bluuebunny/crossref_metadata_2025_split huggingface dataset:
280. Burden of Hyperglycemia in Patients Receiving Dexamethasone for Severe COVID-19
Authors: Fetters Kirk B , Judge Stephen , Hatlen Timothy , Daar Eric 
Published: December 2021

Abstract

Background
Previous studies demonstrated the adverse impact corticosteroids can have on blood glucose homeostasis in both diabetics and non-diabetics. This raises concern for corticosteroid use in severe COVID-19 where the population is enriched for those at highest risk of severe disease, such as diabetics and patients with obesity. Previous studies of dexamethasone in COVID-19 were limited by the inability to assess steroid-induced hyperglycemia or the impact of hyperglycemia on hospital resources.

Objective
The study aimed to describe the clinical characteristics, management, and outcomes related to hyperglycemia, before and after dexamethasone therapy was used as the standard of care in patients with severe COVID-19.

Methods
We performed a pre/post retrospective study of patients with severe COVID-19 pneumonia admitted from May to July 2020 to Harbor-UCLA Medical Center. 126 patients were evaluated. 64 received dexamethasone and 62 did not. To quantify the effect of dexamethasone on diabetic vs. non-diabetic patients, we documented the average blood glucoses and frequency of correctional insulin doses required by each patient group (diabetic with and without dexamethasone, non-diabetic with and without dexamethasone).

Results
While dexamethasone was associated with higher median blood glucose and more frequent correctional insulin dosing in diabetic patients, there was minimal effect of dexamethasone on hyperglycemia in non-diabetic patients. Furthermore, while non-diabetic patients receiving dexamethasone required more doses of correctional insulin per day vs non-diabetic patients not receiving dexamethasone (0.3 doses per day vs 0.1 doses per day), the frequency of correctional insulin doses required by non-diabetics on dexamethasone remained low at 0.3 doses per day.

Conclusion
NIH COVID-19 guidelines recommend administering dexamethasone only if the patient is in a monitored setting. Our data support the NIH concerns that outpatients with diabetes receiving steroids are at risk for hyperglycemic complications. However, contrary to the NIH guidelines, our data suggest that patients without diabetes receiving steroids are at low risk for complications due to hyperglycemia and a majority do not require monitoring.

Disclosures
Eric Daar, MD, Gilead (Consultant)Gilead (Research Grant or Support)Merck (Research Grant or Support)Merck (Consultant)ViiV (Research Grant or Support)
281. Prevalence of Influenza Co-infection in a Real-world Cohort of COVID-19 Patients in the U.S
Authors: Chawla Devika , Chen Xin , Kuhlbusch Klaus , Zalocusky Kelly , Rizzo Shemra 
Published: December 2021

Abstract

Background
Over 29 million people have been infected with COVID-19 in the U.S. alone. While COVID-19 carries serious morbidity and mortality, potential for co-infection with other respiratory infections remains unclear. We aimed to: (1) estimate co-infection prevalence of COVID-19 and influenza, and (2) compare demographics and clinical outcomes of co-infected patients to those of COVID-19 singly-infected patients using U.S. electronic health records (EHR).

Methods
Patients in the Optum De-identified COVID-19 EHR database diagnosed with COVID-19 (lab-confirmed or ICD code) between February 2020 and January 2021 were eligible. Influenza co-infection was defined as an influenza diagnosis (lab-confirmed or ICD code) within ±10 days of COVID-19 diagnosis. We report co-infection prevalence for all COVID-19 patients and for a subset of hospitalized COVID-19 patients.

Results
Among all COVID-19 patients (N = 549,532), 1,794 (0.3%) were co-infected with influenza. Among the hospitalized subset (N = 80,192), 242 (0.3%) were co-infected with influenza. In sensitivity analyses restricting to lab-confirmed influenza, co-infection prevalence was 0.1% overall and 0.2% among hospitalized patients. No meaningful differences were observed in baseline demographics between co-infected and singly-infected patients. Among hospitalized patients, univariate analysis suggested higher likelihood of invasive ventilation (12.8% vs. 9.8%; p=0.14), respiratory failure (56.2% vs. 46.6%, p&lt; 0.01), and ICU stay (27.3% vs. 23.1%, p=0.13), but no meaningful difference in mortality (13.3% vs. 13.0%, p=0.97), for co-infected as compared to singly-infected COVID-19 patients.

Conclusion
In a real-world cohort, we observed a low proportion (0.3%) of COVID-19 patients co-infected with influenza. Co-infected patients had similar baseline characteristics but higher likelihood of hospitalization severity as compared to singly-infected COVID-19 patients. Limitations include low prevalence of circulating influenza and potential missing data bias.

Disclosures
Devika Chawla, PhD MSPH, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Xin Chen, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Klaus Kuhlbusch, PhD MD, F. Hoffmann-La Roche Ltd. (Employee) Kelly Zalocusky, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee) Shemra Rizzo, PhD, F. Hoffmann-La Roche Ltd. (Shareholder)Genentech, Inc. (Employee)
283. Population-Based Co-infection of Carbapenem-Resistant Organisms and SARS-CoV-2 in Massachusetts
Authors: Geoghegan Ashley , Leaf Jessica , Klevens Monina , Troppy Scott 
Published: December 2021

Abstract

Background
Concerns about antibiotic resistance are exacerbated in COVID-19 patients due to frequent antibiotic use, increase in mechanical ventilation and reusable equipment, conservation of PPE, and strain on hospital staff. We described cases with co-infection of carbapenem-resistant organisms (CRO) and SARS-CoV-2 and compared rates in the Massachusetts population.

Methods
All providers and hospitals are required to report CROs and SARS-CoV-2 to the Massachusetts Virtual Epidemiologic Network (MAVEN). We selected cases with both a positive SARS-CoV-2 test and a laboratory confirmed CRO from January through July 2020. We classified by which result occurred first and described demographic and clinical characteristics. We standardized the CRO case definition by excluding CR-Pseudomonas aeruginosa and calculated rates per 100,000 to assess the impact of SARS-CoV-2 on the population-based frequency of CROs. Analyses were conducted in SAS 9.4.

Results
28 confirmed cases of SARS-CoV-2 infection were also diagnosed with a CRO. They were an average age of 71.8, 60.7% male, 67.9% white, and 64.3% were in congregate care prior to their diagnoses. Mortality was 5/28 (17.9%). The 23 (82.1%) with a positive SARS-CoV-2 result first were all hospitalized at least once compared to 40% in the CRO first group (p=0.003). 11 (47.8%) of the SARS-CoV-2 first were already admitted when they tested CRO positive; 7 (30.4%) were admitted for the CRO separately from COVID-19 treatment. None of the CRO first group were admitted for CRO infection. Average length of stay for the SARS-CoV-2 first group was higher than the CRO first group (62.3 days vs 11.0 days; p=0.049). Cases positive for CRO first were all infected with CR-Escherichia coli whereas those positive for SARS-CoV-2 first were infected with CRAB, CRPA, or a CRE (Klebsiella oxytoca or Klebsiella pneumoniae) (p&lt; 0.0001). The rate of CRO/COVID coinfection was 0.203 per 100,000 population; the rates for January through July of CRO alone were 2.5 per 100,000 in 2020 and 2.4 per 100,000 in 2019.

Conclusion
Characteristics of individuals co-infected with CRO and SARS-CoV-2 differed by which diagnosis was made first; however, the SARS-CoV-2 pandemic did not impact the CRO population rate during the time frame studied.

Disclosures
All Authors: No reported disclosures
285. Outcomes and Antibiotic Use in Patients with COVID-19 Admitted to an Intensive Care Unit
Authors: Petteys Megan , Medaris Leigh Ann , Williamson Julie E , Denmeade Travis , Soman Rohit , Anderson William E , Leonard Michael , Polk Christopher 
Published: December 2021

Abstract

Background
Studies have shown the proportion of critically ill patients with COVID-19 receiving empiric antibiotics (ABX) greatly exceeds those with culture-proven bacterial co-infections. However, the benefits of continuing ABX in culture-negative (CxN) cases is unknown; this practice may increase the risks associated with ABX overuse. The purpose of this study was to evaluate outcomes and antibiotic use (AU) in intensive care unit (ICU) patients with COVID-19 based on culture results.

Methods
This was a multicenter, retrospective cohort study evaluating adults in an ICU for the first episode of ABX initiated following a confirmed COVID-19 diagnosis between September to December 2020. Blood and/or respiratory cultures must have been obtained within 24 hours (h) of ABX initiation. Patients were categorized into three groups: 1) CxN, ABX discontinued ≤ 72 h, 2) CxN, ABX continued &gt; 72 h, or 3) Culture-positive (CxP). Data on AU was obtained from electronic medication administration records. The primary outcome was clinical success, defined as being discharged alive or &gt; 2-point decrease in the World Health Organization Clinical Progression Scale score from day of ABX initiation to day 30.

Results
A total of 65 patients were included with 35.4% being CxP. ABX were discontinued ≤ 72 h in 23.8% of CxN patients. Methicillin-susceptible Staphylococcus aureus was the most common organism in 52.2% of CxP patients (66.7% respiratory; 16.7% blood; 16.7% both). Anti-methicillin-resistant Staphylococcus aureus and anti-pseudomonal antibiotics were the most prescribed for the initial regimen (Table 1). ABX de-escalation occurred in 58.5% of patients. Initial ABX duration was significantly longer in the CxP group (P &lt; 0.01). No significant difference in clinical success was observed (Table 2). Although not significantly different, the highest rate of adverse events occurred in the CxN and ABX continued &gt; 72 h group (40.6%).
Table 1. Antibiotic Use in ICU Patients with COVID-19

Table 2. Clinical Outcomes and Adverse Events in ICU Patients with COVID-19

Conclusion
In ICU patients with COVID-19, empiric broad-spectrum ABX are often overutilized with an inertia to de-escalate despite negative culture results, potentially increasing the risk of adverse events. This remains an important area for focused antimicrobial stewardship efforts to mitigate the development of multidrug resistance.

Disclosures
Christopher Polk, MD, Atea (Research Grant or Support)Gilead (Advisor or Review Panel member, Research Grant or Support)Humanigen (Research Grant or Support)Regeneron (Research Grant or Support)
287. Characteristics and Outcomes of COVID-19 Patients with Candidemia at a Community Hospital in Chicago
Authors: Adeyemi Oluwadamilola A , Gonzaga Gregg , Cariño Sean , Kalish Steve B 
Published: December 2021

Abstract

Background
1,416 patients with acute COVID-19 infection were admitted to our hospital in 2020. During that year we noticed an alarming increase in cases of nosocomial Candidemia: 26 versus an average of 2.8 cases per year over the previous 5 years. 19 of the 26 episodes (73%) of Candidemia occurred in patients who were admitted with acute COVID-19 infection. Recent reports suggest that hospitalized patients with COVID-19 are at increased risk for developing Candidemia, however their clinical characteristics, risk factors and outcomes have not been well described. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with Candidemia.

Methods
We performed a retrospective chart review of 19 patients with Candidemia and confirmed COVID-19 infection at a 292-bed community teaching hospital in Chicago, Illinois from January through December 2020. We report a descriptive analysis of the demographic characteristics, comorbidities, complications, and outcomes of these patients.

Results
The average age of our study population was 65 years; 68% were male. The average hospital length of stay (LOS) was 34 days. The mean time from admission to the development of Candidemia was 16 days. Associated co-morbidities included cardiovascular diseases (CVD) in 79%, diabetes mellitus (DM), in 68%, and obesity in 50%. Underlying kidney disease was present in 10%. Treatments for COVID-19 included convalescent plasma (53%), remdesivir (53%), steroids (52%) and tocilizumab (19%). All patients were managed in the intensive care unit (ICU) and 95% required multiple central line (CL) placements. Most of the patients (58%) required hemodialysis (HD); all patients were treated with multiple antibiotics. The average LOS in the ICU was 25 days. Despite anti-fungal treatment, 68% expired. The 28-day mortality was 50%.

Conclusion
The occurrence of Candidemia in our hospitalized patients with acute COVID-19 infection was associated with a history of CVD, DM, obesity, prolonged hospital LOS, requirement for multiple CL, HD, treatment with multiple antibiotics and a long stay in the ICU. The mortality of COVID-19 patients with Candidemia is high. The development of strategies to mitigate the occurrence of nosocomial Candidemia in this population of patients is urgently needed.

Disclosures
All Authors: No reported disclosures
288. Clinical Variables Associated with COVID-19 Mortality and ICU Admission in a Public Safety-net Hospital in Chicago
Authors: Hernandez-Acosta Ruben A , Sarmiento Juan , Patel Palak , Hoffman Michael , Rezai Katayoun 
Published: December 2021

Abstract

Background
The COVID-19 pandemic has disproportionately impacted minorities in the United States. John H. Stroger Jr. Hospital (JSH) is a tertiary care hospital within the safety-net system for Cook County in Chicago, Illinois. In this study we report demographics, clinical characteristics and outcomes of patients admitted with COVID-19 in our hospital during the spring surge of 2020.

Methods
A retrospective study was done including patients &gt; 18 years of age admitted to JSH with positive PCR for SARS-CoV2 from March 18 to May 30th, 2020. Outcomes, clinical and demographic characteristics were extracted from the electronic medical record. Moderate and severe disease were defined as radiographic evidence of pulmonary infiltrates and SpO2 &gt; 94% on room air or SpO2&lt; 94% on room air, respectively. Bivariate analysis and logistic regression were performed to assess for risk factors for admission to the intensive care unit and mortality.

Results
625 patients were included, 424 (68%) were male. Median age was 44 years (44,63). 364 (58%) were Hispanic and 222 (36%) non-Hispanic Blacks. 113 (18%) of patients presented with mild disease, 204 (33%) with moderate disease, 298 (48%) with severe disease. 73 patients (12%) died. 153 (24%) required ICU admission, 84 (13%) required intubation [Table 1]. In bivariate analysis, increasing age and diabetes (DM) were associated with increased mortality and ICU admission (p=0.001, Tables 2 and 3). Race/ethnicity was not associated with increased mortality or ICU admission. In the multivariate analysis, elevated glucose on admission regardless of DM and CKD were associated with mortality (p &lt; 0.001).

Conclusion
JSH is a safety net hospital that provides care for the most vulnerable population of Chicago. The proportion of Hispanic patients increased in the later weeks of the pandemic until they represented most of the inpatient population and presented with more severe disease (Figure 1). Although race was not associated with mortality or ICU admission, the high prevalence of chronic diseases such as hypertension and DM in our population may explain the higher rate of admissions. Strengthening of preventive medicine and social engagement with minorities must be a crucial effort to decrease the burden of COVID-19 in this population.

Graph showing disease severity on admission by Race/Ethnicity (upper). Notice the predominance of severe disease (orange) in Hispanic patients. Graph showing Race/Ethnicity Distribution by Week (lower). Notice the gradual increase and predominance of Hispanic patients (orange) in the later weeks of the study period compared to Black (blue) and White (green) patients.

Disclosures
All Authors: No reported disclosures
291. Epidemiology of Candidemia Rates during COVID-19 and Comparison of Outcomes in Candidemia Between COVID-19 and Non-COVID-19 Patients
Authors: Cruz Angela Beatriz , LeRose Jennifer , Evans Kenisha J , Meyer Monica , Chopra Teena , Chopra Teena 
Published: December 2021

Abstract

Background
Fungemia is associated with high rates of morbidity, mortality and increase in length of hospital stay. Several studies have recognized increased rates of candidemia since the COVID-19 pandemic.

Methods
A retrospective cohort study was conducted at a tertiary healthcare system in Detroit, Michigan to evaluate the impact of the COVID-19 pandemic on incidence of candidemia. The “pre COVID-19” timeframe was defined as January – May 2019 while the “during COVID-19” timeframe was January – May 2020. To compare incidence and patient characteristics between cohorts, t-tests and chi-square analysis was used. Additional sub-analysis was performed in candidemia patients during COVID-19 timeframe comparing outcomes of patients based on COVID-19 status. A Fisher Exact and Satterthwaite Test were used for analysis of categorical and continuous variables, respectively.

Results
Overall, 46 cases of candidemia were identified in both the pre COVID-19 and during COVID-19 periods. Pre COVID-19, the average number of cases was 3.0 ± 1.2 per month. The incidence more than doubled during COVID-19 to 6.2 ± 4.2 cases per month (p = 0.14) (Figure 1). No significant differences in patient demographics were detected between cohorts, however, patients in the COVID-19 cohort had higher rates of corticosteroid use, mechanical ventilation and vasopressors (Table 1). In the 2020 period, 31 patients developed candidemia and 12 (38.7%) patients tested SARS-CoV-2 positive. On average, COVID-19 patients developed candidemia 12.1 days from admission, compared to 17.8 days in the COVID-19 negative cohort (p = 0.340). Additionally, COVID-19 patients with candidemia coinfection were significantly more likely to expire; 83.3% (n=10) COVID-19 patients expired compared to 36.8 (n=7) in the COVID-19 negative cohort (p = 0.025) (Table 2).
Figure 1. Incidence of Candidemia in the Pre-COVID-19 (January 2019 – May 2019) and During COVID-19 (January 2020-May 2020) periods

Table 1. Characteristics of Candidemia patients in the pre-COVID (January 2019-May 2019) and during-COVID periods (January 2020-May 2020)

Table 2. Characteristics of Candidemia patients in the SARS-COV-2 negative and SARS-COV-2 positive cohorts from January 2020-May 2020

Conclusion
The prevalence of fungemia markedly increased during the COVID-19 surge. Increased use of corticosteroids and broad spectrum antimicrobials, prolonged use of central venous catheters and prolonged ICU length of stay likely contributed to this increase. Patients who developed candidemia co-infection with COVID-19 were found to have poorer outcomes as compared to those who were SARS-CoV-2 negative or untested.

Disclosures
All Authors: No reported disclosures
292. Antibiotic Use Is Increased in Patients with Acute Respiratory Distress Syndrome (ARDS) Requiring Extracorporeal Membrane Oxygenation (ECMO) due to COVID-19 Compared with Influenza
Authors: Alex Viehman J , Thorngren Christina K , Nguyen M Hong , Samanta Palash , Clancy Cornelius J , Murray Holt , Rivosecchi Ryan 
Published: December 2021

Abstract

Background
During the COVID-19 pandemic, &gt;50% of hospitalized patients (pts) received an antimicrobial. ECMO is increasingly used in COVID-19 pts with severe ARDS. ECMO has been used for ARDS due to influenza at our center in prior years. Pts on ECMO are at high risk for infections. We compared the rates of antibiotic (Ab) and antifungal (AF) use in pts on ECMO for COVID-19 vs influenza ARDS.

Methods
This was a retrospective review of pts on ECMO for COVID-19 (2020-2021) or influenza (2013-2019). Antimicrobials (Abs and AFs) were categorized as anti-MRSA, anti-pseudomonal β-lactams (AP-BL), carbapenems, and new broader spectrum β-lactams. We calculated total Ab and AF utilization, adjusted for ECMO duration.

Results
Seventy-one pts (36 COVID-19 and 35 influenza) were included. COVID-19 pts had longer ECMO duration (median: 25 vs 11 days, p=.03). 100% and 97% of pts with COVID-19 and influenza received ≥1 Ab, respectively, and 42% and 33% an AF, respectively. COVID-19 pts received longer duration of Abs (26 vs 10 days, p&lt; 0.001) and but not AF. COVID-19 group (gp) were more likely to receive anti-MRSA Ab (69% vs 33%, p=.004); otherwise, there were no differences between gps in types of Abs used. When adjusted for ECMO days, COVID-19 gp received higher median number of Abs (1.23 vs 1, p=.06). Specifically, COVID-19 gp received higher median number of anti-MRSA Ab (0.2 vs 0, p=.007) and AP-BL (0.44 vs 0.28, p=.08). There was no difference in Ab-free days between gps, though the proportion of Ab-free days was lower (0.2 vs 0.36) in COVID-19 pts (p=.08). More COVID-19 pts had pathogens recovered from clinical cultures, especially S. aureus and Enterobacterales (Figure).
Pathogens recovered from clinical cultures

Patients recovered from clinical cultures of patients with COVID-19 and Influenza ARDS requiring ECMO

Conclusion
Among pts on ECMO, those with COVID-19 received significantly longer courses of Abs than those with influenza, even after adjusting for longer durations of ECMO. Differences were driven by receipt of anti-MRSA and AP-BLs. Recovery of pathogenic bacteria was greater in COVID-19 pts than influenza pts. Given difficulties in distinguishing pneumonia from airway colonization among ARDS pts on ECMO, development of diagnostic criteria for pt care, rational antimicrobial stewardship and further research are needed.

Disclosures
Cornelius J. Clancy, MD, Merck (Grant/Research Support)