bluuebunny/crossref_metadata_2025_split huggingface dataset:
304. Impact of Antibiotic Prophylaxis Prior to Treatment with Steroids and Tocilizumab in COVID-19 Patients
Authors: de Novales Francisco Javier Membrillo , Muñoz Miriam Estébanez , Forte Tatiana Mata , Ramírez-Olivencia Germán , Cintas María Isabel Zamora , Sacristán María Simón , de Castro María Sánchez , Gutiérrez Ortega Carlos , Orcal Lucía Elena Ballester 
Published: December 2021

Abstract

Background
The incidence of bacterial or fungal coinfections in COVID-19 patients is low. The incidence of nosocomial superinfections is higher, especially related to ICU admission. Treating COVID-19 with steroids plus tocilizumab (TCZ) has been associated with superinfections. Therefore, the use of antibiotic prophylaxis prior to infusion of TCZ could be considered to reduce the risk of life-threatening superinfections in critically ill patients.

Methods
Retrospective, single center cohort study. COVID-19 patients older than 14 years, admitted to Hospital Central de la Defensa (Madrid, Spain) from Mar 5th to Nov 24th, 2020 with a diagnosis of COVID-19 were included. Local protocols suggested antimicrobial prophylaxis before the infusion of TCZ. Medical records, treatments received, and microbiological data of all patients who received TCZ were reviewed. Microbiological isolates were considered in the 14 days following the administration of TCZ. Two ID specialists independently reviewed the medical record and decided to qualify the isolate as superinfection or colonization.

Results
2,069 patient records were analyzed. 70 patients received TCZ; all of them were admitted to ID wards and under steroid treatment. 45 (64,5%) patients received antibiotic prophylaxis. The preferred antibiotics were ceftriaxone (N = 18) and ceftobiprole (N = 14). No significant differences were found in age, Charlson index or COVID-19 SEIMC-Score. 24 isolates were detected in 14 patients (18 bacterial, 6 fungal). 17 isolates were considered superinfections; the most frequent isolates were C. albicans (N=5), E. faecalis (N=3) and S. epidermidis (N=2). There were no statistically significant differences between the different prophylaxis strategies in terms of in-hospital mortality or ICU admission. However, patients who received ceftobiprole tended to have fewer isolates and fewer superinfections than those receiving ceftriaxone (ceftobiprole group: 2 isolates in 1 patient, 1 (7,1%) patient with superinfection; ceftriaxone 11 isolates in 5 patients, 4 (22,2%) patients with superinfection) (p= 0,35, Fisher exact test).
Table 1. Characteristics of study population.

Table 2. Outcomes according to antimicrobial prophylaxis prior to Tocilizumab.

Table 3. Description of isolates.

Conclusion
Antibiotic prophylaxis prior to infusion of TCZ in patients with COVID-19 and receiving steroids could determine the profile of bacterial and fungal superinfections.

Disclosures
All Authors: No reported disclosures
305. Cholecystitis as a Possible Immunologic Consequence of COVID-19; Case Series from a Large Healthcare System
Authors: Jacobs Anna , Polk Christopher , Sampson Mindy , Kooken Banks , Ludden Thomas , Passaretti Catherine , Passaretti Catherine , Leonard Michael 
Published: December 2021

Abstract

Background
Gastrointestinal manifestations are commonly seen in COVID-19 disease with up to 50% of patients reporting nausea or diarrhea. Cholecystitis has been described in rare cases related to COVID-19, possibly in consequence of immune activation, but biliary disease from SARS-CoV-2 infection is not well described. We examined a case series of patients with both COVID-19 and cholecystitis at our institution.

Methods
We performed a retrospective chart review of all patients with a diagnosis of cholecystitis within 3 months of SARS-CoV-2 infection; looking at clinical, laboratory, and radiographic characteristics of this population.

Results
30 individuals were identified with a diagnosis of cholecystitis within 3 months of diagnosis of SARS-CoV-2 infection. Most patients presenting with cholecystitis were female and obese (see Table 1). 14 individuals were diagnosed with SARS-CoV-2 infection during the same presentation as their cholecystitis diagnosis, usually as part of pre-operative screening. Of 16 individuals diagnosed with SARS-CoV-2 prior to their cholecystitis presentation, a mean of 24 and 17 days elapsed between SARS-CoV-2 infection and cholecystitis symptom onset and radiographic diagnosis, respectively (see Figure 1). Most of these patients had mild respiratory disease, with only 9 developing an oxygen requirement, and only 3 requiring mechanical ventilation. While 17 patients were treated surgically for their cholecystitis, this did not appear to impact symptom resolution.
Table 1. Patient Characteristics

Figure 1. Time between COVID-19 and Cholecystitis

Conclusion
Cholecystitis may be an uncommon complication of COVID-19 disease. Cholecystitis may manifest most often 2-4 weeks following SARS-CoV-2 infection. This timing is similar to that in Multisystem Inflammatory Syndrome following SARS-CoV-2 infection and given similarities in timing to we hypothesize that cholecystitis in our patients could be driven by immune activation.

Disclosures
Christopher Polk, MD, Atea (Research Grant or Support)Gilead (Advisor or Review Panel member, Research Grant or Support)Humanigen (Research Grant or Support)Regeneron (Research Grant or Support) Mindy Sampson, MD, Regeneron (Grant/Research Support) Catherine Passaretti, MD, Nothing to disclose
307. Predictors of Respiratory Bacterial Co-Infection in Hospitalized COVID-19 Patients
Authors: Reed Erica E , Bolker Austin , Coe Kelci E , Smith Jessica M , Stevenson Kurt , Wang Shu-Hua 
Published: December 2021

Abstract

Background
COVID-19 pneumonia can be indistinguishable from other infectious respiratory etiologies, so providers are challenged with deciding whether empiric antibiotics should be prescribed to hospitalized patients with SARS-CoV-2. This study aimed to evaluate predictors of respiratory bacterial co-infections (RBCI) in hospitalized patients with COVID-19.

Methods
Retrospective study evaluating COVID-19 inpatients from Feb 1, 2020 to Sept 30, 2020 at a tertiary academic medical center. Patients with RBCI were matched with three COVID-19 inpatients lacking RBCI admitted within 7 days of each other. The primary objectives of this study were to determine the prevalence of and identify variables associated with RBCI in COVID-19 inpatients. Secondary outcomes included length of stay and mortality. Data collected included demographics; inflammatory markers; bacterial culture/antigen results; antibiotic exposure; and COVID-19 severity. Wilcoxon rank sum, Chi Square tests, or Fisher’s exact tests were utilized as appropriate. A multivariable logistic regression (MLR) model was conducted to identify covariates associated with RBCI.

Results
Seven hundred thirty-five patients were hospitalized with COVID-19 during the study period. Of these, 82 (11.2%) had RBCI. Fifty-seven of these patients met inclusion criteria and were matched to three patients lacking RBCI (N = 228 patients). Patients with RBCI were more likely to receive antibiotics [57 (100%) vs. 130 (76%), p &lt; 0.0001] and for a longer cumulative duration [19 (13-33) vs. 8 (4-13) days, p &lt; 0.0001] compared to patients lacking RBCI. The MLR model revealed risk factors of RBCI to be admission from SNF/LTAC/NH (AOR 6.8, 95% CI 2.6-18.2), severe COVID-19 (AOR 3.03, 95% CI 0.78-11.9), and leukocytosis (AOR 3.03, 95% CI 0.99-1.16).

Conclusion
Although RBCI is rare in COVID-19 inpatients, antibiotic use is common. COVID-19 inpatients may be more likely to have RBCI if they are admitted from a SNF/LTAC/NH, have severe COVID-19, or present with leukocytosis. Early and prompt recognition of RBCI predictors in COVID-19 inpatients may facilitate timely antimicrobial therapy while improving antimicrobial stewardship among patients at low risk for co-infection.

Disclosures
All Authors: No reported disclosures
309. TB Quantiferon Testing Predicts Mortality in Patients with COVID-19
Authors: Baig Mirza Z , Liao Siyun , Powers-Fletcher Margaret , Huaman Moises A , Apewokin Senu 
Published: December 2021

Abstract

Background
Finding reliable clinical predictors for severity of COVID-19 has been challenging. Interferon gamma (IFNG) plays an important role in viral replication. QuantiFERON-TB (QFT) test relies on IFNG release in response to antigens. A positive or negative test signifies adequate IFNG response, whereas an indeterminate result is obtained when such a response is lacking. In this study, we have attempted to see if an indeterminate QFT result can provide prognostic information on patients with COVID–19.
Survival Probability in patients with Covid - 19 and an indeterminate TB Quantiferon test result

Methods
This is a retrospective study of patients who were admitted at our institute with COVID–19 and had a QFT done within one month of the positive SARS-CoV-2 nucleic acid amplification test result. Patient charts were analyzed for clinical course and outcomes, including in-hospital mortality (primary outcome), 90-day mortality, respiratory failure, requirement for intubation and other complications that would portend a more severe disease course.

Results
A total of 120 patient charts were analyzed, out of which 43 (35.8%) had an indeterminate QFT. All the indeterminate results were due to an inadequate mitogen response. The indeterminate QFT group had a 41.86% (18/43) in-hospital mortality vs. 9.09% (7/77) in the negative or positive QFT group (p-value of &lt; 0.001). The 90-day mortality was similar between the two groups. Patients with indeterminate QFT also had a higher incidence of respiratory failure (97.7% vs. 75.3%; p-value = 0.020), requirement for mechanical ventilation (55.8% vs. 23.4%; p-value &lt; 0.001), requirement of ECMO (25.58% vs. 0%; p-vale &lt; 0.001), requirement of pressor (48.83% vs. 14.28%; p-value &lt; 0.001) and requirement for renal replacement therapy (32.5% vs. 1.3%; p-value &lt; 0.001), when compared to patients with a negative or positive QFT. Patients in indeterminate group had a higher hospital length of stay than the other group (p-value = 0.035).

Conclusion
Our study indicates that patients with COVID-19 who fail to mount an adequate IFNG mitogen response in QFT assay have worse clinical outcomes and a more complicated and protracted clinical course. Evaluating cell-mediated immune responses through commercially available IFNG release assays may yield a promising strategy to predict COVID-19 clinical outcomes.

Disclosures
All Authors: No reported disclosures
310. Cryptococcal Infection Following COVID-19 infection in Solid Organ Transplant Recipients: A Case Series
Authors: Walker Jeremey , Pappas Peter , Herrera Lauren Nicholas , White Cameron , Nellore Anoma , McCarty Todd P 
Published: December 2021

Abstract

Background
Fungal infections have been identified with or following SARS-CoV-2 infection, most commonly COVID associated pulmonary aspergillosis. Cryptococcus species are ubiquitous in the environment and the third most common invasive fungal infection following Solid Organ Transplant (SOT). We describe four cases of concurrent or subsequent cryptococcal infection within 90 days following COVID-19 infection.

Methods
We conducted a retrospective study of patients presenting with proven cryptococcosis either concurrently or within 90 days following COVID-19 diagnosis. Cases were identified March 2020 through May 2021. All were seen at the University of Alabama in Birmingham, a regional referral and comprehensive transplant center. Exemption for this review was approved by our IRB.

Results
Four cases were identified, all were SOT recipients. Case details are provided in Table 1. No patients required ICU level care at any point. COVID-19 treatment included 10 days of increased steroids for 3 patients, remdesivir for 2, and 1 received no treatment for COVID-19. In contrast to the typical time-course for cryptococcal infection post-SOT (median time approx. 500 days post-transplant), three patients were greater than 2 years post-transplant and were without rejection or recent changes in immunosuppression. Patient 1 was less than 6 months post liver-kidney transplant and was diagnosed at time of admission with concurrent COVID-19 and cryptococcal pneumonia. Infection was disseminated in the other 3 cases including positive blood cultures in 2 patients and cryptococcal meningitis (CM) in 2 patients. CM cases presented later following COVID-19 and had the longest delay between symptom onset (headache, neurologic symptoms) and CM diagnosis. One patient had CM 8 years prior, but had done extremely well off fluconazole for over 6 years prior to this recurrence. All patients are doing well at most recent follow-up evaluations.
Table 1. Summary of Cases

Conclusion
We describe the first case series with a temporal association between SARS-CoV-2 infection and cryptococcosis. All cases were immunocompromised due to SOT. Some symptoms were attributed to post-COVID syndrome leading to significant delays in diagnosis for those patietns, highlighting the importance of considering this association for at-risk patients.

Disclosures
Todd P. McCarty, MD, Cidara (Grant/Research Support)GenMark (Grant/Research Support, Other Financial or Material Support, Honoraria for Research Presentation)T2 Biosystems (Consultant)
312. Clinical Attributes and Risk Factors for In- Hospital Mortality among Covid-19 Patients in a Community Hospital Setting: A Propensity Matched Analysis
Authors: Seetharam Karthik , Bhat Premila , Kumar Kelash , Wai Thinzar , Yenugadhati Vamsi , Desai Bhargav , Tamsukhin Christina , Jafar Shurovi , Castellon Diego , Badem Olga , Mir Tanveer , Vargas Sadisept , Poonam Fnu , Vargas Blanca , Martinez Juan Carlos , Pathickal Sherin , Akande Olawale , Ward Laurie , Thet Zeyar , Orris Maxine , Kanu Ngozi , Bhatt Utpal , Mir Pervez , Fuentes-Rosales Juan Carlos , Jung Youn-sung , Guadalupe Joseph , Bhat Pravin , Prabhu Hejmadi , Asti Deepak , Chawla Preety , Ponukollu Gopi , Gomez Carlos , Shah Jilan M 
Published: December 2021

Abstract

Background
New York City emerged as the Epicenter for Covid-19 due to novel Coronavirus SARS-CoV-2 soon after it was declared a Global Pandemic in early 2020 by the WHO. Covid-19 presents with a wide spectrum of illness from asymptomatic to severe respiratory failure, shock, multiorgan failure and death. Although the overall fatality rate is low, there is significant mortality among hospitalized patients. There is limited information exploring the impact of Covid-19 in community hospital settings in ethnically diverse populations. We aimed to identify risk factors for Covid-19 mortality in our institution.

Methods
We conducted a retrospective cohort study of hospitalized in our institution for Covid 19 from March 1st to June 21st 2020. It comprised of 425 discharged patients and 245 expired patients. Information was extracted from our EMR which included demographics, presenting symptoms, and laboratory data. We propensity matched 245 expired patients with a concurrent cohort of discharged patients. Statistically significant covariates were applied in matching, which included age, gender, race, body mass index (BMI), diabetes mellitus, and hypertension. The admission clinical attributes and laboratory parameters and outcomes were analyzed.

Results
The mean age of the matched cohort was 66.9 years. Expired patients had a higher incidence of dyspnea (P &lt; 0.001) and headache (0.031). In addition, expired patients had elevated CRP- hs (mg/dl) ≥ 123 (&lt; .0001), SGOT or AST (IU/L) ≥ 54 (p &lt; 0.001), SGPT or ALT (IU/L) ≥ 41 (p &lt; 0.001), and creatinine (mg/dl) ≥ 1.135 (0.001), lower WBC counts (k/ul) ≥ 8.42 (0.009). Furthermore, on multivariate logistic regression, dyspnea (OR = 2.56, P &lt; 0.001), creatinine ≥ 1.135 (OR = 1.79, P = 0.007), LDH(U/L) &gt; 465 (OR = 2.18, P = 0.001), systolic blood pressure &lt; 90 mm Hg (OR = 4.28, p = .02), respiratory rate &gt; 24 (OR = 2.88, p = .001), absolute lymphocyte percent (≤ 12%) (OR = 1.68, p = .001) and procalcitonin (ng/ml) ≥ 0.305 (OR = 1.71, P = .027) predicted in- hospital mortality in all matched patients.

Conclusion
Our case series provides admission clinical characteristics and laboratory parameters that predict in- hospital mortality in propensity Covid 19 matched patients with a large Hispanic population. These risk factors will require further validation.

Disclosures
All Authors: No reported disclosures
313. Host Protein Biomarkers Predicting Severity of Lung Damage due to COVID-19
Authors: Kerschbaumer Isabell , Fazzari Melissa , Burstein Shana R , Furey Aisha , Fox Amy S , Cole Adam M , Gendlina Inessa , Gendlina Inessa , Achkar Jacqueline M 
Published: December 2021

Abstract

Background
Biomarkers to predict the severity of lung damage due to COVID-19 are urgently needed to inform management and treatment decisions. Our objective was to investigate the predictive value of host proteins for worsening respiratory failure in one of the by COVID-19 most affected and diverse patient populations in the US.

Methods
We performed a prospective single-center cross-sectional study of 34 adult patients admitted to Montefiore Medical Center in the Bronx, New York, for respiratory symptoms due to PCR-confirmed COVID-19. Exclusion criteria were age &lt; 21, history of prior SARS-CoV-2 infection, and/or underlying severe chronic lung diseases requiring home O2 and/or high dose steroids. We stratified and compared patients by whether they developed worsening respiratory failure, necessitating transfer to the intensive care unit (ICU) during their hospital stay. Using a custom Luminex Assay, we measured hospital admission serum concentrations of 8 host proteins, representing respiratory-associated epithelial (RAGE, SP-D, CC16), endothelial (Ang-2, vWF), and immune pathways (S100A12, ICAM-1, VCAM-1).

Results
Except for race and WHO COVID-19 scores, demographics, co-morbidities, symptoms, and symptom duration were not statistically significantly different between patients requiring transfer to the ICU (n=15) and non-ICU patients (n=19). Higher log-transformed levels for 5/8 proteins (S100A12, ICAM-1, Ang-2, RAGE, SP-D) showed significant or marginally significant increased cause-specific hazard for ICU transfer (n=15). Estimated cumulative incidence functions further showed a significantly or near significantly increased risk for ICU transfer for patients with above the median values of S100A12 or ICAM-1 (p=0.013), Ang-2 (p=0.056) or RAGE (p=0.077), respectively (Figure 1). Host proteins predicting need for ICU transfer did not correlate strongly with other clinical laboratory markers for COVID-19 severity (CRP, LDH, D-Dimer, Fibrinogen, Ferritin).
Figure 1. Patients with above median levels of host protein markers S100A12, ICAM-1, Ang-2, and RAGE have a significantly or near significantly increased risk for severe respiratory failure requiring transfer to the ICU.

Comparison of estimated cumulative incidence at 7 days post admission for host protein markers above and below median levels for (A) S10012 (median 96,675 pg/ml); (B) ICAM-1 (median (1,192,277 pg/ml); (C) Ang-2 (median 3463 pg/ml); (D) RAGE (median 6356 pg/ml); and (E) SP-D (median 11,832 pg/ml).

Conclusion
These results suggest that host proteins have additional predictive value for the severity of COVID-19-associated lung damage at time of presentation to the hospital.

Disclosures
Inessa Gendlina, Nothing to disclose
314. Six-Month Post-Acute Sequelae of COVID-19: High Self-Reported Morbidity among Women and Younger Adults
Authors: Bhargava Ashish , Zhao Wei , Sharma Mamta , Szpunar Susan M , Saravolatz Louis 
Published: December 2021

Abstract

Background
Long term sequelae across multiple medical domains, including the respiratory, psychiatric, and neurocognitive have been reported after COVID-19. Studies evaluating the impact of this symptom burden, however, are lacking. We aimed to describe the self-reported occurrence of symptoms and their effect on patient functioning six months after their acute hospitalization for COVID-19.

Methods
From a historical cohort study of patients hospitalized for COVID-19 between March 8, and June 14, 2020, we identified patients discharged home. The purpose of the study was explained, and they were asked to consent to a telephone questionnaire. We used a modified version of a previously validated general symptom questionnaire (GSQ-30) to assess multi-system symptom burden. The Patient Health Questionnaire-2 (PHQ-2) was used to screen for major depression.

Results
Of the original 565 patients, 258 patients were discharged home (45%). Of these, 57 (22%) patients were able to be contacted and agreed to participate in the survey. The mean (SD) age of the respondents was 55.1 (14.8) years, and 37 (64.9%) were female. The most common symptoms at follow-up were fatigue (60.0%), dyspnea (57.1%), feeling irritable, sad or decreased pleasure (56.4%), and memory difficulty (56.4%). Females had a significantly higher GSQ score (0.02) than males. Patients ages &lt; 60 years tended to experience similar, if not greater, impaired functioning (p=0.07) compared with those ages ≥ 60 years (Table 1). Females were more likely to be irritable or sad (p=0.007), not feel rested on awakening (p=0.04), have shooting, stabbing and burning pain (p=0.02), have discomfort with normal light and sound (p=0.04), and have memory difficulty (p=0.04) than males (Table 2).
Table 1. Self-Reported Post-Acute Sequelae of COVID syndrome in adults younger than 60 versus adults at or older than 60 Years. SD: Standard deviation, ICU: Intensive care unit, ED: Emergency department, GSQ - General symptom questionnaire, PHQ-2: Patient Health Questionnaire-2

Table 2. Self-Reported Post-acute Sequelae of COVID syndrome in female versus male adults. SD: Standard deviation, ED: Emergency department, GSQ - General symptom questionnaire, PHQ-2: Patient Health Questionnaire-2

Conclusion
Our study describes the clinical burden of post-acute sequelae of COVID-19 (PASC) in four core domains: fatigue, neurologic, neuro-psychiatric and viral-like symptoms. Over 45% of patients ages &lt; 60 years suffered impaired functioning, compared with 21.1% of patient’s ages 60 years and above. Females had significantly higher GSQ scores than men which strongly corelates with the functional impairment among the females. Larger studies are needed to further validate our findings.

Disclosures
All Authors: No reported disclosures