bluuebunny/crossref_metadata_2025_split huggingface dataset:
1316. Uncommon Presentations of Common Variable Immunodeficiency
Authors: Alok Akankcha , Greene John , Aslam Sadaf 
Published: December 2021

Abstract

Background
Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disorder which affects B lymphocyte function and differentiation causing decreased levels of Immunoglobulin G (IgG), Immunoglobulin A (IgA) and Immunoglobulin M (IgM).1 The objective of this study is to highlight how hypogammaglobulinemia can lead to respiratory infections with microbes that are lesser known in the background of CVID with the help of a two-case series.

Methods
Medical records of two patients with CVID were reviewed who were found to have mycobacterium avium-complex intracellulare and streptococcus agalactiae lung infections respectively.

Results
Decreased IgG in CVID means reduced antibody production, low IgA leads to mucosal inflammation and increased susceptibility to respiratory infections2 and lower IgM memory B-cells causes infections with encapsulated microorganisms.3 Table 1 highlights the various respiratory infections and their etiologies that have been reported with CVID, the most common being encapsulated organisms like Haemophilus influenza, Streptococcus pneumonia, Neisseria meningitidis along with enterovirus. Table 2 demonstrates our findings. In the first case we have reported a patient with mycobacterium avium-complex intracellulare (MAC-I). This could be because of hypogammaglobulinemia, decreased B and T-cell interaction and reduced T-cell signaling caused by CVID.4 Although, mycobacterium tuberculosis, simiae and hominis lung infections and mycobacterium bovis systemic infections have been reported before, MAC-I is relatively rare in CVID.5 In our second case, the patient developed streptococcus agalactiae or Group-B streptococcus (GBS) empyema. Most cases of GBS have been reported in pregnant women and infants. Infections with other encapsulated organisms have been reported in CVID but GBS empyema is less frequent and can happen due to decreased bacteria-specific CD4 cells, microbial translocation and hypogammaglobulinemia.6 .
Table 1. Respiratory Infections reported in CVID along with their etiologies.

Figure 1. CT image of MAC-I infection.

Conclusion
We encountered two unique cases of CVID with rare infectious etiologies. The cases are intended to create an awareness and vigilance regarding CVID induced hypogammaglobulinemia which can cause respiratory infections with lesser known pathogens where antibodies may be important.

Disclosures
All Authors: No reported disclosures
1317. Prevalence of Pseudomonas aeruginosa as the Causative Organism for Community Acquired Pneumonia
Authors: Haviland Adam D , Szymczak Wendy , Weston Gregory 
Published: December 2021

Abstract

Background
IDSA/ATS guidelines regarding pneumonia diagnosis and treatment changed in 2019. Guidelines recommend determining local prevalence of MRSA and P. aeruginosa to help guide empiric antibiotic coverage. The aim of our study was to determine the prevalence of P. aeruginosa as the causative organism for adult patients admitted to a large urban academic medical center with community acquired pneumonia (CAP).

Methods
A report of urine streptococcus antigen tests collected January 1st-December 31st in 2019 was generated. Six hundred charts were reviewed and two hundred subjects met inclusion criteria (figure 1). Inclusion criteria were age &gt;18, hospital admission, and documented suspicion of pneumonia by a physician.

Results
The average age was 70 and half of the cases were women. The causative organism was identified in 60/200 cases (table 1). No cases of P. aeruginosa were identified. The most commonly isolated organisms were Influenza A and pneumococcus. 66% of cases had age &gt;65yo, 25% were from long term care facilities, 34% had structural lung disease, 20% had dementia, 15% were hospitalized in the prior 90 days and received IV antibiotics, and 30% of cases met severe CAP criteria (table 2).

Figure 1. Workflow
Table 1. Organisms Identified

Table 2. Risk Factors

Conclusion
Limitations include a low prevalence of renal failure in the study population, and lack of a standardized respiratory infection evaluation. Our results suggest that empiric coverage for P. aeruginosa may not be needed at our center in this cohort of older patients with clinical characteristics sometimes thought to be risk factors for P. aeruginosa.

Disclosures
Wendy Szymczak, PhD, Premier, Inc (Consultant)Qiagen (Consultant, Scientific Research Study Investigator) Gregory Weston, MD MSCR, Allergan (Grant/Research Support)
1318. Clinical and Molecular Characteristics of Hypermucoviscous Klebsiella pneumoniae Causing Pneumonia in Korea
Authors: Lee Ji Yeon , Kim Hyun Ah , Hyun Miri 
Published: December 2021

Abstract

Background
Invasive Klebsiella pneumoniae (K. pneumoniae) was emerged in Asia, well-known for community-onset liver abscess. Healthcare-associated pneumonia caused by hypervirulent K. pneumoniae has been reported in recent studies. The purpose of this study was to evaluate the clinical and molecular characteristics of hypervirulent K. pneumoniae compared with classic K. pneumoniae in respiratory infection.

Methods
The study was performed on 163 K. pneumoniae isolates of respiratory infections collected from Keimyung University of Dongsan Medical Center from November 2013 to November 2015; group A, as classic K. pneumoniae and group B, as hypervirulent K. pneumoniae. Hypermucoviscous phenotype was confirmed with string test. Capsular serotypes, rmpA, magA, allS, mrkD, entB, kfu, and iutA were identified using specific primers by polymerase chain reaction. The biofilm mass was determined using the microtiter plate assay measured by optical density (OD, 570nm).

Results
A total 163 patients were analyzed, 100 (61.3%) of group A and 68 (38.7%) of group B. Community-acquired pneumonia was observed in 49.2% of group B and 18.0% of group A (p=0.001). Underlying diseases except chronic lung disease were more associated with group A. Mean age (72.6±11.7 vs. 68.8±12.5 years, p=0.051) and antimicrobial resistant rates were higher in group A. Mechanical ventilators (21.0% vs. 36.5%, p=0.030) was more associated with group B. Concordances of initial antibiotics (57.5% vs. 92.1%, p=0.001) were more observed in group B. Biofilm formation and infection related 30-day mortality showed no differences between the two groups.

Conclusion
Contrary to our expectations, hypervirulent K. pneumoniae was more associated with community-acquired pneumonia in this study. Compared to classic K. pneumoniae, hypervirulent K. pneumoniae showed more association with severe pneumonia and less association with underlying diseases. In respiratory infection, biofilm formation was not different according to hypermucoviscousity.

Disclosures
All Authors: No reported disclosures
1321. Acquisition and Transmission of Streptococcus pneumoniae in Individuals Over the Age of 60 Years Residing in New Haven, CT, USA
Authors: Wyllie Anne , Mbodj Sidiya , Yolda-Carr Devyn , Thammavongsa Darani A , Waghela Pari , Nakahata Maura , Vega Noel J , York Anna , Allicock Orchid M , Alexander-Parrish Ronika , Arguedas Adriano , Gessner Bradford D , Weinberger Daniel , Hislop Maikel 
Published: December 2021

Abstract

Background
Despite the widespread use of pneumococcal conjugate vaccines, particularly in children, an important burden of pneumococcal disease remains in older adults. The acquisition and transmission rates of pneumococcus between older adults have not been well characterized.

Methods
Between October 2020-June 2021, couples living in the Greater New Haven Area were enrolled if both individuals were over the age of 60 years and did not have any individuals under the age of 60 years living in the household. Saliva samples and questionnaires regarding social patterns and medical history were obtained every 2 weeks for a period of 10 weeks. Following culture-enrichment, extracted DNA was tested using qPCR for pneumococcus-specific sequences piaB and lytA. Individuals were considered positive for pneumococcal carriage when qPCR Ct-values for piaB +/- lytA were less than 40.

Results
To date, we have collected 495 saliva samples from 95 individuals (48 households). Of 495 saliva samples, 31 (5.9%) have tested positive for pneumococcus by either piaB only (n=9) or both lytA and piaB (n=22). Of 95 individuals, 16 (16.8%) (representing 13, or 27.1% households) have tested positive at least once. Six of the 16 (37.5%) carriers tested positive at multiple timepoints, though none were colonized at all 6 time points over the course of the 10 weeks of study enrolment. For 3 of the 48 (6.3%) households, both members of the couple were identified as carriers, though not necessarily at the same sampling moment.

Conclusion
The preliminary findings of this longitudinal transmission model demonstrate evidence of pneumococcal acquisition among older adults measured by molecular tools. These transmission patterns and high rates of pneumococcal carriage in adults were observed during a period when the COVID-19 pandemic led to numerous preventative public health measures that may have reduced pneumococcal transmission (e.g., social distancing, mask wearing, bans on mass gatherings, restaurant closures, travel restrictions).

Disclosures
Anne Wyllie, PhD, Global Diagnostic Systems (Consultant)Pfizer (Advisor or Review Panel member, Research Grant or Support)PPS Health (Consultant)Tempus Labs, Inc (Research Grant or Support) Ronika Alexander-Parrish, RN, MAEd, Pfizer (Employee, Shareholder) Adriano Arguedas, MD, Pfizer (Employee) Bradford D. Gessner, MD, MPH, Pfizer Inc. (Employee) Daniel Weinberger, PhD, Affinivax (Consultant)Merck (Consultant, Grant/Research Support)Pfizer (Consultant, Grant/Research Support)
1322. Complications and Hospital Resource Utilization among Patients with Bacterial Nosocomial Pneumonia in the US, 2012-2019
Authors: Zilberberg Marya , Nathanson Brian , Puzniak Laura A , Zilberberg Noah , Shorr Andrew F 
Published: December 2021

Abstract

Background
Nosocomial pneumonia (NP) remains a costly complication of hospitalization. Consisting of hospital-acquired ventilated (vHABP) and non-ventilated (nvHABP), and ventilator-associated (VABP) bacterial pneumonia, these conditions themselves are fraught with further complications. We examined hospital resource utilization (HRU) and the rates of important complications in these three groups in a large US database.

Methods
We conducted a multicenter retrospective cohort study within Premier Research database, a source containing administrative, pharmacy, and microbiology data. The three types of NP were identified based on a slightly modified, previously published ICD-9/10-CM algorithm,1 and compared with respect to hospital costs, length of stay (LOS) and development of C. difficile infection (CDI), extubation failure (EF), and reintubation (RT). CDI was identified by its treatment with metronidazole, vancomycin, or fidaxomicin. Marginal effects were derived from multivariable regression analyses.

Results
Among 17,819 patients who met the enrollment criteria, 26.5% had nvHABP, 25.6% vHAPB, and 47.9% VABP. Patients with nvHABP were oldest (mean 66.7+/-15.1 years) and those with VABP were youngest (59.7+/-16.6 years). vHABP was associated with the highest chronic disease burden (mean Charlson score 4.1+/-2.8) and VABP with lowest (3.2+/-2.5). Patients with nvHABP had lowest severity of acute illness (ICU 58.0%, vasopressors 7.7%), and those with vHABP were most likely to require vasopressors (38.8%). The adjusted EF and RT in vHABP and VABP, and CDI rates, and adjusted post-infection onset hospital LOS across all groups were similar. The adjusted marginal post-infection onset ICU LOS and total hospital costs relative to nvHABP were 5.9 (95% CI 5.4, 6.3) days and &6,814 (95% CI &3,637, &9,991) in vHABP, and 6.5 (95% CI 6.0, 6.9) days and &16,782 (95% CI &13,446, &20,118) in VABP.

Conclusion
Both HABP and VABP remain associated with significant morbidity and HRU in the US. VABP was associated with the longest post-infection ICU LOS and highest hospital costs.

Reference
1. Zilberberg et al. Chest 2019;155:1119-30

Disclosures
Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)
1323. Efficacy and Safety of Telavancin Compared to Vancomycin for Cystic Fibrosis Pulmonary Exacerbation in Adults
Authors: Shorman Mahmoud , wadi ghassan , Veve Michael P 
Published: December 2021

Abstract

Background
Telavancin (TLV) is an advanced generation lipoglycopeptide with activity against methicillin-resistant Staphylococcus aureus (MRSA), but there are limited patient outcomes in the setting of cystic fibrosis pulmonary exacerbation (CFPE). The study objective was to compare the efficacy and safety of TLV to vancomycin (VAN) in CFPE.

Methods
Retrospective cohort conducted from 1/2011-6/2020. Inclusion criteria were: i) age ≥16 years, ii) hospitalized for CFPE with documented signs/symptoms of infection, iii) confirmed or suspected MRSA lower respiratory tract infection, iv) receipt of ≥48 hours of TLV or VAN. The primary outcome was 30-day CFPE-related readmission: infection recurrence, clinical worsening on treatment, or ADE requiring readmission. Secondary outcomes included adverse drug events (ADE) on therapy: acute kidney injury (AKI), rash, thrombocytopenias, cardiac abnormalities.

Results
101 patients were included: 52 (52%) TLV, 49 (49%) VAN. The median (IQR) age was 22 (21-27) years, 50% were women, and 86% were Caucasian. The majority (84%) of patients had some federal health insurance; 19% had private health insurance. 93% of patients used a maintenance cystic fibrosis (CF) medication, and 35% had previous CF-therapy compliance concerns. 62% had a previous positive culture for MRSA; 22 (43%) TLV patients had documented MRSA infection on admission compared to 41 (84%) VAN (P&lt; 0.001). The median (IQR) time to TLV initiation from admission was 1 (0.8-1.4) days. 13 patients were readmitted within 30-days due to CFPE; 8 (15)% TLV vs. 5 (10%) VAN (unAdjOR, 0.63; 95%CI, 0.19-2.1). Reasons for 30-day CFPE: TLV: 7 infection recurrence, 1 clinical worsening; VAN: 2 clinical worsening, 2 infection recurrence, 1 treatment-related ADE. When accounting for confounders, TLV was not associated with 30-day CFPE-related readmission (adjOR, 0.34, 95%CI, 0.1-1.2). Patients who received VAN more commonly experienced an ADE while hospitalized (18%), most notably AKI

Conclusion
TLV was associated with similar short-term clinical outcomes compared to VAN for treatment of CFPE due to confirmed or suspected MRSA. Patients who received TLV experienced fewer overall ADEs.

Disclosures
Mahmoud Shorman, MD, Cumberland (Grant/Research Support) ghassan wadi, MD, Cumberland (Grant/Research Support) Michael P. Veve, Pharm.D., Cumberland (Grant/Research Support)Paratek Pharmaceuticals (Research Grant or Support)
1326. Possible Predictors of Coinfection in COVID-19: Making a Difficult Diagnosis
Authors: Lehmann Christopher J , Shah Rohan N , Zhu Mengqi , Pettit Natasha N , Ridgway Jessica , Sherer Renslow 
Published: December 2021

Abstract

Background
Coinfection with COVID-19 and a secondary pathogen contributes to morbidity and mortality. Despite its contribution to outcomes, diagnosing coinfection is challenging and no predictive tools have been established. To better assess risk factors for coinfection, we performed a review of all patients hospitalized for COVID-19 in our institution and evaluated them for candidate predictors of coinfection.

Methods
Medical records were reviewed in all patients admitted with COVID-19 at University of Chicago Medical Center between March 1, 2020 and April 18, 2020. Those identified as having coinfection were compared to those without coinfection. Secondary review was performed for characteristics of the coinfection, including diagnosis, microbiology, drug resistance, and nosocomial acquisition.

Results
401 patients were included in the study, the mean age was 60 years (SD-17), 29% had severe disease, and 13% died. At least one test for coinfection was performed in 99% of patients. Coinfection was identified in 15% (72/401) of patients. Coinfection was associated with older age, disease severity, and hospital complications, such as DVT/PE, AKI, and delirium. [Table 1] No symptom, non-microbiologic test, radiograph, or preexisting condition was associated with coinfection. Dyspnea, chest pain, and obesity were more common in those without coinfection. 74% received antibiotics. The most common sites for coinfection were urinary 33%, lower respiratory 26%, and blood 24%. [Table2] Bacteria were most frequently recovered (82%). The most commonly recovered pathogens were Enterobacterales (42%), Staphylococcus aureus (12%), and Pseudomonas (4%). 42% of the infections were hospital acquired, 16% caused by MDRO, and 13% were catheter or ventilator associated.
Table 1. Clinical Characteristics Associated with Coinfection

Abbreviations: sd, standard deviation; WBC, white blood cell count; CRP, C-reactive protein; COPD, chronic obstructive pulmonary disease; ARDS, acute respiratory distress syndrome; DVT, deep venous thrombosis; PE, pulmonary embolism; MI, myocardial infarction; AKI, acute kidney injury
Table 2. Characteristics of Coinfection

Abbreviations: Cath, catheter; Vent, ventilator; Assoc, Associated; MDRO, Multiple Drug Resistant Organism

Conclusion
Coinfection in COVID-19 was most closely associated with age, COVID-19 disease severity, and complicated hospitalization. No presenting symptoms, non-microbiologic test, or radiograph was associated with coinfection, underscoring the challenge in diagnosing coinfection. A remarkable number of infections were hospital acquired, MDRO, and catheter/ventilator associated. Further prospective study on coinfection in COVID-19 is needed to guide diagnosis and treatment.

Disclosures
Renslow Sherer, MD, Gilead Sciences, Inc (Grant/Research Support)
1327. Human Rhinovirus Infection in Multiple Myeloma Patients: Effect on Morbidity and Mortality
Authors: Hasan Lana , Crescencio Juan Carlos Rico , Jenkins Mitchell , Burgess Mary J 
Published: December 2021

Abstract

Background
Human Rhinovirus (hRV) causes mild, primarily upper respiratory tract symptoms in immunocompetent hosts. However, in immunocompromised patients, it often progresses to a lower respiratory tract infection. Multiple myeloma (MM) patients are immunocompromised due to inherent immunodeficiency and exposure to biologic and chemotherapeutic agents. The complications of hRV infection in MM patients are not well known. In this study, we aim to identify the morbidity and mortality associated with hRV in MM participants.

Methods
This was a retrospective study, using Arkansas Clinical Registry Database, which identified all MM patients diagnosed with hRV infection by nasopharyngeal multiplex polymerase chain reaction (PCR) in January-December 2019. Duplicates within 30 days were excluded. Patients were followed for 30 days after diagnosis. We assessed the need for hospitalization, intensive care unit (ICU) admission, oxygen administration, mechanical ventilation, and death. We collected their absolute neutrophil (ANC) and lymphocyte count (ALC) within three days of diagnosis and compared values using Mann-Whitney U test.

Results
We identified 217 MM patients with hRV. Ninety (41%) had prior autologous stem cell transplant, 148 (68%) had received chemotherapy within 30 days. Ninety (41%) had chest imaging, with 11 (12%) having infiltrates. Out of the 217, 69 (31.9%) were admitted, with a mean length of stay of 3 days. 13% of the admitted patients were transferred to the ICU. 65.5% of the admitted patients needed oxygen, and two required mechanical ventilation. The mean ANC and ALC for the admitted group was 3.88 cells/µL and 1.22 cells/µL respectively, compared to 3.57 cells/µL and 1.07 cells/µL in the outpatient group, p=0.6 and 1. Five participants died.

Conclusion
Human Rhinovirus infection in MM patients was associated with significant morbidity, including hospitalization, ICU care, supplemental oxygen requirement, and even mechanical ventilation in 2 patients. Death was observed within 30 days, although rarely. The mean ALC and ANC were not predictive of the severity of the disease. Recognizing hRV effects on morbidity and mortality could lead to earlier recognition and management of complications in MM patients.

Disclosures
All Authors: No reported disclosures
152. Sharp Decline in Rates of Community Respiratory Viral Infections Among NIH Clinical Center Patients During the COVID-19 Pandemic
Authors: Woolbert Michele , Sinaii Ninet , Spalding Christine , Henderson David K , Palmore Tara N 
Published: December 2021

Abstract

Background
During the first year of the COVID-19 pandemic, nonpharmaceutical interventions had a broad impact on viral transmission apart from SARS-CoV-2. The NIH Clinical Center has used the BioFire FilmArray multiplex PCR respiratory pathogen panel (RPP) for evaluation of upper respiratory symptoms since 2014. Beginning in 3/20, respiratory samples from symptomatic patients were tested by SARS-CoV-2 PCR and the RPP. We performed a retrospective study comparing frequency and rates of community respiratory viruses detected by RPP from 1/14 through 3/21.

Methods
Results of RPPs from nasopharyngeal swabs/washes, bronchoalveolar lavages, and bronchial washes were included. Results from viral challenge studies were excluded. Charts were reviewed to determine whether repeat positives for the same virus within 12 months represented new infections; repeats from the same infection were excluded. A quantitative data analysis was completed using cross tabulations; comparisons were done using mixed models, applying Dunnett’s correction for multiplicity.

Results
A total of 3,329 patients underwent 8,122 RPPs from 1/14 through 3/21. Frequency of all respiratory pathogens declined from an annual range of 0.88-1.97% from 1/14-3/20 to 0.29% in 4/20-3/21 (p &lt; 0.001). Individual viral pathogens declined sharply in frequency during the pandemic, with zero cases of influenza A/B, parainfluenza, or metapneumovirus detected from 4/20-3/21. One case each of adenovirus, RSV, CoV OC43, and CoV HKU1 were detected in 4/20-3/21. Rhino/enterovirus detection continued, but with a substantially lower frequency of 4.27% in 4/20-3/21, compared with an annual range of 8.65-18.28% from 1/14-3/20 (p &lt; 0.001).

Frequency of detection of all respiratory pathogens tested using the Biofire FilmArray multiplex PCR respiratory pathogen panel from January 2014 through March 2021. The frequency of pathogen detection from April 2020 through March 2021 declined substantially in comparison with previous years.

Frequency of detection of influenza A, influenza B, rhinovirus/enterovirus, parainfluenza (1, 2, 3, 4), and respiratory syncytial virus from January 2014 through March 2021. The frequency of detection of these pathogens declined sharply starting in April 2020.

Conclusion
During the pandemic, the burden of viral respiratory infections detected among patients at the NIH Clinical Center improved considerably. This reprieve was likely thanks to the layered COVID-19 prevention and mitigation measures implemented in the community and the hospital: masking, distancing, symptom screening, isolation and testing symptomatic persons. As COVID-19 vaccination allows relaxation of masking, community transmission of respiratory viruses will likely resume; continued mask-wearing in the hospital may provide an enduring benefit by preventing nosocomial transmission.

Disclosures
Tara N. Palmore, MD, Nothing to disclose