bluuebunny/crossref_metadata_2025 huggingface dataset:
135. Impact of #idjclub, a Synchronous Twitter Journal Club, as a Novel Infectious Disease Education Platform
Authors: Schwartz Ilan S , Woc-Colburn Laila , McCarty Todd P , Cutrell James B , Cortes-Penfield Nicolas W
Published: January 2021

Background

Journal clubs have been a mainstay of medical education since the days of Osler. Social media platforms allow virtual journal clubs to connect global participants. We describe the creation and impact of #IDJClub, an Infectious Diseases (ID) Twitter journal club.

Methods

We launched #IDJClub in October 2019. The format presents a recent ID publication for a 1-hour synchronous Twitter chat led by an ID physician from @IDJClub. Sessions started monthly, but increased in frequency due to interest during the COVID-19 pandemic. Pre-scripted tweets guide participants through the article description and analysis. We used Symplur’s Healthcare Hashtag project to track the number of impressions, tweets, participants, and the engagement rate (average tweets/participant) of #IDJClub per 60 minute discussion plus the following 30 minutes to capture ongoing conversations. We also conducted an online anonymous survey using Likert scales and open-ended questions to assess educational impact.

Results

As of June 11 2020, @IDJClub garnered 5,338 followers from around the world (Figure 1). In its first 9 months, 12 virtual journal clubs were conducted with a mean of 791,624 impressions, 328 tweets, and 48 participants per session, which steadily increased over time (Figure 2). A total of 134 participants completed the survey, of whom 40% were ID physicians, 19% pharmacists, 13% ID fellows, and 10% medical residents. Most respondents followed 1–2 (38%) or 3–4 (38%) of the discussions, with variable levels of active participation. Majorities agreed that #IDJClub provided clinically useful knowledge, increased personal confidence in review of literature, and compared favorably with in-person journal clubs (Figure 3). The format addressed several barriers such as lack of access to in-person journal clubs or subject experts at one’s own institution and lack of time to read new research or attend traditional journal clubs (Figure 4).

Conclusion

#IDJClub is an effective platform for virtual journal club, providing an engaging, open-access tool for critical appraisal of ID literature. This innovation in medical education overcomes several barriers to traditional journal clubs while fostering professional relationships within the global ID community.

Disclosures

Todd P. McCarty, MD, Amplyx (Scientific Research Study Investigator)Cidara (Scientific Research Study Investigator)
142. Frequency of Short-course Empiric Antibiotic Use as an Antimicrobial Stewardship Metric
Authors: McGregor Jessina C , McCracken Caitlin M , Hohmann Samuel F , Pakyz Amy L
Published: January 2021

Background

Antimicrobial stewardship metrics that provide actionable guidance are needed to support efforts to improve hospital use of antibiotics. Antibiotics such as vancomycin and piperacillin/tazobactam are common empiric agents used frequently when the infectious process remains unknown. Thus short, incomplete courses of therapy are used more frequently for such agents. We aimed to evaluate the variability in short courses of vancomycin and piperacillin/tazobactam use across U.S. hospitals.

Methods

We performed a cross-sectional study among U.S. hospitals that contributed inpatient pharmacy data to the Vizient clinical database in 2016. We identified vancomycin and piperacillin-tazobactam courses initiated within the 48 hours of admission, measured as days of therapy received. We calculated the percent of patients that received 1, 2, 3, 4 or >4 days of therapy at each facility to describe short course empiric therapy use. To describe the variability across facilities, we then assessed the median, interquartile range (IQR), and total range of that percentage.

Results

We identified 145 hospitals representing approximately 3.7 million patient encounters for inclusion in this study. Within 48 hours of admission, 13.9% of encounters received vancomycin, 7.7% piperacillin/tazobactam, and 4.6% received both. The figure demonstrates the variability in the frequency of short course antibiotic use across hospitals; boxes indicate the IQR with the transecting line representing the median and whiskers representing the full range. The proportion of patients that received one day of therapy varied most across hospitals, with vancomycin ranging from 0–100%. In contrast, the frequency of patients that received greater than four days of therapy varied considerably less across hospitals; 0–33% for vancomycin.

Conclusion

The variability in use of short course empiric therapies suggests that use for non-infectious processes or infections not appropriately treated by these agents varies greatly across facilities. Measuring short course use for common empiric agents may serve as an important antimicrobial stewardship metric. Such a metric could inform antimicrobial stewardship efforts to reduce unnecessary initiation of empiric antimicrobial therapy.

Disclosures

All Authors: No reported disclosures
151. The Use of Dried Blood Spot Cards to Assess Serologic Responses of Individuals Vaccinated Against Measles, Hepatitis A, Tetanus, Influenza and Varicella Zoster
Authors: Danko Janine R , Taylor Robert , Reinhardt Brian , Watson Nora L , Banks Taylor
Published: January 2021

Background

Traditional blood sampling by venipuncture is cumbersome and expensive. Dried Blood Spot (DBS) sampling is desirable because of its ease of sample collection, transportation and storage. It has been used in clinical diagnosis but not been thoroughly studied for the potential use to assess the immune status of individuals following natural infection or preventive vaccination. The goal of this study is to compare DBS to traditional blood samplings in detection of antibodies in individuals vaccinated against measles, hepatitis A, tetanus, influenza and varicella zoster.

Methods

Blood from 220 vaccinated individuals were collected by venipuncture into serum separation tubes and by fingerstick onto Whatman 903® protein saver cards. ELISA was used to test DBS eluates and serum samples for antibodies against measles, varicella, tetanus and hepatitis A. Sensitivities, specificities, and correlation coefficients were evaluated to compare optical density (OD) values of paired serum and DBS samples. Hemagglutinin inhibition (HAI) and microneutralization assay (MNA) were used to determine anti-influenza antibody in serum and DBS samples. The long term stability of DBS samples at different temperatures was assessed using simulated immune measles blood.

Results

DBS OD was highly correlated with serum OD for antibodies to measles (r = 0.93), varicella (r = 0.82), and tetanus (r = 0.91) (Fig.1). Sensitivities of DBS OD ranged from 86–99% and specificities ranged from 96–100% using cut-offs established by each assay. By contrast, the hepatitis A data showed a low sensitivity (31%) and a weak correlation (r = 0.14) between DBS and serum samples. HAI and MNA assays showed a broad range of anti-influenza A (H1N1 and H3N1) antibody titers in serum samples but failed to detect the antibodies in DBS eluates. The stability data indicated that DBS samples were stable for 4 weeks when stored at room temperature and for 6 months at 4°C (Fig. 2).

Figure 1. Correlation of antibody levels detected by DBS sampling to the antibody levels detected by serum sampling for measles, hepatitis A, tetanus and varicella zoster.

Figure 2. Stability of the blood samples on DBS cards stored under various temperatures for 25 weeks as measured by the titers of anti-measles antibody (IgG) at various time points.

Conclusion

DBS sampling was sensitive, specific, and highly correlated with traditional venipuncture sampling in detection of antibodies against measles, tetanus and varicella zoster, but not hepatitis A and influenza. Thus, the success of using DBS sampling to assess the antibody levels in immunized individuals may be dependent on the pathogens and the type of assay used.

Disclosures

All Authors: No reported disclosures
157. patient to Environment Transmission of Multidrug-resistant Bacteria Within Intensive Care Units
Authors: Ziegler Matthew J , Kelly Brendan , David Michael Z , Dutcher Lauren , Tolomeo Pam C , Bekele Selamawit , Loughrey Sean , Reesey Emily , Glaser Laurel , Lautenbach Ebbing
Published: January 2021

Background

Identifying risk factors for environmental contamination with multidrug-resistant organisms (MDROs) is essential to prioritize methods for prevention of hospital transmission.

Methods

Patients admitted to an ICU with an MDRO detected on clinical culture in the prior 30 days were enrolled. Patients (4 body sites) and high-touch objects (HTO) (3 composite sites) in ICU rooms were sampled. Environmental transmission was defined by shared MDRO species cultured on patient and HTO cultures obtained on multiple time points during the patient’s stay. Risk factors for environmental transmission were identified with logistic regression.

Results

Forty-five patients were included (median 2 days of longitudinal sampling [IQR 1–4 days]). Enrollment anatomic cultures included extended-spectrum beta-lactamase-producing Enterobacterales (ESBLE) (n=12, 27%), carbapenem-resistant organisms (CRO) (n=4, 9%), methicillin-resistant S.aureus (MRSA) (n=11, 24%), vancomycin-resistant Enterococci (VRE) (n=4, 9%), and C.difficile (CDIFF) (n=14, 31%). Patient colonization during serial sampling was common with CRO (n=21, 47%), ESBLE (n=16, 36%), and VRE (n=16, 36%) and less so with MRSA (n=7, 16%) and CDIFF (n=5, 11%). Detection of MDROs on environmental surfaces was also common with identification of CRO in 47% of patient rooms (n=21) and ESBLE in 29% (n=13); MRSA (n=2, 4%), VRE (n=9, 20%), and CDIFF (n=3, 7%) were rarer. Patient to environment transmission was observed in 40% of rooms (n=18). Thirteen (29%) rooms had foreign MDRO contamination (i.e., one not detected on a body culture), most (n=10) with CRO. Environmental MDROs were most common in bathroom/sinks (n=22), followed by surfaces near the patient (n=10), and least common surfaces often touched by staff within the room (n=6).

On multivariable logistic regression, naïve to clustering by patient, recent receipt of a proton pump inhibitor (OR 2.35, 95% CI 1.00 – 5.52, P=0.049) and presence of one or more wounds (OR 2.56, 95% CI 1.05 – 6.26, P=0.038) were significantly associated with environmental transmission (OR 1.56, 95% CI 1.01 – 2.43, P=0.046) (Table 1).

Conclusion

MDRO contamination of patient rooms is common with detection of organisms attributed to, and foreign to, the occupant.

Disclosures

Michael Z. David, MD PhD, GSK (Consultant)
165. Cefiderocol Treatment for Serious Infections Caused by Carbapenem-resistant Bacteria: Post-hoc Analysis of Outcomes by Pathogen in the CREDIBLE-CR Study
Authors: Matsunaga Yuko , Ariyasu Mari , Takemura Miki , Yamano Yoshinori , Toyoizumi Kiichiro , Kinoshita Masahiro , Echols Roger , Den Nagata Tsutae
Published: January 2021

Background

The efficacy and safety of cefiderocol (CFDC), a novel siderophore cephalosporin, for the treatment of serious infections due to carbapenem-resistant (CR) Gram-negative pathogens was assessed in the CREDIBLE-CR study. The current analysis evaluated clinical and microbiological outcomes by baseline CR pathogen.

Methods

An open-label, prospective, randomised 2:1, Phase 3 study (CREDIBLE-CR; NCT02714595) was conducted in adult patients with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia, bloodstream infections or sepsis, and complicated urinary tract infections caused by CR Gram-negative pathogens. Patients received either intravenous (IV) CFDC 2g, q8h, 3-h infusion, or IV best available therapy (BAT: up to 3 drugs in combination), for 7–14 days (extendable to 21 days). Clinical and microbiological outcomes were assessed in the CR microbiological intent-to-treat (CR-MITT) population by CR pathogen, baseline MIC and by mechanism of carbapenem resistance at test of cure (TOC). Only summary statistics were collected.

Results

In the CR-MITT population (CFDC N=80; BAT N=38), Acinetobacter baumannii (46.3% and 44.7%), Klebsiella pneumoniae (33.8% and 31.5%), and Pseudomonas aeruginosa (15% and 26%) were the most frequent pathogens in CFDC and BAT arms, respectively. For all CR pathogens, clinical cure rates were achieved in 52.5% in the CFDC arm and 50.0% in the BAT arm at TOC; rates were similar between treatment arms by baseline CR pathogen (Table 1). Numerically higher clinical cure and microbiological outcomes were observed with CFDC for Enterobacterales (Table 1), especially against NDM-producing bacteria or those with porin-channel mutations (Table 1). CFDC MIC values ranged between ≤0.03 and 4 μg/mL, except for one pathogen (Table 2). Microbiological outcomes for CR A. baumannii, CR K. pneumoniae, and CR P. aeruginosa at TOC by baseline MICs of ≤4 μg/mL ranged between 0–40%, 0–100%, and 0–100%, respectively; at MIC ≤4 μg/mL, clinical and microbiological outcomes were equal (Table 2).

Conclusion

CFDC, via a novel mechanism of entry and its stability against β-lactamases, was effective against serious infections caused by CR pathogens with various resistance mechanisms or baseline MIC values.

Disclosures

Yuko Matsunaga, MD, Shionogi Inc. (Employee) Mari Ariyasu, BPharm, Shionogi & Co., Ltd. (Employee) Miki Takemura, MSc, Shionogi & Co., Ltd. (Employee) Yoshinori Yamano, PhD, Shionogi & Co., Ltd. (Employee) Kiichiro Toyoizumi, PhD, Shionogi & Co., Ltd. (Employee) Masahiro Kinoshita, MPharm, Shionogi & Co., Ltd. (Employee) Roger Echols, MD, Shionogi Inc. (Consultant) Tsutae Den Nagata, MD, Shionogi & Co., Ltd. (Employee)
172. Serum Igg Profiling Healthy 1- and 2- year Old Toddlers Reveals a Subgroup with Clinically Informative Reactivities to Pathogens and Autoantigens
Authors: Reto Patricia Pichilingue , Raj Prithvi , Li Quan-Zhen , Dozmorov Igor , De la Morena Maria Teresa , vanOers Nicolai
Published: January 2021

Background

The antibody repertoire in an infant/toddler develops in response to the microbiome, infections, environmental exposures, and vaccinations. Monitoring the specificity of these antibody responses in normal toddlers will provide indicators of disease susceptibility.

Methods

The serum Immunoglobulin (Ig)G and IgM antibody reactivity patterns in 1- and 2-year-old healthy toddlers was determined by examining the Ig specificity to diverse infectious agents, autoantigens and vaccine antigens with an antigen array. The toddlers were stratified based on their antibody reactivity to these diverse antigens with a normalized fluorescence intensity measure. Repeat profiling was performed at year 2 to reveal longitudinal changes in the IgG and IgM responses. Clinical information, along with DNA sequencing, and selected cytokine assays were used to establish an odds ratio for immune disease potential among the cohort.

Results

Healthy 1- and 2- year old IgG responses revealed cohorts of low, moderate, and high Ig responder groups that was unconnected with total serum IgG levels. The high responder group had elevated IgG reactions to selected pathogens, particularly viruses as well as to autoantigens. This high reactivity group, representing 17% of the cohort, had high odds ratios with maternal gestational diabetes, age, and a family history of asthma. While all toddlers developed strong antibody responses to Measles-Mumps-Rubella vaccines (MMR), more variation was noted towards other vaccines. In infections to Molluscum contagiosum, the IgG serum levels were transient regardless of the responder group. The high responder group had DNA polymorphisms linked to enhanced immune responses that correlated with elevated cytokine levels as well as eczema and asthma.

A subset of toddlers has strong IgG responses to pathogens and vaccines

Conclusion

A subset of normal healthy toddlers has a high potential for immune system abnormalities and autoimmunity based on higher serum antibody responses to pathogens and autoantigens, genetic polymorphisms, and elevated cytokine responses.

Disclosures

All Authors: No reported disclosures
176. Selected Impact of the 13-valent Pneumococcal Conjugate Vaccine (PCV13) on Invasive Pneumococcal Disease (IPD) at Eight Children’s Hospitals in the United States. 2014–2019
Authors: Kaplan Sheldon L , Barson William J , Lin Philana L , Romero Jose R , Bradley John S , Tan Tina Q , Pannaraj Pia S , Givner Larry , Hulten Kristina G
Published: January 2021

Background

The 2011 IDSA/PIDS Clinical Practice Guidelines for the Management of Community-acquired Pneumonia (CAP) in Children Older than 3 months recommended empiric treatment with either ampicillin/penicillin or ceftriaxone based on PCV13 vaccine status and the local antibiotic susceptibilities of IPD isolates. No study has addressed differences in antibiotic susceptibilities for isolates from children with pneumococcal pneumonia (PP) based on PCV13 status.

Methods

Investigators from 8 US children’s hospitals identified infants and children with IPD between 1/1/2014 and 12/31/2019. IPD was documented by positive cultures from a normally sterile site. PP diagnosis required an abnormal chest radiograph. Clinical data were recorded and isolates analyzed for serotype (ST) by the capsular swelling method and antimicrobial susceptibilities by standard methods. Administration of PCV7/13 was documented through the patient’s medical records, health care provider or a vaccine registry. Fisher Exact was performed; p< 0.05 was significant.

Results

690 IPD patients with isolates were available (0–18 y); 24% (166/690) of the isolates were PCV13 STs (ST3-75, ST19F-45, ST19A-36, ST7F-5, other STs-5). The most common non-PCV13 ST isolates were ST35B-60, ST23B-59, ST33F-47, ST22F-43, ST15C-35, ST23A-27, ST15B-26, ST10A-26, ST15A-23. Of non-PCV13 isolates, 41% (217/524) were among the 7 additional STs in PCV20. For children with PP (n=157), the distributions of penicillin (Table) (p=0.8) and ceftriaxone MICs were no different for isolates obtained from children regardless of prior PCV13 doses. Less than 7% of PP isolates were resistant to penicillin (MIC >2 µg/mL).

Table. Minimal inhibitory concentrations (MIC) of pneumococcal isolates related to the number of PCV13 doses each patient received prior to pneumococcal pneumonia (PP).

Number of PCV13 doses

Conclusion

PCV13 status should not modify empiric antibiotics for children with suspected pneumococcal CAP. 41% of non-PCV13 IPD isolates were among the 7 additional PCV20 STs.

Disclosures

Sheldon L. Kaplan, MD, Allergan (Research Grant or Support)Pfizer (Grant/Research Support) Tina Q. Tan, MD, Pfizer (Grant/Research Support, Other Financial or Material Support, Chair, DMSB for PCV20 vaccine) Pia S. Pannaraj, MD, MPH, AstraZeneca (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member)
318. Deferring Amputation in Diabetic Foot Osteomyelitis: Doing more Harm than Good?
Authors: Zhou Shiwei , Schmidt Brian M , Henig Oryan , Kaye Keith S
Published: January 2021

Background

Diabetic foot osteomyelitis (DFO) is a leading cause of below knee amputation (BKA). Even when medical treatment is deemed unlikely to succeed, patients with DFO are often resistant to amputation.

Methods

An observational cohort analysis was done on patients with DFO at Michigan Medicine who were evaluated by podiatry and recommended BKA from Oct 2015 - Jun 2019. Primary outcome was mortality after BKA recommendation. Secondary outcomes were healing of affected limb, rate of BKA or above knee amputation (AKA) and total antibiotic days in the 6 months following. All intravenous antibiotics and oral courses of linezolid and fluoroquinolones were captured.

Results

Of 44 patients with DFO, 18 chose BKA, 26 chose medical management with wound care. Mean age of the cohort was 61, 68% male, 80% white with a median Charlson Comorbidity Index of 6 (IQR 4,7). The two groups were similar with regards to demographics and comorbid conditions. Those who chose medical management did so because their infection was non-life-threatening and they desired to avoid amputation.

One-year mortality was greater in patients who were medically managed compared to those who had BKA (23.1% vs 0%, OR 11.7, 95% CI 0.6–222.9). Considering only the 33 patients who were followed for at least 2 years, 2-year mortality was also greater in the medically managed group compared to the BKA group (38.5% vs 5.6%, OR 10.6, 95% CI 1.2–92.7, Figure 1). Fewer patients in the medical management group had complete healing of their wound/stump compared to the BKA group (46.2% vs 88.9%, OR 9.3, 95% CI 1.8–49.1). In the medically managed group, 18 (69%) patients went on to require BKA or AKA at a median of 76.5 days compared to 2 (11%) in the BKA group who required AKA at 1 and 11 days following recommendation. Median antibiotic days were significantly greater in the medically managed group compared to the BKA group (55 IQR 42,78 vs 17 IQR 10,37, p=0.0017).

Conclusion

In this cohort of DFO patients where BKA was recommended, medical management was associated with increased mortality, poor healing of the affected limb, and excess antibiotic exposure compared to BKA. These findings are particularly notable as case mix and severity of illness were similar between the two groups. This study can be used to inform providers and patients in cases where BKA is recommended.

Disclosures

All Authors: No reported disclosures
319. Distribution of Joint Involvement for Arbovirus-Associated Persistent Arthralgia May Help Distinguish Between Similar Diseases
Authors: Farahani Shayan , Kikyo Fumitaka , Cui Charley , Palacio Federico , Powers-Fletcher Margaret
Published: January 2021

Background

Imported cases of arbovirus infections associated with persistent arthralgia in travelers returning from endemic areas are often misdiagnosed due to overlapping clinical presentations and lack of widely available diagnostic testing. Identifying differences in joint involvement between arboviruses that cause persistent arthralgia may facilitate an earlier diagnosis. The purpose of this study was to determine if such distinct joint involvement has been reported in published literature for arbovirus-associated persistent arthralgia.

Methods

Chikungunya (CHIKV), Ross River Virus (RRV), Sindbis Virus (SINV) and Mayaro Virus (MAYV) were selected for their association with persistent arthralgia. Candidate manuscripts were identified using the PubMed database and search terms included virus names as well as terms associated with persistent arthralgia. Inclusion criteria consisted of 1) patient data on persistent arthralgia and 2) description of joint involvement. Joint involvement data was manually extracted and compared between viruses using a Fisher’s exact test. Pairwise post-hoc comparisons were then conducted using Fisher’s exact test and a Bonferroni correction was applied.

Results

Data from 1,833 patients were extracted from 57 manuscripts that met inclusion criteria (RRV = 194, SINV = 87, CHIKV = 1,526, MAYV = 26). Reported involvement of hands, wrists, elbows, shoulders, ankles and knees were recorded (Table 1). Distribution of joint involvement was then calculated for each virus (Figure 1). The difference in distribution of joint pain between the four arboviruses was statistically significant (P = 0.004). Comparisons revealed RRV and CHIKV are distinguishable from each other (P = 0.004).

Table 1. Reported Joint Involvement

Figure 1. Distribution of Joint Involvement

Conclusion

These findings suggest that differences in distribution in joint involvement may exist between patients with persistent arthralgia following arbovirus infection. Future studies aimed at more clearly elucidating these differences are warranted and may help develop a more rapid and accurate diagnostic algorithm that could improve patient care.

Disclosures

All Authors: No reported disclosures
321. Eleven-year Case Series of the Anatomy and Microbiology of Musculoskeletal Infections in People who Inject Drugs
Authors: Schade Meredith A , London Abby , Lin Dan
Published: January 2021

Background

Complex musculoskeletal infections(MSKI) can be seen in injection drug users. The objective of the study was to describe the anatomic location and microbial etiology of MSKI.

Methods

This is a single center, eleven-year case series of adult patients admitted with infection of the musculoskeletal system from January 1, 2008 to December 31, 2018. Diagnosis codes for MSKI were used. As there are no diagnosis codes that specifically identify injection drug use, ICD-9 and ICD-10 codes for related diagnoses were used. The codes included opioid use disorder, drug abuse, heroin use, drug overdose, cocaine use, and methamphetamine use.Charts were then carefully reviewed to determine if a MSKI related to IDU had occurred. Fisher’s exact test was used to calculate P values.

Results

A total of 849 individual medical records were identified. Eighty-six distinct episodes of infection were found in eighty-two patients. Most patients were white, non-Hispanic, male, 50 years of age or younger. Tobacco use disorder(87.8%) and hepatitis C(64.6%) were common. Mental health disorders were identified in one third. The axial skeleton was involved in 61.6% and the appendicular in 25.6%. Soft tissue infection alone was present in 9%. Bacterial infections predominated with Staphylococcus aureus most frequent(67.4%) followed by Pseudomonas aeruginosa (11.6%). Candida species were uncommon. All soft tissue infections were polymicrobial. Infections of the appendicular skeleton were managed with antibiotics and surgery whereas infections of the axial skeleton were more likely to receive antibiotics alone. Seventy two percent had successfully completed treatment at one year. The remainder had relapsed due to same infection, died or were lost to follow up.

Demographics of Study Population

Anatomy and Microbiology of MSKI in PWID and 1-year Treatment Outcomes

Anatomy and Microbiology of MSKI in PWID with Different Treatment Modalities

Conclusion

MSKI in PWID continue to be found in younger persons with relatively few comorbidities. The infections predominantly involve the axial skeleton and are caused most often by Staphylococcus aureus. Gram-negative infections also occur and are due to environmental bacteria. Spinal infections were managed medically whereas infections of peripheral joints were also managed with surgery. An unfortunate number had relapse of infection, died or were lost to follow-up at 1 year, demonstrating the challenges of managing MSKI in this unique population

Disclosures

All Authors: No reported disclosures
348. Etiology of Eosinophilic Meningitis in Korea
Authors: Park Sunghee , Jung Jiwon , Chong Yong Pil , Kim Sung-Han , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Woo Jun Hee , Kim Min Jae
Published: January 2021

Background

Eosinophilic meningitis is defined as the presence of more than 10 eosinophils per mm3 in the cerebrospinal fluid (CSF), or eosinophils accounting for more than 10 percent of CSF leukocytes in a patient with symptoms or signs suggestive of acute meningitis. Parasites are known to be the most common cause of eosinophilic meningitis worldwide, but there is limited research on patients in South Korea.

Methods

We retrospectively reviewed patients with eosinophilic meningitis at a tertiary hospital in Seoul, South Korea, from 2004 to 2018. Patients who were suspected of having a non-infectious cause were excluded. Etiology and clinical characteristics such as age, sex, risk factors, symptoms and signs, laboratory and radiologic findings, treatment, and prognosis were identified.

Results

Of the 35 patients included in this study, 11 (31.4%) had parasitic causes, with 8 (22.9%) diagnosed as neurocysticercosis, and 3 (8.6%) as toxocara meningitis. Four (11.4%) were diagnosed with fungal meningitis, and underlying immunodeficiency was found in 2 of these patients. Tuberculous meningitis was suspected in 4 (11.4%), while viral and bacterial meningitis were rare causes of eosinophilic meningitis, with 2 (5.7%) and 1 (2.9%) patients, respectively. One patient with neurocysticercosis and one patient with fungal meningitis died, while 8 (22.9%) had remaining neurologic sequelae. The etiology was unknown in 13 patients (37.1%). Four of these patients received empirical anti-tuberculosis therapy, while 5 were treated empirically with acyclovir.

Conclusion

Parasite infections, especially neurocysticercosis and toxocariasis, were the most common cause of eosinophilic meningitis in South Korean patients. Fungal meningitis, while relatively rare, is often aggressive and should always be considered when searching for the cause of eosinophilic meningitis.

Disclosures

All Authors: No reported disclosures
352. Seronegative Relapse of Brucellosis in the Central Nervous System
Authors: Papadopoulos Vassilis E , Tountopoulou Argyro , Patas Kostas , Vakrakou Aegli , Koropouli Eleftheria , Vassilopoulou Sophia , Mitsikostas Dimos
Published: January 2021

Background

Brucellosis is the most common zoonotic infection in the world. High risk areas include the Mediterranean Basin, Eastern Europe and the Middle East. Clinical presentation is quite heterogenous.

CNS involvement (neurobrucellosis) varies widely, from 0,5 to 25%. This reflects a high prevalence in endemic areas and the lack of established criteria for a diagnosis. We present a patient with a seronegative relapse of brucellosis, confined in the CNS, identified by Brucella IgG ELISA and 16S rRNA sequencing.

Methods

Case Report

Results

A 60-year-old man, farmer, with a history of systematic brucellosis two years before admission, presented with high fever, headache and agitation. A serum agglutination test and anti-Brucella IgG ELISA were negative at baseline. Spinal tap revealed lymphocytosis and low glucose. CSF culture was negative. The patient received ceftriaxone, ampicillin and acyclovir with an initial remission. A week later the patient’s symptoms relapsed. Administration of ceftriaxone and acyclovir was reinitiated with clinical improvement, however, lymphocytic meningitis persisted even after 15 days of treatment.

Brain MRI demonstrated nonspecific white matter hyperintensities and severe meningitis as identified by contrast-enhanced 3D Flair MRI. CSF oligoclonal bands showed intrathecal immunoglobin synthesis. CSF agglutination tests and CSF IgG ELISA were positive for Brucella. Though CSF PCR for Brucella was negative, 16S rRNA sequencing revealed the presence of Brucella spp. Patient was treated with ceftriaxone and dexamethasone and despite an initial worsening of neurological symptoms of tremor, loss of balance, hearing loss and diplopia, a clinical remission was achieved after a month and a laboratory remission after eight months of treatment.

Brain MRI: 3D Flair Sequence with Contrast Enhancement

Table. CSF Parameters

Conclusion

Neurobrucellosis presents with a variety of clinical symptoms and it should always be considered in neurological patients in highly endemic areas. Establishing a diagnosis is challenging. In our patient, CSF oligoclonal bands and the agglutination test in the CSF helped in achieving a diagnosis, suggesting their possible role in the diagnostic criteria. Although still under debate, the use of corticosteroids in our patient as well as the prolonged use of ceftriaxone in the therapeutic regime were crucial.

Disclosures

All Authors: No reported disclosures
366. Characteristics and Outcomes of COVID-19 Patients with Fungal Infections
Authors: Herc Erica , Yared Nicholas F , Kudirka Adam , Suleyman Geehan
Published: January 2021

Background

There is concern that patients with coronavirus disease 2019 (COVID-19) are at risk of developing secondary bacterial and fungal infections; however, data on the clinical characteristics and outcomes of COVID-19 patients with fungal infections are limited. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with fungal infections.

Methods

This was a retrospective chart review of 51 patients with fungal infections at an 877-bed teaching hospital in Detroit, Michigan from March through May 2020. Demographic data, comorbidities, complications, treatment, and outcomes, including relapse, readmission and mortality were collected. We performed a descriptive analysis.

Results

A total of 51 patients with fungal infections were included, in which 31 (60.8%) had confirmed or suspected COVID-19 infection. Of the COVID-19 patients, the average age was 66 years and the majority (54.9%) were female. The average length of stay (LOS) was 29.3 days. Aspergillus sp. (2 A. fumigatus, 1 A. niger) were isolated in 3 (10%) patients while 23 (74.2%) had candidemia diagnosed via blood culture or T2Candida® Panel. One had a positive serum galactomannan. The average time from admission to diagnosis was 13 days. Significant comorbidities included hypertension (74%), diabetes (51.6%), coronary artery disease (25.8%), congestive heart failure (32.2%), chronic kidney disease (22.6%), and malignancy (16.1%). Most patients received steroids (83.9%) and broad-spectrum antibiotics (80.6%), had a central line (80.6%), and required intensive care unit management (90%). Only 71% were treated with antifungals. One patient with candidemia relapsed due to poor source control; two were readmitted within 30 days. In-hospital mortality rate was 51.6% among COVID-19 patients.

Conclusion

COVID-19 patients with fungal infections had multiple comorbidities, prolonged hospitalization and predisposing risk factors for fungal infections with a high in-hospital mortality rate. Prevention of fungal infections in COVID-19 patients is paramount.

Disclosures

All Authors: No reported disclosures
377. Diabetes as a prognostic factor for mortality in Coronavirus Disease 19 (COVID-19): a systematic review and meta-analysis comprising 18,506 patients
Authors: Chamorro-Pareja Natalia , Karamanis Dimitrios , Zavras Phaedon D , Li Weijia , Mathias Priyanka , Kokkinidis Damianos , Palaiodimos Leonidas
Published: January 2021

Background

Diabetes Mellitus is one of the leading causes of morbidity and mortality in the world. Infectious diseases are more common and associated with worse outcomes among diabetics. Diabetes is considered a predictor of morbidity in patients with COVID-19.

Methods

Medline, Embase, Google Scholar, and medRxiv were systematically reviewed up to May 10th, 2020 for observational studies on diabetic adult populations hospitalized for COVID-19 and that assessed possible correlation between diabetes and mortality.

A meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Heterogeneity among trials for each outcome was assessed with the I-squared test. Values < 25% indicated low, 25 to 70% moderate, and > 70% high heterogeneity. Egger test and funnel plots were used to assess for publication bias.

Results

Fourteen observational studies (12 retrospective and 2 prospective) met the prespecified criteria for inclusion in the analysis, including 18,506 patients (43% women): 3,713 diabetics (DM group) and 14,793 non-diabetics (no-DM group). The mean or median age was above 60 years in 12 studies. DM group had a higher risk of death compared to the no-DM group, heterogeneity was significant (OR: 1.65; 95% CI: 1.35–1.96; I2 77.4%). Sensitivity analysis for US studies only also revealed a higher chance of death among the DM group (OR: 1.34; 95% CI: 1.04–1.85; I2 73.7%).

Conclusion

In conclusion, death was 65% more likely among diabetic inpatients compared to non-diabetics. Further studies are needed to assess whether this association is independent or not, and to investigate to role of glucose control prior or during the disease.

Disclosures

All Authors: No reported disclosures
394. Pseudo-outbreak of Coagulase-negative Staphylococcus Species from Blood Cultures Highlights Unique Challenges in Care of Critically Ill Patients With COVID-19
Authors: Park Stacy , Attai April E , Enfield Kyle , Bell Taison , Hill Brandon , Carpenter Rick , Cox Heather L , Mathers Amy
Published: January 2021

Background

In response to the COVID-19 pandemic, a dedicated intensive care unit for patients infected with SARS-CoV-2 was created at our institution. We noticed a marked increase in the number of blood cultures positive for coagulase-negative Staphylococcus species (CoNS) that highlights unique challenges that arise with the creation of new units and workflows.

Methods

We reviewed all blood culture results from the COVID-19 intensive care unit (CoVICU) from April 15 to May 29. We reviewed all blood cultures taken from the oncology ward, medical intensive care unit (MICU), and emergency department (ED) for the same time frame as a comparison. We calculated contamination rates, using the clinical microbiology laboratory criteria for possible contaminants based on species and number of positive blood cultures.

Results

There were 324 total blood cultures collected from the CoVICU with 27/324 (8.3%) positive for organisms deemed contaminant, 10/324 (3.1%) were positive considered bloodstream infections (BSI); the ratio of BSI:contaminant was 1:2.7. For the MICU, ED, and oncology units contamination rates were 2/197 (1%), 33/747 (4.4%), and 2/334 (0.6%), respectively; and the ratio of BSI:contaminant was 5:1, 2.2:1, and 17.5:1, respectively. There was a significant relationship between contamination rates and unit, X2(3, N = 1602) = 30.85, p < 0.001.

Conclusion

Upon investigation, peripheral blood draw kits were not stocked in the CoVICU. Additionally, certain components of standard work for blood culture collection (e.g. glove exchange) could not be performed per usual practice due to isolation precautions. Peripheral blood draws were routinely performed by nurses in CoVICU and MICU while phlebotomy performed these in other comparison units. We suspect that lack of availability of blood draw kits and disruption of typical workflow in isolation rooms contributed to an unusually high number of contaminated blood cultures among patients admitted to the CoVICU. Notably, the CoVICU and MICU providers were the same pool of caregivers, further supporting a process issue related to isolation precautions. Institutions should be aware of the need for extra attention to supply chain management and examination of disruption to standard work that arise in the management of COVID-19 patients.

Disclosures

All Authors: No reported disclosures
400. Secondary Infections in COVID-19 Patients Receiving Tocilizumab in a Community Hospital
Authors: Usiak Shauna , DiFilippo Laurie , Frattellone Meredith , Kincart Mary , Kerr Christine
Published: January 2021

Background

Secondary bacterial/fungal infection in patients with pandemic strains of Influenza has been well documented in the literature. Little is known about the development of secondary bacterial or fungal infections in patients with COVID-19. Additionally, COVID patients receiving tocilizumab as treatment may be at higher risk for developing a secondary infection due to theoretical risk of immunosuppression.

Table 1

Table 2

Methods

A retrospective analysis of all COVID positive patients admitted to a 128 bed community hospital in Westchester County, NY from March 1 – May 31, 2020. The data was analyzed to determine incidence of secondary infections based on positive cultures in patients and further stratified based on receipt of tocilizumab.

Results

Out of 445 COVID positive patients reviewed, 69 (15.5%) had positive bacterial/fungal cultures. Average age of the patient population reviewed was 64 (range 1 – 106) and 60% of the patients were male. As of May 31, 2020, 114 of the patients had expired, 281 were discharged, 23 were transferred, and 27 were still admitted to the hospital.

Of the 445 total patients, 42 received at least 1 dose of tocilizumab. Out of those patients, 6 patients (14.3%) had subsequent positive cultures. (Table 1) This was not statistically significant (p = 0.8185).

Most common positive specimens were in urine (n=38), blood (n=33), and respiratory specimens (n=20). Most commonly found co-pathogens were Escherichia coli (n=22), Coagulase-negative staphylococci (n=11), and Pseudomonas aeruginosa (n=9).

Of the 69 patients with positive cultures, 27 received ICU level of care. (Table 2)

Conclusion

A small retrospective study found that the incidence of bacterial or fungal co-infection for COVID positive patients was high but did not find receipt of tocilizumab was associated with secondary infections. This suggests areas for future study and further investigation as hospitals consider use of immunomodulatory therapies in the treatment of COVID-19.

Disclosures

All Authors: No reported disclosures
407. Utilization of Blood Cultures, Risk factors and Outcomes of Bloodstream Infections in Patients Hospitalized with COVID-19
Authors: Gudipati Smitha , Vahia Amit T , Pahl Nicole , Brar Indira , Suleyman Geehan , Arshad Samia , Zervos Marcus , Alangaden George
Published: January 2021

Background

During the coronavirus disease 2019 (COVID-19) surge, there was a sharp increase of blood cultures (BC) performed at Henry Ford Health System (HFHS). However, the epidemiology and outcomes of bloodstream infections (BSI) in COVID-19 patients (pts) remains undefined. We report the utilization of blood cultures, risk factors and mortality associated with BSI in a large cohort of COVID-19 pts.

Methods

A retrospective analysis was performed of all COVID-19 pts that had BC performed during hospitalization at HFHS, a 5-hospital system in southeast Michigan. BSI was defined using NHSN criteria. Demographics, comorbidities, severity of illness, and outcome of pts with and without BSI were compared.

Results

From 3/10/2020 to 4/28/2020, 2541 pts were hospitalized with lab-confirmed COVID-19. 1393 (55%) of these pts had BC performed and 80 (5.74%) met criteria for BSI. Of the 84 pathogens identified, Staphylococcus aureus was most common (Figure 1). As compared to 1313 COVID-19 pts without BSI, those with BSI were older (70.1 vs 64.5 years, P = 0.0024). Other factors significantly associated with BSI included chronic kidney disease, higher mSOFA score, ICU stay and mechanical ventilation (all P < 0.0001) (Table 1). Multivariate analysis revealed age (OR, 1.07 CI [1.06–1.08]), ICU stay (OR, 7.91 [CI: 5.75–10.87]) and mSOFA score (OR, 1.29 [CI: 1.13–1.47]) were independent risk factors associated with mortality. BSI was not associated with increased mortality (Table 3).

Conclusion

Although more than half of hospitalized COVID-19 pts had BC done, the number of BSI were low suggesting overutilization of BC. BSI was associated with older age and disease severity. Mortality was not affected by BSI but was primarily driven by age and severity of illness.

Disclosures

Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau) Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)
412. Assessment and Capability of SARS-CoV-2 Detection in the Veterans Health Administration
Authors: Sharma Aditya , Oda Gina , Holodniy Mark
Published: January 2021

Background

Rapid scale up of testing to detect Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is essential to direct clinical management, optimize infection control actions, and guide public health response efforts to mitigate the spread of Coronavirus Disease 2019 (COVID-19). As the largest integrated health care system in the United States, the Veterans Health Administration (VHA) supported the laboratory-based detection of COVID-19 in a network of 170 medical centers across the country.

Methods

SARS-CoV-2 testing data from VHA databases were analyzed to assess SARS-CoV-2 detection characteristics. Testing capacity was calculated by multiplying the number of inventoried instruments available for SARS-CoV-2 detection by estimates of instrument-specific maximum throughput with the assumption that instruments would be operational for 16 hours a day and 7 days a week.

Results

From March 01, 2020 to May 31, 2020, 224,059 Emergency Use Authorization approved RT-PCR tests for SARS-CoV-2 on more than 7 different assay platforms were conducted among 168,761 individuals attending VHA facilities; 10,048 individuals (5.9%) tested positive. During this period, the average rate of tests completed for SARS-CoV-2 increased to more than 4,000 per day (Figure 1A), the percentage of hospitalized individuals who were tested for SARS-CoV-2 increased to approximately 80% (Figure 1B), the median turnaround time from specimen collected to result reported decreased to less than 1 day (Figure 1C), and the percentage of SARS-CoV-2 clinical specimens collected in VHA facilities that were tested at VHA laboratories increased to more than 80% (Figure 1D). Based on inventories of high-throughput and rapid diagnostic instruments (Figure 2), VHA could perform at least 20,000 tests for SARS-CoV-2 per week.

Figure 1. Testing metrics for SARS-CoV-2 across VHA facilities. A) Number of daily tests for SARS-CoV-2 completed. B) Percentage of hospitalized Veterans tested for SARS-CoV-2. C). Median turnaround time of completed tests for SARS-CoV-2 from specimen collection to result reported. D) Percentage of SARS-CoV-2 specimens collected in VHA facilities that were tested in VHA laboratories.

Figure 2. Distribution of instruments to detect SARS-CoV-2 across VHA facilities.

Conclusion

Key indicators of laboratory performance for SARS-CoV-2 detection, including test turnaround time, percentage of hospitalized individuals tested, and overall testing volume improved substantially in VHA during the first 3 months of testing during the pandemic. Ongoing efforts seek to enhance just-in-time diagnostic capacity, ensure continuity of specimen collection supplies and laboratory consumables, and identify and minimize gaps in access to testing facilities.

Disclosures

All Authors: No reported disclosures
421. If at first you do not succeed…. Repeat SARS-COV2 PCR testing
Authors: Shea Stephanie M , Patel Gopi , Schaefer Sarah , Nowak Michael D , Sordillo Emilia Mia , Paniz-Mondolfi Alberto , Gitman Melissa R
Published: January 2021

Background

Nucleic Acid Amplification Tests (NAATs) of nasopharyngeal specimens (NPS) have become standard for diagnosis of SARS-COV2. IDSA guidelines suggest repeat testing after 24–48 h when initially negative and clinical suspicion persists. We characterized patients from whom initial NPS were NAAT-negative, but repeats were NAAT-positive, in order to identify which patients might benefit from repeat NAAT for SARS-CoV-2, and the appropriate interval.

Methods

We conducted an IRB-approved retrospective review of laboratory and electronic medical record data for all patients evaluated for SARS-CoV-2 infection at the Mount Sinai Health System, whose initial NAATs were done between March 16 – March 30, 2020, and who were retested within one month. NAATs were performed on NPS in viral transport medium using the Roche Diagnostics cobas® 6800 SARS-CoV-2 Test. Baseline patient characteristics, clinical and radiographic findings were identified.

Results

Of 235 patients eligible for inclusion, 172 (70.5%) were initially NAAT-negative, and 118 (68.6%) remained NAAT-negative over 1 month follow up. 54 (31.4%) converted to NAAT-positive over the next 1-month. Of patients who became NAAT-positive, 31 (57.4%) were inpatients who converted results within a single admission; the average interval was 6d 7h between the NAAT-negative and NAAT-positive results, and the minimum interval was 10.5 h. Symptoms examined for correlation for conversion to NAAT-positive were: fever, cough, shortness of breath, and combined nausea/vomiting/diarrhea. Duration of symptoms reported at triage did not appear to affect time to conversion to NAAT-positive. No individual symptom was more likely to be associated with conversion to NAAT- positive. However, time to conversion to NAAT-positive was shorter for patients with multiple symptoms. In general, chest radiography (CXR) findings correlated with NAAT results; interval to NAAT-positive was shorter for patients with worsening CXR findings.

Conclusion

Our data supports repeat testing in patients with multiple clinical symptoms suggestive of SARS CoV-2 infection and negative initial NP test results. Further studies are needed to determine the true clinical sensitivity and specificity of SARS-CoV-2 NAAT assays.

Disclosures

All Authors: No reported disclosures