bluuebunny/crossref_metadata_2025 huggingface dataset:
335. Using high temperatures to eradicate prosthetic joint associated biofilms on metal implants using alternating magnetic field: Efficacy and safety implications
Authors: Shaikh Sumbul , Prasad Bibin , Sturge Carolyn , Pybus Christine A , Pifer Reed , Wang Qi , Chatzinoff Yonathan , Bing Chenchen , Chopra Rajiv , Greenberg David E
Published: January 2021

Background

Prosthetic joint infection (PJI) is a significant complication of modern arthroplasty. Revision surgery is frequently required due to the formation pf biofilm. The presence of biofilm makes non surgical treatment difficult in part because traditional antibiotics are unable to penetrate this structure.

We have developed a noninvasive way to eradicate biofilm off the outer surface of metal implant utilizing alternating magnetic fields (AMF). AMF creates focused surface heating on metal lic implants and can be delivered in a fashion spares significant heating of surrounding tissue. The study was to determine efficacy and safety of AMF when combined with traditional antibiotics in animal models of implant infection.

Methods

Pseudomonas aeruginosa (PA) and staphylococcus aureus (SA) were grown individually on stainless steel ball that were implanted into the thigh muscle of the mice. Mice placed in a custom built solenoid coil for AMF treatments. AMD exposures generating peak temperature of 80 or 65 C on the implant were delivered once a day. Treatment groups included AMF alone, antibiotic alone, and combination therapy. Antibiotics tested included ciprofloxacin, ceftraixone and rifampin. Residual biofilm was measured by CFU counts. Histopathology was analyzed to determine area of damage in response to AMF treatment.

Results

Combination of a single AMF pulse with antibiotics lead to a greater biofilm reduction than either treatment alone. PA with AMD (80 C peak) and ciprofloxacin resulted in >2 log reduction of biofilm (p< 0.0001) compared to minimal reduction (AMF or ciprofloxacin alone) at Day 4. Similar treatment outcome was seen with SA and ceftraixone with combination treatment resulting on multi log reduction. Combined treatment effects were seen at lower temperatures (65 C). Histopathologic analysis demonstrates a small area of tissue damage at the end of treatment (Day 4). In mice that were survived fro additional 28-days after the final treatment, the tissue showed no signs of damage.

Conclusion

AMF combined with antibiotics leads to enhanced reduction of biofilm on metallic implants in vivo. This non invasive approach to eradicating biofilm could serve as a new paradigm in treating these challenging infections.

Disclosures

All Authors: No reported disclosures
338. Analysis of Etiologies of Aseptic Meningitis within a Nation-Wide Hospital Network
Authors: Aravagiri Arunmozhi S , Kubomoto Scott , Napatkamon Ayutyanont , Wilson Sarah , Mallela Sudhakar
Published: January 2021

Background

Aseptic meningitis can be caused by an array of microorganisms, both bacterial and non-bacterial, as well as non-infectious conditions. Some etiologies of aseptic meningitis require treatment with antibiotics, antiviral, antifungals, anti-parasitic agents, immunosuppressants, and or chemotherapy. There are limited diagnostic tools for diagnosing certain types of aseptic meningitis, therefore knowing the differential causes of aseptic meningitis, and their relative percentages may assist in diagnosis. Review of the literature reveals that there are no recent studies of etiologies of aseptic meningitis in the United States (US). This is an epidemiologic study to delineate etiologies of aseptic meningitis in a large database of 185 HCA hospitals across the US.

Methods

Data was collected from January 2016 to December 2019 on all patients diagnosed with meningitis. CSF PCR studies, and CSF antibody tests were then selected for inclusion.

Results

Total number of encounters were 3,149 hospitalizations. Total number of individual labs analyzed was 10,613, and of these 262 etiologies were identified. 23.6% (62) of cases were due to enterovirus, 18.7% (49) due to HSV-2, 14.5% (38) due to West Nile virus, 13.7% (36) due to Varicella zoster (VZV), 10.5% (27) due to Cryptococcus. Additionally, we analyzed the rate of positive test results by region. Nationally, 9.7% of tests ordered for enterovirus were positive. In contrast, 0.5% of tests ordered for HSV 1 were positive. The southeastern United States had the highest rate of positive tests for HSV 2 (7% of tests ordered for HSV 2 were positive). The central United States had the highest rate of positive test for West Nile virus (11% of tests ordered for West Nile were positive). The northeastern region and the highest rate of positive tests for varicella zoster (18%).

Table 1: Percentage of positive CSF tests (positive tests/tests ordered)

Table 2: Lists the number of HIV patients and transplant patients that had positive CSF PCR/serologies

Figure 1: Percentage of positive CSF tests in each region

Conclusion

Approximately 40% of aseptic meningitis population had treatable etiologies. A third of the Cryptococcus meningitis population had HIV. Furthermore, enteroviruses had the majority of cases within the US, which are similar to studies done in other parts of the world.

Disclosures

All Authors: No reported disclosures
339. Assessing Utilization of the Venereal Disease Research Laboratory Test in Cerebrospinal Fluid for the Diagnosis of Neurosyphilis: A Cohort Study
Authors: Sytsma Terin , Theel Elitza , Temesgan Zelalem , Toledano Michel
Published: January 2021

Background

The Venereal Disease Research Laboratory (VDRL) test performed in cerebrospinal fluid (CSF) is considered highly specific for the diagnosis of neurosyphilis, but algorithms to diagnose neurosyphilis require positive syphilis serologic testing prior to obtaining CSF-VDRL. Inappropriate use of diagnostic tests depletes healthcare resources, and contributes to rising healthcare expenditures. CSF-VDRL has historically been improperly utilized; however there is no recent evaluation of its use in clinical practice. We aimed to quantify rates of appropriate CSF-VDRL testing, determine the CSF-VDRL false-positivity rate and describe causes of false-positive CSF-VDRL reactivity.

Methods

In this retrospective cohort study of three Mayo Clinic sites (Rochester, MN, Jacksonville, FL, and Scottsdale, AZ), we measured the rate of appropriate CSF-VDRL test utilization in patients with negative testing from January 1, 2011 to December 31, 2017. We then identified all patients with positive CSF-VDRL testing from January 1, 1994 to February 28, 2018, characterized true- and false-positive rates and described causes of CSF-VDRL false-positivity.

Results

Among 8,553 persons with negative CSF-VDRL results, testing was unnecessarily ordered in 8,399 (98.2%). The word “syphilis” or “neurosyphilis” appeared in the notes of only 1,184 (13.8%) individuals with a negative CSF-VDRL result. From January 1994 through February 2018, 33,933 CSF-VDRL tests were performed on 32,626 individual patients. Among 60 positive CSF-VDRL results, 41 (68.3%) were true-positives, 2 (3.3%) were indeterminate, and 17 (28.3%) were false-positives. Every patient with true-positive CSF-VDRL had positive serologic syphilis testing prior to CSF testing. All patients with false-positive CSF-VDRL results were inappropriately tested. Neoplastic meningitis was a common cause of false-positive CSF-VDRL results.

Conclusion

This is the first study in decades to review CSF-VDRL utilization for the diagnosis of neurosyphilis. Inappropriate use of CSF-VDRL testing for diagnosis of neurosyphilis remains problematic in clinical practice. Following recommended testing algorithms would prevent unnecessary testing, preserve resources, and minimize false-positive results.

Disclosures

All Authors: No reported disclosures
340. Association between Meningococcal Meningitis and Santa Ana Winds in Mexican Children and Adolescents from Tijuana, Baja-California, Mexico
Authors: Chacon-Cruz Enrique , Lopatynsky-Reyes Erika Z , Montano-Duron Jesus G
Published: January 2021

Background

The Tijuana, Baja-California, and San Diego, California, USA -border, is considered to be the most transited in the world. Based on our active surveillance studies, Tijuana has the highest incidence of meningococcal meningitis (MeM) in Mexico (Chacon-Cruz E. et al.: Ther. Adv. Vaccines 2016; 4: 15–9. J. Infect. Dis. Treat. 2017; 3: 1–4. Emerg. Infect. Dis. 2011; 17: 543–6. And Ther. Adv. Vaccines 2019; 6: 1–7), and an outbreak of MeM in 2013 (Chacon-Cruz et al. Ther. Adv. Vaccines 2014; 2: 71–6). The Santa Ana Winds (SAWs) are episodic pulses of easterly, downslope, offshore flows over the coastal topography of the California Border Region: Southern California and Northern Baja-California (Mexico), occurring mostly from October to April, and are associated with very dry air, often with anomalous warming at low elevations, similar to the Harmattan winds associated with MeM outbreaks in Africa. We hypothesized that the high incidence of MeM in Tijuana is, in part, associated with SAWs. This association has never yet been described.

Methods

Based on 13 years of active/prospective surveillance (2005–2018) in children > 7 days and < 16 years of age at the General Hospital of Tijuana, we identified 51 cases of MeM (25% lethality), and 30 non-meningococcal meningitis (NMeM). Association between cases per month of MeM and NMeM, with SAWs seasons (from a 65 years review: Guzman-Morales J, et al. Geophys. Res. Lett. 2016; 43: 2827–34), was calculated by Risk Ratio (RR). A z test was also used to compare proportions of MeM during SAWs seasons vs. non-SAWs seasons.

Results

From 51 MeM, 44 (86.27%) occurred during SAWs seasons (z test = 7.32, p< 0.0002). Cases per month during 13 years (91 months for SAWs seasons and 60 months for non-SAWs seasons) were as follow (See Figure-1):

SAWs seasons: non-SAWs seasons:

MeM 0.483 cases/month 0.107 cases/month

NMeM 0.186 cases/month 0.216 cases/month

RR =1.76, p=0.0002 (95% CI 1.23 to 2.49)

Conclusion

1. In Tijuana, Baja-California, Mexico, there is a strong association of Meningococcal Meningitis with seasons when Santa Ana Winds occur.

2. Routine immunization against vs. Neisseria meningitidis should be seriously considered in the region.

Disclosures

All Authors: No reported disclosures
341. Clinical and Laboratory Data in Patients with Viral and Bacterial Meningitis in Conjunction with FilmArray Meningitis/Encephalitis Panel Use: A Multi-Site Retrospective Cohort Study
Authors: Goodrich Nathaniel , Nabower Aleisha M , Rajbhandari Prabi , Martin Kimberly C , Ekambaram Maheswari , Eisenberg Jaclyn , McCulloh Russell , Cipriano Frank , Stone Bryan , Lyden Elizabeth , Snowden Jessica
Published: January 2021

Background

The ability to quickly recognize and diagnose meningitis is a critical component in its management. The use of the FilmArray Meningitis/Encephalitis (ME) panel has made pathogen identification easier and faster. Although literature exists regarding clinical and laboratory data in patients with bacterial meningitis, less is known about the characteristics of viral meningitis caused by viruses detected by the ME panel This study aims to compare differences in clinical and laboratory characteristics between viral and bacterial meningitis identified by the ME panel.

Methods

We conducted a multisite retrospective review of pediatric patients with cerebral spinal fluid (CSF) positive for viral or bacterial organisms from January 2015 - February 2019. Demographic, clinical, and lab characteristics were extracted from medical records. Frequencies and percentages are used to explain descriptive data. Fisher’s exact test was used for categorical data. The Mann-Whitney test was used for continuous data.

Results

Four hundred thirty-eight patients were included in the analysis with baseline characteristics found in Table 1. Among these, 345 and 93 patients tested positive for viral and bacterial organisms respectively. Viral organisms identified are presented in Figure 1. Patients with bacterial organisms were more likely to have a history of prematurity, a prior neurosurgical procedure, neurological symptoms at presentation, neurological complications, and death within 30 days of admission. The median serum white blood cell (WBC) count, C-reactive protein (CRP), procalcitonin, CSF WBC count, CSF neutrophil percentage, and CSF protein were significantly higher in patients with bacterial organisms compared to viral organisms (Table 2).

Table 1: Baseline Characteristics of the Study Population

Figure 1: Viral organisms identified.

Table 2: Comparison of Laboratory Data by CSF Pathogen Group

Conclusion

Patients positive for bacterial meningitis were more likely to have higher markers of infection compared to patients with viral organisms. Patients with bacterial organisms were also more likely to have death within 30 days of admission and neurological symptoms and subsequent complications, although the small number of patients limits these conclusions. These findings may help clinicians utilize clinical and laboratory data in conjunction with a ME panel result.

Disclosures

All Authors: No reported disclosures
342. Clinical Utility of a Next Generation Sequencing Test for Pathogen Detection in Pediatric Central Nervous System Infections
Authors: Ramchandar Nanda , Foley Jennifer , Enriquez Claudia , Osborne Stephanie , Arrieta Antonio , Sendi Prithvi , Totapally Balagangadhar , Dimmock David , Farnaes Lauge , Salyakina Daria , Janvier Michelin J
Published: January 2021

Background

Pediatric central nervous system (CNS) infections are potentially life-threatening and may incur significant morbidity. Identifying a pathogen is important, both in terms of guiding therapeutic management, but also in characterizing prognosis. However, standard care testing by culture, serology, and PCR is often unable to identify a pathogen. We examined use of next generation sequencing (NGS) of cerebrospinal fluid (CSF) in detecting an organism in children with CNS infections.

Methods

We prospectively enrolled children with CSF pleocytosis and suspected CNS infection admitted to 3 tertiary pediatric hospitals. After standard care testing had been performed, the remaining CSF was submitted for analysis by NGS.

Results

We enrolled 70 subjects over a 12-month recruitment period. A putative organism was isolated from CSF in 24 (34.3%) subjects by any diagnostic modality. NGS of the CSF samples identified a pathogen in 20 (28.6%) subjects. False positive results by NGS were identified in 2 patients. There were no cases in which NGS alone identified a pathogen. In 4 cases, a putative organism was recovered by standard care testing of the CSF, but not by CSF NGS. CSF culture recovered a putative organism in 12 cases (12.1%). A CSF PCR multiplex panel was utilized for 51 subjects. An organism was detected in 15 of these (29.4%). Using a reference composite of standard care testing, we determined the sensitivity and specificity of CSF NGS to be 83.3% (95% CI, 62.6–95.3%) and 91.3% (95% CI, 79.2–97.6%) respectively.

Conclusion

Sequencing of CSF has the potential to rapidly and comprehensively identify infection with a single test. Further studies are needed to determine the optimal use of NGS for diagnosis of CNS infections.

Disclosures

All Authors: No reported disclosures
344. Demographics of Patients with Brain Abscesses: A 10-year Mayo Clinic-Multicenter-Based Population Descriptive Study
Authors: Campioli Cristina G Corsini , Go John Raymond U , Sohail M Rizwan , O’Horo John C , O’Horo John C
Published: January 2021

Background

Brain abscess and cerebritis are diseases associated with high-risk morbidity and mortality despite the advancement of imaging technologies and antimicrobial therapy for the past 30 years. We aimed to describe the demographics of patients with brain abscess and cerebritis at Mayo Clinic.

Methods

We retrospectively reviewed the demographics of all adult patients with the diagnosis of intracranial brain abscess, cerebritis, or both at our institution from January 1, 2009, through December 31, 2019. All analyses were performed using JMP software (Cary, NC).

Results

A total of 666 patients with brain abscess and cerebritis were identified during the study period. The median patient age was 59.7 years, and the majority were males (64.8%; P=0.0001). A total of 587 (88.1%) patients self-identified as Whites (P=< 0.0001) and 608 (91.2%) as Non-Hispanic or Latino (P=< 0.0001). A total of 453 (68.01%) patients were from the Midwest, with Minnesota and Wisconsin being the two most common States with 243 (36.4%; P=< 0.0001) and 101 (15.1%; P=0.01) patients respectively. The majority of patients (69.2%) had coronary artery disease and peripheral vascular disease with a median Charlson comorbidity index of 7 (P= < 0.0001) and an estimated 10-year survival of 0%.

Conclusion

Male, White Non-Hispanics, and elderly patients seem to be the most prevalent patient population at risk for brain abscess or cerebritis. This investigation provides clinicians the demographic data needed to identify potentially complex patients with brain abscesses.

Disclosures

M. Rizwan Sohail, MD, Aziyo Biologics (Consultant)Medtronic Inc (Consultant, Research Grant or Support)
345. Early Oral Therapy for Streptococcus anginosus Purulent Brain Infections: A Single Center Experience
Authors: Dodson Daniel S , Heizer Heather R , Gaensbauer James
Published: January 2021

Background

Pediatric Streptococcus anginosus intracranial pyogenic are commonly treated with prolonged intravenous (IV) antibiotics, exposing patients to risks of a long-term central catheter. Antibiotics with high oral bioavailability, such as levofloxacin, may allow early oral transition.

Methods

To characterize patients with S. anginosus intracranial infections transitioned to oral therapy, we performed a retrospective review at Children’s Hospital Colorado from 1/2004 to 2/2019. Inclusion criteria were radiologic evidence of an infected parenchymal, subdural, or epidural fluid collection AND a positive culture for S. anginosus from an intracranial source, specific extracranial sources (sinus, scalp, orbit), or blood. The primary endpoint was oral antibiotic failure defined as worsening infection on oral therapy. Comparisons were done using Fisher’s exact test.

Results

94 patients met inclusion criteria, 57 of whom were transitioned to oral therapy during treatment. Oral levofloxacin was used in 54 of the 57. 12% of oral transitions occurred in the first 14 days of therapy (range 3–8 days), and 35% in the first 28 days. Patients transitioned in the first 28 days were more likely to have an epidural collection (p:< 0.01), and less likely to have a subdural collection (p: 0.03) or brain abscess (p:< 0.01). Of the 57, none had oral antibiotic failure. Contributing reasons for oral transition included central line complications (18%), IV medication reaction (18%), hematologic abnormality presumed secondary to IV antibiotics (33%), and provider judgement (56%). Two patients required re-introduction of IV therapy for reasons other than clinical failure (one for medication non-adherence and one for adverse reaction to levofloxacin).

Conclusion

We observed success and tolerance of levofloxacin-based oral therapy for pediatric pyogenic intracranial S. anginosus brain infections and confirmed the frequent occurrence of adverse events associated with IV treatment. Transition to oral therapy should be considered, particularly if complications of IV therapy arise in treatment of an epidural infection. A subset of patients in our study transitioned within the first 14 days of therapy; prospective studies are needed to characterize the safety of such very early transition.

Disclosures

All Authors: No reported disclosures
350. Neurocysticercosis – Gender Differences in Clinical Presentations
Authors: Pendyala Bharath , Lingamaneni Prasanth , DeMarais Patricia , Warrior Lakshmi , Huhn Gregory
Published: January 2021

Background

Neurocysticercosis is a Neglected Tropical Disease and an important public health issue. Our goal was to collect and analyze data regarding clinically significant gender differences among our Neurocysticercosis patients.

Methods

A retrospective chart search with ICD 9/ ICD 10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between years 2013–2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables.

Results

Among 90 total patients included, male (49.4%) and female (50.6%) distribution were nearly identical. The mean age in females was found to be higher than males (52.5 vs 42.0, P < 0.0001). Almost an equal number of males and females presented with either seizures (63.6% vs 57.8%, P= 0.85), headaches (25.0% vs 28.9%, p= 0.85), or other symptoms (11.4% vs 13.3%, p= 0.85). Males had more generalized seizures compared to females (60% vs 38%, P= 0.37), although this result was not statistically significant. Females were more likely to present with > 1 lesion (82.2% vs 56.8%, P= 0.01). Males were more likely to have cystic lesions (64.7% vs 27.9%, P < 0.001) compared to females who had more calcified lesions on presentation (65.1% vs 20.6%, P < 0.001). Male patients were more likely to have contrast enhancement or edema surrounding the lesions (61.4% vs 33.3%, P= 0.01) and were more likely to require treatment with Albendazole/Praziquantel (75.8% vs 31.7%, P < 0.001).

Conclusion

Although previously reported data is limited, there is a suggestion that there are gender differences in host immune response and that inflammation surrounding parenchymal lesions is more intense in females. This study suggests that men either present early in the disease phase or have different immune responses than women and require anti-parasitic therapy more frequently. More research in this aspect is needed.

Disclosures

All Authors: No reported disclosures
353. Starry Night, Starry Bright, A Lil’ Doxy Will Help You See the Light
Authors: Smith Brandon , McCreary Erin K , Viehman J Alex
Published: January 2021

Background

Bartonella henselae neuroretinitis (BHNR) is a rare complication of cat scratch disease (CSD) occurring in 1–2% of cases. BHNR requires prompt diagnosis and treatment to prevent potential vision loss. Doxycycline, in combination with rifampin, is consider the treatment of choice. Empiric therapy is often started based on clinical suspicion prior to serologic confirmation. We present a case of BHNR requiring doxycycline graded challenge.

Methods

We report a case of a 45-year-old female with a past history of multiple sclerosis treated with natalizumab presenting with acute right-sided vision loss. She reported suffering a cat scratch 6 weeks prior and had noteworthy tick exposure. She was admitted to our hospital for progressively worsening vision loss. MRI brain demonstrated right-sided enhancement consistent with retinitis. Ophthalmology exam suggestive of infectious papillitis, neuroretinitis, and granulomatous inflammation.

Results

Infectious diseases (ID) was consulted with concern for BHNR and a history of a severe tetracycline allergy, throat swelling age 17. Given declining vision and a differential including both Lyme disease and BHNR, the decision was made to empirically treat with doxycycline while awaiting serologic studies. She successfully underwent doxycycline graded challenge (10mg administered IV followed by 100mg administered IV one hour later) and ultimately completed a 6-week course of doxycycline in combination with 2 weeks of rifampin followed by 4 weeks of azithromycin. Bartonella serologies returned positive 1:256 and her Lyme screen was negative. At her 6-week follow up, her vision had significantly improved but not yet returned to baseline.

Retina images

Visual field testing

Conclusion

Doxycycline serves as a treatment of choice for BHNR; however, our patient reported a severe, likely IgE-mediated reaction to tetracycline 28 years prior. She subsequently tolerated the first doxycycline graded challenge at our institution. Unlike B-lactam allergies, there is a paucity of literature exploring the cross-reaction potentials of various tetracyclines. Limited evidence has suggested that cross-reactions are not absolute. Tetracycline allergies present an opportunity for antimicrobial stewardship.

Disclosures

All Authors: No reported disclosures
354. The Epidemiology and Clinical Features of Acanthamoeba Disease in the United States, 1956–2018
Authors: O’Laughlin Kevin , Cope Jennifer R , Marsh Zachary A
Published: January 2021

Background

Acanthamoeba is a free-living ameba found worldwide in soil and water that can cause severe illness. Transmission is thought to be through the skin, eyes, or lungs; Acanthamoeba can cause disseminated infection (Acanthamoeba disease) in addition to the more widely recognized Acanthamoeba keratitis. Infections however are rare, and only case reports or small case series have been published. We review Acanthamoeba disease cases from the Centers for Disease Control and Prevention (CDC) free-living ameba registry to characterize the disease in the United States.

Methods

CDC maintains a free-living ameba (FLA) registry of laboratory-confirmed Acanthamoeba cases (excluding keratitis) sourced from published case reports, CDC case report forms, and CDC laboratory results. SAS© version 9.4 software was used to calculate descriptive statistics and frequencies.

Results

We identified 163 cases of Acanthamoeba disease between 1956 and 2018. Of cases with documented outcome, 85% were fatal (105/124). Most (88%) cases were in patients who were immunocompromised (136/155): 66 people living with HIV (of whom 49 were classified as having AIDS); 33 recipients of organ transplantation; 30 people diagnosed with malignancy. The most common manifestation of disease was encephalitis (49%). Other clinical presentations included cutaneous lesions (20%) and rhinosinusitis (6%); 40 cases involved multiple organ systems. Median patient age was 42 years (range 0–83 years). Males accounted for 71% (114/160) of cases. California (29) and Texas (14) had the most case reports; 30 other states reported cases. The source of exposure was unknown in most cases (75%); soil and water were documented in 14 and 17 cases, respectively.

Conclusion

Acanthamoeba disease in the United States is primarily characterized by encephalitis and cutaneous lesions that affect predominately immunocompromised individuals. Acanthamoeba as a cause of encephalitis in immunocompromised patients should be considered by clinicians, which may lead to earlier diagnosis and treatment.

Disclosures

All Authors: No reported disclosures
360. A Case Control Study of COVID-19 in Patients with End Stage Renal Disease (ESRD)
Authors: Lim Su Lin , Chan Kok Hoe , Lagudu Sudha , Szabela Maria , Slim Jihad
Published: January 2021

Background

COVID-19 is a major global pandemic. Since the first case reported in Wuhan, China, COVID-19 has spread across the globe with more than 7.6 million individuals affected worldwide. Several studies have tried to investigate the risk factors for mortality but there has bot been a definitive study in patients with ESRD. Herein, we aimed to investigate whether ESRD is associated with mortality as compared to age, gender and comorbidities matched cohorts.

Methods

A retrospective case control study was performed on patients 18-year-old with confirmed SARS-CoV-2 admitted to our hospital during the study period (03/15/2020 to 05/15/2020). Demographic, characteristics and clinical outcome were retrieved and reviewed. We found 39 ESRD patients, we matched them for 5 variables: Age, gender, diabetes mellitus (DM), hypertension (HTN), and body mass index (BMI). Age was stratified into 3 groups (< 30, 30 to 60, >60), history of DM and HTN were defined by reviewing the admission medications, and BMI was divided into 2 categories (< 30 and 30 kg/m2). The primary endpoint was percentage of inpatient mortality.

Results

We had 39 ESRD patients with COVID-19 out of the 400 patients admitted during the study period with known clinical outcome. Nineteen patients (49%) were between 30 to 60 years old while the rest (51%) were older than 60 years old. As for gender, 25 (64%) were males and 14 (36%) females. Additional comorbidities were present in 38 patients with hypertension (92%) being the most common, followed by DM (64%) and BMI >30 kg/m2 (49%). With the 5 variables, we were able to match with 177 controls.

Nineteen individuals expired out of the 39 ESRD patients (49%), as compared to 46 patients from the 177 matched cohort (26%) (z-score 2.80, p=0.0051; odds ratio [OR], 2.71; 95% confidence interval [CI], 1.28–5.41).

Conclusion

Our results suggest that ESRD patients is an independent risk factor for increased mortality in patients with COVID 19 disease. Larger prospective studies will need to confirm this finding and try to find ways to mitigate this very high mortality in this vulnerable population.

Disclosures

Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
361. A Case Control Study of COVID-19 Outcome in Patients with HIV
Authors: Atallah Liana , Chan Kok Hoe , Natali Kayla M , Nagarakanti Sindhu , Slim Jihad
Published: January 2021

Background

Little is known regarding outcome of patients living with HIV (PLWH) when they get admitted to a hospital for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. We decided to conduct a case-controlled study to try to answer the question if PLWH are at higher risk of mortality compared to individuals without HIV infection but with the same risk factors that affects outcome in COVID-19 disease.

Methods

A retrospective case matched control study was performed from 03/15/2020 to 05/15/2020. We reviewed all confirmed SARS-CoV-2 infected patients who were admitted to our hospital during the study period and retrieved 7 variables: Age, gender, diabetes mellitus (DM), hypertension (HTN), body mass index (BMI), chronic kidney disease (CKD), HIV status. We divided the age in 3 groups (< 30, 30 to 60, > 60), we defined the presence of DM and HTN by reviewing the admission medications, BMI > 30 defined obesity, and CKD was present if eGFR < 45 ml/min prior to the current admission. We found 12 PLWH, we matched them for the 6 variables, we found 94 controls. The primary endpoint was percentage of inpatient mortality.

Results

Of the 436 confirmed SARS-CoV-2 infection admitted between 03/15/20 and 05/15/20, 36 were still hospitalized. Twelve were PLWH out of the 400 patients with known outcome; 7 patients (58%) have the age range between 30 to 60 years old while the rest (42%) have age > 60 years old. Male to female ratio was 1:1 (6 patients each). Comorbidities were present in 10 patients (83%) with HTN (83%) being the most common, followed by CKD (58%), obesity (33%), and DM (33%).

Only 1 patient expired out of the 12 PLWH (8%) admitted with COVID-19, as compared to 26 patients from the 98 matched cohort (27%) (z-score 1.38, p=0.17; odds ratio [OR], 3.972; 95% confidence interval [CI], 0.62–44.37).

Conclusion

Our study suggests that PLWH do not have a worse prognosis than their matched controls for the most significant comorbid conditions affecting outcome in COVID-19 disease. Further studies with a larger sample size are urgently needed to confirm this finding.

Disclosures

Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
362. A Modified Early Warning Score Predicts Decompensation in COVID-19 Patients
Authors: Cavalier Joanna S , Goldstein Benjamin , O’Brien Cara L , Bedoya Armando
Published: January 2021

Background

The novel coronavirus disease (COVID-19) results in severe illness in a significant proportion of patients, necessitating a way to discern which patients will become critically ill and which will not. In one large case series, 5.0% of patients required an intensive care unit (ICU) and 1.4% died. Several models have been developed to assess decompensating patients. However, research examining their applicability to COVID-19 patients is limited. An accurate predictive model for patients at risk of decompensation is critical for health systems to optimally triage emergencies, care for patients, and allocate resources.

Methods

An early warning score (EWS) algorithm created within a large academic medical center, with methodology previously described, was applied to COVID-19 patients admitted to this institution. 122 COVID-19 patients were included. A decompensation event was defined as inpatient mortality or an unanticipated transfer to an ICU from an intermediate medical ward. The EWS was calculated at 12-hour and 24-hour intervals.

Results

Of 122 patients admitted with COVID-19, 28 had a decompensation event, yielding an event rate of 23.0%. 8 patients died, 13 transferred to the ICU, and 6 both transferred to the ICU and died. Decompensation within 12 and 24 hours were predicted with areas under the curve (AUC) of 0.850 and 0.817, respectively. Using a three-tiered risk model, use of the customized EWS score for patients identified as high risk of decompensation had a positive predictive value of 44.4% and 11.1% and specificity of 99.3% and 99.6% and 12- and 24-hour intervals. Amongst medium-risk patients, the score had a specificity of 85.0% and 85.4%, respectively.

Conclusion

This EWS allows for prediction of decompensation, defined as transfer to an ICU or death, in COVID-19 patients with excellent specificity and a high positive predictive value. Clinically, implementation of this score can help to identify patients before they decompensate in order to triage at time of presentation and allocate step-down beds, ICU beds, and treatments such as remdesivir.

Disclosures

All Authors: No reported disclosures
363. Acute Kidney Injury and Renal Replacement Therapy in Hospitalized COVID-19 Patients in the United States and Other Geographic Regions
Authors: Gilbert Shannon NovosadShannon NovosadLeah , Apata Ibironke W , Overton Rahsaan , Garg Shikha , Kim Lindsey , Jackson Brendan R , Patel Priti
Published: January 2021

Background

Acute kidney injury (AKI) is a complication that has been described among severely ill patients with COVID-19 and may be more common in those with underlying chronic kidney disease (CKD). Some patients with AKI require renal replacement therapy (RRT), including continuous RRT (CRRT). During the COVID-19 pandemic, some US areas experienced CRRT supply shortages. We sought to describe the percent of hospitalized COVID-19 patients who developed AKI or needed RRT to inform patient care and resource planning.

Methods

We searched for studies in the literature and public health investigations that described CKD, AKI, and/or RRT in COVID-19 patients from January 2020 onward. Studies were excluded if no CKD, AKI, or RRT information was provided. We abstracted counts of hospitalized COVID-19 patients, including those admitted to intensive care units (ICU) who developed AKI, underwent RRT, and/or had CKD. Data were pooled across cohorts by geographic region with available data (US, China, or United Kingdom [UK]). We compared proportions using Chi-square tests.

Results

A total of 311 studies were identified; 23 studies (US n=11; China n=11; UK n=1) that described kidney disease and/or kidney-related outcomes in hospitalized COVID-19 patients were included. Underlying CKD prevalence was higher in US cohorts (10.3%) compared with China (2.5%) or UK (1.5%) (p< 0.0001). AKI was markedly higher among hospitalized (31.3% vs. 6.4%; p < 0 .001) and ICU patients (55.4% vs. 18.2%; p< 0.0001) in the US compared to China. The percent of ICU patients requiring RRT in the US (16.8%) was significantly different from that reported in China (12.5%) and the UK (23.9%) (p< 0.0001). Limitations include differences in CKD and RRT definitions across studies.

Conclusion

AKI is a frequent outcome among US COVID-19 patients, affecting almost one third of hospitalized and more than half of ICU patients. AKI was reported more frequently in the US than China. The percent of ICU patients who received RRT was higher in the US and UK than in China. Understanding the occurrence of kidney-related outcomes among patients with COVID-19 including the impact of underlying CKD and regional practice variations is essential for healthcare systems to successfully plan for RRT needs during the pandemic.

Disclosures

All Authors: No reported disclosures
364. Baseline characteristics, comorbidities, and outcomes of COVID-19 patients hospitalized in Southwest Georgia, U.S. – an interim analysis of an early hot spot
Authors: Chastain Daniel B , Osae Sharmon P , Burt Ashley M , VanLandingham Kevin , Sibold Natalie , Henao-Martinez Andres , Franco-Paredes Carlos , Young Henry N
Published: January 2021

Background

Understanding the spectrum of disease severity and death are critical for identifying unrecognized risk factors associated with morbidity and mortality from coronavirus disease 19 (COVID-19). The purpose of this study was to describe the baseline characteristics, clinical presentation, and outcomes among patients hospitalized with COVID-19 in a major hotspot in the U.S. Southeast.

Methods

This multicenter retrospective chart review included adult patients hospitalized with COVID-19, defined by laboratory-detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in Southwest Georgia. The primary outcome was mortality, which was assessed through discharge or June 14, 2020, whichever occurred first. Secondary outcomes included comorbidities, laboratory and radiographic findings, as well as clinical course.

Results

A total of 120 patients were included with a median age of 61 years (IQR 50–72). The majority were African American (73%) and female (56%). Comorbidities on admission were present in 88% of patients; most prevalent were hypertension (76%), diabetes mellitus (55%), and chronic pulmonary disease (27%). Median Charlson comorbidity index was 4 (IQR 2–6) and BMI was 32.8 kg/m2 (IQR 26.2–39.5). On presentation, patients most often complained of dyspnea (69%), fever (63%), and cough (53%), with a median SOFA score of 2 (IQR 2–4). Most patients were admitted to the general ward (71%), of which 17% were subsequently transferred to ICU. During hospitalization, 27% were mechanically ventilated for a median 11 days (IQR 5–13.5), 18% developed ARDS, and 43% developed AKI. Median length of stay was 9.5 days (IQR 3.75–14). Overall mortality was 20%, which was significantly higher among patients with comorbidities (p = 0.047), as well as those who developed ARDS (p < 0.001) or AKI (p = 0.027).

Conclusion

Most reports of COVID-19 have focused on large urban settings. However, early during the pandemic, we identified a large cluster of cases with a high-case fatality rate in a semirural setting in Southwest Georgia in the U.S.

Disclosures

All Authors: No reported disclosures
367. Clinical Characteristics and Outcomes in Patients with Pneumonia secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
Authors: Nichols Courtney , Sobhanie Mahdee , Colburn Nora , Lustberg Mark , El Boghdadly Zeinab , Liscynesky Christina , Hebert Courtney , Day Shandra R
Published: January 2021

Background

Since discovery in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes the disease of COVID-19 has become a global pandemic. Little is known about which risk factors lead to more severe disease or increased mortality in patients diagnosed with SARS-CoV-2. We aimed in this study to compare clinical characteristics associated with disease severity and increased mortality in hospitalized patients with COVID-19.

Methods

This was a single-center, retrospective study at The Ohio State University Wexner Medical Center to compare clinical characteristics associated with increased mortality in hospitalized patients with confirmed SARS-CoV-2. Adults patients positive for SARS-CoV-2 between March 1, 2020 and April 20, 2020 were included in the study. Prisoners and pregnant women were excluded. Baseline demographics, clinical characteristics, and outcomes were collected, and then compared to determine association with mortality. Statistical analysis used univariate and multivariate logistic regression analysis to evaluate the relationship between patient characteristics and mortality.

Results

The cohort included 92 patients. Median age was 58 years (ranging from 25–93) and 47/92 were men (51%). 12 patients were admitted directly to the intensive care unit (ICU), with 22 additional patients transferred to the ICU. 23 patients required mechanical ventilation. Clinical characteristics significantly associated with mortality in univariate analysis included underlying coronary artery disease (CAD) (OR=7.8, p = 0.002), chronic obstructive pulmonary disease (OR=5.21, p=0.02), living in an extended care facility (ECF) (OR=4.2, p=0.025), and immunocompromised status (OR=4.2, p=0.025). Multivariate analysis showed a statistically significant association in patients with underlying CAD (OR=13.1, p=0.001) and those admitted from an ECF (OR=12.1, p=0.005), when adjusted for other variables in the model.

Characteristics Associated with Mortality in Patients with COVID-19 in Univariate Analysis

Conclusion

Our study found that CAD and admission from an ECF were associated with SARS-CoV-2 mortality, when adjusted for age and other comorbidities. Further studies are necessary to identify potential preventative strategies to mitigate mortality in this vulnerable population.

Disclosures

All Authors: No reported disclosures
368. Clinical Characteristics of Hospitalized COVID-19 American Indian Patients in Rural Arizona
Authors: Nham Amy , Close Ryan M
Published: January 2021

Background

American Indians have an increased risk of serious complications from COVID-19 due to the high prevalence of comorbidities such as diabetes, heart disease, obesity, and asthma. To date, there has been limited analysis of COVID-19 in the AI population. This study describes the characteristics of hospitalized COVID-19 patients from a well-defined AI population in eastern Arizona. Additionally, we explored the impact of early referral via contact tracing versus those who self-presented.

Methods

Retrospective chart reviews were completed for patients hospitalized for COVID from March 29 to May 16, 2020. Summary statistics were used to describe demographics, symptoms, pre-existing conditions, and hospitalization data.

Results

We observed 447 laboratory-confirmed cases of COVID-19, resulting in 71 (15.9%) hospitalizations over a 7-week period and a hospitalization rate of 159 per 1,000 persons. Of the 50 hospitalizations reviewed sequentially, 56% were female, median age of 55 (IQR 44–65). Median number of days hospitalized was 4 (2–6), with 16% requiring intensive care unit support, 15% intubated, 12% readmitted, and 10% deceased. 67% had an epidemiological link, and 32% had an emergency department or outpatient clinic visit within 7 days of hospitalization. All patients were symptomatic; the most common symptoms were cough (90%), shortness of breath (78%), and subjective fever (66%). 86% of patients had a pre-existing condition; the most common pre-existing conditions were diabetes (66%), obesity (58%), and hypertension (52%, Figure 1). All patients had elevated LDH, 94% had elevated CRP, 86% had elevated d-dimer, and 40% had lymphopenia; only 10% had an elevated WBC count and 26% had thrombocytopenia (Table 1). 26% of the patients were referred in by the tracing team (Table 2). Analysis of 500 hospitalizations will be available in October 2020.

Conclusion

Most AI patients hospitalized had a pre-existing condition, symptoms of cough or shortness of breath, and elevated LDH, CRP, and d-dimer. More research is needed to understand the patterns of COVID-19 related disease in vulnerable populations, like AI/AN, and to examine the utility of early referral by contact tracing teams in rural settings which may guide future tracing strategies.

Disclosures

All Authors: No reported disclosures
369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital
Authors: Bengualid Victoria , Martinez Maria , Hysenaj Zhenisa , Willner Debra M , Berger Judith
Published: January 2021

Background

The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients.

Patient Characteristics and Outcome

Methods

IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome.

Results

A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%.

Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms.

Mortality

The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die.

Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001).

Conclusion

This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality.

Disclosures

All Authors: No reported disclosures