bluuebunny/crossref_metadata_2025_split huggingface dataset:
331. Hospitalized COVID-19 infections in Infants &lt; 1 Year of Age
Authors: Gagliardo Christina , Nwaobasi-Iwuh Eberechi I , Shah Niva , Prasad Aparna , Kairam Neeraja , Chiu Stephanie , DeSantis Elizabeth , Nativ Simona , Laurie Kathryn , Di Pentima M Cecilia 
Published: December 2021

Abstract

Background
Nearly 4 million children have tested positive for coronavirus disease 2019 (COVID-19) in the United States. Some studies suggest infants might be at increased risk for severe illness and hospitalization from COVID-19. Our objective was to describe the clinical and laboratory features of young infants admitted to a hospital system with COVID-19.

Methods
An observational retrospective study was performed in infants ≤1 year of age admitted with COVID-19 from March 1, 2020 to May 30, 2021. Data was extracted into a REDCap database and analyzed using descriptive statistics.

Results
Sixteen infants &lt; 1 year were hospitalized with COVID-19. Fever, poor feeding, and respiratory symptoms were the most common presenting symptoms (Table 1). Two required pediatric intensive care unit (ICU) care, three required oxygen support, and one was intubated. There were no deaths. Five infants with echocardiograms performed showed normal findings. Four infants received Remdesivir without side effects.

Conclusion
Infants with COVID-19 can present with severe disease requiring ICU care and oxygen support. In our experience, a large proportion of infants developed hematologic abnormalities, but none had cardiac involvement. Preventive measures including vaccination will become critical to decrease transmission and severe disease in this young patient population.

Disclosures
All Authors: No reported disclosures
333. Comparing COVID-19-related Morbidity and Mortality between Patients with and without Substance Use Disorder: A Retrospective Cohort Study
Authors: McLaughlin Angela , Burns Rebecca , Ryan Morgan , Assoumou Sabrina A 
Published: December 2021

Abstract

Background
Early data suggest that people with substance use disorder (SUD) who develop coronavirus disease 2019 (COVID-19) have increased intubation and mortality rates when compared to those without SUD. Information on other COVID-19-related complications in this population is limited. We evaluated COVID-19 outcomes in patients with and without SUD.

Methods
We created a retrospective cohort of patients with COVID-19 admitted to an urban safety net hospital from 3/16/2020 to 4/8/2020. Inclusion criteria were admission with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 and age greater than 18 years. SUD included alcohol use disorder or heavy alcohol use as defined by the National Institute on Alcohol Abuse and Alcoholism, use of cocaine, non-prescribed opioids or amphetamines. Primary outcome was inpatient mortality. Secondary outcomes were clinical complications (intubation, secondary infections, renal failure, venous thromboembolism, stroke, hepatitis, myocardial infarct, multisystem organ failure) and resource utilization (length of stay, intensive care unit [ICU] admission, ICU days, readmission). We used multivariable regression to assess factors associated with mortality and length of stay, and univariate analyses for other outcomes.

Results
Of 409 included patients, 70 (17.1%) had SUD. Those with SUD were more likely to be male and have pulmonary disease or hepatitis C. There were no differences in other comorbidities, mean age or race/ethnicity. After multivariable analysis, SUD was not associated with mortality (aOR 1.60; 95% CI, 0.60-3.81). Similarly baseline oxygenation defined as the ratio of oxygen saturation to fraction of inspired oxygen (aOR 1.57; 0.11-13.0) and administration of immunomodulatory therapy (tocilizumab, sarilumab or anakinra) (aOR 1.41; 0.65-3.01) did not affect mortality. In contrast, age (aOR 1.06; 1.03-1.09), sex (aOR 2.30; 1.04-5.47) and obstructive sleep apnea (aOR 4.07; 1.64-9.66) were associated with mortality. We did not find any associations with secondary outcomes.

Conclusion
Our findings suggest that substance use alone may not increase COVID-19 adverse outcomes. Future studies should evaluate these results in the current period of improved COVID-19 therapy.

Disclosures
All Authors: No reported disclosures
334. Impact of Overall Dexamethasone Exposure on Development of Invasive Pulmonary Aspergillosis in Hospitalized Patients with COVID-19
Authors: Skoglund Erik , Kum Amy , Mac Allison , Nguyen Mark 
Published: December 2021

Abstract

Background
Abbreviated courses of corticosteroids, such as dexamethasone, have demonstrated significant improvements in clinical outcomes among patients infected with COVID-19, although chronic corticosteroid use can predispose patients to opportunistic infections. The RECOVERY trial investigators showed reduced 28-day mortality among patients treated with 6 mg/day dexamethasone for up to 10 days, however in clinical practice the dosage and duration of dexamethasone therapy can vary widely based on severity of disease and provider discretion. Upon observing an anecdotal increase in the number of patients presenting with potential invasive aspergillosis during the third wave of COVID-19, we sought to evaluate the impact of overall dexamethasone exposure on the development of invasive pulmonary aspergillosis.

Methods
Patients presenting to our institution from Dec. 2020 – Jan. 2021 with positive PCR for SARS-CoV-2 were screened for dexamethasone therapy. Assignment of high vs low dose dexamethasone groups were retrospectively made based on overall dexamethasone exposure. Low dose dexamethasone assignment was restricted to a total exposure of no more than 78 mg during a patient’s hospitalization. Adjudication of invasive pulmonary aspergillosis was made based on criteria that included host factors, radiologic findings, clinical factors, and mycological evidence.

Results
Dexamethasone therapy was provided to 202 patients admitted to the hospital with COVID-19. Invasive pulmonary aspergillosis was determined to be probable in n=7 patients based on European Organization for Research and Treatment of Cancer (EORTC) criteria, and in n=13 patients based on expanded criteria. Patients in the low dose dexamethasone group were less likely to be diagnosed with probable IPA based on EORTC criteria (n=0, 0% on low dose vs. n=7, 11% on high dose) as well as expanded criteria (n=9, 5% on low dose vs. n=11, 17% on high dose), p&lt; 0.001.

Conclusion
Patients hospitalized with COVID-19 receiving high-dose dexamethasone may be at a higher risk of opportunistic infections such as invasive pulmonary aspergillosis compared to patients who receive low-dose dexamethasone therapy. Further investigation is needed to obtain higher certainty of IPA diagnosis.

Disclosures
All Authors: No reported disclosures
335. Staphylococcus aureus Bacteremia as a Potential and Severe Complication from Intramuscular COVID-19 Vaccine Injection
Authors: Kus Miguel Sebastian Pedromingo 
Published: December 2021

Abstract

Background
Abscess formation and bacteremia following intramuscular injections are rare complications from vaccine injections, and they are most commonly seen in immunocompromised individuals. Staphylococcus aureus is one of the etiological agents that can be found during this complication. Spain started to vaccine its population at the beginning of 2021. We noticed an important increase in Staphylococcus aureus infections and bacteremia during this period of time, leading us to study the relationship with previous vaccination.

Methods
In this case series we present a cohort of twenty patients with Staphylococcus aureus bacteremia (SAB) during the study period (January 1, 2021 through May 31, 2021), attended in our Institution (Hospital Nuestra Señora de Sonsoles, Ávila, Spain). We tried to establish or at least create the debate of a possible relationship with a previous COVID-19 vaccine.

Results
From January 1, 2021 through May 31, 2021, 20 SAB were identified in our Institution. 13/20 patients were vaccinated (all of them with the mRNA vaccine type). 5/13 (38%) were male and 8/13 (62%) female. 10 of them (77%) received at least one dose of the vaccine before hospital admission, and 3 of them (23%) after admission. From the 10 previously COVID-19-vaccinated patients treated for SAB (CVPSAB), 4 died - 40% (2 deaths directly related to the SAB).

Conclusion
Although SAB may be a rare side effect after intramuscular injections or vaccines, it always implies an outstanding risk due to potential complications. Even if our study is not able to directly establish a link between SAB and previous vaccination, it implies a possible association between the vaccine injection and a threating disease (SAB). We should be aware of this probable relationship, so that we can maximize preventive measures.

Disclosures
All Authors: No reported disclosures
336. COVID-19 and Pneumocystis jiroveci Pneumonia
Authors: Saling Christopher , Kasule Sabirah N , Vikram Holenarasipur R 
Published: December 2021

Abstract

Background
More accounts of opportunistic infection in COVID-19 patients are emerging. At our institution, we identified 2 COVID-19 patients with Pneumocystis jiroveci pneumonia (PJP) opportunistic infection. This prompted a review of the literature to identify trends in patient characteristics, risk factors, and outcomes in this population.

Methods
A literature review was conducted using PubMed that identified 13 other patients with both COVID-19 and PJP infection. Age, gender, human immunodeficiency virus (HIV) status, other immunocompromised states, time between COVID-19 and PJP diagnosis, and clinical outcomes were captured for analysis.

Results
Eleven patients were male. The average age was 56 years. All but 2 patients were immunocompromised. At time of PJP diagnosis, seven patients had newly diagnosed HIV and one had known, well-controlled HIV. One patient had rheumatoid arthritis receiving leflunomide, 1 had ulcerative colitis receiving budesonide and sulfasalazine, 2 patients had multiple myeloma whereby both were on lenalidomide, 1 patient was a renal transplant recipient immunosuppressed on tacrolimus, mycophenolate, and methylprednisolone, and 1 patient had chronic lymphocytic leukemia getting fludarabine, cyclophosphamide, and rituximab. Nine patients had positive COVID-19 and PJP tests performed within 7 days of one another. One patient tested positive for PJP 54 days into admission for COVID-19. This patient received high dose steroids and tocilizumab for initial COVID-19 infection. Three patients were re-hospitalized with PJP after a recent admission for COVID-19 pneumonia, with a mean time to readmission of 25 days. One of these 3 patients had no treatment for COVID-19, while 2 received steroids. Five of the total 15 patients (33%) died.

Conclusion
COVID-19 treatments with high dose steroids and tocilizumab can make patients vulnerable for opportunistic infection with PJP. Furthermore, COVID-19 is known to cause lymphopenia which may further increase this risk. A diagnosis of concomitant PJP can be especially challenging due to nearly identical radiographical findings. Serum beta-D glucan and HIV testing can be especially helpful in this situation, and there should be a low threshold for performing bronchoalveolar lavage.

Disclosures
All Authors: No reported disclosures
339. COVID-19 Mortality in a Private Hospital in Mexico City
Authors: Ruiz Maria Lorena Cabrera , Castañeda-Méndez Paulo , Aguilar-Zapata Daniel , Mar Javier Reyes , Octavio Gonzalez Chon , Soto-Ramirez Luis E 
Published: December 2021

Abstract

Background
According to the Institute of Global Health Science (IGHS), mortality for Covid-19 patients treated in public hospitals in Mexico ranges between 30-50%, decreasing to 20% in private health care facilities. Our objective was to describe the mortality rate in a teaching private hospital in Mexico City.

Methods
We included all patients that were admitted to hospital Medica Sur, in the south part of Mexico City during year 2020. We analyzed the total mortality presented in all our patients with a follow up of two months, and relay that to age and gender.

Results
During year 2020, we admitted in our hospital 1,075 patients with confirmed diagnosis of COVID-19 through nasopharyngeal molecular test; 772 were male (71.8%) with more than 50% between 40 and 59 years, while females were more frequent between 40 and 69 years’ age. Seventy-four patients (6.88%) died during hospitalization; 59 (79.7%) males and 15 females. Mortality rate was clearly related to age (figure 1) with 30% mortality for males between 80-89 years and 19% for females.
Mortality rate by gender and age

Conclusion
Mortality in private hospitals was clearly lower than in public hospitals. In our hospital, mortality was lower than 10%, mostly related to their availability of unlimited intensive care without ECMO and despite the lack of some drugs like Remdesivir. As described, space limitations for intensive care as well as the lack of trained personal impacted significantly the mortality in public hospitals.

Disclosures
All Authors: No reported disclosures
340. Outcomes of COVID-19 in Hospitalized SOT Recipients: Experence in Colombia, South America
Authors: Rosso Fernando , Tafurt Eric 
Published: December 2021

Abstract

Background
SOTs (SOT) recipients with COVID-19 are considered to be at high risk of severe clinical outcomes. Several descriptive studies have reported a high frequency of intensive care unit admission and death rates. There is a lack of evidence regarding the best approach for immunosuppressive therapy in SOT recipients with COVID-19.

Methods
We performed a single-centered, retrospective, observational study of all SOT recipients with SARS-CoV-2 confirmed infection RT-PCR from nasopharyngeal swab specimens who were admitted to the emergency department from March 25 to September 1, 2020. Glucocorticoid therapy was administered according to the criteria of the attending physician. We classified glucocorticoid dose as low dose therapy if the patient received dexamethasone 6 mg/day or methylprednisolone 40 mg/day, and a high dose if the patient received methylprednisolone 80–160 mg/day. Specimens collected within the first 48 hours
were defined coinfection, while specimens collected after 48 hours were defined as hospital-acquired superinfection.

Results
Of a total of 43 SOT recipients with COVID-19, 17 (39%) required intensive care unit admission. 32 (74.4%) required glucocorticoid therapy: 13 received low dose and 19 high dose. 15 (34.8%) had secondary infections. A total of 12 (27.9%) presented hospital-acquired bacterial superinfections, mostly caused by P. aeruginosa, most of isolations were from respiratory tract cultures. The median time from hospital admission to superinfection diagnosis was 9 (7-13) days. Community-acquired co-infection at COVID-19 diagnosis was documented only in 3 (6.9%) patients, mostly caused by K. Pneumoniae, all isolations were from urine culture. Glucocorticoid therapy was indicated in 32 (80%) patients, 19 received high dose and 13 low doses. Overall hospital mortality was 17.5%. ICU mortality was 41%. Overall mortality in the high dose steroids group was 37 % vs . 0% in the low dose group.

Conclusion
Our results showed a higher frequency of superinfection in SOT recipients with COVID-19 compared to previous reports, and higher ICU mortality. Further studies are needed to establish the best approach for glucocorticoid therapy in SOT recipients with COVID-19.

Disclosures
All Authors: No reported disclosures
341. Evaluation of Antimicrobial Use and Prescribing Patterns During the COVID-19 Pandemic in Patients Receiving Tocilizumab
Authors: Barsoum Barbara , Chang Kai-Ming , Mulvey Nicole , Donaghy Henry , Doan Thien-Ly 
Published: December 2021

Abstract

Background
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients experience systemic inflammation and respiratory distress, which appears to be associated with increased cytokine release. During the peak of coronavirus disease 2019 (COVID-19), tocilizumab was used to treat critically ill patients with potential cytokine storm. However, tocilizumab has an increased risk of developing serious infections.

Methods
This retrospective observational chart review was approved by Institutional Review Board and evaluated patients admitted from March to November 2020, who were SARS-CoV-2 positive and received tocilizumab for the treatment group and no tocilizumab for the control group. The primary endpoint is usage of antimicrobials. The secondary endpoints are development and outcomes of secondary infections and hospital length of stay and mortality. Chi-square test was used for categorical data and Mann-Whitney test was used for continuous data.

Results
A total of 160 patients were included in analysis, with 80 in each arm. 60% of patients in the treatment group required antibiotics compared to 35% in the control group (p = 0.0015), with the highest usage of anti-MRSA coverage, beta-lactams, cephalosporins, and carbapenems in both groups. Antifungal therapy was required in 21.3% of patients in the tocilizumab group compared to 6.3% in the control group (p = 0.0059), with echinocandins being the most used class in both groups. The median days of antimicrobial use in the tocilizumab group was 14 (IQR 7, 24.5) compared to 9 (IQR 6.5, 19) in the control group (p = 0.3346). In the treatment group, 60% of patients developed a secondary infection compared to 35% of patients in the control group (p &lt; 0.0017). Secondary infection treatment failure was observed in 75% of tocilizumab patients compared to 60.7% of control patients (p = 0.1910). In hospital mortality was 50% in patients who received tocilizumab compared to 27.5% in the control group (p &lt; 0.0039).

Conclusion
Patients on tocilizumab received more antimicrobials, but with a similar spectrum of antimicrobial coverage. Patients who received tocilizumab had higher odds of developing secondary infections and expiring during their hospital stay. There were similar durations of antimicrobial therapy and treatment outcomes.

Disclosures
All Authors: No reported disclosures
343. RURAL-COVID-19 Trial: Retrospective Analysis of COVID-19 Coinfections in Hospitalized Urban and Rural Adults
Authors: Hamilton Caroline , Frazier Heather , Vazquez Jose A 
Published: December 2021

Abstract

Background
The impact of COVID-19 in rural communities has been well described. However, little is known regarding differences in coinfections among COVID-19 patients in rural vs. urban settings. Our primary objective is to evaluate community acquired coinfection (CACo) rates (&lt; 72 hrs from admission) and healthcare-associated infection (HAI) rates ( &gt; 72 hrs from admission) in these populations. Secondary objectives include use of empiric antibiotics, pathogen prevalence, and patient outcomes.

Methods
Retrospective analysis of the first 255 adult patients admitted to a tertiary medical center with symptomatic COVID-19 and confirmed by PCR. Rural and urban categories were determined using patient address and county census data. Isolated pathogens were individually evaluated and considered coinfections if the patient met predetermined criteria.
Predetermined Coinfection Criteria

Results
The rates of CACo for rural (n = 90) and urban (n = 165) residents were 11.1% and 13.3%, respectively. Non-respiratory coinfections, such as bloodstream and urinary tract infections, were more common in urban residents; however, empiric antibiotics were started in 75.1% of all subjects. Methicillin susceptible staphylococcus aureus and Escherichia coli were the most common pathogens isolated on admission in both populations. HAI rates were 13.3% in the rural residents vs 13.9% in the urban residents with Methicillin resistant staphylococcus aureus as the most common respiratory pathogen, although Pseudomonas aeruginosa was the most prevalent overall pathogen. There was no significant difference in hospital length of stay or 30-day all-cause mortality among both populations.

Patient Outcomes Among Rural and Urban Populations

Conclusion
There was no significant difference in the rate of CACo or HAI among rural or urban populations. Despite the high rate of antibiotic use to empirically cover community acquired respiratory infections at the start of the pandemic, only 1.9% of the subjects had a possible or proven respiratory coinfection on admission. Despite prior research showing worse outcomes for rural populations with COVID-19, our data demonstrates that coinfection rates and patient outcomes were similar among these populations when receiving medical care at an academic hospital.

Disclosures
All Authors: No reported disclosures
347. SARS-CoV-2 and Acute Otitis Media in Children: A Case Series
Authors: Frost Holly M , Sebastian Thresia , Keith Amy , Kurtz Melanie , Dominguez Samuel R , Dominguez Samuel R , Parker Sarah , Jenkins Timothy C 
Published: December 2021

Abstract

Background
Reports in adults with COVID-19 and acute otitis media (AOM) show that severe symptoms and hearing loss may be more common than with the clinical presentation of typical AOM. However, the association of SARS-CoV-2 with AOM in children is poorly understood.

Methods
Cases were identified as a subpopulation enrolled in the NOTEARS prospective AOM study in Denver, CO from March-December 2020. Children enrolled were 6-35 months of age with uncomplicated AOM and prescribed amoxicillin. Children diagnosed with AOM and SARS-CoV-2, detected by polymerase chain reaction assay, were included in the case series. Data was obtained from electronic medical records and research case report forms. Patients completed surveys at enrollment and 5, 14 and 30 days after enrollment that included the Acute Otitis Media Severity of Symptoms (AOM-SOS©) scale. All patients had nasopharyngeal otopathogen testing completed.

Results
A total of 108 patients had been enrolled through December 2020 (all of whom were subsequently tested for SARS CoV-2). During the study period for this case series, 16 patients were enrolled, and 7 (43.6%) were identified with AOM/SARS-CoV-2 co-infection. Among these 7 patients, fever was present in 3 children (29%). Four children (57%) attended daycare. Only 2 children (29%) had testing for SARS CoV-2 as part of their clinical workup. Mean AOM-SOS© scores were similar among the SARS CoV-2 positive and negative patients with no statistical significance noted with two-sided t-tests: 13.6 (± 4.5) vs 14.2 (± 4.9) at enrollment, 1.4 (± 1.8) vs 4.2 (±4.9) on Day 5, and 0.6 (± 0.9) vs. 2.5 (±6.1) on Day 14 (Table 1). Among the 7 patients, no child had an AOM treatment failure or recurrence. Of the 6 patients in whom bacterial and viral testing have been completed, a bacterial otopathogen was identified in 6 (100%), and a viral pathogen in 3 (50%) children (Table 2).
Table 1. Clinical features of children with concurrent SARS-CoV-2 and AOM

Table 2. Laboratory findings of children with concurrent SARS-CoV-2 and AOM.

Conclusion
SARS-CoV-2 can occur in children with AOM. It is important that providers maintain a high index of suspicion for COVID-19 even in patients with clinical evidence of AOM, particularly to ensure families are appropriately advised on isolation and quarantine requirements. AOM with SARS-CoV-2 does not appear to be more severe than AOM without SARS-CoV-2.

Disclosures
Samuel R. Dominguez, MD, PhD, BioFire Diagnostics (Consultant, Research Grant or Support)DiaSorin Molecular (Consultant)Pfizer (Grant/Research Support) Samuel R. Dominguez, MD, PhD, BioFire (Individual(s) Involved: Self): Consultant, Research Grant or Support; DiaSorin Molecular (Individual(s) Involved: Self): Consultant; Pfizer (Individual(s) Involved: Self): Grant/Research Support