcare access, and exposure to measles via international air travel. The models were trained on 2014 case data and validated on 2018 case data. Models were compared using area under the receiver operating curve (AUC), sensitivity, specificity, positive predictive value (PPV), and F2 score (combined measure of sensitivity and PPV).

Results

There were 667 measles cases in 2014 and 375 in 2018 in the U.S. We identified U.S. counties for 635 (95.2%) cases in 2014 and 366 (97.6%) cases in 2018 through published sources, corresponding to 81/3143 (2.6%) counties in 2014 and 64/3143 (2.0%) counties in 2018 with ≥1 measles case. HDBSCAN had the highest sensitivity (0.92), but lowest AUC (0.68) and PPV (0.04) (Table). XGBoost had the highest F2 score (0.49), best balance of sensitivity (0.72) and specificity (0.94), and AUC = 0.92. Logistic regression had high AUC (0.91) and specificity (1.00) but the lowest sensitivity (0.16).

Conclusion

Machine learning approaches outperformed logistic regression by maximizing sensitivity to predict counties with measles cases, an important criterion to consider to prevent or prepare for future outbreaks. XGBoost or logistic regression could be considered to maximize specificity. Prioritizing sensitivity versus specificity may depend on county resources, priorities, and measles risk. Different modeling approaches could be considered to optimize surveillance efforts and develop effective interventions for timely response.

Disclosures

Stephanie Kujawski, PhD MPH, Merck & Co., Inc. (Employee, Shareholder) Boshu Ru, Ph.D., Merck & Co. Kenilworth, NJ (NYSE: MRK) (Employee, Shareholder) Amar K. Das, MD, PhD, Merck (Employee) richard baumgartner, PhD, Merck (Employee) Shuang Lu, MBA, MS, Merck (Employee) Matthew Pillsbury, PhD, Merck & CO. (Employee, Shareholder) Joseph Lewnard, PhD, Merck (Consultant, Grant/Research Support) James H. Conway, MD, FAAP, GSK (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Moderna (Advisor or Review Panel member)Pfizer (Advisor or Review Panel member)Sanofi Pasteur (Research Grant or Support) Manjiri D. Pawaskar, PhD, Merck & Co., Inc. (Employee, Shareholder)