bluuebunny/crossref_metadata_2025 huggingface dataset:
327. Assessment of Bacterial Co-infection Rates and Antibiotic Exposure in COVID-19 Patients
Authors: Luetkemeyer Adam J , Bennett Nick , Aragon Laura , Ploetz Jeannette , Boyd Sarah E
Published: December 2021

Background

COVID-19 pandemic data suggest risk for bacterial co-infection upon hospital presentation remain extremely low. Despite low co-infection rates, antibiotics are prescribed for most patients. Current data are limited regarding institutional-specific change in antibiotic use over the course of the pandemic. Given the low rates of co-infections, Saint Luke’s Health System’s COVID-19 Treatment Taskforce developed a COVID-19 evaluation and treatment order set which included procalcitonin (PCT) . As co-infection literature emerged, active education was provided, and order sets were modified to provide passive education regarding co-infection rates. We aimed to assess antibiotic practice changes as data and strategies to influence use evolved during the pandemic.

Methods

This was a multi-center, single health-system retrospective cohort study. Ten community hospitals and 1 academic medical center were included in analysis. Inclusion criteria were age ≥18 years, admitted during April or September 2020 and had a positive COVID-19 result on admission. Patients were excluded if they were readmitted for COVID-19 related issues. Both primary and secondary outcomes were analyzed from the first 7 days after admission. The primary outcome was rate of respiratory bacterial co-infections. This was determined through sputum and blood cultures, urinary antigens including Streptococcus pneumoniae and Legionella, and PCT. Secondary outcomes included rate of antibiotic use, antibiotic days of therapy (DOT), length of therapy, and antibiotic use trends.

Baseline Characteristics

Results

A total of 294 patients were included with 69 patients in April 2020 and 225 in September 2020. Primary and secondary results are shown in Table 2. Rate of culture-confirmed bacterial co-infection when examining April 2020 was 4.38% and 4.44 % in September 2020. Antibiotic uses, antibiotic DOT, and length of therapy were all significantly lower in September 2020 compared to April 2020.

Conclusion

Our results show bacterial co-infections were extremely low in our health system. Despite positive trends in antibiotic use, prescribing remained high. More targeted interventions to decrease antibiotic exposure in COVID-19 patients are needed.

Disclosures

All Authors: No reported disclosures
328. Bacteremia in Patients Hospitalized with Covid-19 Disease, Risk Factors, Impact of immunomodulator Therapy, Role of Inflammatory Markers, Antibiotic Use, and Outcomes: A Single Center Retrospective Study
Authors: Zahra Aleena , Fries Bettina C , Fries Bettina C
Published: December 2021

Background

Novel coronavirus 2019 (Covid19) caused by SARS-CoV2 can lead to significant morbidity and mortality. There is unclear association between Covid19 and bacteremia. Patient characteristics and outcomes are not well defined. This retrospective cohort study assessed this in patients with Covid19 and bacteremia.

Methods

Patients with Covid-19 admitted to a tertiary care suburban academic medical center (UH) were assessed retrospectively by EMR chart review for co-morbidities, pre and in hospital factors, and outcomes as defined below. Bacteremias grouped into gram-negative or gram-positive with collation of each unique bacterial species (Table 1).

Results

Total 1398 patients with Covid19 hospitalized at UH during local peak of pandemic of whom 238 (17.02%) developed 264 bacteremias with gram-positive (244, 92.4%) and gram-negative organisms (20, 7.57%). Relevant characteristics (Table 2) 53% with immunomodulator therapy (steroids/Tocilizumab), mean length of stay 21.04days (SEM ± 1.67) with day SARS-CoV2 PCR positivity -1.15days from hospitalization (SEM ± 0.49) and day initial bacteremia 6.38 (SEM ± 0.77), 55.4% required ICU admission, with 89% ICU admissions requiring mechanical ventilation. Most common co-morbidity (Figure 1 full list) Hypertension 56.3% followed by Obesity (BMI >30) 45.8% and CAD/CHF 40.3%. Laboratory parameters (Table 3)significant for average difference (date bacteremia- date admission) for Procalcitonin 4.15ng/mL (SEM ± 0.97, p-value 0.02), CRP -0.934mg/dL (SEM ± 0.95, p-value 0.32), WBC 7.027 K/uL (SEM ± 0.65, p-value < 0.005). These analyses excluded difference of 0 from hospital day 1 bacteremia. Average antibiotic number (1+ dose per antibiotic) 3.24 (SEM ± 0.16) and total C difficile cases 3 (1.26%). Mortality rate34.45%.

Relevant hospitalization characteristics, Covid19 and bacteremia co-infections

Relevant laboratory parameters for patients with Covid19 and bacteremia co-infection

Conclusion

Patients with Covid19 and bacteremia had high mortality (Figure 2), 53% received immunomodulator therapy, possibly contributing to bacteremia development. With bacteremia increase in WBC and Procalcitonin, not CRP, noted. Most organisms CoNS, likely contaminants, gram positive bacteremias likely from indwelling lines. Only 3 C difficile infections identified. Trends noted in Procalcitonin rise, immunomodulator therapy, and low C difficile infection rates warrant further studies.

Post-hospitalization Outcomes

Disclosures

All Authors: No reported disclosures
329. Severe Obesity: A Critical Risk Factor for In-Hospital Complications and Mortality in the Hispanic Population
Authors: Baireddy Moulika , Neppala Sivaram , Sundarakumar Dinesh Kumar , Santos Hector
Published: December 2021

Background

Obesity, Diabetes mellitus type 2, race and other characteristics has been associated with an increased risk of adverse outcomes in patients with COVID-19 disease. The prevalence of obesity in the United States in 2017-2018 was 42.4%. Webb County, Texas with a 95.6% Hispanic population shows an obesity prevalence of 35.8% in 2014. It is unclear whether obesity increases the risks of complications and mortality in Hispanic population from COVID-19 disease.

Methods

This is a retrospective cohort study of patients admitted to the hospital with the diagnosis of COVID-19 between March 2020 and August 2020. 950 patients were tested and admitted to the hospital with the diagnosis of COVID-19 pneumonia. Patients were categorized into classes of body habitus by BMI: underweight (< 18.5), normal (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 ( >40.0).

Results

950 Hispanic patients were included (Male-52.8%, Female- 47.2%) in the study. In total, 19.05% of our patients died during the hospitalization with an increased risk of mortality in patients having obesity class 2 (RR 4.14, 95% CI = 2.2–7.7 p=< 0.0001), and obesity class 3 (RR 6.0, 95% CI = 1.3–4.6 p=< 0.0001) compared with those with normal BMI. Mortality was higher in obese patients who required invasive mechanical ventilation at 93.75% compared to obese patients who were non-ventilated at 4.29%. Patients with obesity class 2 and 3 had higher risks of in-hospital complications including AKI requiring renal replacement therapy, ARDS, and arrythmias most commonly atrial fibrillation/flutter at 26.7%, 18.42% and 13.5%.

Characteristics of In-hospital complication complications due to COVID-19 disease

Conclusion

Patients admitted to the hospital with the diagnosis of COVID-19 disease with obesity classes 2 and 3 have a significantly increased risk of mortality as compared to normal and overweight patients. Severe obesity was also associated with increased hospital complications of AKI, ARDS, and Atrial Fibrillation. This further affirms that obesity is a pertinent risk factor to be considered in COVID-19 patients.

Disclosures

All Authors: No reported disclosures
331. Hospitalized COVID-19 infections in Infants < 1 Year of Age
Authors: Gagliardo Christina , Nwaobasi-Iwuh Eberechi I , Shah Niva , Prasad Aparna , Kairam Neeraja , Chiu Stephanie , DeSantis Elizabeth , Nativ Simona , Laurie Kathryn , Di Pentima M Cecilia
Published: December 2021

Background

Nearly 4 million children have tested positive for coronavirus disease 2019 (COVID-19) in the United States. Some studies suggest infants might be at increased risk for severe illness and hospitalization from COVID-19. Our objective was to describe the clinical and laboratory features of young infants admitted to a hospital system with COVID-19.

Methods

An observational retrospective study was performed in infants ≤1 year of age admitted with COVID-19 from March 1, 2020 to May 30, 2021. Data was extracted into a REDCap database and analyzed using descriptive statistics.

Results

Sixteen infants < 1 year were hospitalized with COVID-19. Fever, poor feeding, and respiratory symptoms were the most common presenting symptoms (Table 1). Two required pediatric intensive care unit (ICU) care, three required oxygen support, and one was intubated. There were no deaths. Five infants with echocardiograms performed showed normal findings. Four infants received Remdesivir without side effects.

Conclusion

Infants with COVID-19 can present with severe disease requiring ICU care and oxygen support. In our experience, a large proportion of infants developed hematologic abnormalities, but none had cardiac involvement. Preventive measures including vaccination will become critical to decrease transmission and severe disease in this young patient population.

Disclosures

All Authors: No reported disclosures
333. Comparing COVID-19-related Morbidity and Mortality between Patients with and without Substance Use Disorder: A Retrospective Cohort Study
Authors: McLaughlin Angela , Burns Rebecca , Ryan Morgan , Assoumou Sabrina A
Published: December 2021

Background

Early data suggest that people with substance use disorder (SUD) who develop coronavirus disease 2019 (COVID-19) have increased intubation and mortality rates when compared to those without SUD. Information on other COVID-19-related complications in this population is limited. We evaluated COVID-19 outcomes in patients with and without SUD.

Methods

We created a retrospective cohort of patients with COVID-19 admitted to an urban safety net hospital from 3/16/2020 to 4/8/2020. Inclusion criteria were admission with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 and age greater than 18 years. SUD included alcohol use disorder or heavy alcohol use as defined by the National Institute on Alcohol Abuse and Alcoholism, use of cocaine, non-prescribed opioids or amphetamines. Primary outcome was inpatient mortality. Secondary outcomes were clinical complications (intubation, secondary infections, renal failure, venous thromboembolism, stroke, hepatitis, myocardial infarct, multisystem organ failure) and resource utilization (length of stay, intensive care unit [ICU] admission, ICU days, readmission). We used multivariable regression to assess factors associated with mortality and length of stay, and univariate analyses for other outcomes.

Results

Of 409 included patients, 70 (17.1%) had SUD. Those with SUD were more likely to be male and have pulmonary disease or hepatitis C. There were no differences in other comorbidities, mean age or race/ethnicity. After multivariable analysis, SUD was not associated with mortality (aOR 1.60; 95% CI, 0.60-3.81). Similarly baseline oxygenation defined as the ratio of oxygen saturation to fraction of inspired oxygen (aOR 1.57; 0.11-13.0) and administration of immunomodulatory therapy (tocilizumab, sarilumab or anakinra) (aOR 1.41; 0.65-3.01) did not affect mortality. In contrast, age (aOR 1.06; 1.03-1.09), sex (aOR 2.30; 1.04-5.47) and obstructive sleep apnea (aOR 4.07; 1.64-9.66) were associated with mortality. We did not find any associations with secondary outcomes.

Conclusion

Our findings suggest that substance use alone may not increase COVID-19 adverse outcomes. Future studies should evaluate these results in the current period of improved COVID-19 therapy.

Disclosures

All Authors: No reported disclosures
334. Impact of Overall Dexamethasone Exposure on Development of Invasive Pulmonary Aspergillosis in Hospitalized Patients with COVID-19
Authors: Skoglund Erik , Kum Amy , Mac Allison , Nguyen Mark
Published: December 2021

Background

Abbreviated courses of corticosteroids, such as dexamethasone, have demonstrated significant improvements in clinical outcomes among patients infected with COVID-19, although chronic corticosteroid use can predispose patients to opportunistic infections. The RECOVERY trial investigators showed reduced 28-day mortality among patients treated with 6 mg/day dexamethasone for up to 10 days, however in clinical practice the dosage and duration of dexamethasone therapy can vary widely based on severity of disease and provider discretion. Upon observing an anecdotal increase in the number of patients presenting with potential invasive aspergillosis during the third wave of COVID-19, we sought to evaluate the impact of overall dexamethasone exposure on the development of invasive pulmonary aspergillosis.

Methods

Patients presenting to our institution from Dec. 2020 – Jan. 2021 with positive PCR for SARS-CoV-2 were screened for dexamethasone therapy. Assignment of high vs low dose dexamethasone groups were retrospectively made based on overall dexamethasone exposure. Low dose dexamethasone assignment was restricted to a total exposure of no more than 78 mg during a patient’s hospitalization. Adjudication of invasive pulmonary aspergillosis was made based on criteria that included host factors, radiologic findings, clinical factors, and mycological evidence.

Results

Dexamethasone therapy was provided to 202 patients admitted to the hospital with COVID-19. Invasive pulmonary aspergillosis was determined to be probable in n=7 patients based on European Organization for Research and Treatment of Cancer (EORTC) criteria, and in n=13 patients based on expanded criteria. Patients in the low dose dexamethasone group were less likely to be diagnosed with probable IPA based on EORTC criteria (n=0, 0% on low dose vs. n=7, 11% on high dose) as well as expanded criteria (n=9, 5% on low dose vs. n=11, 17% on high dose), p< 0.001.

Conclusion

Patients hospitalized with COVID-19 receiving high-dose dexamethasone may be at a higher risk of opportunistic infections such as invasive pulmonary aspergillosis compared to patients who receive low-dose dexamethasone therapy. Further investigation is needed to obtain higher certainty of IPA diagnosis.

Disclosures

All Authors: No reported disclosures
335. Staphylococcus aureus Bacteremia as a Potential and Severe Complication from Intramuscular COVID-19 Vaccine Injection
Authors: Kus Miguel Sebastian Pedromingo
Published: December 2021

Background

Abscess formation and bacteremia following intramuscular injections are rare complications from vaccine injections, and they are most commonly seen in immunocompromised individuals. Staphylococcus aureus is one of the etiological agents that can be found during this complication. Spain started to vaccine its population at the beginning of 2021. We noticed an important increase in Staphylococcus aureus infections and bacteremia during this period of time, leading us to study the relationship with previous vaccination.

Methods

In this case series we present a cohort of twenty patients with Staphylococcus aureus bacteremia (SAB) during the study period (January 1, 2021 through May 31, 2021), attended in our Institution (Hospital Nuestra Señora de Sonsoles, Ávila, Spain). We tried to establish or at least create the debate of a possible relationship with a previous COVID-19 vaccine.

Results

From January 1, 2021 through May 31, 2021, 20 SAB were identified in our Institution. 13/20 patients were vaccinated (all of them with the mRNA vaccine type). 5/13 (38%) were male and 8/13 (62%) female. 10 of them (77%) received at least one dose of the vaccine before hospital admission, and 3 of them (23%) after admission. From the 10 previously COVID-19-vaccinated patients treated for SAB (CVPSAB), 4 died - 40% (2 deaths directly related to the SAB).

Conclusion

Although SAB may be a rare side effect after intramuscular injections or vaccines, it always implies an outstanding risk due to potential complications. Even if our study is not able to directly establish a link between SAB and previous vaccination, it implies a possible association between the vaccine injection and a threating disease (SAB). We should be aware of this probable relationship, so that we can maximize preventive measures.

Disclosures

All Authors: No reported disclosures
336. COVID-19 and Pneumocystis jiroveci Pneumonia
Authors: Saling Christopher , Kasule Sabirah N , Vikram Holenarasipur R
Published: December 2021

Background

More accounts of opportunistic infection in COVID-19 patients are emerging. At our institution, we identified 2 COVID-19 patients with Pneumocystis jiroveci pneumonia (PJP) opportunistic infection. This prompted a review of the literature to identify trends in patient characteristics, risk factors, and outcomes in this population.

Methods

A literature review was conducted using PubMed that identified 13 other patients with both COVID-19 and PJP infection. Age, gender, human immunodeficiency virus (HIV) status, other immunocompromised states, time between COVID-19 and PJP diagnosis, and clinical outcomes were captured for analysis.

Results

Eleven patients were male. The average age was 56 years. All but 2 patients were immunocompromised. At time of PJP diagnosis, seven patients had newly diagnosed HIV and one had known, well-controlled HIV. One patient had rheumatoid arthritis receiving leflunomide, 1 had ulcerative colitis receiving budesonide and sulfasalazine, 2 patients had multiple myeloma whereby both were on lenalidomide, 1 patient was a renal transplant recipient immunosuppressed on tacrolimus, mycophenolate, and methylprednisolone, and 1 patient had chronic lymphocytic leukemia getting fludarabine, cyclophosphamide, and rituximab. Nine patients had positive COVID-19 and PJP tests performed within 7 days of one another. One patient tested positive for PJP 54 days into admission for COVID-19. This patient received high dose steroids and tocilizumab for initial COVID-19 infection. Three patients were re-hospitalized with PJP after a recent admission for COVID-19 pneumonia, with a mean time to readmission of 25 days. One of these 3 patients had no treatment for COVID-19, while 2 received steroids. Five of the total 15 patients (33%) died.

Conclusion

COVID-19 treatments with high dose steroids and tocilizumab can make patients vulnerable for opportunistic infection with PJP. Furthermore, COVID-19 is known to cause lymphopenia which may further increase this risk. A diagnosis of concomitant PJP can be especially challenging due to nearly identical radiographical findings. Serum beta-D glucan and HIV testing can be especially helpful in this situation, and there should be a low threshold for performing bronchoalveolar lavage.

Disclosures

All Authors: No reported disclosures
339. COVID-19 Mortality in a Private Hospital in Mexico City
Authors: Ruiz Maria Lorena Cabrera , Castañeda-Méndez Paulo , Aguilar-Zapata Daniel , Mar Javier Reyes , Octavio Gonzalez Chon , Soto-Ramirez Luis E
Published: December 2021

Background

According to the Institute of Global Health Science (IGHS), mortality for Covid-19 patients treated in public hospitals in Mexico ranges between 30-50%, decreasing to 20% in private health care facilities. Our objective was to describe the mortality rate in a teaching private hospital in Mexico City.

Methods

We included all patients that were admitted to hospital Medica Sur, in the south part of Mexico City during year 2020. We analyzed the total mortality presented in all our patients with a follow up of two months, and relay that to age and gender.

Results

During year 2020, we admitted in our hospital 1,075 patients with confirmed diagnosis of COVID-19 through nasopharyngeal molecular test; 772 were male (71.8%) with more than 50% between 40 and 59 years, while females were more frequent between 40 and 69 years’ age. Seventy-four patients (6.88%) died during hospitalization; 59 (79.7%) males and 15 females. Mortality rate was clearly related to age (figure 1) with 30% mortality for males between 80-89 years and 19% for females.

Mortality rate by gender and age

Conclusion

Mortality in private hospitals was clearly lower than in public hospitals. In our hospital, mortality was lower than 10%, mostly related to their availability of unlimited intensive care without ECMO and despite the lack of some drugs like Remdesivir. As described, space limitations for intensive care as well as the lack of trained personal impacted significantly the mortality in public hospitals.

Disclosures

All Authors: No reported disclosures
340. Outcomes of COVID-19 in Hospitalized SOT Recipients: Experence in Colombia, South America
Authors: Rosso Fernando , Tafurt Eric
Published: December 2021

Background

SOTs (SOT) recipients with COVID-19 are considered to be at high risk of severe clinical outcomes. Several descriptive studies have reported a high frequency of intensive care unit admission and death rates. There is a lack of evidence regarding the best approach for immunosuppressive therapy in SOT recipients with COVID-19.

Methods

We performed a single-centered, retrospective, observational study of all SOT recipients with SARS-CoV-2 confirmed infection RT-PCR from nasopharyngeal swab specimens who were admitted to the emergency department from March 25 to September 1, 2020. Glucocorticoid therapy was administered according to the criteria of the attending physician. We classified glucocorticoid dose as low dose therapy if the patient received dexamethasone 6 mg/day or methylprednisolone 40 mg/day, and a high dose if the patient received methylprednisolone 80–160 mg/day. Specimens collected within the first 48 hours

were defined coinfection, while specimens collected after 48 hours were defined as hospital-acquired superinfection.

Results

Of a total of 43 SOT recipients with COVID-19, 17 (39%) required intensive care unit admission. 32 (74.4%) required glucocorticoid therapy: 13 received low dose and 19 high dose. 15 (34.8%) had secondary infections. A total of 12 (27.9%) presented hospital-acquired bacterial superinfections, mostly caused by P. aeruginosa, most of isolations were from respiratory tract cultures. The median time from hospital admission to superinfection diagnosis was 9 (7-13) days. Community-acquired co-infection at COVID-19 diagnosis was documented only in 3 (6.9%) patients, mostly caused by K. Pneumoniae, all isolations were from urine culture. Glucocorticoid therapy was indicated in 32 (80%) patients, 19 received high dose and 13 low doses. Overall hospital mortality was 17.5%. ICU mortality was 41%. Overall mortality in the high dose steroids group was 37 % vs . 0% in the low dose group.

Conclusion

Our results showed a higher frequency of superinfection in SOT recipients with COVID-19 compared to previous reports, and higher ICU mortality. Further studies are needed to establish the best approach for glucocorticoid therapy in SOT recipients with COVID-19.

Disclosures

All Authors: No reported disclosures
341. Evaluation of Antimicrobial Use and Prescribing Patterns During the COVID-19 Pandemic in Patients Receiving Tocilizumab
Authors: Barsoum Barbara , Chang Kai-Ming , Mulvey Nicole , Donaghy Henry , Doan Thien-Ly
Published: December 2021

Background

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients experience systemic inflammation and respiratory distress, which appears to be associated with increased cytokine release. During the peak of coronavirus disease 2019 (COVID-19), tocilizumab was used to treat critically ill patients with potential cytokine storm. However, tocilizumab has an increased risk of developing serious infections.

Methods

This retrospective observational chart review was approved by Institutional Review Board and evaluated patients admitted from March to November 2020, who were SARS-CoV-2 positive and received tocilizumab for the treatment group and no tocilizumab for the control group. The primary endpoint is usage of antimicrobials. The secondary endpoints are development and outcomes of secondary infections and hospital length of stay and mortality. Chi-square test was used for categorical data and Mann-Whitney test was used for continuous data.

Results

A total of 160 patients were included in analysis, with 80 in each arm. 60% of patients in the treatment group required antibiotics compared to 35% in the control group (p = 0.0015), with the highest usage of anti-MRSA coverage, beta-lactams, cephalosporins, and carbapenems in both groups. Antifungal therapy was required in 21.3% of patients in the tocilizumab group compared to 6.3% in the control group (p = 0.0059), with echinocandins being the most used class in both groups. The median days of antimicrobial use in the tocilizumab group was 14 (IQR 7, 24.5) compared to 9 (IQR 6.5, 19) in the control group (p = 0.3346). In the treatment group, 60% of patients developed a secondary infection compared to 35% of patients in the control group (p < 0.0017). Secondary infection treatment failure was observed in 75% of tocilizumab patients compared to 60.7% of control patients (p = 0.1910). In hospital mortality was 50% in patients who received tocilizumab compared to 27.5% in the control group (p < 0.0039).

Conclusion

Patients on tocilizumab received more antimicrobials, but with a similar spectrum of antimicrobial coverage. Patients who received tocilizumab had higher odds of developing secondary infections and expiring during their hospital stay. There were similar durations of antimicrobial therapy and treatment outcomes.

Disclosures

All Authors: No reported disclosures
343. RURAL-COVID-19 Trial: Retrospective Analysis of COVID-19 Coinfections in Hospitalized Urban and Rural Adults
Authors: Hamilton Caroline , Frazier Heather , Vazquez Jose A
Published: December 2021

Background

The impact of COVID-19 in rural communities has been well described. However, little is known regarding differences in coinfections among COVID-19 patients in rural vs. urban settings. Our primary objective is to evaluate community acquired coinfection (CACo) rates (< 72 hrs from admission) and healthcare-associated infection (HAI) rates ( > 72 hrs from admission) in these populations. Secondary objectives include use of empiric antibiotics, pathogen prevalence, and patient outcomes.

Methods

Retrospective analysis of the first 255 adult patients admitted to a tertiary medical center with symptomatic COVID-19 and confirmed by PCR. Rural and urban categories were determined using patient address and county census data. Isolated pathogens were individually evaluated and considered coinfections if the patient met predetermined criteria.

Predetermined Coinfection Criteria

Results

The rates of CACo for rural (n = 90) and urban (n = 165) residents were 11.1% and 13.3%, respectively. Non-respiratory coinfections, such as bloodstream and urinary tract infections, were more common in urban residents; however, empiric antibiotics were started in 75.1% of all subjects. Methicillin susceptible staphylococcus aureus and Escherichia coli were the most common pathogens isolated on admission in both populations. HAI rates were 13.3% in the rural residents vs 13.9% in the urban residents with Methicillin resistant staphylococcus aureus as the most common respiratory pathogen, although Pseudomonas aeruginosa was the most prevalent overall pathogen. There was no significant difference in hospital length of stay or 30-day all-cause mortality among both populations.

Patient Outcomes Among Rural and Urban Populations

Conclusion

There was no significant difference in the rate of CACo or HAI among rural or urban populations. Despite the high rate of antibiotic use to empirically cover community acquired respiratory infections at the start of the pandemic, only 1.9% of the subjects had a possible or proven respiratory coinfection on admission. Despite prior research showing worse outcomes for rural populations with COVID-19, our data demonstrates that coinfection rates and patient outcomes were similar among these populations when receiving medical care at an academic hospital.

Disclosures

All Authors: No reported disclosures
347. SARS-CoV-2 and Acute Otitis Media in Children: A Case Series
Authors: Frost Holly M , Sebastian Thresia , Keith Amy , Kurtz Melanie , Dominguez Samuel R , Dominguez Samuel R , Parker Sarah , Jenkins Timothy C
Published: December 2021

Background

Reports in adults with COVID-19 and acute otitis media (AOM) show that severe symptoms and hearing loss may be more common than with the clinical presentation of typical AOM. However, the association of SARS-CoV-2 with AOM in children is poorly understood.

Methods

Cases were identified as a subpopulation enrolled in the NOTEARS prospective AOM study in Denver, CO from March-December 2020. Children enrolled were 6-35 months of age with uncomplicated AOM and prescribed amoxicillin. Children diagnosed with AOM and SARS-CoV-2, detected by polymerase chain reaction assay, were included in the case series. Data was obtained from electronic medical records and research case report forms. Patients completed surveys at enrollment and 5, 14 and 30 days after enrollment that included the Acute Otitis Media Severity of Symptoms (AOM-SOS©) scale. All patients had nasopharyngeal otopathogen testing completed.

Results

A total of 108 patients had been enrolled through December 2020 (all of whom were subsequently tested for SARS CoV-2). During the study period for this case series, 16 patients were enrolled, and 7 (43.6%) were identified with AOM/SARS-CoV-2 co-infection. Among these 7 patients, fever was present in 3 children (29%). Four children (57%) attended daycare. Only 2 children (29%) had testing for SARS CoV-2 as part of their clinical workup. Mean AOM-SOS© scores were similar among the SARS CoV-2 positive and negative patients with no statistical significance noted with two-sided t-tests: 13.6 (± 4.5) vs 14.2 (± 4.9) at enrollment, 1.4 (± 1.8) vs 4.2 (±4.9) on Day 5, and 0.6 (± 0.9) vs. 2.5 (±6.1) on Day 14 (Table 1). Among the 7 patients, no child had an AOM treatment failure or recurrence. Of the 6 patients in whom bacterial and viral testing have been completed, a bacterial otopathogen was identified in 6 (100%), and a viral pathogen in 3 (50%) children (Table 2).

Table 1. Clinical features of children with concurrent SARS-CoV-2 and AOM

Table 2. Laboratory findings of children with concurrent SARS-CoV-2 and AOM.

Conclusion

SARS-CoV-2 can occur in children with AOM. It is important that providers maintain a high index of suspicion for COVID-19 even in patients with clinical evidence of AOM, particularly to ensure families are appropriately advised on isolation and quarantine requirements. AOM with SARS-CoV-2 does not appear to be more severe than AOM without SARS-CoV-2.

Disclosures

Samuel R. Dominguez, MD, PhD, BioFire Diagnostics (Consultant, Research Grant or Support)DiaSorin Molecular (Consultant)Pfizer (Grant/Research Support) Samuel R. Dominguez, MD, PhD, BioFire (Individual(s) Involved: Self): Consultant, Research Grant or Support; DiaSorin Molecular (Individual(s) Involved: Self): Consultant; Pfizer (Individual(s) Involved: Self): Grant/Research Support
348. Characteristics and Outcomes in Hospitalized Patients with Covid-19 Complicated by Fungemia: A Single Center Retrospective Study
Authors: Zahra Aleena , Fries Bettina C , Fries Bettina C , Sae-Tia Sutthichai
Published: December 2021

Background

Covid19 caused by SARS-CoV2 can lead to significant morbidity and mortality. Fungemia is a rare hospital-associated infection and there are limited data regarding its association with Covid19. We reviewed all cases of fungemia in our Covid19 cohort at Stony Brook University Hospital (SBUH).

Methods

We conducted a retrospective medical record review of patients admitted with Covid19 in a 3-month interval. We reviewed positive blood cultures for fungi and recorded co-morbidities, co-infections, length of stay, treatments, and outcomes (survival vs death). There were 60 positive blood cultures for fungi in 25 unique patients (Table 1); in prior years < 30 per year reported at SBUH.

Table 1. Fungal Blood Cultures

Collation of each unique identified fungal species from fungal blood cultures in patients hospitalized with Covid-19

Results

During a 3 month interval at the local peak of the pandemic 1398 patients hospitalized with Covid19 at SBUH, 25 cases of fungemia were detected; C. albicans (CA) n=8,32%, non C albicans species (nCA) n=16,64%, and C. neoformans n=1,4%, 17/25 (68%) also with bacteremia during same hospitalization. In same 3 months there were 264 cases of bacteremia and Covid19 co-infection. Demographics and medical co-morbidities of fungemic patients are in Table 2. Majority were men (76%). No difference between fungaemic (FC) and total cohort (TC) in median age (62 vs 62), DM p=0.31, HTN p=1.0, COPD p=0.12. Within FC, DM was higher in nCA group (58.8%) vs CA group (37%). Mortality was 40% in FC vs 15% in TC, p< 0.001. Within FC mortality was 56% in nCA and 25% in CA group. C. parapsilosis was the most common nCA species isolated with 43% mortality. FC more likely to require ICU and mechanical ventilation (88% vs 15%, p< 0.0001) and had longer median length of stay 42 days vs 22 days. The median time from admission to fungaemia was 21d, from central line placement 19d, Table 3. Of FC 21 (84%) were treated with steroids/Tocilizumab concurrently. Of note, no mortality was recorded in the 4 patients that did not receive steroids/Tocilizumab.

PCT and WBC were significantly higher at time of fungemia as compared to admission, Table 3.

Table 2, Patient co-morbidities and hospitalization stay characteristics

Co-morbidities and requirement for ICU stay, mechanical ventilation for total cohort Covid-19 and fungemic cohort

Table 3, Patient Characteristics and Laboratory Parameters

Relevant patient characteristics and laboratory parameters in patients hospitalized with Covid19 and fungemia

Conclusion

Fungemia in hospitalized patients with COVID-19 is associated with higher mortality. We observed higher fatality in non C. albicans infections. Prolonged use of central line catheters and concurrent treatment with steroids/tociluzimab are likely high-risk factors for development of fungemia.

Disclosures

All Authors: No reported disclosures
349. Diagnostic Testing and Antibiotic Utilization in Patients with COVID-19
Authors: Groft Lauren , Opran Iulia , Tadesse Yeabsera , Vo Hang , Heil Emily , Heil Emily , Schrank Gregory , Claeys Kimberly C
Published: December 2021

Background

Patients with COVID-19 receive high rates of antibiotic therapy, despite viral origin of infection. Reports of bacterial coinfection range from 3.5 to 8% in the early phase of infection. This study aimed to evaluate the relationship between diagnostic tests and antibiotic utilization in patients admitted with COVID-19 at the University of Maryland Medical Center to better inform future prescribing practices.

Methods

Retrospective cohort study of adult patients with a positive SARS-CoV-2 PCR on admission from March 2020 through June 2020. Associations between diagnostic tests employed and antibiotic initiation and duration were explored using bivariate analysis (SPSS®).

Results

Baseline characteristics of 224 included patients are reported in Table 1. Excluding SARS-CoV-2 PCRs, most frequently performed diagnostic tests included blood cultures (65.6%), MRSA nasal surveillance (45.1%), respiratory cultures (36.2%), respiratory viral panel (RVP) (33.0%), and Legionella (28.6%) and pneumococcal (26.3%) urine antigens. Positivity of RVP, Legionella, pneumococcus, blood, and respiratory tests were low (1.3%, 0.4%, 0.9%, 1.8%, and 6.7%, respectively). A total of 62% of patients were initiated on antibacterial therapy with a median cumulative antibiotic duration of 77.9 hours (IQR 41.4, 111.8). History of chronic respiratory disease (76% vs. 58.6%; P=0.025), any degree of oxygen requirement on admission (72% vs. 42.6%; P=0.006), and performance of blood cultures (70.7% vs. 46.8%, P< 0.0001) were associated with antibiotic initiation. Positive bacterial diagnostic respiratory culture (median duration 72.8h [IQR 46.7, 96.6] vs. 97.3h [IQR 79.8, 194.1]; P=0.027) and positive blood culture (median duration 80.1h [IQR 42.1, 111.7] vs. 97.5h [IQR 71.8, 164.8]; P=0.046) were associated with longer antibiotic duration. Patients who did not have respiratory cultures performed had similar antibiotic durations as those with negative respiratory cultures.

Table 1. Baseline Characteristics

Conclusion

Despite low coinfection rates, negative diagnostic tests did not result in shorter empiric antibacterial duration. These findings highlight the ongoing need for both diagnostic and antimicrobial stewardship in COVID-19.

Disclosures

Emily Heil, PharmD, MS, BCIDP, Nothing to disclose Kimberly C. Claeys, PharmD, GenMark (Speaker’s Bureau)
351. Antibiotic Management Decisions and Use of a Multiplex PCR Panel for Pneumonia Diagnosis Among Critically Ill Patients with COVID-19
Authors: Bionghi Neda , Dietz Donald E , Zucker Jason , Zucker Jason , Huang Simian , Whittier Susan , Green Daniel A , Wu Fann , Sobieszczyk Magdalena , Theodore Deborah
Published: December 2021

Background

Antibiotic use among patients with COVID-19 is common, exceeds the prevalence of probable bacterial co-infection, and promotes development of resistant organisms. Lack of diagnostic microbiological data may prolong empiric broad-spectrum therapy. Here we evaluate the use of the BioFire FilmArray pneumonia panel (PP), a novel rapid diagnostic test, and antibiotic decisions among intensive care unit (ICU) patients with COVID-19.

Methods

We conducted a retrospective review of adult ICU patients admitted with COVID-19 between January 2020 and May 2021 at an academic medical center. ICU patients who underwent bronchoscopy/bronchoalveolar lavage (BAL) with PP (PP group) were matched by age (< 65 or ≥65), BMI (< 30 or ≥30), and BAL date (within 60 days) to ICU patients who did not undergo BAL (no-BAL group). PP patients were matched by age and BMI to ICU patients who underwent BAL without PP (no-PP group). Antibiotic use was compared between groups. Chi squared analysis, t-test, and ANOVA were used for comparisons as appropriate.

Results

65 patients were included; the majority were male (65%), < 65 years (86%), and had BMI ≥30 (54%) (Table 1). Only 17 no-PP matches were identified for PP patients due to infrequent BALs. Similar proportion of patients in PP and no-PP groups had organisms identified from BAL (54% vs. 47%, p=0.65). Among PP patients with a detected organism, all (n=13) had subsequent changes in antibiotic regimen ≤72 hours after BAL; 10/13 (77%) had a change targeted to detected organism and 5/13 (39%) had antibiotic narrowing. Among PP patients with no detected organism, only 4/11 (36%) had antibiotic narrowing or maintenance off antibiotics. In all groups, average antibiotic use exceeded 70% of admission duration.

Table 1. Patient characteristics and antibiotic management. Abbreviations: BAL - bronchoalveolar lavage

Conclusion

Rapid, highly sensitive diagnostic tests have potential to guide clinical decisions and promote antibiotic stewardship among patients with severe viral pneumonia and suspected bacterial co-infection. In this descriptive analysis, antibiotic management did not differ significantly with use of PP. While most patients with detected organism on PP had targeted antibiotic changes, a negative PP did not appear to influence antibiotic narrowing. Larger studies and provider education are needed to evaluate potential of the PP for antibiotic stewardship.

Disclosures

Jason Zucker, MD, MS, Nothing to disclose Daniel A. Green, M.D., BioFire (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member) Deborah Theodore, MD, BioFire Diagnostics (Other Financial or Material Support, Donation of testing materials to support investigator-initiated research)
352. COVID-19 Not a Risk Factor of Alopecia Areata: Results of a National Cohort Study in South Korea
Authors: Kim Jeehyun , Hong Kwan , Yum Sujin , Gomez Raquel Elizabeth Gomez , Chun Byung Chul
Published: December 2021

Background

There have been approximately 158 million coronavirus disease 2019 (COVID-19) pandemic survivors worldwide by June 9, 2021. As a result, concerns about hair loss in COVID-19 patients have emerged among dermatologists. However, most of extant literature have limited implications by relying on cross-sectional studies with restricted study subjects without control group. Therefore, our study aims to investigate the risk of developing alopecia areata (AA) among COVID-19 patients in South Korea using adequate control based on national representative data.

Methods

We used the National Health Insurance Service (NHIS) COVID-19 cohort database, comprising COVID-19 patient and control group, all of whom were diagnosed from January 1, 2020 to June 4, 2020. Patients were defined as individuals who were confirmed as COVID-19 positive, regardless of disease severity. Controls were defined as whom confirmed as COVID-19 negative. People with a history of AA during the period 2015–2019 were excluded. The primary endpoint was a new diagnosis of AA (ICD-10-CM-Code: L63). Adjusted incidence rate ratio (IRR) of developing AA was estimated using log-link Poisson regression model based on incidence density of case and control group. The model adjusted for (1) age and sex (2) demographic variables (age, sex, place of residence, and income level). Statistical significance was set at p< 0.05.

Results

A total of 226,737 individuals (7,958 [3.5%] cases and 218,779 [96.5%] controls) were included in the final analysis. There were more females than males, both in test positives and negatives at 59.9% and 52.3%, respectively. The largest test positive population was those in age group 20 to 29 years (25.5%),. The test negatives had the largest population in age group 30 to 39 years (17.1%). The ratio of newly diagnosed AA was 18/7,958 (0.2%) in cases and 195/218,779 (0.1%) in controls. IRRs of COVID-19 patients having newly diagnosed AA compared to controls were 0.78 (0.48‒1.27) when age and sex were adjusted for, and 0.60 (0.35‒1.03) when all demographic variables were adjusted for.

Flowchart of study subject selection

Conclusion

Diagnosis of COVID-19 was not significantly associated with development of AA even after appropriately adjusting for covariates.

Disclosures

All Authors: No reported disclosures
356. The Role of Procalcitonin in Antimicrobial Stewardship Among Cancer Patients Admitted with COVID-19
Authors: Dagher Hiba , Chaftari Anne-Marie , Hachem Ray Y , Jiang Ying , Malek Alexandre , Garnes Natalie J Dailey , Borjan Jovan , Mulanovich Victor , Raad Issam I
Published: December 2021

Background

Procalcitonin (PCT) has been used to guide antimicrobial therapy in bacterial infections. With the wide spread use of empiric use of antibiotics in cancer patients admitted with COVID-19 disease, we aimed to evaluate the role of PCT in decreasing the duration of empiric antimicrobial therapy among cancer patients admitted with COVID-19.

Methods

We conducted a retrospective study of cancer patients admitted to MD Anderson Cancer Center who had a PCT test done within 72 hours of admission following their COVID-19 diagnosis between March 1, 2020 and June 6, 2021. Patients were divided into 2 groups of PCT < 0.25 ng/mL and PCT >=0.25 ng/mL. We assessed pertinent cultures including blood and respiratory, as well as antibacterial use and duration of empiric antibacterial therapy.

Results

We identified 544 patients with a median age of 62 years (range, 14-93). There were 312 (57%) patients that had at least one culture obtained from a sterile or infected site within 7 days following admission. None of the patients who had PCT< 0.25 had a positive culture whereas 41/111 (37%) patients with PCT >= 0.25 had at least one positive culture [P< 0.0001]. Among the 373 patients who had a PCT < 0.25, 129 (35%) patients received more than 72 hours of IV antibiotics compared to 87/171 (51%) among patients with PCT >=0.25 [P= 0.0003].

Conclusion

These results confirm the correlation between a PCT level greater than 0.25 and a documented bacterial infection. Furthermore, procalcitonin could be useful in enhancing antimicrobial stewardship in cancer patients with COVID-19 by reducing the duration of antimicrobial therapy beyond the initial empiric 72 hours until PCT results become available.

Disclosures

Natalie J Dailey Garnes, MD, MPH, AlloVir (Other Financial or Material Support, collaborator on research protocol)
357. A Comparison of Chest CT Findings in Cancer and Non-Cancer Patients with COVID-19
Authors: Malek Alexandre , Dagher Hiba , Hachem Ray Y , Jiang Ying , Chaftari Anne-Marie , Raad Issam I
Published: December 2021

Background

The purpose of this study was to compare chest computed tomography (CT) scan findings in cancer versus non-cancer patients with COVID-19 infection. We sought to assess the correlation between radiologic patterns of COVID-19 pneumonia, clinical course, and outcomes.

Methods

We performed a retrospective study of COVID-19 positive cancer and non-cancer pts who had chest CT scans at the time of diagnosis, at our hospital and 16 other centers in Asia, Australia, Europe, North America and South America, between March, 2020 and November, 2020. Patients’ age, underlying diseases, symptoms, laboratory studies, and radiologic findings consisting of bilateral ground-glass opacities (GGOs), multifocal organizing pneumonia (MOP) were collected in association with clinical outcomes.

Results

We identified 426 pts with cancer and 622 non-cancer pts. Thereafter, cancer pts were analyzed into 3 distinct groups and similar to non-cancer pts: GGOs group (n=224, 54%), GGOs+MOP group (n=61, 14.6%), and a third group of neither GGOs or MOP (n=131, 31.4%) in cancer pts, and in non-cancer pts: GGOs group (n=387, 62.8%), GGOs +MOP group (n=100, 16.2%), and a third group of neither GGOs or MOP (n=129, 21%). The median patients’ age was 54 in non-cancer pts vs 62 in cancer pts (p< 0.001) and there were more males in the non-cancer group 57% vs 47% (p=0.001). Cough was more prevalent in non-cancer pts, 71% vs 59% (p< 0.001) and similar to fever (73% vs 57%, p< 0.001). Neutropenia < 0.5 k/µL and lymphocytopenia < 1 k/µL were more frequent in cancer pts (p< 0.001). In cancer pts, there was no statistically significance difference between the 3 groups (hospital admission, mechanical ventilation, readmission within 30 days, and mortality), except pts who required non-invasive (NI) ventilation were more frequent in the GGOs group, 55% (p=0.005). In non-cancer, pts with GGOs +MOP have higher hospital admission, ICU transfer, NI- and mechanical ventilation compared to the 2 other groups (p< 0.001). While readmission to hospital or mortality rate within 30 days were similar between the 3 groups.

Conclusion

This study reveals that non-cancer pts tended to have more radiologic findings on chest CT scan compared to cancer pts at the time of COVID-19 diagnosis and were associated with more worrisome COVID-19-related clinical outcomes.

Disclosures

All Authors: No reported disclosures