bluuebunny/crossref_metadata_2025_split huggingface dataset:
535. Harm reduction strategies and positive behaviors of medical providers in mitigating the effects of COVID-19 among HIV-infected children and HIV-exposed infants
Authors: Ebeid Mariam , Smith Amy , Inagaki Kengo , Palmer April , Santos Roberto 
Published: January 2021

Abstract

Background
There are limited data on the disease course of COVID-19 among children with HIV and among HIV-exposed infants. It is sensible to maximize the preventive effort against SARS-CoV-2 infections in this group of patients using harm reduction strategies and positive behaviors provided by medical providers.

Methods
A quality improvement project was started in the 2nd week of April in our Children’s Hospital Subspecialty Clinic caring for children with HIV and HIV-exposed infants on antiretroviral therapy (ART). All patients are offered Telehealth at baseline and at 4 weeks after interventions making sure they remain adherent to their ART, with enough supply of ART for 4 weeks, and discussed harm reduction strategies (hand washing, use of hand sanitizer & face mask, social distancing, shelter-at-home) via telehealth and video clips. The goal was an increase of hand hygiene performance by 25% at 4 weeks after interventions. The number of hand washing and hand sanitizer use per day was categorized as &lt; 5, 5–10, and &gt;10 per day and was analyzed by Cochran-Armitage test for trend. Adherence to ART was categorized as &lt; 50%, 50–90%, &gt;90–100% per week.

Results
There are 19 patients included: 11 with HIV infections (9–20 yo) and 8 HIV-exposed infants (2 weeks-6 months old), where parents received the intervention. At baseline, 32% of the participants washed hands &gt;10 times a day, which increased to 71% after intervention (p value: 0.013). While 21% of participants washed hands &lt; 5 times a day at baseline, all participants washed their hands 5 times or more after the intervention. Sanitizer use of &gt;10 times a day increased from 21% to 43% (p value: 0.026). (Fig. 1 and 2) This was notable increase, as 47% used hand sanitizers &lt; 5 times a day pre-intervention. No one was diagnosed with COVID-19, and all remained asymptomatic at 4-week follow up. All children with HIV remained adherent (&gt;90–100% per week) to their ART.

Conclusion
The degree of hand hygiene among children with HIV and HIV-exposed infants was increased 4 weeks after the intervention consisting of harm reduction strategies and positive behaviors by medical providers. All patients remained healthy and adherent to ART 4 weeks after the project began. COVID-19 pandemic is an opportunity for impactful health education that can positively affect the patients’ life.

Disclosures
All Authors: No reported disclosures
542. SARS CoV-2-Associated Multisystem Inflammatory Syndrome of Children (MIS-C) in the Washington DC Metropolitan Region
Authors: DeBiasi Roberta L , Smith Karen L , Bell Michael , Berul Charles , Ansusinha Emily , Bundy Vanessa , Delaney Meghan , Diab Yaser , Hahn Andrea , Hamdy Rana F , Hanisch Benjamin , Harik Nada , Harahsheh Ashraf S , Herstek Jessica , Kline Jaclyn , Koay Wei Li A , Krishnan Anita , Jantausch Barbara , Majumdar Suvankar , Parikh Kavita , Pershad Jay , Ronis Tova , Sadler Eleanor D , Sharma Hemant , Sharron Matthew P , Srinivasalu Hemalatha , Sule Sangeeta , Wells Elizabeth , Wessel David 
Published: January 2021

Abstract

Background
Background: Multi-system Inflammatory Syndrome of Children (MIS-C) has recently emerged internationally as a serious inflammatory complication of SARS-CoV-2 infection with significant morbidity for the pediatric population.

Methods
This observational retrospective cohort study includes 33 children meeting CDC criteria for MIS-C treated between March 15 and June 17, 2020 at Children’s National Hospital in Washington DC. Clinical and demographic data were extracted from medical records and are summarized.

Results
Of 33 hospitalized MIS-C patients, 42% were critically ill, and 58% were non-critically ill. The median age was 8.9 years (0.7–18.7 years). More males (58 %) than females (43 %) were represented in the MIS-C cohort. The majority (75%) of children had no underlying medical condition. Criteria for incomplete or complete Kawasaki Disease (KD) were present in 39% of patients, while an additional 9% had some features of KD. However the remaining 52% of MIS-C patients presented with other sub-phenotypes including prominent severe abdominal pain and/or nonspecific multiorgan dysfunction. 30% presented with shock requiring volume and/or inotropic support. SARS-CoV-2 antibodies were present in 61% of patients. Virus was detectable by PCR in 36% of patients. At the time of initial evaluation, 39% (13/33) of children had identified cardiac abnormalities including myocardial dysfunction (5/33; 15%), coronary ectasia (4/33; 12%), coronary aneurysm (3/33; 9%), or pericardial effusion 5/33; 15%) either alone or in combination. Cytokine profiling identified elevation of several cytokines in this cohort, including IL-6. Treatment has included intravenous immunoglobulin, aspirin, anakinra and other immunomodulatory therapies, with overall rapid response to therapy. No deaths have occurred.

Conclusion
The emergence of MIS-C late in the surge of SARS-CoV-2 circulation in the Washington DC metropolitan region has added to the already significant burden of hospitalized and critically ill children in our region. A significant percentage of these children present with cardiac dysfunction and abnormalities, whether or not with KD features at presentation. Detailed characterization of immune responses and long term outcome of these patients is a priority.

Disclosures
Andrea Hahn, MD, MS, Johnson and Johnson (Consultant)
546. Capturing Clinician’s Experiences Repurposing Drugs to Inform Future Studies During COVID-19
Authors: Duggal Mili , Stone Heather , Paul Parvesh , Charles Reema , Sacks Leonard , Southall Noel 
Published: January 2021

Abstract

Background
CURE ID is an internet-based repository developed collaboratively by FDA and NCATS/NIH, with the support of WHO and IDSA. It encourages clinicians globally to share novel uses of existing drugs for patients with difficult-to-treat infections. It is designed to serve as a rapid communication platform for healthcare providers during an outbreak, providing for systematic case-sharing, discussion, and the latest literature. Besides case reports, CURE ID offers a discussion platform for clinicians, disease-specific clinical trials curated from clincialtrials.gov, and a newsfeed that shows relevant journal articles and news related to COVID-19 and other infectious diseases.

Methods
The CURE ID team extracted individual case reports on patient-level treatments and outcomes of COVID-19 infection from the published literature and gathered clinician-submitted cases through the electronic case report form. Additionally, CURE ID partnered with the University of Pennsylvania’s CORONA database to further populate the CURE ID database with published cases.

Results
As of submission, lopinavir-Ritonavir (n=51) was the most commonly reported drug used. The following were also reported: hydroxychloroquine (n=31), azithromycin (n=28), arbidol (n=22), interferon alfa-2B (n=18), moxifloxacin (n=18), methylprednisolone (n=17), ivermectin (n=14), lopinavir (n=12), oseltamivir (n=12). The other drugs reported were danoprevir-ritonavir, intravenous immunoglobulins, interferon, interferon alfa, and tocilizumab. CURE ID currently includes more than 150 detailed COVID case reports of 65 repurposed drugs. We expect case reporting for specific drugs to be dynamic and additional data to accrue. Updated results will be presented.

Conclusion
Several drugs are being repurposed to treat COVID-19. CURE ID gives clinicians an opportunity to share their treatment experiences and discuss their questions with a global community of healthcare providers. By utilizing the CURE ID platform, in conjunction with data gathered from other registries, observational studies and clinical trials, hypotheses can be generated that may inform future clinical trials and ultimately, potentially find safe and effective treatments for this deadly disease.

Disclosures
All Authors: No reported disclosures
551. Convalescent plasma early in disease course improves survival in COVID-19
Authors: Nauriyal Varidhi , Shallal Anita , Vahia Amit T , Samuel Linoj , Tibbetts Robert , Lopez-Plaza Ileana , Ramesh Mayur 
Published: January 2021

Abstract

Background
Convalescent plasma (CP) has been described as a potential therapy for coronavirus disease 2019 (COVID-19). Given paucity of data, we sought to describe characteristics of CP recipients in survivors and non-survivors.

Methods
We conducted retrospective review of electronic medical records which included any patient with a positive SARS-CoV-2 PCR test who received CP at an 890-bed quaternary care hospital in Southeast Michigan between March-May 2020. Data collected included: demographics, co-morbidities, mSOFA score on admission, laboratory values, and treatment. Outcomes assessed included inflammatory markers and clinical status based on an 8-point ordinal scalea. These values were recorded on admission, the date of CP (day 1), day 3, 7, and day 30 post-CP. Patient outcomes were stratified by ordinal scale score and compared using Mann-Whitney U tests to examine differences in clinical characteristics: scale of 1–4 (“meaningful survivor”), 5–7 (“survivor”), and 8 (“non-survivor”).

Results
Results of our study are summarized in Table 1 and 2. Non-survivors were older than survivors (62 vs 71 years; p=0.026). There was no statistically significant difference between patient gender, race, number of days from positive PCR test to CP, treatments, and co-morbidities. There was a trend toward higher mSOFA score on admission in non-survivors (p=0.056). A lower ordinal scale score on the date of receiving CP was significantly associated with meaningful survivorship (6 vs 7, p=0.005).
Comparisons of Characteristics Based on Ordinal Scale at Day 30

Comparisons of Outcomes Based on Ordinal Scale at Day 30

Conclusion
Patients who have a lower ordinal scale score on the date of CP administration are most likely to have meaningful survivorship at day 30. Future studies should evaluate optimal timing and outcomes for CP therapy in COVID-19.

Disclosures
All Authors: No reported disclosures
555. Effectiveness of a Treatment Team on Adherence to Health System Guidelines for Hydroxychloroquine Use During Two Phases of the COVID-19 Epidemic
Authors: Viehman J Alex , Nguyen M Hong , Garner Will , Apostolopoulou Anna , Harris Gavin H , Lucas Aaron , Jagadeesan Vidya , Butler Sharlay , Rapinski Glen J , McCreary Erin K , Arbulu Ricardo , Ganchuk Steven , Yang Anne , Avasarala Amitha , Trificante Rosalie , Bollam Rahul , Zou Richard H , Moghbeli Kaveh , Darwish Malik , Hemadri Amit , Weslander Erin , Campfield Brian T , Michaels Marian G , Haidar Ghady , Daley Jesssica , Martin Elise , Bariola J Ryan 
Published: January 2021

Abstract

Background
Our hospital system created system guidelines to standardize care across 24 hospitals for COVID-19 treatment during the pandemic. Guidelines changed over time. Hydroxychloroquine (HCQ) was unrestricted during phase 1, then restricted by pharmacy outside of a randomized clinical trial (RCT) during phase 2 (excepting those ineligible for RCTs).

Methods
This was a prospective study to assess system-wide adherence to COVID-19 treatment guidelines, and to evaluate patient outcomes.

Results
Of 261 patients, median age was 67 years (IQR 56–76); 49% (129/261) were male, and 45% (118/261) required ICU care.
Overall, 47% (122/261) were in phase 1; HCQ was offered to 57% (69/122) during this phase. The rate of HCQ prescription in phase 2 decreased significantly to 10% (14/136), (p &lt; 0.001). Adherence to COVID-19 treatment protocol was 97% (135/139) during phase 2. Mortality was similar in both phases (22% vs 28%, p=0.32), as was median length of stay (8 vs 7 days, p=0.3). Overall 66 patients (25%) died in the hospital; neither non-adherence (p=1) to system guidelines nor receipt of HCQ (p=0.17) were risk factors for death.
Independent predictors of mortality included: new renal replacement therapy (OR 61, 95%CI 6.7–560, p &lt; 0.001), mechanical ventilation (OR 4.9, 95%CI 2.0–11, p &lt; 0.001), abnormal chest X-ray (OR 4.3, 95%CI 1.4–12.6, p =0.009), history of heart failure (OR 3.9, 95%CI 1.5–11, p=0.006), lack of fever on admission (OR 3.5, 95%CI 1.7 -7.6, p =0.001), receipt of corticosteroids (OR 2.7 95%CI 1.1–6.6, p=0.026) and increased age (OR 1.07 per year, 95%CI 1.04–1.1, p &lt; 0.001). Bacterial pneumonia occurred in 8% (21/261), more commonly in those who died (p=0.02). Black patients had a higher race-specific death rate (308 vs 197) per 1000 than white patients (p&lt; 0.001).

Conclusion
During the COVID-19 pandemic, our health system guidelines and pharmacy restrictions were successful in delivering consistent care across hospitals. Restriction of HCQ for COVID-19 treatment to RCTs reduced its use in phase two. Non-adherence to systemic guidelines was infrequent, and not associated with adverse outcomes. A COVID-19 treatment team of physicians and pharmacists can effectively coordinate therapy across hospitals in the setting of rapidly changing guidelines.

Disclosures
J. Ryan Bariola, MD, Infectious Disease Connect (Employee)Mayne Pharma (Advisor or Review Panel member)Merck (Research Grant or Support)
558. Innovative CME Tools in the Teaching of Evolving Strategies in the Management and Prevention of COVID-19
Authors: Hanson Brianna , Welch Lauren , Frese Matthew , Gallo Christina 
Published: January 2021

Abstract

Background
In 2020, Med Learning Group (MLG) launched an interactive, multi-faceted educational initiative focusing on COVID-19. The innovative education & tools developed for FRONTLINE are publicly available for the entire healthcare community to use. Learners range from a variety of specialties, including infectious disease specialists, pulmonary medicine specialists, emergency room practitioners, advanced practitioners, nurses, & other healthcare professionals to help support them in their effort to optimize care of patients with COVID-19.
MLG partnered with Health Resources & Services Administration, Project ECHO, Public Health Foundation & community, VA & academic centers to create a collaborative network with shared goals for education.

Methods
This initiative seeks to reach over 25,000 learners with innovative educational programs & tools to enhance the learning experience, facilitate continuous learning & support the translation of education into practice, & encourage HCP-patient dialogue:
• COVID Community of Care Website/Application
• COVID Frontline Update Podcast Series
• Virtual/Live ECHO Series with 3D animations of pathophysiology
• Enduring ECHO Module with Case Discussions
• Quality Improvement Personalized Posters

Results
By September 2020, we will have the results from pre/posttests, intra-activity Q&A, evaluations, & 60- to 90-day follow-on assessments. We will evaluate learners’ changes in knowledge & competence, & reported practice changes. In addition, MLG will have feedback collected via surveys & interviews on the various point-of-care tools. Based off previous MLG educational initiatives, it is expected that learners will find value in the various tools available in this programming.

Conclusion
Advanced tools like virtual live learning platforms, mobile websites/apps, 3D animations & podcasts will prove to be an asset to the continuing education of HCPs treating patients with COVID-19. The outcomes are expected to demonstrate the extent to which HCPs have enhanced their ability to identify clinical predictors of disease severity of COVID-19 & apply current treatment guidelines, clinical trial data, & patient-specific factors to the management of patients with COVID-19. These results will be available in time to share via a poster at IDWeek 2020.

Disclosures
All Authors: No reported disclosures
562. Tocilizumab for the Treatment of Severe COVID-19: A Retrospective, Multi-Center, Case-Matched Series
Authors: Norman Sarah , Jones Sara , Reeves David , Cheatham Christian 
Published: January 2021

Abstract

Background
At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients.

Methods
This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections.

Results
The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin &gt; 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer &gt; 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients.

Conclusion
These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results.

Disclosures
Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)
566. Tocilizumab: A Friend or a Foe in COVID-19 Management?
Authors: Hernandez Jarelys M , Jariwala Ripal , Piccicacco Nicholas , Aslam Sadaf , Lakshmi Seetha 
Published: January 2021

Abstract

Background
The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to many proposed treatments for COVID-19 induced cytokine release syndrome (CRS). We aimed to investigate the treatment response of Tocilizumab (TZB), an Interleukin-6 (IL-6) inhibitor in this single center study.

Methods
A retrospective chart review in COVID-19 patients was conducted from 03/18/20 - 05/20/20. Patients with PCR confirmed COVID-19 who received TZB were included. Variables included dose and timing of TZB, trend of acute phase reactants, time to improved oxygenation and defervescence, 30-day mortality, and hospital/intensive care unit (ICU) length of stay (LOS). Descriptive statistics were used.

Results
Twelve patients received TZB at least once during the study period. Median patient age was 51.5 years (interquartile range (IQR), 34–87), and mean body weight of 109 kg (SD = 33.8). At time of admission, mean day of illness was 6.6 days (SD = 3.3) into their illness. All patients received a standardized TZB dose of 400 mg, and 2 patients received a second dose. Nine out of 11 patients (75%) had elevated median IL-6 baseline levels of 38.3 (IQR &lt; 5- 96.22). The average CRS score was elevated at 3.3 at the time of TZB administration.
All patients who received TZB were on supplemental oxygen, and 58% were mechanically ventilated. A decrease in oxygen requirement in 24 hours was seen in mechanically ventilated patients (71%) compared to those not on mechanical ventilation (20%). Median ICU days were 17.5 (IQR, 3–39), and median LOS days were 21.5 (IQR 8–46). All patients had sustained decreases in CRP post-TZB administration.
Almost half of patients (42%) were treated for bacterial pneumonia post TZB and 3 (25%) patients were treated for herpes simplex virus (HSV) reactivation. Majority (92%) of patients received additional COVID-19 therapies such as hydroxychloroquine, convalescent plasma, or remdesivir. During the study period only one patient expired.

Conclusion
Our findings suggest that TZB may have a role in mechanically ventilated patients in decreasing oxygen requirement. However larger randomized studies are needed to understand which patients would benefit the most. Our study also highlights secondary infections and HSV reactivation in TZB patients.

Disclosures
All Authors: No reported disclosures
569. A Multidisciplinary Approach to the Pre-evaluation Process of Pediatric Solid Organ Transplant Patients
Authors: Toia Jacquie , Le Kevin , Panek Natalia , Boese Justin , Jhaveri Ravi , Muller William J , Mithal Leena B 
Published: January 2021

Abstract

Background
Pediatric transplant recipients are at increased risk of infection-related morbidity and mortality, both from opportunistic infections and vaccine-preventable diseases. Since vaccine immunogenicity may wane with organ failure and immunosuppressive therapies, it is recommended that transplant candidates are immunized early in their disease course, prior to transplant. However, transplant candidates are often incompletely immunized due to factors including complexity of care and multiple providers. A multidisciplinary approach involving Infectious Diseases (ID) is crucial to ensure that vaccination status is optimized prior to transplant and to prevent and treat infectious complications.

Methods
During the solid organ transplant evaluation process, liver, intestinal, and heart transplant candidates and their families meet with Infectious Diseases, Transplant Pharmacy, and Organ Procurement clinicians. The multidisciplinary team effort ensures that transplant candidates receive appropriate vaccines prior to transplant, based on immunization history and serology results. The team helps to manage infections diagnosed during the evaluation process (active or latent), identify risk factors for infection, optimize antimicrobial dosing based on comorbid conditions and concomitant medications, and follows patients post-transplant. Transplant candidates and their families are educated on how organ donation and organ allocation function in the US.

Results
Since launch of our multidisciplinary solid organ transplant team, we have completed pre-transplant ID evaluations on 64 patients [Table 1]. Nearly all (97%) of pre-transplant evaluated patients received vaccine optimization (booster/new vaccine doses) [Table 2]. Forty-five patients (70%) underwent organ transplant. Many intestinal (67%), cardiac (46%), and liver (27%) transplant candidates with pre-transplant evaluations required subsequent ID consultation.
Table 1

Table 2

Conclusion
Multidisciplinary ID pre-transplant evaluation leads to individualized vaccine optimization and infection management. Families benefit from education and counseling as well as familiarity with the Transplant ID consult service, involved in a large percentage of these patients in their peri- and post-transplant course.

Disclosures
All Authors: No reported disclosures