bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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 &lt; 25% indicated low, 25 to 70% moderate, and &gt; 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

Abstract

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 &lt; 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

Abstract

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

Abstract

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 &lt; 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

Abstract

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

Abstract

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
437. Asymptomatic Healthcare Worker COVID-19 Testing Program
Authors: Horton Lucy E , Taplitz Randy , Torriani Francesca J , Abeles Shira R , Ikeda Lydia , Ikeda Tyson 
Published: January 2021

Abstract

Background
The SARS-CoV-2 pandemic remains a major threat worldwide. Healthcare workers (HCWs) are particularly impacted by the COVID-19 pandemic with high infection rates reported from HCWs in hard-hit regions2,3, raising concerns about nosocomial infections and the effectiveness of personal protective equipment in protecting HCWs. Asymptomatic infection is estimated 17.9% to 33.3%4 and is a common source of transmission5.
We designed a HCW testing program to address patient and employee concerns about exposures in the healthcare setting at our 808-bed health system. During the time of employee testing, the mean (range) number of inpatients with a diagnosis of COVID was 30 (22–38) of a mean (range) daily census of 560 (492–602) (approximately 5.4%).

Methods
This opt-in program offered SARS-CoV-2 testing of asymptomatic HCWs with paired nasopharyngeal or mid-turbinate swab for PCR (Roche) and serum IgG antibody testing (Diazyme). While initially designed as a pilot project in the Emergency Departments and COVID-19 units, it was quickly expanded to a health system-wide initiative.

Results
From April 22 to June 2, PCR testing was performed on 5826 asymptomatic HCWs with four PCR tests resulting positive (0.09%). Of 5589 serologic tests (anti-SARS-CoV-2 IgG) performed, 57 tested positive (1.02 %). All HCW with a positive IgG had a concurrent negative PCR.

Conclusion
In this cross-sectional evaluation, the point prevalence of SARS-CoV-2 IgG in asymptomatic HCWs at UC San Diego was less than 1%, supporting modeling estimations at the San Diego County level of very low levels of community exposure at the time of this testing.
Further analyses of incidence rates and potential risk factors such as employee roles within the healthcare system, community and healthcare exposures, and home zip code are underway.
Asymptomatic HCW testing is a strategy that can provide the perception of additional safety to both the workforce and patients as the health system reopens, while potentially reduce transmission from asymptomatic persons through active case finding and isolation.

Disclosures
Randy Taplitz, MD, Merck (Advisor or Review Panel member)
440. Clinical Characteristics of Early Noncritical Hospitalized Patients with Coronavirus Disease 2019 (COVID-19): A Single-Center Retrospective Study in New York City
Authors: Lee Michelle , Fayad Mona , Mabud Tarub , de Lara Paulino Tallon , Hernandez Adiac Espinosa , Anez Gustavo A Contreras , Freites Christian Olivo , Kholi Maanit , Chadha Nikhil , Jean Raymonde 
Published: January 2021

Abstract

Background
COVID-19 first originated in Wuhan, China, in December 2019. As of April 9, 2020, New York State had become the single largest global epicenter of COVID-19.

Methods
This is a retrospective chart review of the first 33 patients with RT-PCR-confirmed COVID-19 admitted from the emergency department to a general medicine unit in a single academic hospital in New York City between March 11th to March 27th, 2020. Patient’s demographic, clinical, laboratory, radiographic investigations, treatments and clinical outcomes were retrospectively extracted from the electronic medical record and followed until April 10th, 2020. Patients were divided into severe and nonsevere sub-cohorts. Statistics were descriptive in nature.

Results
The study cohort (median age 68 yr, 67% male) presented with subjective fevers (82%), cough (88%), and dyspnea (76%). The median incubation period was 3 days. Most cases met SIRS criteria upon admission (76%). Patients had elevated inflammatory markers. Patients were treated with antimicrobials, corticosteroids, hydroxychloroquine, and varying levels of supplemental oxygen. Mortality was 15% and 18% of the cohort required intensive care services.

Conclusion
Patient age, presenting clinical symptoms, comorbidity profile, laboratory biomarkers, and radiographic features are consistent with findings published from China. Severe patients had peaks in inflammatory biomarkers later in the hospitalization, which may be useful to trend. Further studies are necessary to create guidelines to better risk-stratify COVID-19 patients based on clinical severity.

Disclosures
All Authors: No reported disclosures
449. Disproportionate of COVID-19 Mortality across NYC: Experience from the Bronx Hospital during the First Wave of Pandemic Crisis
Authors: Suwanwongse Kulachanya , Shabarek Nehad 
Published: January 2021

Abstract

Background
The Bronx (BX) is an urban city with the most poverty, least educated population and poorest health outcomes among 62 counties in New York State. Unsurprisingly, BX has the highest rates of COVID-19 diagnoses across New York City (NYC). Lincoln Medical Center (LMC) is part of the NYC health and hospital system (NYC H+H) and has the highest COVID-19 admissions in BX and the second-highest across NYC. Herein we report our preliminary data on mortality rate (MR) of hospitalized COVID-19 patients and discuss the disproportionate of MR across NYC.

Methods
On 26 April 2020, we acquired the total number of hospitalized COVID-19 and deaths and mechanically ventilated (MV) COVID-19 and death from LMC and all other NYC H+H. Scheffe test was used to determine MR differences. The P-value (p) &lt; 0.005 was set as a statistically significant threshold.

Results
MR of our hospitalized COVID-19 patients was 31%, which is higher than that of Man (24%, p 0.001). However, LMC has a high proportion of MV COVID-19 (local and transferred cases). Sub-group analysis of non-MV COVID-19 showed LMC MR (6%) is lower than Brooklyn (BL) (17%, p 0.00) and Queens (Qu) (17%, p 0.00) and didn’t differ from Man NYC H+H centers (8%, p 0.68). Analysis of MR among MV patients between LMC and other NYC H+H centers across four boroughs did not discover any differences.
Hospitalized COVID-19 MR from all NYC H+H centers in BX (28%) did not differ from Man (24%, p 0.7) and Qu (28%, p 0.99). Interestingly, we found that MR is the highest in BL (33%). Moreover, MR of non-MV COVID-19 was higher in BL (17%) and Qu (17%) than BX (10%) and Man (8%) NYC H+H centers. We hypothesize this may result partly from the tense and shortage of health care resources in these two boroughs, especially, at the beginning of pandemic so some critical patients may not receive adequate care such as delaying intubation. Further research investigating reasons for this disproportion will help in developing the best available care plan for the ongoing crisis.
Percentage of COVID-19 Mortality in each group

Multiple comparison by Scheffe Test of MR of hospitalized patients with COVID-19 at LMC and across 4 NYC boroughs

Multiple comparison by Scheffe Test of MR of non-MV patients with COVID-19 at LMC and across 4 NYC boroughs

Conclusion
Despite the high COVID-19 incidence and poor epidemiologic health risks of the population in BX, MR of hospitalized COVID-19 seemed to be the same as Man and Qu, and surprisingly lower than BL. MR of non-MV COVID-19 in BX is lower than BL and Qu. The studies determining the reasons underlying this disproportionate would be worthwhile.

Disclosures
All Authors: No reported disclosures