bluuebunny/crossref_metadata_2025_split huggingface dataset:
316. Use of (1-3)-β-D-Glucan Assay for Diagnosis of Candidemia in Patients Hospitalized with SARS-CoV-2 Infection
Authors: Malik Yesha , Dupper Amy , Cusumano Jaclyn , Patel Dhruv , Twyman Kathryn , Altman Deena , Mazo Dana , Chasan Rachel 
Published: December 2021

Abstract

Background
Candidemia is a rare but serious complication of SARS-CoV-2 hospitalization. Combining non-culture and culture-based diagnostics allows earlier identification of candidemia. Given higher reported incidence during COVID-19 surges, we investigated the use of (1-3)-β-D-glucan (BDG) assay at our institution in those who did and did not develop candidemia.

Methods
Retrospective study of adults admitted to The Mount Sinai Hospital between March 15-June 30 2020 for SARS-CoV-2 infection, with either ≥1 BDG assay or positive fungal blood culture. Data was collected with the electronic medical record and Vigilanz. A BDG value ≥ 80 was used as a positivity cutoff. Differences in mortality were assessed by univariate logistic regression using R (version 4.0.0). Statistical significance was measured by P value &lt; .05.

Results
There were 75 patients with ≥1 BDG assay resulted and 28 patients with candidemia, with an overlap of 9 between the cohorts. Among the 75 who had BDG assay, 23 resulted positive and 52 negative. Nine of 75 patients developed candidemia. Of the 23 with a positive assay, 5 developed candidemia and 18 did not. Seventeen of the 18 had blood cultures drawn within 7 days +/- of BDG assay. Four patients with candidemia had persistently negative BDG; 2 had cultures collected within 7 days +/- of BDG assay. With a cut-off of &gt;80, the negative predictive value (NPV) was 0.92. When the cut-off increased to &gt;200, NPV was 0.97 and positive predictive value (PPV) was 0.42. Average antifungal days in patients with negative BDG was 2.6 vs. 4.2 in those with a positive. Mortality was 74% in those with ≥1 positive BDG vs. 50% in those with persistently negative BDGs. There was a trend towards higher odds of death in those with positive BDG (OR = 2.83, 95% CI: 1.00-8.90, p &lt; 0.06).

Conclusion
There was substantial use of BDG to diagnose candidemia at the peak of the COVID-19 pandemic. Blood cultures were often drawn at time of suspected candidemia but not routinely. When cultures and BDG were drawn together, BDG had a high NPV but low PPV. High NPV of BDG likely contributed to discontinuation of empiric antifungals. The candidemic COVID-19 patients had high mortality, so further investigation of algorithms for the timely diagnosis of candidemia are needed to optimize use of antifungals while improving mortality rates.

Disclosures
All Authors: No reported disclosures
318. Description of Patients Readmitted within 30 Days from COVID-19 Hospitalization
Authors: Al-Saadi Mahmoud , Malvestutto Carlos , Sobhanie Mohammad Mahdee , Hebert Courtney , Colburn Nora , Lustberg Mark 
Published: December 2021

Abstract

Background
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to increased hospitalizations and utilization of critical care services. There are few studies describing co-morbidities and demographics associated with patients re-admitted within 30-days of discharge. The purpose of this study is to describe this patient population.

Methods
This was a single-center, retrospective study at The Ohio State University Wexner Medical Center to identify patients who were admitted secondary to SARS-CoV-2 and required readmission within 30 days due to complications that might be associated with COVID-19. Adults admitted between 3/15/2020 and 11/15/2020 were included in this study. Baseline demographics including age, gender and race in addition to select comorbidities were identified.

Results
250 patients were identified who were readmitted for various reasons. Readmitted patients had a median age of 55 years, 44% were male, and 41.2% were Black/African American. 62.4% of the population was obese (BMI ≥30 kg/m2) with 21.6% with a BMI ≥ 40 kg/m2. The top three co-morbidities seen included Diabetes Mellitus (DM) (32.2%), Hyperlipidemia (48.3%) and Hypertension (51.7%).

Conclusion
Though this study lacked a comparator group, it is clear that patients readmitted with all cause etiologies were disproportionally Black/African-American and obese, with a high prevalence of DM, hyperlipidemia, and hypertension. We recommend close monitoring of patients in these groups to reduce COVID19 readmissions. This is the first step in identifying which patients may be more likely to develop complications and required readmission, the next step is to compare these patients to those that were not readmitted to develop a risk model for readmission.

Disclosures
Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member) Mohammad Mahdee Sobhanie, M.D., Regeneron (Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator, Was a sub-investigator for Regeneron 2066 and 2069)
319. Presepsin as a Prognostic Biomarker for Mortality in COVID-19 Patients vs Community-Adquired Pneumonia (CAP) Patients
Authors: Morales-Cely Lina , Bravo-Castelo Laura A , Bustos-Moya Ingrid G , Fuentes Yuli , Lozada-Arciniegas Julian , Ibañez-Prada Elsa Daniela , Narváez - Ramírez Oriana , Ramirez Paula , Parra-Tanoux Daniela , Gomez-Duque Salome , Gamboa-Silva Enrique , Caceres Eder , Reyes Luis F 
Published: December 2021

Abstract

Background
Lower respiratory tract infections such as community-acquired pneumonia (CAP) and coronavirus disease 2019 (COVID-19) are the main current causes of mortality worldwide. Several scores and biomarkers have been proposed to identify patients at risk of dying, with unclear results. Presepsin is a glycoprotein expressed on the surface of the membrane of monocytes and macrophages and its utility has been proven in sepsis as a predictor of severity and treatment response. However, it is unknown the utility of this biomarker as a mortality predictor among COVID-19 and CAP patients. Thus, the aim of this study was to determine the utility of serum presepsin to identify patients at risk of dying due to COVID-19 and CAP.

Methods
A prospective observational study was conducted at Clinica Universidad de La Sabana, Colombia. We included 240 patients who required hospital admission due to CAP or COVID-19. Plasma samples were collected within 24 hours of admission. The presepsin concentration was quantified using the PATHFAST system. Afterwards, a two-tailed test was used to compare mortality rates among patients and their presepsin plasma concentration. Lastly, the ROC was calculated to determine presepsin’s sensibility as a mortality predictor.

Results
A total of 88 patients with CAP and 152 patients with COVID-19 were included in the study. The median [with IQR] in Presepsin plasma concentration was higher in all patients who died (920 [573 - 2340] vs 573 [307,5 - 1052,5], p-value&lt; 0.0001). Furthermore, comparing to the study group, the median concentration of presepsin was higher in patients deceased by COVID-19 than those who survived. (1358 [642,8 - 2976,8] vs 570 [333,2 - 1007,5], p-value&lt; 0.0001). In addition, the area under the curve (AUC) ROC of presepsin to predict risk of mortality was 0.769. DeLong’s test comparing ROC curves in COVID-19 and CAP patients had a p-value=0.073.
Serum presepsin results

Conclusion
Plasma concentrations of presepsin plasma were higher among COVID-19 patients who died. Moreover, serum concentration of presepsin were not useful to identify CAP patients at risk of dying. However, practical use of Presepsin as a prognostic biomarker of severity is yet to be assessed as further studies are needed.

Disclosures
All Authors: No reported disclosures
321. Clinical Characteristics of Hospitalized HIV Patients with COVID-19 in Miami
Authors: Ayoade Folusakin , Castro Jose G , Valls Priscilla , Quiroz Tanya R , Amoros Annette 
Published: December 2021

Abstract

Background
HIV is a significant risk factor for acquiring SARS-CoV-2 infection and is associated with increased risk of mortality from COVID-19. Information on the clinical characteristics of persons living with HIV(PLWH) hospitalized due to COVID-19 infection are inconsistent and sparse. As Miami area is currently the epicenter of new HIV infection, an understanding of the clinical characteristics of COVID-19 in hospitalized HIV patients in South Florida is needful.

Methods
This is a single center retrospective case series analysis of individuals with HIV hospitalized with COVID-19 from March 1, 2020 to March 31, 2021. We analyzed relevant data related to demographics, comorbidities, clinical presentation, HIV viral load and CD4 profiles, serum inflammatory markers, COVID-19 treatment and survival.

Results
25 patients were identified. The demographic, socioeconomic and clinical data are described in Table 1. 88% of subjects. were on HIV antiretroviral treatment (ART) but only 60% had CD4 counts &gt; 200cells/mm3. More study results are shown in Figures 1 and 2. The serum ferritin ranged from 29 to 40,577ng/mL while serum creatinine ranged from 0.51 to 2.8mg/dL, mean 1.04± 0.46 mg/dL. The Pearson correlation between serum ferritin and serum creatinine (SCreat) was 0.715, p &lt; 0.001 and between lymphopenia and SCreat, it was 0.544, p=0.005. 40% of subjects with CD4 &lt; 200 cells/mm3 died compared to 33% with CD4 &gt; 200 cells/mm3.
Figure 1. Bar chart showing month and year of hospital admission for COVID-19 in HIV infected persons

Table 1

Figure 2. Bar chart showing different percentages of the cohort who received the different COVID-19 treatment illustrated

Conclusion
This first case series of hospitalized COVID-19 patients in PLWH illustrate important demographic and socioeconomic trends with an imbalance towards African Americans. The group mortality rate appear to be higher compared to the overall mortality rate of COVID-19 reported in the general population or other published HIV-COVID-19 coinfection case series. This is not surprising given the fact that only 64% of the cohort had undetected viral load and only 60% had CD4 counts &gt; 200 despite reported 88% ART use. Correlations between lymphopenia and serum ferritin on one hand and serum creatinine on the other hand should be further explored in a larger case series or prospective study. Since COVID-19 mortality is related to HIV severity, improving socioeconomic status and ART compliance could play a big role in positively improving outcome of hospitalized HIV-COVID 19 patients.

Disclosures
All Authors: No reported disclosures
323. Distribution of Pathogens in Coinfections of Patients Admitted with COVID-19
Authors: Neshangi Srilatha , Siddiqui Budder , Tran Sarah , Zhang Phillip 
Published: December 2021

Abstract

Background
Patients who are admitted to the hospital with Coronavirus Disease 2019 (COVID-19) often have protracted hospitalizations complicated by bacterial or fungal co-infections. This also raises the question whether there is some feature of COVID-19 that predisposes to development of specific co-infections. To begin answering that question, we sought to review the distribution of microorganisms identified in bacterial and respiratory cultures in patients admitted with COVID-19.

Methods
In a retrospective review of all patients admitted with COVID-19 in the year 2020 at a single academic tertiary medical facility, all positive blood and respiratory cultures were reviewed. Common contaminants were removed. Duplicate growth of the same organism within the same patient was not counted as a separate event.

Results
787 patients were admitted with COVID-19 for the specified time frame. There were 131 and 147 unique events of documented bacterial or fungal growth seen in blood cultures and respiratory tract cultures, respectively. The most commonly identified organism in blood cultures was Staphylococcus aureus (3.94% of patients with COVID-19), followed closely by Enterococcus (2.41%), Klebsiella (1.65%), and Escherichia (1.27%). Staphylococcus aureus was also the most frequently isolated organism in respiratory cultures (7.24% of patients with COVID-19), followed by Pseudomonas (3.43%), Klebsiella (1.78%), Serratia (0.89%), and Stenotrophomonas (0.89%).

Conclusion
This suggests that the distribution of pathogens implicated in coinfections in this patient population may not be substantially different from what might be expected in patients admitted for reasons outside of COVID-19. Further investigation with a larger patient population would provide more generalizable data, including patients admitted for reasons outside of COVID-19.

Disclosures
All Authors: No reported disclosures
325. Empiric Antibiotics for COVID-19 and the Utility of Procalcitonin
Authors: Desens Adrienne D , Mohadjer Kiya D , Thompson Jessica 
Published: December 2021

Abstract

Background
Bacterial coinfection in COVID-19 is infrequent, yet empiric antibiotic use is common. The objectives of this study were to investigate the effect of empiric antibiotics on time to resolution of COVID-19 pneumonia, elucidate the impact of COVID-19 on procalcitonin levels, and determine the incidence of respiratory bacterial coinfection.

Methods
This was a retrospective study of adult patients hospitalized with COVID-19 between June 1, 2020 and September 30, 2020. Patients were included if they had at least one procalcitonin level. They were excluded if admitted to an intensive care unit within 24 hours of presentation or received antibiotics for an indication besides pneumonia. Patients were stratified into 4 groups based on procalcitonin level and receipt of antibiotics. The primary outcome was time to clinical resolution of pneumonia. A key secondary outcome was incidence of confirmed respiratory bacterial coinfection.

Results
A total of 199 patients were included. Patients with a procalcitonin greater than 0.25 ng/mL who received antibiotics had a longer median time to clinical resolution of pneumonia, 8 days (95% CI, 4 to 11 days) vs. 3 or 4 days in other groups (P&lt; 0.001). Additionally, this same group required greater baseline oxygen supplementation, had more comorbidities, and increased mortality compared to all other groups. Median time to clinical resolution of pneumonia was also longer in patients who received antibiotics compared to those who did not (5 vs. 4 days, P=0.017) and in those with a procalcitonin greater than 0.25 ng/mL compared to those with PCT less than or equal to 0.25 ng/mL (7 vs. 4 days, P&lt; 0.001). Renal dysfunction was more prevalent in patients with an elevated procalcitonin (45% vs. 17.5%). The overall incidence of confirmed respiratory bacterial coinfection was 1.5%.

Conclusion
Irrespective of procalcitonin level, empiric antibiotics were not associated with a shorter time to resolution of COVID-19 pneumonia in non-critically ill patients. Elevated procalcitonin is likely a reflection of the severity of COVID-19 disease and baseline renal function rather than bacterial infection. Additionally, the overall incidence of confirmed bacterial coinfection in non-critically ill patients hospitalized with COVID-19 was low.

Disclosures
Kiya D. Mohadjer, PharmD, BCPS, BCIDP, Eli Lilly and Company (Shareholder)Gilead Sciences (Shareholder)
327. Assessment of Bacterial Co-infection Rates and Antibiotic Exposure in COVID-19 Patients
Authors: Luetkemeyer Adam J , Bennett Nick , Aragon Laura , Ploetz Jeannette , Boyd Sarah E 
Published: December 2021

Abstract

Background
COVID-19 pandemic data suggest risk for bacterial co-infection upon hospital presentation remain extremely low. Despite low co-infection rates, antibiotics are prescribed for most patients. Current data are limited regarding institutional-specific change in antibiotic use over the course of the pandemic. Given the low rates of co-infections, Saint Luke’s Health System’s COVID-19 Treatment Taskforce developed a COVID-19 evaluation and treatment order set which included procalcitonin (PCT) . As co-infection literature emerged, active education was provided, and order sets were modified to provide passive education regarding co-infection rates. We aimed to assess antibiotic practice changes as data and strategies to influence use evolved during the pandemic.

Methods
This was a multi-center, single health-system retrospective cohort study. Ten community hospitals and 1 academic medical center were included in analysis. Inclusion criteria were age ≥18 years, admitted during April or September 2020 and had a positive COVID-19 result on admission. Patients were excluded if they were readmitted for COVID-19 related issues. Both primary and secondary outcomes were analyzed from the first 7 days after admission. The primary outcome was rate of respiratory bacterial co-infections. This was determined through sputum and blood cultures, urinary antigens including Streptococcus pneumoniae and Legionella, and PCT. Secondary outcomes included rate of antibiotic use, antibiotic days of therapy (DOT), length of therapy, and antibiotic use trends.
Baseline Characteristics

Results
A total of 294 patients were included with 69 patients in April 2020 and 225 in September 2020. Primary and secondary results are shown in Table 2. Rate of culture-confirmed bacterial co-infection when examining April 2020 was 4.38% and 4.44 % in September 2020. Antibiotic uses, antibiotic DOT, and length of therapy were all significantly lower in September 2020 compared to April 2020.

Conclusion
Our results show bacterial co-infections were extremely low in our health system. Despite positive trends in antibiotic use, prescribing remained high. More targeted interventions to decrease antibiotic exposure in COVID-19 patients are needed.

Disclosures
All Authors: No reported disclosures
328. Bacteremia in Patients Hospitalized with Covid-19 Disease, Risk Factors, Impact of immunomodulator Therapy, Role of Inflammatory Markers, Antibiotic Use, and Outcomes: A Single Center Retrospective Study
Authors: Zahra Aleena , Fries Bettina C , Fries Bettina C 
Published: December 2021

Abstract

Background
Novel coronavirus 2019 (Covid19) caused by SARS-CoV2 can lead to significant morbidity and mortality. There is unclear association between Covid19 and bacteremia. Patient characteristics and outcomes are not well defined. This retrospective cohort study assessed this in patients with Covid19 and bacteremia.

Methods
Patients with Covid-19 admitted to a tertiary care suburban academic medical center (UH) were assessed retrospectively by EMR chart review for co-morbidities, pre and in hospital factors, and outcomes as defined below. Bacteremias grouped into gram-negative or gram-positive with collation of each unique bacterial species (Table 1).

Results
Total 1398 patients with Covid19 hospitalized at UH during local peak of pandemic of whom 238 (17.02%) developed 264 bacteremias with gram-positive (244, 92.4%) and gram-negative organisms (20, 7.57%). Relevant characteristics (Table 2) 53% with immunomodulator therapy (steroids/Tocilizumab), mean length of stay 21.04days (SEM ± 1.67) with day SARS-CoV2 PCR positivity -1.15days from hospitalization (SEM ± 0.49) and day initial bacteremia 6.38 (SEM ± 0.77), 55.4% required ICU admission, with 89% ICU admissions requiring mechanical ventilation. Most common co-morbidity (Figure 1 full list) Hypertension 56.3% followed by Obesity (BMI &gt;30) 45.8% and CAD/CHF 40.3%. Laboratory parameters (Table 3)significant for average difference (date bacteremia- date admission) for Procalcitonin 4.15ng/mL (SEM ± 0.97, p-value 0.02), CRP -0.934mg/dL (SEM ± 0.95, p-value 0.32), WBC 7.027 K/uL (SEM ± 0.65, p-value &lt; 0.005). These analyses excluded difference of 0 from hospital day 1 bacteremia. Average antibiotic number (1+ dose per antibiotic) 3.24 (SEM ± 0.16) and total C difficile cases 3 (1.26%). Mortality rate34.45%.

Relevant hospitalization characteristics, Covid19 and bacteremia co-infections

Relevant laboratory parameters for patients with Covid19 and bacteremia co-infection

Conclusion
Patients with Covid19 and bacteremia had high mortality (Figure 2), 53% received immunomodulator therapy, possibly contributing to bacteremia development. With bacteremia increase in WBC and Procalcitonin, not CRP, noted. Most organisms CoNS, likely contaminants, gram positive bacteremias likely from indwelling lines. Only 3 C difficile infections identified. Trends noted in Procalcitonin rise, immunomodulator therapy, and low C difficile infection rates warrant further studies.

Post-hospitalization Outcomes

Disclosures
All Authors: No reported disclosures
329. Severe Obesity: A Critical Risk Factor for In-Hospital Complications and Mortality in the Hispanic Population
Authors: Baireddy Moulika , Neppala Sivaram , Sundarakumar Dinesh Kumar , Santos Hector 
Published: December 2021

Abstract

Background
Obesity, Diabetes mellitus type 2, race and other characteristics has been associated with an increased risk of adverse outcomes in patients with COVID-19 disease. The prevalence of obesity in the United States in 2017-2018 was 42.4%. Webb County, Texas with a 95.6% Hispanic population shows an obesity prevalence of 35.8% in 2014. It is unclear whether obesity increases the risks of complications and mortality in Hispanic population from COVID-19 disease.

Methods
This is a retrospective cohort study of patients admitted to the hospital with the diagnosis of COVID-19 between March 2020 and August 2020. 950 patients were tested and admitted to the hospital with the diagnosis of COVID-19 pneumonia. Patients were categorized into classes of body habitus by BMI: underweight (&lt; 18.5), normal (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 ( &gt;40.0).

Results
950 Hispanic patients were included (Male-52.8%, Female- 47.2%) in the study. In total, 19.05% of our patients died during the hospitalization with an increased risk of mortality in patients having obesity class 2 (RR 4.14, 95% CI = 2.2–7.7 p=&lt; 0.0001), and obesity class 3 (RR 6.0, 95% CI = 1.3–4.6 p=&lt; 0.0001) compared with those with normal BMI. Mortality was higher in obese patients who required invasive mechanical ventilation at 93.75% compared to obese patients who were non-ventilated at 4.29%. Patients with obesity class 2 and 3 had higher risks of in-hospital complications including AKI requiring renal replacement therapy, ARDS, and arrythmias most commonly atrial fibrillation/flutter at 26.7%, 18.42% and 13.5%.
Characteristics of In-hospital complication complications due to COVID-19 disease

Conclusion
Patients admitted to the hospital with the diagnosis of COVID-19 disease with obesity classes 2 and 3 have a significantly increased risk of mortality as compared to normal and overweight patients. Severe obesity was also associated with increased hospital complications of AKI, ARDS, and Atrial Fibrillation. This further affirms that obesity is a pertinent risk factor to be considered in COVID-19 patients.

Disclosures
All Authors: No reported disclosures