bluuebunny/crossref_metadata_2025_split huggingface dataset:
348. Characteristics and Outcomes in Hospitalized Patients with Covid-19 Complicated by Fungemia: A Single Center Retrospective Study
Authors: Zahra Aleena , Fries Bettina C , Fries Bettina C , Sae-Tia Sutthichai 
Published: December 2021

Abstract

Background
Covid19 caused by SARS-CoV2 can lead to significant morbidity and mortality. Fungemia is a rare hospital-associated infection and there are limited data regarding its association with Covid19. We reviewed all cases of fungemia in our Covid19 cohort at Stony Brook University Hospital (SBUH).

Methods
We conducted a retrospective medical record review of patients admitted with Covid19 in a 3-month interval. We reviewed positive blood cultures for fungi and recorded co-morbidities, co-infections, length of stay, treatments, and outcomes (survival vs death). There were 60 positive blood cultures for fungi in 25 unique patients (Table 1); in prior years &lt; 30 per year reported at SBUH.
Table 1. Fungal Blood Cultures

Collation of each unique identified fungal species from fungal blood cultures in patients hospitalized with Covid-19

Results
During a 3 month interval at the local peak of the pandemic 1398 patients hospitalized with Covid19 at SBUH, 25 cases of fungemia were detected; C. albicans (CA) n=8,32%, non C albicans species (nCA) n=16,64%, and C. neoformans n=1,4%, 17/25 (68%) also with bacteremia during same hospitalization. In same 3 months there were 264 cases of bacteremia and Covid19 co-infection. Demographics and medical co-morbidities of fungemic patients are in Table 2. Majority were men (76%). No difference between fungaemic (FC) and total cohort (TC) in median age (62 vs 62), DM p=0.31, HTN p=1.0, COPD p=0.12. Within FC, DM was higher in nCA group (58.8%) vs CA group (37%). Mortality was 40% in FC vs 15% in TC, p&lt; 0.001. Within FC mortality was 56% in nCA and 25% in CA group. C. parapsilosis was the most common nCA species isolated with 43% mortality. FC more likely to require ICU and mechanical ventilation (88% vs 15%, p&lt; 0.0001) and had longer median length of stay 42 days vs 22 days. The median time from admission to fungaemia was 21d, from central line placement 19d, Table 3. Of FC 21 (84%) were treated with steroids/Tocilizumab concurrently. Of note, no mortality was recorded in the 4 patients that did not receive steroids/Tocilizumab.
PCT and WBC were significantly higher at time of fungemia as compared to admission, Table 3.
Table 2, Patient co-morbidities and hospitalization stay characteristics

Co-morbidities and requirement for ICU stay, mechanical ventilation for total cohort Covid-19 and fungemic cohort
Table 3, Patient Characteristics and Laboratory Parameters

Relevant patient characteristics and laboratory parameters in patients hospitalized with Covid19 and fungemia

Conclusion
Fungemia in hospitalized patients with COVID-19 is associated with higher mortality. We observed higher fatality in non C. albicans infections. Prolonged use of central line catheters and concurrent treatment with steroids/tociluzimab are likely high-risk factors for development of fungemia.

Disclosures
All Authors: No reported disclosures
349. Diagnostic Testing and Antibiotic Utilization in Patients with COVID-19
Authors: Groft Lauren , Opran Iulia , Tadesse Yeabsera , Vo Hang , Heil Emily , Heil Emily , Schrank Gregory , Claeys Kimberly C 
Published: December 2021

Abstract

Background
Patients with COVID-19 receive high rates of antibiotic therapy, despite viral origin of infection. Reports of bacterial coinfection range from 3.5 to 8% in the early phase of infection. This study aimed to evaluate the relationship between diagnostic tests and antibiotic utilization in patients admitted with COVID-19 at the University of Maryland Medical Center to better inform future prescribing practices.

Methods
Retrospective cohort study of adult patients with a positive SARS-CoV-2 PCR on admission from March 2020 through June 2020. Associations between diagnostic tests employed and antibiotic initiation and duration were explored using bivariate analysis (SPSS®).

Results
Baseline characteristics of 224 included patients are reported in Table 1. Excluding SARS-CoV-2 PCRs, most frequently performed diagnostic tests included blood cultures (65.6%), MRSA nasal surveillance (45.1%), respiratory cultures (36.2%), respiratory viral panel (RVP) (33.0%), and Legionella (28.6%) and pneumococcal (26.3%) urine antigens. Positivity of RVP, Legionella, pneumococcus, blood, and respiratory tests were low (1.3%, 0.4%, 0.9%, 1.8%, and 6.7%, respectively). A total of 62% of patients were initiated on antibacterial therapy with a median cumulative antibiotic duration of 77.9 hours (IQR 41.4, 111.8). History of chronic respiratory disease (76% vs. 58.6%; P=0.025), any degree of oxygen requirement on admission (72% vs. 42.6%; P=0.006), and performance of blood cultures (70.7% vs. 46.8%, P&lt; 0.0001) were associated with antibiotic initiation. Positive bacterial diagnostic respiratory culture (median duration 72.8h [IQR 46.7, 96.6] vs. 97.3h [IQR 79.8, 194.1]; P=0.027) and positive blood culture (median duration 80.1h [IQR 42.1, 111.7] vs. 97.5h [IQR 71.8, 164.8]; P=0.046) were associated with longer antibiotic duration. Patients who did not have respiratory cultures performed had similar antibiotic durations as those with negative respiratory cultures.
Table 1. Baseline Characteristics

Conclusion
Despite low coinfection rates, negative diagnostic tests did not result in shorter empiric antibacterial duration. These findings highlight the ongoing need for both diagnostic and antimicrobial stewardship in COVID-19.

Disclosures
Emily Heil, PharmD, MS, BCIDP, Nothing to disclose Kimberly C. Claeys, PharmD, GenMark (Speaker’s Bureau)
351. Antibiotic Management Decisions and Use of a Multiplex PCR Panel for Pneumonia Diagnosis Among Critically Ill Patients with COVID-19
Authors: Bionghi Neda , Dietz Donald E , Zucker Jason , Zucker Jason , Huang Simian , Whittier Susan , Green Daniel A , Wu Fann , Sobieszczyk Magdalena , Theodore Deborah 
Published: December 2021

Abstract

Background
Antibiotic use among patients with COVID-19 is common, exceeds the prevalence of probable bacterial co-infection, and promotes development of resistant organisms. Lack of diagnostic microbiological data may prolong empiric broad-spectrum therapy. Here we evaluate the use of the BioFire FilmArray pneumonia panel (PP), a novel rapid diagnostic test, and antibiotic decisions among intensive care unit (ICU) patients with COVID-19.

Methods
We conducted a retrospective review of adult ICU patients admitted with COVID-19 between January 2020 and May 2021 at an academic medical center. ICU patients who underwent bronchoscopy/bronchoalveolar lavage (BAL) with PP (PP group) were matched by age (&lt; 65 or ≥65), BMI (&lt; 30 or ≥30), and BAL date (within 60 days) to ICU patients who did not undergo BAL (no-BAL group). PP patients were matched by age and BMI to ICU patients who underwent BAL without PP (no-PP group). Antibiotic use was compared between groups. Chi squared analysis, t-test, and ANOVA were used for comparisons as appropriate.

Results
65 patients were included; the majority were male (65%), &lt; 65 years (86%), and had BMI ≥30 (54%) (Table 1). Only 17 no-PP matches were identified for PP patients due to infrequent BALs. Similar proportion of patients in PP and no-PP groups had organisms identified from BAL (54% vs. 47%, p=0.65). Among PP patients with a detected organism, all (n=13) had subsequent changes in antibiotic regimen ≤72 hours after BAL; 10/13 (77%) had a change targeted to detected organism and 5/13 (39%) had antibiotic narrowing. Among PP patients with no detected organism, only 4/11 (36%) had antibiotic narrowing or maintenance off antibiotics. In all groups, average antibiotic use exceeded 70% of admission duration.
Table 1. Patient characteristics and antibiotic management. Abbreviations: BAL - bronchoalveolar lavage

Conclusion
Rapid, highly sensitive diagnostic tests have potential to guide clinical decisions and promote antibiotic stewardship among patients with severe viral pneumonia and suspected bacterial co-infection. In this descriptive analysis, antibiotic management did not differ significantly with use of PP. While most patients with detected organism on PP had targeted antibiotic changes, a negative PP did not appear to influence antibiotic narrowing. Larger studies and provider education are needed to evaluate potential of the PP for antibiotic stewardship.

Disclosures
Jason Zucker, MD, MS, Nothing to disclose Daniel A. Green, M.D., BioFire (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member) Deborah Theodore, MD, BioFire Diagnostics (Other Financial or Material Support, Donation of testing materials to support investigator-initiated research)
352. COVID-19 Not a Risk Factor of Alopecia Areata: Results of a National Cohort Study in South Korea
Authors: Kim Jeehyun , Hong Kwan , Yum Sujin , Gomez Raquel Elizabeth Gomez , Chun Byung Chul 
Published: December 2021

Abstract

Background
There have been approximately 158 million coronavirus disease 2019 (COVID-19) pandemic survivors worldwide by June 9, 2021. As a result, concerns about hair loss in COVID-19 patients have emerged among dermatologists. However, most of extant literature have limited implications by relying on cross-sectional studies with restricted study subjects without control group. Therefore, our study aims to investigate the risk of developing alopecia areata (AA) among COVID-19 patients in South Korea using adequate control based on national representative data.

Methods
We used the National Health Insurance Service (NHIS) COVID-19 cohort database, comprising COVID-19 patient and control group, all of whom were diagnosed from January 1, 2020 to June 4, 2020. Patients were defined as individuals who were confirmed as COVID-19 positive, regardless of disease severity. Controls were defined as whom confirmed as COVID-19 negative. People with a history of AA during the period 2015–2019 were excluded. The primary endpoint was a new diagnosis of AA (ICD-10-CM-Code: L63). Adjusted incidence rate ratio (IRR) of developing AA was estimated using log-link Poisson regression model based on incidence density of case and control group. The model adjusted for (1) age and sex (2) demographic variables (age, sex, place of residence, and income level). Statistical significance was set at p&lt; 0.05.

Results
A total of 226,737 individuals (7,958 [3.5%] cases and 218,779 [96.5%] controls) were included in the final analysis. There were more females than males, both in test positives and negatives at 59.9% and 52.3%, respectively. The largest test positive population was those in age group 20 to 29 years (25.5%),. The test negatives had the largest population in age group 30 to 39 years (17.1%). The ratio of newly diagnosed AA was 18/7,958 (0.2%) in cases and 195/218,779 (0.1%) in controls. IRRs of COVID-19 patients having newly diagnosed AA compared to controls were 0.78 (0.48‒1.27) when age and sex were adjusted for, and 0.60 (0.35‒1.03) when all demographic variables were adjusted for.
Flowchart of study subject selection

Conclusion
Diagnosis of COVID-19 was not significantly associated with development of AA even after appropriately adjusting for covariates.

Disclosures
All Authors: No reported disclosures
356. The Role of Procalcitonin in Antimicrobial Stewardship Among Cancer Patients Admitted with COVID-19
Authors: Dagher Hiba , Chaftari Anne-Marie , Hachem Ray Y , Jiang Ying , Malek Alexandre , Garnes Natalie J Dailey , Borjan Jovan , Mulanovich Victor , Raad Issam I 
Published: December 2021

Abstract

Background
Procalcitonin (PCT) has been used to guide antimicrobial therapy in bacterial infections. With the wide spread use of empiric use of antibiotics in cancer patients admitted with COVID-19 disease, we aimed to evaluate the role of PCT in decreasing the duration of empiric antimicrobial therapy among cancer patients admitted with COVID-19.

Methods
We conducted a retrospective study of cancer patients admitted to MD Anderson Cancer Center who had a PCT test done within 72 hours of admission following their COVID-19 diagnosis between March 1, 2020 and June 6, 2021. Patients were divided into 2 groups of PCT &lt; 0.25 ng/mL and PCT &gt;=0.25 ng/mL. We assessed pertinent cultures including blood and respiratory, as well as antibacterial use and duration of empiric antibacterial therapy.

Results
We identified 544 patients with a median age of 62 years (range, 14-93). There were 312 (57%) patients that had at least one culture obtained from a sterile or infected site within 7 days following admission. None of the patients who had PCT&lt; 0.25 had a positive culture whereas 41/111 (37%) patients with PCT &gt;= 0.25 had at least one positive culture [P&lt; 0.0001]. Among the 373 patients who had a PCT &lt; 0.25, 129 (35%) patients received more than 72 hours of IV antibiotics compared to 87/171 (51%) among patients with PCT &gt;=0.25 [P= 0.0003].

Conclusion
These results confirm the correlation between a PCT level greater than 0.25 and a documented bacterial infection. Furthermore, procalcitonin could be useful in enhancing antimicrobial stewardship in cancer patients with COVID-19 by reducing the duration of antimicrobial therapy beyond the initial empiric 72 hours until PCT results become available.

Disclosures
Natalie J Dailey Garnes, MD, MPH, AlloVir (Other Financial or Material Support, collaborator on research protocol)
357. A Comparison of Chest CT Findings in Cancer and Non-Cancer Patients with COVID-19
Authors: Malek Alexandre , Dagher Hiba , Hachem Ray Y , Jiang Ying , Chaftari Anne-Marie , Raad Issam I 
Published: December 2021

Abstract

Background
The purpose of this study was to compare chest computed tomography (CT) scan findings in cancer versus non-cancer patients with COVID-19 infection. We sought to assess the correlation between radiologic patterns of COVID-19 pneumonia, clinical course, and outcomes.

Methods
We performed a retrospective study of COVID-19 positive cancer and non-cancer pts who had chest CT scans at the time of diagnosis, at our hospital and 16 other centers in Asia, Australia, Europe, North America and South America, between March, 2020 and November, 2020. Patients’ age, underlying diseases, symptoms, laboratory studies, and radiologic findings consisting of bilateral ground-glass opacities (GGOs), multifocal organizing pneumonia (MOP) were collected in association with clinical outcomes.

Results
We identified 426 pts with cancer and 622 non-cancer pts. Thereafter, cancer pts were analyzed into 3 distinct groups and similar to non-cancer pts: GGOs group (n=224, 54%), GGOs+MOP group (n=61, 14.6%), and a third group of neither GGOs or MOP (n=131, 31.4%) in cancer pts, and in non-cancer pts: GGOs group (n=387, 62.8%), GGOs +MOP group (n=100, 16.2%), and a third group of neither GGOs or MOP (n=129, 21%). The median patients’ age was 54 in non-cancer pts vs 62 in cancer pts (p&lt; 0.001) and there were more males in the non-cancer group 57% vs 47% (p=0.001). Cough was more prevalent in non-cancer pts, 71% vs 59% (p&lt; 0.001) and similar to fever (73% vs 57%, p&lt; 0.001). Neutropenia &lt; 0.5 k/µL and lymphocytopenia &lt; 1 k/µL were more frequent in cancer pts (p&lt; 0.001). In cancer pts, there was no statistically significance difference between the 3 groups (hospital admission, mechanical ventilation, readmission within 30 days, and mortality), except pts who required non-invasive (NI) ventilation were more frequent in the GGOs group, 55% (p=0.005). In non-cancer, pts with GGOs +MOP have higher hospital admission, ICU transfer, NI- and mechanical ventilation compared to the 2 other groups (p&lt; 0.001). While readmission to hospital or mortality rate within 30 days were similar between the 3 groups.

Conclusion
This study reveals that non-cancer pts tended to have more radiologic findings on chest CT scan compared to cancer pts at the time of COVID-19 diagnosis and were associated with more worrisome COVID-19-related clinical outcomes.

Disclosures
All Authors: No reported disclosures
360. Evaluation of Cycle Threshold Values in Patients with Symptomatic COVID-19 Infection
Authors: Dixon Danielle , Madrid-Morales Julieta , Cadena-Zuluaga Jose , Frei Christopher R 
Published: December 2021

Abstract

Background
One of the tests used to identify COVID-19 infections is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) test. There is a measure known as the cycle threshold (Ct) value, which provides an indirect measure of viral load. It has been proposed that the Ct value could help with clinical decisions regarding duration of isolation. We hypothesize that Ct values will correlate with symptom duration in a population of veterans with COVID-19 infection.

Methods
We reviewed the records of patients presenting to the emergency department (ED) or admitted to Audie L. Murphy VA Medical Center in San Antonio, Texas with positive SARS-CoV-2 PCR tests. We looked at patients who received multiple SARS-CoV-2 RT-qPCR tests. We compared date of onset of symptoms and cycle threshold values from their initial test to another test ordered after 7, 10, and 20 days from symptom onset. We recorded the Ct value for the N2 and E genes. Patients were classified into mild, severe and critical based on Center for Disease Control and Prevention (CDC) criteria. A Ct value of &gt;30 as threshold for transmissible disease was used based on previously published studies.

Results
We identified 49 patients with more than two SARS-CoV-2 RT-qPCR tests. Patients with mild disease with tests less than or equal to ten days from symptom onset (n=10) had a mean Ct value 23.2 (±5.6) and 26.0 (±5.8) for the E and N2 genes. Patients with mild disease with tests greater than ten days from symptom onset (n=4) had mean Ct values of 26.0 (±6.5) and 27.8 (±6.8). When we stratified the patient population by disease severity, patients with severe and critical disease with tests less than ten days from symptom onset (n=24) had mean Ct values of 20.1 (±7.3) and 23.4 (±7.5). Patients with severe and critical disease greater than twenty days (n=6) had Ct values of 29.0 (±5.1) and 31.1 (±5.4).

Conclusion
We found that Ct values increased with longer symptom duration. We currently use the CDC criteria to discontinue isolation at ten days for mild disease and twenty days for severe and critical disease. The findings of this study suggest that our current practice for duration of isolation correlates with increasing Ct values near or above the threshold for transmissible disease.

Disclosures
All Authors: No reported disclosures
361. Aseptic Meningitis Associated to SARS Cov2 Infection and MIS-C: Pediatric Presentation of Covid-19
Authors: Quintero Mónica J Olguín , Pellegrini Sergio RenÉ Bonilla , JuÁrez Rodolfo N JimÉnez , Casillas María Citlalli Casillas 
Published: December 2021

Abstract

Background
Novel SARS CoV2 may target the central nervous system and several neurological symptoms have been reported in patients with Coronavirus disease (COVID-19). Mucocutaneous and inflammatory symptoms are important in pediatric population associated to immune dysregulation. There are few reports of clinical manifestations in children and less frequently the isolation and affection of Central Nervous System.

Methods
A previously healthy four months female infant with familiar contact to SARS-CoV2 four weeks ago. Start with fever of 104°F, vomiting, maculopapular rash on the anterior thorax and upper extremities involving the palms and soles associated with edema. On physical examination, irritable, bulging anterior fontanelle, non-purulent bilateral conjunctival injection, cheilitis and rash was confirmed.

Results
Laboratory findings: thrombocytopenia, elevated D-Dimer, fibrinogen, PCT, CRP, ferritin and ESR with hypoalbuminemia. MIS-C is integrated with cutaneous, gastrointestinal and neurological affections. Empirically ceftriaxone, vancomycin and acyclovir are started due to suspicion of meningoencephalitis. RT-PCR for SARS-CoV-2 positive. CSF: transparent appearance, slightly xanthochromic color, coagulation and negative film. Proteins 105 mg / dl, glucose 45 mg / dl, leukocytes 121 mm3, erythrocytes 66 mm3, PMN 8% and MNN 92%. Negative culture,PCR Herpes Virus negative,Viral load for SARS CoV2 in CSF 3,400 cop / ml and plasma 118,900 cop / ml, Aseptic meningitis is confirmed by SARS-CoV-2. Antiviral and antibiotics are discontinued and Gamma globulin and methylprednisolone are administered. Evolving favorably and egress at 6th day to complete oral steroid treatment for 3 more day.

Conclusion
The mechanism by which SARS-CoV2 affects the CNS is still unknown.This findings suggests direct infection can be possible. Although it is also described vascular affection has been found that the Spike protein of the virus binds to ACE-2 receptor present in the cerebral vascular endothelium. Neurological manifestations have been described even without respiratory symptoms. A novel pediatric case with viral load for SARS-CoV-2 in CSF is demonstrated. Importance of detecting SARS-CoV-2 in children with encephalitis, which can progress satisfactorily.

Disclosures
All Authors: No reported disclosures
363. Characteristics of Envelope and Nuclear Gene Expression Patterns in Asymptomatic SARS-CoV-2 Patients: A Single Center Retrospective Observational Study
Authors: Mizuno Keiko , Komatu Takayuki , Usuda Daisuke , Hocchi Shiori , Ashizawa Karin , Aoki Takashi , Ogura Kanako , Takami Hiroki , Nomura Tomohisa , Sugita Manabu 
Published: December 2021

Abstract

Background
Reverse transcription-polymerase chain reaction (RT-PCR) is used for the diagnosis of COVID-19, caused by SARS-CoV-2. RT-PCR is a method that detects the virus by amplifying two regions of the target viral genome, namely the nuclear (N) and envelope (E) encoding sequences. However, no reports have shown a relationship between the symptoms and the gene expression patterns, especially in asymptomatic patients. Herein, we validated the characteristics of E and N gene expression patterns using RT-PCR on samples obtained from asymptomatic COVID-19-positive patients.

Methods
In this retrospective cohort study, conducted at Juntendo University Nerima Hospital, Tokyo, Japan, SARS-Cov-2 RT-PCR positive patients whose specimens had been obtained and analyzed by our laboratory technicians from September 1, 2020 to December 31, 2020 were enrolled. For RT-PCR, the LightMix Modular SARS-CoV-2 reagent (TIB MOLBIOL company) was used. After excluding patients who had symptoms, background, demographic, laboratory, and gene expression pattern data were collected from RT-PCR-positive asymptomatic patients. We also investigated patients who met the release criteria of the Center for Disease Control and prevention. Continuous and categorical variables were analyzed, with p&lt; 0.05 set as statistical significance using the student-t test, chi-square test, or Fisher’s exact test, respectively.

Results
Of 92 RT-PCR-positive asymptomatic patients, 57 comprised the expression E only group (Group E) and 35 comprised the E+N group (Group E+N). Significantly more patients in Group E met the release criteria compared to those in Group E+N [41 (71%) vs 10 (28%), p&lt; 0.001]. Among patients who met the release criteria, those in Group E+N had significantly more immunosuppression [7 (70%) vs 8 (30%), p=0.004].
Moreover, among the patients who underwent RT-PCR screening, no patients in Group E developed symptoms [0 vs 6 (42%), p=0.02].

Conclusion
The results of this study suggest that RT-PCR-positive asymptomatic patients can be divided into three patterns: pre-symptomatic, gene E+N-positive patients; post-symptomatic covid-19-recovered patients, regardless of gene E and N expression patterns; and false positive, gene E-positive patients.

Disclosures
All Authors: No reported disclosures