bluuebunny/crossref_metadata_2025_split huggingface dataset:
543. SARS-CoV-2 Viral Dynamics For Symptomatic People Living with HIV Requiring Hospitalization For COVID-19
Authors: Virata Michael D , Villanueva Merceditas , Shenoi Sheela , Ladines-Lim Joseph B , Aoun-Barakat Lydia 
Published: January 2021

Abstract

Background
Over 8 million people have been infected with severe acute respiratory syndrome 2 (SARS-CoV-2). People living with HIV (PWH) affected by SARS-CoV-2 represent a small proportion of patients admitted to the hospital for COVID-19 disease. Viral dynamics in this subpopulation are still unknown.

Methods
We conducted a retrospective cohort study from a large, urban academic center in New Haven, CT of patients consecutively admitted with laboratory confirmed SARS-CoV-2 infection through May 31, 2020. Main outcome measure was the ribonucleic acid (RNA) viral load (VL) detected in respiratory samples by cycle threshold (Ct) values and trend over time as a measure of nucleic acid concentration and replication. Epidemiological, clinical, laboratory results, ART treatment, COVID treatment and outcomes were abstracted from patient records. We evaluated the relationship between virologic data and disease severity.

Results
Among 19 PWH hospitalized with covid19, 84% were &gt;50 years of age, 53% were women, 63% were black, 95% were on antiretrovirals, 95% with undetectable HIV VL (&lt; 50 copies/ml), and median CD4 count of 827.9 cells/mm3. Symptom duration was 2–14 days. Median length of stay was 12 days. There was no in-hospital mortality. A total of 62 respiratory samples were collected at various time points and evaluated for SARS-CoV-2 RNA viral load. Eight patients had 1 specimen. Patient with more severe disease had higher baseline SARS-CoV-2 viral loads. Mean Ct values for N1 and N2 on admission were 21.6 and 23.7, respectively.

Conclusion
PWH with COVID19 represents only a small percentage of hospitalized patients and viral dynamics are not well defined. SARS-CoV-2 VL was higher among PWH with advanced disease at the presentation of illness. Overall, PWH with COVID-19 had favorable outcomes.

Disclosures
All Authors: No reported disclosures
549. Clinical Characteristics and Outcomes of Patients with COVID-19 treated with Convalescent Plasma in Miami, Florida
Authors: Anjan Shweta , Skiada Dimitra , Cuartas Miriam Andrea Duque , Salguero Douglas , Serota David P , Gonzales-Zamora Jose , Ayoade Folusakin , Beauchamps Laura , Quiroz Tanya R , Bertran-Lopez Jovanna , Raccamarich Patricia , Montgomerie Emily K , Barreto Irma , Abbo Lilian M , Abbo Lilian M , Doblecki-Lewis Susanne , Wu Yanyun , Alcaide Maria L 
Published: January 2021

Abstract

Background
The Coronavirus disease of 2019 (COVID-19) global health crisis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in unprecedented mortality, impacted society, and strained healthcare systems, yet sufficient data regarding treatment options are lacking. Convalescent plasma, used since 1895 for infectious disease outbreaks, offers promise as a treatment option for COVID-19.

Methods
This is a retrospective study of patients diagnosed by a nasopharyngeal swab SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT-PCR), who received convalescent plasma between April to June 2020 at two large hospitals in Miami, Florida, as part of the US FDA Expanded Access Program for COVID-19 convalescent plasma (CCP).

Results
A total of 23 patients received CCP, 13 (57%) had severe COVID-19 disease, while 8 (35%) had critical or critical with multiorgan dysfunction. Median time of follow up was 26 (range, 7–79) days. Overall, 11 (48%) survived to discharge, 6 (26%) died, while 6 (26%) are currently hospitalized. All deaths reported were due to septic shock from secondary infections. 15 (65%) showed improvement in oxygen requirements 7 days post CCP transfusion. Measured inflammatory markers, c-reactive protein, lactate dehydrogenase, ferritin and d-dimer improved 7 days post transfusion in 13 (57%) patients. No adverse events due to the transfusion were reported. 10 (43.4%) patients had a negative SARS-CoV-2 RT-PCR at a median of 14.5 (range, 4–31) days after receiving convalescent plasma.

Conclusion
Administration of convalescent plasma was found to be safe, with favorable outcomes in this small cohort of relatively high acuity patients. Larger studies including control arms are needed to establish the efficacy of convalescent plasma on clinical and virologic outcomes for patients with COVID-19.
Table

Disclosures
All Authors: No reported disclosures
552. Could Anticoagulant Use Prior to Infection with COVID-19 Decrease Mortality?
Authors: Natali Kayla M , Chan Kok Hoe , Atallah Liana , Nagarakanti Sindhu , Slim Jihad 
Published: January 2021

Abstract

Background
The novel coronavirus (COVID-19) has resulted in substantial morbidity and mortality worldwide. Infection with COVID-19 has been associated with coagulopathy and inflammation. This prothrombotic state has been identified in the literature as an indicator of poor prognosis and those with COVID-19 who receive anticoagulation therapy may have better outcomes. Due to this prothrombotic state, patients who are currently receiving anticoagulation therapy for other indications prior to infection with COVID-19 may have better outcomes.

Methods
This was a retrospective case control study conducted at an inner city hospital. Patients were eligible if they were hospitalized between March 15, 2020 and May 15, 2020 and had confirmed infection due to COVID-19. Patients were matched by age, sex, body mass index (BMI), diabetes mellitus (DM), hypertension (HTN) and estimated glomerular filtration rate (eGFR) by chronic kidney disease (CKD) state. This study evaluated morality in patients who were receiving long term anticoagulation therapy prior to infection with COVID-19 compared to those who were not.

Results
Of the 436 patients hospitalized with confirmed infection due to COVID-19, 400 were eligible for analysis. Twenty-two were on anticoagulation therapy prior to admission. Among those patients, 68% were male and 32% were female. The majority of the patients were greater than 60 years of age (82%). Comorbidities were present in 21 patients and were as follows: HTN (95%), CKD (67%), DM (57%), obesity (36%). Of the 22 patients, five expired due to COVID-19 infection compared to 52 patients from the 149-patient matched cohort [z-score 1.13, p = 0.26; odds ratio (OR) 1.82; 95% confidence interval [CI], 0.69–4.71].

Conclusion
Prior long-term anticoagulation use does not appear to have a protective effect in patients with COVID-19 infection. Studies with larger sample size will be needed to answer this important question.

Disclosures
Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
553. Critically Ill patients Receiving Tocilizumab Compared With Those Not Receiving Tocilizumab for Treatment of COVID-19
Authors: Leonard Michael , Asher anthony , Kooken Banks , Donahue Erin , Symanowski james , Roshdy Danya , onsrud jennifer , Umani Saad , Copelan edward , shahid zainab 
Published: January 2021

Abstract

Background
Background::
Immune modulation in patients with clinical features suggestive of a cytokine release syndrome (CRS) has become a pharmacologic target for potential treatment of COVID-19 and prevention of ARDS. Tocilizumab is an IL-6 receptor blocker FDA-approved for chimeric antigen receptor (CAR) T cell-induced severe or life-threatening CRS. The objective of this study was to describe clinical outcomes associated with tocilizumab compared with those not receiving tocilizumab in critically ill patients with severe COVID-19.

Methods
Methods:
Retrospective case series of 49 adult patients admitted to an intensive care unit with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients receiving tocilizumab were compared with those not receiving tocilizumab. The primary outcome was clinical improvement (decrease in supplemental oxygen requirement, discharge from ICU, or live discharge from hospital). Secondary endpoints included mortality and frequency of extubation. All comparative endpoints were assessed at 2 weeks after ICU admission.

Results
Results:
49 patients were identified with SARS-CoV-2 who were admitted to an ICU, 16 received tocilizumab. Baseline characteristics were similar; most were African American males with comorbidities such as obesity, cardiovascular disease, and diabetes. The time from symptom onset to positive test and subsequent intubation were similar (4 and 7 days, respectively). 75% received one dose (all received 8 mg/kg). The median time from symptom onset to tocilizumab administration was 11 days.
In patients receiving tocilizumab compared with those not receiving tocilizumab, there were similar rates of clinical improvement (44% versus 61%, p=0.27), extubation (31% versus 45%, p=0.60), and mortality (18% versus 19%, p &gt;0.99, respectively). 81% of the tocilizumab group had resolution of fever and 75% had improvement in C-reactive protein levels.

Conclusion
Conclusion:
In this study of patients with progressed disease, outcomes were similar regardless of receipt of tocilizumab. Randomized controlled trials are needed to assess the impact of earlier administration and identify clinical characteristics to assist with selection of appropriate patients who may benefit from tocilizumab.

Disclosures
All Authors: No reported disclosures
559. Outcomes of Convalescent Plasma Transfusion for SARS-CoV2 Patients in the Intensive Care Unit
Authors: Khalid Rabeeya , Thomas Alvin G , Zhu Daisy , Minga Iva , Desai Nirmit , Kaplan Leonard 
Published: January 2021

Abstract

Background
SARS-CoV2 is a grave illness and few therapeutic agents have yielded benefit or reduced mortality. Administration of convalescent plasma (CP) in viral illnesses in the past, including SARS, before day 14, has been associated with a shorter hospital course. In the present study, we are interested in determining the benefit of administering CP to critically ill patients in the intensive care unit, and the impact on mortality and other clinical markers.

Methods
5 critically ill patients with confirmed SARS-CoV2 infection were observed in the uncontrolled case series study. Mechanically ventilated patients with severe ARDS (PaO2/FiO2 &lt; 100) were eligible to receive CP transfusion. We reviewed daily vital signs, inflammatory markers, PaO2/FiO2 ratio and SOFA scores before and after CP transfusions. SARS-CoV2 PCR viral load testing was completed on day 0 of transfusion and repeated on day 3 and 6. Complications during the hospitalization and 30-day mortality were assessed.

Results
All 5 patients were mechanically ventilated at the time of transfusion and between day 7 to 31 of their illness. Following plasma transfusion, body temperature and inflammatory markers remained elevated in four patients (figure 1). SOFA score and PaO2/FiO2 ratios continued to worsen in three and four patients respectively (figure 2). SARS-CoV2 PCR remained positive in 4 patients. 4 of the 5 patients had died at the end of the follow up period. One patient was successfully extubated on day 29 (table 1) and discharged after a long hospital course.
Fever curve and trends of inflammatory markers

Trends of SOFA socre and PaO2:FiO2 ratio

Patient characteristics

Conclusion
In our patient cohort, the administration of CP did not improve laboratory markers or clinical outcomes. Some notable limitations of this study are the small sample size, and that the patients received CP late in their disease course. Further investigation is necessary to draw definitive conclusions about the utility of CP in the treatment of SARS-CoV2.

Disclosures
All Authors: No reported disclosures
571. “Real world” Impact of Letermovir for Prevention of Cytomegalovirus Infection in Hematopoietic-Cell Transplantation
Authors: Loecher Alyssa M , Yum Kendra , Park Daniel , Kim Sara , Saunders-Hao Patricia , Jakubowski Rita , Keyzner Alla , Steinberg Amir , Rana Meenakshi , Jacobs Samantha E 
Published: January 2021

Abstract

Background
Letermovir (LTM) was FDA-approved in 2017 for cytomegalovirus (CMV) prophylaxis in allogeneic hematopoietic cell transplant (HCT) patients. We evaluated the “real-world” impact of LTM in adult HCT recipients at the Mount Sinai Hospital in New York following addition of LTM to our formulary in June 2018.

Methods
In this retrospective study, we compared 31 consecutive allogeneic HCT recipients from June 2018-June 2019 who received LTM prophylaxis from Day +10–100 to 36 consecutive CMV-seropositive patients who underwent allogeneic HCT June 2017-June 2018 and did not receive LTM. Clinical and laboratory data were abstracted from the existing electronic medical record. The primary outcome was development of clinically significant CMV infection (CS-CMV) through 6 months post-HCT, defined as CMV viremia or disease requiring antiviral therapy.

Results
There were no baseline differences in patient demographics or transplant characteristics between patients who did and did not receive LTM prophylaxis. The median duration of LTM prophylaxis was 96 days (IQR, 66–116). At 6-months post-HCT, the cumulative incidence of CS-CMV was lower in patients receiving LTM prophylaxis vs no prophylaxis (29% vs 61%, respectively; p=0.004, Figure 1). Patients who received LTM developed CS-CMV at a later time post-HCT than those who did not receive prophylaxis (median 160 vs 39 days, respectively; p &lt; 0.01). Among patients with CS-CMV, the median duration of antiviral therapy was 39 vs 70 days in the LTM prophylaxis vs no prophylaxis groups, respectively (p&lt; 0.01). While there was no difference in the incidence of graft-versus-host disease (GVHD), the median time to GVHD diagnosis was longer in the LTM group (63 days vs 27 days in the no prophylaxis group; p=0.02). Between patients who did and did not receive LTM prophylaxis no statistically significant difference was observed, respectively, in incidence of CMV disease (3% vs 14%), hospital re-admission (68% vs 67%), or mortality (26% vs 14%) at 6 months post-HCT.

Conclusion
We demonstrated the “real-world” utility of LTM for CMV prevention in HCT recipients. Future studies should further evaluate the impact of LTM on antiviral drug usage, GVHD, and other transplant-related outcomes in this population.

Disclosures
All Authors: No reported disclosures
587. Equity in academic advancement: findings from an IDSA-sponsored survey of infectious disease physicians
Authors: Manne-Goehler Jennifer , Krakower Douglas , Marcelin Jasmine R , Del Rio Carlos , Stead Wendy 
Published: January 2021

Abstract

Background
Recent evidence has shown substantial disparities in the rate of advancement to full professorship among women as compared to men faculty in academic infectious diseases (ID). We sought to identify barriers to academic advancement overall and by gender among faculty physicians in this field.

Methods
We conducted a web-based survey of academic faculty in ID. The survey was made available to the IDWeek2019 attendees and digitally via email and social media to the IDSA membership at large from 9/18/19 – 11/8/2019. The survey assessed demographic characteristics and barriers to faculty advancement and achievement, building on prior research. Survey themes included faculty promotion track, part-time work history and a suite of questions about workplace atmosphere and policies related to career advancement. Multivariable Poisson regression models were used to evaluate the association between these factors and full professorship.

Results
Of 1,036 respondents, 790 were retained in the final dataset [Men: 322 (40.7%), Women: 458 (58.0%), Other: 10 (1.3%)]. 352 respondents were Instructors or Assistant Professors (38.5%), 198 were Associate Professors (25.1%) and 240 were Full Professors (30.4%). Fewer women reported that their promotion process was transparent (57.4% v. 67.6%, p=0.004) and more women Full Professors felt they had been “sponsored” compared to men at their same rank (73.3% v. 53.6%, p=0.002). In regression analyses (Table 1), gender, publications and clinical trial leadership were significantly associated with full professor rank and promotion transparency and NIH grants emerged as possible correlates of this outcome. Salary support, part-time work, women in leadership, faculty promotion track and sponsorship were not associated with this outcome.
Table 1. Results of Poisson regression analysis

Conclusion
Sponsorship and transparency of promotion criteria differed by gender and emerged as potentially important factors associated with full professorship in academic ID. Future policies to promote equity in advancement should address these issues.

Disclosures
All Authors: No reported disclosures
596. Clinical outcomes and healthcare utilization in uninsured patients requiring long-term antibiotic therapy
Authors: Vo Daniel , Hamad Yasir 
Published: January 2021

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) is frequently indicated in the management of severe bacterial infections. Uninsured patients may more have difficulties accessing OPAT services (compared to those with a payer source) which can lead to prolonged hospitalizations or early discharge with potentially suboptimal therapy. We sought to assess disparities in the care of hospitalized, uninsured patients who had an OPAT indication and to examine subsequent clinical outcomes.

Methods
We performed a retrospective analysis of consecutive patients admitted to an academic hospital from 09/01/2018-12/31/2018 who received an infectious diseases consultation and had an index diagnosis of endocarditis (IE), Staphylococcus aureus BSI, or bone and joint infection including osteomyelitis, prosthetic joint infection, and septic arthritis identified by ICD-10 code. Clinical data were collected during index admission; outcomes were followed for up to 30 days after discharge. We examined differences in length of stay (LOS), discharge against medical advice (AMA), and composite outcome of death and readmission at 30 days in uninsured and privately insured patients.

Results
Of 104 patients, 66 (63.5%) were privately insured and 38 (36.5%) were uninsured. Baseline clinical characteristics are presented in Table 1. Uninsured patients were younger (40.9 versus 51.4 years, p&lt; 0.001) and more likely to be African American (55.3% versus 19.7%, p&lt; 0.001). Uninsured patients were more likely to leave AMA (18.4% versus 0%, p=0.001), complete shorter duration of IV antibiotics (p=0.001), and receive oral antibiotics at discharge (15.8% versus 3.0%, p=0.049). Length of stay was numerically longer in this group although not significant (15.5 days versus 10 days, p=0.053). Composite outcome of readmission or death from all cause at 30 days was lower in the uninsured group; however, after adjusting for age, the results were not significant (aOR 0.372, 95% CI 0.106-1.297, p=0.121).
Table 1. Demographic and clinical characteristics of privately insured and uninsured patients

Conclusion
Uninsured patients were more likely to leave AMA, complete shorter duration of IV antibiotics, and receive oral antibiotics at discharge compared with privately insured patients. Thirty-day readmission and death rates were not significantly different among the two groups.

Disclosures
All Authors: No reported disclosures
612. In-Person vs Tele-Infectious Disease Care: Is One Better?
Authors: Gupta Nupur , Sanghvi Adit B , Bariola J Ryan , Mellors John , Abdel-Massih Rima 
Published: January 2021

Abstract

Background
Telemedicine (TM) has allowed physicians to expand beyond traditional in-person practice to provide care at remote locations. Initial performance of TM programs in ID has been reported, including favorable outcomes, but limited data exists on how inpatient Tele-ID compares to in-person.1,2 To address this gap, we analyzed data from hospitals that transitioned from in-person ID care to Tele-ID.
References

Methods
Travel time between the 3 rural Pennsylvania hospitals (total 432 inpatient beds) by car is 1 hour 40 minutes. All in-person consults were provided by an independent ID physician who traveled daily between sites. Starting July 2018, all consults were provided by Tele-ID consisting of one full-time equivalent physician. This included live audio-video visits and e-consults. Data were extracted from electronic health record; between 1/1/2018-6/30/2018 for in-person and 7/1/2018-12/30/2018 for Tele-ID. Key outcomes assessed were number of initial encounters, length of stay (LOS) after ID consult, proportions of patients discharged home, transferred to tertiary centers, and ID related readmission at 30 days.

Results
Study population consisted of 642 encounters with majority being Caucasian, female and average age 67 years (Table 1). Tele-ID had higher comorbidity scores vs in-person ID (Table 1). Total encounters were significantly greater for Tele-ID than in-person ID (Table 2; p=0.018). LOS after ID consult, transfers to tertiary centers, readmissions at 30 days, and discharges home were similar between the two groups (Table 2). Most common diagnosis was “bacteremia;” notably Tele-ID made a broader range of diagnosis (Figure 1). Limitations include a small sample size and possibility of a temporal bias, although the patient characteristics were similar except for higher co-morbidity for the Tele-ID service.

Conclusion
This comparative study shows that patient outcomes are similar between in-person and Tele-ID, despite higher volume and complexity encountered by Tele-ID. The greater number of consults and broader range of diagnosis made by Tele-ID suggests greater productivity, possibly related to travel time elimination. Tele-ID appears to be a good alternative solution for rural locations that lack in-person access to ID care.

Disclosures
J. Ryan Bariola, MD, Infectious Disease Connect (Employee)Mayne Pharma (Advisor or Review Panel member)Merck (Research Grant or Support) John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer)