bluuebunny/crossref_metadata_2025_split huggingface dataset:
268. Methicillin Sensitive Versus Methicillin Resistant Staphylococcus aureus Nosocomial Meningitis
Authors: Akyol Deniz , özcem Selin Bardak , Mermer Sinan , Aydemir Şöhret , Yamazhan Tansu , Arda Bilgin , Özgiray Erkin , Yurtseven Taşkın , Ulusoy Sercan , Sipahi Oğuz Reşat 
Published: December 2021

Abstract

Background
Herein, we aimed to analyze the outcomes of the methicillin sensitive (MS) versus methicillin resistant (MR) culture-proven Staphylococcus spp. nosocomial meningitis (S-NM) in our setting.

Methods
We extracted data and outcomes for all adult patients (age &gt;18 years) consulted by the Infectious Diseases Consultants and diagnosed NM (developed at a compatible time according to CDC nosocomial meningitis definitions) between January 2006 and 2021 and fulfilled the following study inclusion criteria: (a) Age ≥18-year-old; (b) CSF culture is positive for Staphylococcus spp. (c) Presence of at least two of three clinical/laboratory criteria as meningitis findings: (i) Body temperature &gt;38oC; (ii) CSF finding; &gt;250 leucocytes/mm3; (iii) at least one of the following clinical findings, ie. impairment of consciousness, neck stiffness, nausea/vomiting. Identification of the infecting bacteria and determination of antimicrobial susceptibility were performed using the VITEK 2 automated system (BioMerieux Inc, Mercy L’etoil, France) and conventional methods. Resistance to methicillin was tested by E-test (bioMérieux). Antibacterial susceptibility tests were evaluated according to Clinical Laboratory Standards Institute (CLSI) criteria until 2014 and EUCAST between 2015 and 2021. Chi-square and Student T tests were used for statistical comparison.

Results
A total of 9 patients in MSS-NM, 41 patients in MRS-NM group fulfilled the study inclusion criteria. Age, gender, and CSF findings (except CSF glucose was significantly lower in MSS-NM) were similar in both groups (Table 1). Besides, EOT clinical success and overall success (EOT success followed by one-month survival without relapse or reinfection) rates were similar (Table 1). Relapse and reinfection rates during post-treatment one month period were 0%-0% and 0%-6.6% in MSS/MRS-NM, respectively. In MRS-NM group reinfection pathogens were Acinetobacter baumannii and Pseudomonas aeruginosa after 12 and 30 days end of treatment.
Characteristics of NM

Conclusion
Overall success in MSS-NM was acceptable while it was non-significantly lower in MRS-NM. The medical community should seek better infection control measures from NM.

Disclosures
All Authors: No reported disclosures
271. US Hospitalizations and 60-Day Readmission Rates Associated with Herpes Simplex Virus Encephalitis
Authors: Hansen Michael , Hasbun Rodrigo , Hasbun Rodrigo 
Published: December 2021

Abstract

Background
Herpes Simplex encephalitis (HSE) is the most common cause of encephalitis hospitalizations with a known etiology. However, it remains a challenge to capture a comprehensive and robust understanding of the disease, particularly for long term outcomes after acute diagnosis and treatment. In particular, there is a growing body of literature showing increased concern for recurrent encephalopathic disease several weeks after initial HSE recovery. We sought to describe and analyze features associated with all cause readmissions and encephalopathy associated readmissions amongst HSE cases.

Methods
HSE hospitalizations and 60-day rehospitalizations were assessed in a retrospective cohort using linked hospitalizations from the Healthcare Utilization Project (HCUP) National Readmission Database (NRD) from 2010 through 2017. Risk factors for all-cause readmissions and encephalopathy associated readmissions were assessed with a weighted logistic regression model.

Results
There were 10,272 HSE cases in the United States between 2010 and 2017, resulting in a national rate of 4.95 per 100,000 hospitalizations. A total of 23.7% were readmitted at least once within 60-days. Patients that were readmitted were older (mean age 62.4 vs. 57.9, p&lt; 0.0001), had a greater number of procedures at the index hospitalization (aOR 1.03, p&lt; 0.0001) and have a higher Charlson comorbidity score (aOR 1.11, p&lt; 0.0001). Amongst those readmitted, 465 (16.5%) had an encephalopathy related diagnosis. Over eight years, the prevalence of encephalopathy associated readmissions increased from 0.12 to 0.20 (figure 1). Encephalopathy specific readmissions were found to be associated with greater age (mean age 6.9 vs. 61.7, p = 0.004) and findings of cerebral edema at index hospitalization (aOR 2.16, p &lt; 0.0001).
Most Common Diagnosis Groups Listed at the 60-Day Readmission

Conclusion
HSE 60-day readmissions are relatively common, particularly among older and sicker individuals. Readmissions were often associated with new neurological symptoms concerning for either recurrent or new encephalopathic events. Early signs and symptoms of neurological disease at index were correlated with encephalopathic specific readmissions.

Disclosures
Rodrigo Hasbun, MD, MPH, Biofire (Speaker’s Bureau) Rodrigo Hasbun, MD, MPH, Biofire (Individual(s) Involved: Self): Consultant, Research Grant or Support
272. Clinical Utility of Sulfamethoxazole Serum Level Monitoring in the Treatment of Brain Abscesses due to Nocardia Species
Authors: Campioli Cristina G Corsini , Rivera Christina G , Mara Kristin , Saleh Omar Abu 
Published: December 2021

Abstract

Background
Although trimethoprim-sulfamethoxazole (TMP-SMX) has consistently demonstrated significant interindividual variability, therapeutic drug monitoring is used to optimize dosing and avoid adverse reactions that may contribute to treatment interruption. While data exists on the use of SMX level monitoring in pneumocystis, there is a lack of data in SMX serum monitoring utility for invasive Nocardia infections.

Methods
We retrospectively reviewed adults who received TMP-SMX to treat nocardial brain abscess (BA) and underwent SMX testing level from January 2010 to December 2020.

Results
Overall, 24 patients had Nocardia spp. BA; Twenty-two (91.7%) were treated with TMP-SMX, and 16/22 (72.7%) had a documented SMX serum level. The median age was 64 (IQR 58-69) years, and the majority were males (77.3%). Compared to those who did not have a documented SMX serum level, patients with SMX levels had a higher prevalence of hemodialysis (HD, 42.9% vs. 33%; P=.99) and malignancy (50% vs. 33.3%; P=.65). The most common BA location was the frontal lobe (43.8% vs. 33.3%; P=.99), with a single (68.8% vs. 50%; P=.62) and smaller (1.3 vs. 1.9 cm; P=.58) brain fluid collection, and with fewer midline shift (6.3% vs. 16.7%; P=.48), respectively. The median TMP-SMX duration was 350 days (P=.31). The most common dosing was 2-double strength, three times a day (31.8%). The SMX median level was 158.5 (IQR 120-218) mcg/mL, collected at two hours (75%) post-administration in the induction phase (81.3%). The most common recommendation was to continue therapy based on the level results. Eleven (46%) patients had a level &gt;150 mcg/mL, and 5 (45.5%) reported drug toxicity, including nausea in 3, acute kidney injury in 2, and thrombocytopenia in 2 patients. Ninety-four percent of the patients with SMX levels had surgical intervention for therapeutic purposes vs. 83% of those without it (P=.65). A total of 11 (50%) patients were cured, 3 (18.8%) relapsed, and 2 (12.5%) died.

Conclusion
Patients with SMX serum level monitoring are more likely to be on HD, during the induction phase and among those with higher and more frequent dosing. About half of patients with SMX levels &gt;150 mcg/mL experienced drug toxicity; however, SMX levels did not impact patient outcome and length of treatment.

Disclosures
All Authors: No reported disclosures
284. Antibiotic Prescribing Trends in Hospitalized Influenza Versus COVID-19 Patients at a Community-Based Health System
Authors: Martinez Aileen , Cardona Lyssette , Ricci Nina 
Published: December 2021

Abstract

Background
The 2019 coronavirus SARS-CoV-2 continues to affect global population health. Patients with severe disease that require hospitalization due to COVID-19 pneumonia remain at further risk of bacterial co-infections. There is limited evidence suggesting up to 3.5% bacterial co-infection upon admission and up to 13.5% of secondary infections after hospitalization for pneumonia yet antibacterial therapy usage remain as high, or even higher, than data seen for viral pneumonia, such as influenza. Unnecessary use of antimicrobial therapy may lead to further resistance and requires stewardship attention.

Methods
A single-center retrospective chart review was conducted in a community health system on all inpatient influenza admissions between October 1st 2019 to March 31st 2020 and all COVID-19 admissions during the same 6-month period one year later. Patients were excluded if age &lt; 18, observation or emergency visit. The study aims to determine the percentage of patients that were prescribed antibacterial therapy during influenza season compared to during the COVID-19 pandemic.

Results
A total of 175 patients were included in the influenza group while 1411 patients were included in the COVID-19 group (Table 1). The percent of inpatients with positive bacterial respiratory cultures were 12% in both influenza and COVID-19 groups. Positive bacterial respiratory cultures collected within 48 hours of admission were 3.4% in the influenza group compared to 1.2% in the COVID -19 group. Seventy-three percent of patients in the influenza group received antibiotics during admission compared to 78% in the COVID -19 group. Azithromycin and/or ceftriaxone was most commonly prescribed (58% vs. 60%) (Figure 1). The median length of stay was 3 days in the influenza group compared to 5 days in the COVID-19 group. In hospital mortality was higher in the COVID-19 group (1.7% vs. 9%).

Conclusion
Despite the viral origin of influenza and COVID-19 and low incidence of bacterial infection, antibacterials were frequently prescribed in both indications but it appears to trend more so in the COVID-19 group. There is an opportunity to enhance antimicrobial stewardship for the treatment of COVID-19 in acute care settings.

Disclosures
All Authors: No reported disclosures
294. Surveillance for Potential Post-Acute COVID-19 Syndrome Medical Complications in the Emergency Department (ED) – A Retrospective Longitudinal Study of ED Patients Who Had Evidence of SARS-CoV-2 Infection Versus Those Who Did Not
Authors: Lake Isabel , Wang Richard C , Rothman Richard E , Laeyendecker Oliver , Fernandez Reinaldo , Dashler Gaby , Quinn Thomas , Hsieh Yu-Hsiang 
Published: December 2021

Abstract

Background
As the COVID-19 pandemic continues, growing attention has been placed on whether patients previously infected with SARS-CoV-2 have an increased risk of developing and/or exacerbating medical complications. Our study aimed to determine whether individuals with previous evidence of SARS-CoV-2 infection prior to their current emergency department (ED) visit were more likely to present with specific clinical sign/symptoms, laboratory markers, and/or clinical complications.

Methods
A COVID-19 seroprevalence study was conducted at Johns Hopkins Hospital ED (JHH ED) from March 16 to May 31, 2020. Evidence of ever having SARS-CoV-2 infection (PCR positive or IgG Ab positive) was found in 268 ED patients at this time (i.e. infected and/or previously infected). These patients were matched 1:2 to controls, by date, to other patients who attended the JHHED. Clinical signs/symptoms, laboratory markers, and/or clinical complications associated with ED visits and/or hospitalizations at JHH within 6 months after their initial ED visit was abstracted through chart review for these 804 patients. Cox proportional hazards regression analyses were performed.

Results
Among 804 ED patients analyzed, 50% were female, 56% Black race, and 15% Hispanic with a mean age of 47 years. 323 (40%) patients had at least 1 subsequent ED visit and additional 70 (9%) had been admitted to JHH. After controlling for race and ethnicity, patients with evidence of current or prior COVID-19 infection were more likely to require supplemental oxygen [hazards ratio (HR) =2.53; p=0.005] and have a cardiovascular complication [HR =2.13; p=0.008] during the subsequent ED visit than the non-infected patients.

Conclusion
Our findings demonstrate that those previously infected with SARS-CoV-2 have an increased frequency of cardiovascular complications and need for supplemental oxygen in ED visits in the months after their initial SARS-CoV-2 infection was detected. EDs could serve as a critical surveillance site for monitoring post-acute COVID-19 syndrome complications.

Disclosures
Richard E. Rothman, PhD, MD, Chem bio (Grant/Research Support)
317. Invasive Fungal Infections in Critically-ill Patients with COVID-19 in Mexico City
Authors: Bojorges-Aguilar Eduardo S , Roman-Montes Carla M , Martinez-Gamboa Areli , Rangel-Cordero Andrea , Diaz-Lomeli Paulette G , Rivero-Sigarroa Eduardo , Sifuentes-Osornio Jose , de Leon Alfredo Ponce , Gonzalez-Lara Fernanda 
Published: December 2021

Abstract

Background
Invasive fungal infections (IFI) are emergent complications in SARS-CoV-2 infection. We aimed to describe the epidemiology, characteristics and outcome of IFI during the pandemic.

Methods
Between March 2020 and April 2021, patients admitted to the Intensive Care Unit (ICU) in a COVID-19 center in Mexico City who developed IFI were included. COVID-19 associated pulmonary aspergillosis (CAPA) was defined according to the ECMM/ISHAM criteria. Demographic and clinical data were obtained from the electronic medical record. Descriptive analysis was made. The study was approved by the Institutional Review Board.

Results
Sixty-seven (67/743, 9%) patients with COVID-19 developed IFI during ICU stay, of which 37 (55%) had CAPA, 24 (36%) had Invasive Candidiasis (IC), 3 Cryptococcosis and 3 pulmonary Mucormycosis. The median age was 57.5 (IQR 48-68) and 46 (69%) were male. Thirty-six (54%) had obesity and 20 (30%) type 2 diabetes. Sixty-two received COVID-19 directed therapy: 48/67 (72%) steroids, 4/67 (6%) tocilizumab and 8/67 (12%) were included in clinical trials. Among 24 patients with IC, 13 (54%) were fluconazole-resistant C. parapsilosis, 11 (46%) C. albicans and 2 C. glabrata. Twenty-two received antifungal treatment, 20 with echinocandins and 2 fluconazole. Among 37 CAPA, 8 (22%) were probable and 29 (78%) possible. Serum galactomannan was positive in 8 (22%), 33 respiratory cultures grew Aspergillus (31 tracheal aspirates and 2 bronchoalveolar lavage). Aspergillus fumigatus was the most frequent isolate in 18/33 (55%). Chest CT showed ground glass opacities in 21 (57%). Most received voriconazole (26/37, 70%). The median time from ICU admission to IFI was 9.5 (IQR 3-14) days. The median ICU and hospital stay length were 30 days (IQR 16-41) and 40 days (IQR 23-49), respectively. In-hospital mortality was 48%. The incidence rate of IC was higher early in the pandemic, due to Infection Control breaches, while higher CAPA incidence may have occurred later due to ventilation system gaps (Figure 1).
Bi-monthly Invasive Fungal Infection incidence rate/100 ICU admissions.

Conclusion
We found 9% incidence of IFIs in critically-ill COVID-19 patients with high mortality. The majority received steroids, had obesity and had a prolonged hospital stay. Most had possible CAPA. An outbreak of fluconazole-resistant C. parapsilosis was found.

Disclosures
All Authors: No reported disclosures
320. Differentiating Dengue from COVID-19: A Diagnostic Challenge in the Tropical Regions of the Americas
Authors: Rosso Fernando , Rojas Olga Lucia agudelo 
Published: December 2021

Abstract

Background
The differentiation between dengue and coronavirus disease 2019 (COVID-19) diagnoses is a challenge in tropical regions due to the similarity of symptoms and limited access to specific diagnostic tests for each disease. The objective of this study was to describe the initial symptoms and laboratory test values of patients who presented to the emergency department with dengue or COVID-19. A cross-sectional study was performed in a single center in Cali, Colombia

Methods
The inclusion criteria were patients with a diagnosis of dengue or COVID-19 who were older than 14 years of age. All patients experienced fever or other symptoms for fewer than ten days. Linear regression was performed to evaluate the differences in the neutrophil-lymphocyte ratio (NLR) between patients diagnosed with COVID-19 and dengue and was adjusted for sex and age group (≤31 and &gt;31 years). The sample size was calculated to test the hypothesis that the median NLR in COVID-19 patients is higher than that in dengue patients. A p-value &lt; 0.05 was considered statistically significant for all analyses

Results
A total of 93 patients were included: 70 with dengue and 23 with COVID-19. Dengue patients were younger than COVID-19 patients. There were significant differences between dengue and COVID-19 patients regarding platelet count (p&lt; 0.01), neutrophil count (p&lt; 0.01), neutrophil-lymphocyte ratio (NLR) (p&lt; 0.01), and abnormal alanine transaminase (ALT) (p=0.03). The NLR was significantly higher in COVID-19 patients than in dengue patients (p&lt; 0.01).
Table 1. Demographics, clinical and laboratory characteristics in COVID-19 and dengue patients.

Conclusion
In conclusion, during the first week of symptoms, absolute neutrophil count, NLR, and platelet count could help guide the initial differential approach between dengue and COVID-19. These findings could be useful in geographical areas with a lack of resources.

Disclosures
All Authors: No reported disclosures
330. Evaluating the Relationship Between Comorbidity Treatment Status and In-hospital Mortality Among COVID-19 Patients
Authors: Davenport Cristy , Osae Sharmon P , Thomas Geren , Young Henry N , Henao Martínez Andrés F , Franco-Paredes Carlos , Chastain Daniel B 
Published: December 2021

Abstract

Background
Chronic comorbidities increase the risk of poor outcomes in patients with COVID-19. However, there are insufficient data to determine whether control of chronic comorbidities influences outcomes. The purpose of this study was to determine whether pharmacologic treatment for common comorbidities influences in-hospital mortality.

Methods
This multicenter, retrospective study included adult patients with diabetes, hypertension, and/or dyslipidemia who were hospitalized with COVID-19 in Southwest GA, U.S. Patients were divided into two groups based on treatment status, where treated was defined as documentation in the electronic medical record of outpatient pharmacologic therapy indicated for that specific comorbidity while untreated was defined as no record of pharmacologic therapy for one or more comorbidity. The primary outcome was to compare in-hospital mortality between treated and untreated COVID-19 patients. Secondary outcomes included comparing length of hospital stay, development of thrombotic events, requirement for vasopressors, mechanical ventilation, and transfer to the ICU between groups.

Results
A total of 360 patients were included with a median age of 66 years (IQR 56-75). The majority were African American (83%) and female (61%) with a median Charlson Comorbidity Index of 4 (IQR 2-6). Hypertension, diabetes, and dyslipidemia were present in 91%, 55%, and 45% of patients, respectively, of which 76% (n=274) were treated. Mortality was similar between treated and untreated patients (25% vs 20%, p=0.304). Average length of stay was 9.5 days (SD 8.7) in treated patients compared to 10.6 days (SD 9.1) in untreated patients (p=0.302). No differences were observed in the rates of thrombosis (3% vs 4%, p=0.765), receipt of vasopressors (23% vs 21%, p=0.741), mechanical ventilation (31% vs 27%, p=0.450), or transfer to the ICU (27% vs 14%, p=0.112).

Conclusion
Hospitalized COVID-19 patients being treated for hypertension, diabetes, and/or dyslipidemia have similar rates of complications and mortality compared to untreated patients. Further research is needed to determine whether degree of control of chronic comorbidities impacts COVID-19 outcomes.

Disclosures
All Authors: No reported disclosures
344. Prevalence and Impact of Post-Acute Sequelae of COVID-19 Among People Experiencing Homelessness in King County, WA Between September 2020 - May 2021
Authors: Scott Emily M , Cox Sarah N , Rogers Julia H , Wasse Jessica Knaster , Chu Helen Y 
Published: December 2021

Abstract

Background
Homeless shelters are high risk settings for SARS-CoV-2 transmission. People experiencing homelessness (PEH) have high rates of chronic illness, and have been disproportionately affected by COVID-19. The burden of post-acute sequelae of COVID-19 (PASC) in PEH has not been well-studied and PEH may be uniquely affected due to barriers to medical care and the potential exacerbation of existing threats to health, housing, employment, and self-care.

Methods
The Seattle Flu Study conducted community-based surveillance for SARS-CoV-2 in nine homeless shelters from September 1, 2020 and May 31, 2021. Individuals with and without respiratory symptoms were tested for SARS-CoV-2 infection using a PCR assay. We completed follow-up surveys with shelter residents age ≥18 years at days 5, 10, 30 and 60+ after positive or inconclusive diagnosis with SARS-CoV-2 infection. Individuals were asked about residual symptoms, impact on activities of daily living, access to medical care, and health-related quality of life.

Results
Of 51 eligible participants, 22 (43%) completed a follow-up survey, with six at day 5 or 10 survey, 11 at day 30, and 18 at day 60+. The median time from enrollment to last follow-up survey was 77 (range 49-138) days. Five (23%) participants reported at least one symptom at day 0, five (83%) at day 5 or 10, eight (73%) at day 30 and seven (39%) at day 60+ (Figure 1). Eight (36%) reported at least one symptom on a day 30 or 60+ follow up survey that interfered or prevented their daily activities. Nine (41%) received medical care at the quarantine facility. Of those with symptoms persisting beyond day 10, four (30%) received medical care outside of a medical provider at the quarantine facility.

Prevalence of self-reported symptoms at Day 0 (enrollment), Day 5 or 10, Day 30, and Day 60+ in shelter residents who tested positive or inconclusive for SARS-CoV-2.

Conclusion
PEH reported a high prevalence of persistent COVID-19 symptoms 30+ days after their SARS-CoV-2 detection. Few participants accessed medical care for their persistent illness. The impact of COVID-19 extends beyond acute illness and PASC may exacerbate existing challenges PEH face in health and wellbeing.

Disclosures
Helen Y. Chu, MD MPH, Bill and Melinda Gates Foundation (Consultant)Cepheid (Research Grant or Support)Ellume (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi-Pasteur (Research Grant or Support)