bluuebunny/crossref_metadata_2025_split huggingface dataset:
357. Complications and Outcomes of Obese Patients Hospitalized with COVID-19
Authors: Shallal Anita , Morrison Austin R , Brar Indira , Suleyman Geehan 
Published: January 2021

Abstract

Background
Coronavirus disease 2019 (COVID-19) has greatly affected the US, where obesity is present in over 40% of the population. Evidence suggests that obesity is associated with a higher risk of developing severe disease and complications. The objective of this study was to assess the relationship between body mass index (BMI) and outcomes in hospitalized patients with COVID-19.

Methods
A retrospective cohort study of patients with confirmed COVID-19 infection at Henry Ford Health System in metropolitan Detroit from March-May 2020. Demographics, comorbidities, severity of illness, complications, treatment and outcomes of obese (BMI &gt; 30) and non-obese (BMI &lt; 30) patients were compared. Data were analyzed using SPSS.

Results
Summary of results comparing non-obese and obese patients is presented in tables 1 and 2. Median BMI (kg/m2) in each group was 26 and 36.5, respectively. Age and black race differed significantly between the two groups (p&lt; 0.001). Younger patients were more obese compared to older patients. Diabetes and obstructive sleep apnea (OSA) were significantly more common in obese patients. Obese patients were significantly more likely to receive antibiotics in the ED (p=0.015), require vasopressors for shock (p=0.004), and undergo renal replacement therapy (p=0.005). Although 37% of obese patients were intubated, obesity was not a significant risk factor for mechanical ventilation (MV). 30-day readmission and mortality were significantly higher in non-obese patients. In the regression analysis, age over 60, tachypnea at admission, acute kidney injury, and diabetes were significantly associated with need for MV, but not BMI.

Conclusion
In our cohort, a high frequency of obesity is noted among black and younger patients. Obese patients were more likely to require intensive treatments, including renal replacement therapy and vasopressors but not mechanical ventilation. Complications and outcomes in COVID-19 should be further evaluated by BMI categories.

Disclosures
Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)
358. Sociodemographic and clinical features of children and adolescents with SARS-CoV-2 infection in Nashville, Tennessee
Authors: Howard Leigh , Garguilo Kathryn , Gillon Jessica , Webber Steven , Halasa Natasha B , Banerjee Ritu , Banerjee Ritu 
Published: January 2021

Abstract

Background
Little is known regarding the full spectrum of illness among children with SARS-CoV-2 infection across integrated healthcare settings, as many published pediatric cohorts focus on hospitalized patients with SARS-CoV-2 infection.

Methods
Active surveillance was performed for SARS-CoV-2 detections among symptomatic and asymptomatic children and adolescents ≤18 years of age in a quaternary care academic hospital laboratory in the Southeastern U.S. For symptomatic patients with a positive respiratory specimen for SARS-CoV-2 by polymerase chain reaction (PCR), and for neonates born to SARS-CoV-2-positive mothers, we performed phone follow-up and medical record review at days 2, 7, and 30 after diagnosis. Testing was initiated 3/12/20 for symptomatic patients and 5/4/20 for screening asymptomatic patients.

Results
By 6/14/20, SARS-CoV-2 tests were positive in 193/5306 (3.6%) specimens from unique patients ≤18 (Table 1), compared to 2653/36503 (7.2%) specimens in patients &gt;18 years. Specimens from 181/2638 (6.8%) symptomatic and 12/2768 (0.4%) asymptomatic children were positive. Nine infants born to SARS-CoV-2 infected mothers had negative PCR tests at birth; 1 infant subsequently acquired SARS-CoV-2 infection at 5 weeks of age. Sociodemographic and clinical data for 181 SARS-CoV-2-positive symptomatic children are displayed in Table 2 and Figure 1. The most common symptoms were cough (59%), fever (50%), and rhinorrhea (39%). Nine/181 symptomatic patients (5%) were hospitalized, primarily for respiratory symptoms. Symptom resolution occurred by follow-up day 2 in 82/178 (46%) and day 7 in 128/164 (78%) patients with complete assessments to date. 131/181 (72%) of children had known SARS-CoV-2 positive contacts. We observed no cases of multisystem inflammatory syndrome in children.

Conclusion
In our community, pediatric SARS-CoV-2 prevalence was low, but was much higher among symptomatic than asymptomatic children. Symptoms were mild, and the duration of symptoms brief, in the majority of these patients captured within an integrated ambulatory and hospital-based healthcare system, capturing the full spectrum of the disease profile in this age group.

Disclosures
Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
359. Ventilator-associated pneumonia in patients with SARS-CoV-2–associated acute respiratory failure requiring mechanical ventilation: a retrospective cohort study
Authors: Luyt Charles-Edouard , Vidal Pauline , Burrel Sonia , Hekimian Guillaume , Brechot Nicolas , Schmidt Matthieu , Combes Alain , Boutolleau David , Robert Jérôme , Chastre Jean 
Published: January 2021

Abstract

Background
Data on incidence, clinical presentation and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited.

Methods
Case series of patients with COVID-19 pneumonia admitted to a single ICU in France. All consecutive patients requiring MV with RT-PCR–confirmed SARS-CoV-2 infection between March 12th and April 24th, 2020 were included. Frequency, clinical characteristics, responsible pathogens and outcomes of VAP were assessed, and compared to an historical cohort of patients with severe influenza-associated pneumonia requiring MV admitted to the same ICU during the preceding three winter seasons.

Results
Fifty-four consecutive patients with COVID-19–associated respiratory failure requiring MV were included (median (IQR) age 48 (42–58) years; 74% male; 93% requiring veno-venous ECMO). VAP occurred in 46 (85%) of them (median (IQR) prior MV duration before the first episode, 11 (8–16) days) (Table 1). Pathogens responsible for VAP were predominantly Enterobacteriaceae (72%), and particularly inducible AmpC-cephalosporinase producers (41%), followed by Pseudomonas aeruginosa (35%) (Table 2). Pulmonary infection recurrence and death were observed in 46 (85%) and 17 (31%) patients, respectively. Details on recurrent episodes and pathogens responsible for recurrences are given in Table 3. Most recurrences were relapse (i.e. infection with the same pathogen), with a high proportion occurring during antimicrobial treatment despite its adequacy. Despite a high rate of P. aeruginosa VAP in patients with influenza-associated ARDS, pulmonary infection recurrence rate was significantly lower than in patients with COVID-19. Overall mortality was similar in the two groups.
Baseline characteristics of patients

Characteristics of first ventilator-associated pneumonia episode

Characteristics of recurrent VAP episodes in Covid-19 and influenza patients.

Conclusion
Patients with severe COVID-19–associated respiratory failure requiring MV had a very high late-onset VAP rate. Inducible AmpC cephalosporinase–producing Enterobacteriaceae and Pseudomonas aeruginosa appeared to be frequently responsible for VAP, with multiple subsequent episodes and difficulties to eradicate the pathogen from the lung.

Disclosures
All Authors: No reported disclosures
365. Characteristics and outcomes of COVID-19 patients admitted to a regional health system in the southeast
Authors: Teixeira Charles , Shiflett Henry , Jandhyala Deeksha , Lewis Jessica , Curry Scott R , Salgado Cassandra 
Published: January 2021

Abstract

Background
COVID-19, first described in Wuhan, China, is now a global pandemic. We describe a cohort of patients (pts) admitted to our academic health system (HS) in the southeast, where demographics and comorbidities differ significantly from other regions in the U.S.

Methods
This was a retrospective review of 161 consecutive pts admitted with COVID-19 from 3/12/20 to 6/1/20. We assessed demographics, comorbidities, presenting symptoms, treatments and outcomes and compared pts who died during hospitalization to those who survived to discharge (EpiInfo 7.2, Atlanta, GA).

Results
Mean age was 60.5 years, 51.6% were female, 72% African American (AA) and 69.6% admitted from home. 54.5% had a BMI &gt;30, 72% had HTN, 47.2% diabetes, and 33.6% COPD or asthma. The majority (68.8%) presented with fever (&gt;38.0) and required supplemental oxygen within 8 hours of admission (63.4%). Cough (65.6%), dyspnea (57.5%), myalgias (30.6%) and diarrhea (23.8%) were also common. 40.4% received hydroxychloroquine, 23.6% steroids and 19.9% convalescent plasma. 42.9% required ICU care, 27.3% were intubated, and 19.3% died. Characteristics associated with death included older age, male sex, HTN, ESRD on HD, and cancer. Symptoms associated with death included absence of cough, absence of myalgias, previous admission for COVID-19, tachypnea, need for supplemental oxygen, elevated BUN and creatinine, and elevated ferritin. Interventions associated with death included use of steroids, receipt of ICU care, intubation, delay to intubation, and use of vasopressors or inotropes. Complications associated with death included development of a new arrhythmia, bacteremia, pneumonia, ARDS, thrombosis, and new renal failure requiring HD (Table).
Table 1. Patient Characteristics by Death

Table 2. Patient Characteristics by Death

Table 3. Patient Characteristics by Death

Conclusion
COVID-19 pts admitted to our southeast U.S. HS had significant comorbidities, most commonly obesity, HTN, and diabetes. Additionally, AA comprised a disproportionate share (72%) of our cohort compared to the general population of our state (30%), those tested in our region (32.9%), and those found to be positive for COVID-19 (35.8%). In-hospital mortality was 19.3% and intubation, particularly if delayed, was associated with death as were several complications, most notably arrhythmia, ARDS, and renal failure with HD.

Disclosures
All Authors: No reported disclosures
371. Cluster of carbapenemase-producing Enterobacterales secondary infections during the COVID-19 crisis at a New York City hospital
Authors: Gomez-Simmonds Angela , Annavajhala Medini K , McConville Thomas H , Dietz Donald E , Shoucri Sherif M , Laracy Justin C , Nelson Brian , Whittier Susan , Uhlemann Anne-Catrin , Uhlemann Anne-Catrin 
Published: January 2021

Abstract

Background
Patients with COVID-19 may be at increased risk for secondary bacterial infections. At our quaternary care hospital in New York City, the rapid escalation of COVID-19 cases was accompanied by a massive surge in the need for hospital and critical care capacity. During this time, we noted a increase in infections caused by carbapenemase-producing Enterobacterales (CPE).

Methods
We retrospectively assessed microbiology data to identify patients with positive testing for SARS-CoV-2 who had clinical cultures with meropenem-resistant and/or carbapenemase gene-positive Enterobacterales. We obtained microbiological and clinical data by manual chart review. Available clinical isolates underwent long-range genomic sequencing using the MinION (Oxford) for rapid genotyping, resistance gene detection, and phylogenetic analysis.

Results
From March 1 to May 18, we identified 33 CPE isolates from 13 patients, including 29 Klebsiella pneumonia and four Enterobacter cloacae. Most patients (11/13) had a positive respiratory culture, and 7/13 developed bacteremia. All patients had prolonged, complex hospitalizations with extensive antibiotic exposure. We performed long-range sequencing on 19 isolates from 12 patients. 15/16 K. pneumoniae isolates belonged to sequence type (ST) 258 encoding KPC (14 KPC-2; 1 KPC-3); one ST70 isolate encoded KPC-2. All four E. cloacae isolates belonged to ST270 and encoded NDM-1. Phylogenetic analysis of ST258 isolates including historical isolates from our hospital revealed a distinct lineage of isolates from COVID-19 patients (72% bootstrap support), with expected clustering of isolates from the same patient and patients that were cohorted together.

Conclusion
While CPE have declined substantially in New York City in recent years, increased detection in patients with COVID-19 may signal a reemergence of these highly resistant pathogens in the wake of the global pandemic. System-level factors, such as the rapid scale-up of critical care capacity, while clearly needed to address the unprecedented reach of COVID-19, may have contributed to isolate clustering in these patients. Increased surveillance and antimicrobial stewardship efforts will be needed to mitigate the impact of CPE in the future.

Disclosures
All Authors: No reported disclosures
374. Complication with Bacterial Pneumonia in Hospitalized Patients with Coronavirus Disease 2019 (COVID-19)
Authors: Kang Minji , Haste Nina , Legaspi Jamie , Torriani Francesca J , Abeles Shira 
Published: January 2021

Abstract

Background
Early reports have indicated widespread empiric antimicrobial usage in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As data regarding bacterial complications in patients with Coronavirus Disease 2019 (COVID-19) are limited and emerging, it is important to delineate the burden of complications with bacterial pneumonia in patients with COVID-19 and its implication on antimicrobial usage.

Methods
We conducted a retrospective cohort study of all hospitalized patients diagnosed with COVID-19 based on detection of SARS-CoV-2 on RT-PCR from March 1, 2020 to May 10, 2020. Data were collected retrospectively to determine the presence of bacterial pneumonia among patients hospitalized with COVID-19 and to identify demographics, comorbidities, or laboratory values that may help to distinguish patients with bacterial pneumonia. Fisher’s exact test was used to analyze categorical data and Student’s t test was used to analyze differences between means.

Results
Among 99 patients hospitalized with COVID-19 during the study period, complication with bacterial pneumonia was seen in 17 (17%) based on sputum, tracheal aspirate or lower respiratory tract cultures performed 8.9 ± 7.8 (mean ± SD) days from the detection of SARS-CoV-2 on RT-PCR. Staphylococcus aureus was the causative organism in 8 (47%) cases while Enterobacteriaceae were isolated in 7 (41%) cases, Burkholderia cepacia in one (6%) and Rahnella aqualitis in one (6%) case. There were no significant differences in demographics, comorbidities, or laboratory findings between patients with or without complication with bacterial pneumonia. However, those with complication with bacterial pneumonia were more likely to be intubated (24% vs. 88%, p&lt; 0.01), on vasopressors (23% vs. 82%, p &lt; 0.01), and require intensive care unit admission (37% vs. 94%, p&lt; 0.01).

Conclusion
Nosocomial and ventilator-associated pneumonia were commonly seen among hospitalized patients with COVID-19 requiring intubation and intensive care use admission. With complications of bacterial pneumonia common among critically-ill patients infected with SARS-CoV-2, widespread antimicrobial usage may increase the selective pressure for antibiotic resistance in this patient population.

Disclosures
All Authors: No reported disclosures
376. COVID-19 Severity in HIV+ Patients Receiving Tenofovir
Authors: Homsi Nora , Vermeulen Kendra , Snyder Mitchell , Cennimo David J , Sonyey Alexandra 
Published: January 2021

Abstract

Background
Early in the COVID-19 pandemic, tenofovir (TAF/TDF) was identified as a potential agent for SARS-CoV-2 due to binding to RNA-dependent RNA polymerase similarly to remdesivir. This led to the hypothesis that TAF/TDF may be lessening the severity and improving outcomes of COVID-19 infection.
COVID-19 Severity

COVID-19 Infection Outcomes

Methods
Patients were identified by searching for HIV infection and SARS-CoV2 PCR testing. Type of antiretroviral therapy (ART), CD4+ cell count, HIV viral load (VL), comorbidities, presenting symptoms, severity of COVID infection, and outcomes were analyzed. COVID disease was classified as mild, moderate, severe, or critical based on World Health Organization criteria. We primarily sought to determine the effect of TAF/TDF on the severity of COVID infection. The secondary endpoint was to determine the effect of low CD4 count and HIV VL on the severity of infection.

Results
39 HIV+ patients were tested at least once for SARS-CoV2 by PCR at VA NJ Health Care System. 18 of 39 patients were PCR positive. In those, common presenting symptoms included: fever (15/18), cough (7/18), and lethargy/fatigue (6/18). 16 of the 39 HIV+ patients’ ART included TAF/TDF; 8 of 18 COVID+ and 8 of 21 COVID-. In the COVID- group, 2 patients had CD4 count &lt; 200 cells/mm3, 3 patients had HIV VL &gt;200, and 19 of 21 had at least 1 comorbidity. In the COVID+ group, 3 had CD4 count &lt; 200 cells/mm3, none had detectible HIV viremia, and all but one had comorbidities. Of COVID+ infections, 7 were mild, 3 moderate, 8 severe, and 5 patients died. 4 of the 5 patients that did not survive were in non-TAF/TDF group. All 3 patients with CD4 count &lt; 200 cells/mm3 had severe disease. 6 out of 8 patients developed mild disease in TAF/TDF group vs. 1 out of 10 patients in non-TAF/TDF group. 1 out of 8 and 7 out of 10 patients had severe or critical disease in TAF/TDF vs non-TAF/TDF groups respectively.

Conclusion
In this sample of 18 HIV+ patients with COVID-19 infection, patients receiving TAF/TDF were more likely to develop mild disease and have full recovery than those who were on TAF/TDF-free regimens (75% vs. 10% and 87.5% vs. 50%, respectively). Patients not on TAF/TDF-based regimens had a higher rate of developing severe and critical COVID-19 disease (40% vs. 0% and 30% vs. 12.5%, respectively).

Disclosures
All Authors: No reported disclosures
379. Epidemiology of Antimicrobial Use Among SARS-CoV-2 Positive and Negative Admissions in the US: A Multicenter Evaluation
Authors: Puzniak Laura A , Bauer Karri A , Finelli Lyn , De Anda Carisa , Moise Pamela , Yu Kalvin , Vankeepuram Latha , Parikh Prashant , Gupta Vikas 
Published: January 2021

Abstract

Background
SARS-CoV-2, a novel coronavirus, emerged in Wuhan, China in December of 2019, and became a pandemic. Increases in bacterial/fungal co-infections have occurred during influenza pandemics and early data from this pandemic indicate high utilization of antimicrobial therapy. We compared the utilization of antimicrobials and health outcomes between SARS-CoV-2 positive and negative patients.

Methods
Patients hospitalized at 271 US acute care facilities from 3/1/20–5/30/20 with ≥1 day length of stay (LOS) and ≥24 hours of antimicrobial therapy tested for SARS-CoV-2 were included in the study (BD Insights Research Database [Becton, Dickinson & Company, Franklin Lakes, NJ]). Demographics, antimicrobial utilization, duration of antimicrobial therapy, hospital LOS and ICU LOS data were analyzed by SARS-CoV-2 test results.

Results
142,054 patients were tested for SARS CoV-2 and 12% (n=17,075) were SARS-CoV-2 positive. SARS-CoV-2 negative and positive patients did not differ regarding presence of a positive bacterial culture. Total LOS, % ICU admission, and ICU LOS were higher among SARS-CoV-2 positive patients (Table). In total 48% of admissions were prescribed antimicrobial therapy; rates were higher in SARS-CoV-2 positive versus negative admissions (68% vs. 46%). The most common antimicrobials and classes are in Table.
Antimicrobial therapy and outcomes in hospitalized SARS-CoV-2 tested patients.

Conclusion
Almost half of patients tested for SARS-CoV-2 were prescribed antimicrobials, with antimicrobial use higher among those with SARS-CoV-2, despite similar rates of positive cultures. On average, antimicrobials were prescribed within 10 hours from the time to admission among patients tested. These treatment patterns may highlight the difficulties in making treatment decisions and concerns over potential bacterial superinfection in SARS-CoV-2, but also indicate potential overuse of antimicrobials. Collateral damage from antimicrobial overuse include increase selection of antimicrobial resistance, adverse effects of drugs, and unnecessary treatment costs. It will be important to continue to evaluate the utilization and appropriateness of antimicrobial use among SARS-CoV-2 patients.

Disclosures
Laura A. Puzniak, PhD, Merck (Employee) Karri A. Bauer, PharmD, Merck Research Laboratories (Employee) Lyn Finelli, DrPH, MS, Merck & Co Inc, (Employee) Carisa De Anda, PharmD, Merck & Co Inc, (Employee) Pamela Moise, PharmD, Merck & Co., Inc. (Employee, Shareholder) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Latha Vankeepuram, MS, BD (Employee) Prashant Parikh, n/a, Becton, Dickinson and Company (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding)
381. HIV Patients with COVID-19 Hospitalized in a Tertiary Care Center in Mexico City
Authors: Espejo Ortiz Cristian E , Serrano Pinto Yamile G , Sierra Madero Juan G , Iñiguez Alvaro Lopez , Crabtree-Ramírez Brenda 
Published: January 2021

Abstract

Background
The main risk factors for severe COVID-19 described are diabetes, hypertension, cardiovascular disease, obesity, chronic lung and renal disease. HIV infection has not been found to be an independent factor for severe COVID-19, however, only small case series of HIV and COVID-19 have been reported. The aim of this study is to describe clinical characteristics and outcomes of HIV positive patients with COVID-19 hospitalized in a tertiary care hospital in Mexico City.

Methods
A single-center review of HIV-infected patients diagnosed with COVID-19 was performed using medical records from March 1st, 2020 to May 20th, 2020. We describe the clinical characteristics and outcomes

Results
A total of 11 PLWH were diagnosed with COVID-19, only 9 were hospitalized and are described here. One died, 6 were discharged and 2 remain hospitalized (table 1). Overall, the median age was 46 years, all males and most (7/9) were on INSTI based ART regimen and undetectable HIV viral load (9/9), with a median of CD4 counts of 581 cell/mm3. The median days since onset of COVID19 symptoms was 7 days. 6/9 had at least one comorbidity: hypertension (3/9) and chronic kidney disease (3/9). 7/9 had body max index &gt;25. 7/9 had moderate to severe lung disease, evidenced by computed tomography. 4/9 required invasive mechanical ventilation, and all were successfully extubated.
Table 1. Characteristics and outcomes *

Conclusion
Most of the HIV patients who required hospitalization due to COVID19 had comorbidities. In spite of severe and critical presentations, most patients have recovered. Outcomes appear no different from those seen for non-HIV infected patients, however larger studies to determine the risk that HIV infection confers to COVID19 outcomes are needed.

Disclosures
All Authors: No reported disclosures