bluuebunny/crossref_metadata_2025_split huggingface dataset:
2619. Impact of Positive Real-Time Polymerase Chain Reaction Respiratory Viral Panel on the Duration of Antimicrobials
Authors: Dass Akshith , Diaz-Cardona Yahira , Patel Sunita 
Published: November 2023

Abstract

Background
Viral pathogens are increasingly identified as the most common cause of respiratory infections. Viral respiratory panels, such as the real-time polymerase chain reaction (RT PCR), have high specificity and sensitivity for infections due to detected pathogens and are a safe tool to detect viral pathogens. The American Thoracic Society (ATS) recognizes that detecting viral pathogens or mixed viral and bacterial infections in patients with lower respiratory infections can promote appropriate antibiotic use. Optimizing the use of antibiotics is critical to effectively treat infections, protect patients from harm caused by unnecessary antibiotic use, and combat antibiotic resistance. The primary objective of this study is to determine the impact of viral respiratory panel results on the duration of antibiotic use and outcomes in patients with respiratory tract infections.

Methods
A retrospective cohort study of adult patients admitted to Cleveland Clinic Mercy Hospital from November 2021 through May 2022 with a diagnosis of suspected respiratory infection and ordered an RT PCR panel was performed. Patients with a confirmed bacterial co-infection were excluded. The primary outcome of this study is the median duration of antibiotic use. Secondary outcomes include all-cause hospital mortality, hospital length of stay, all-cause hospital readmission within 30 days, and Clostridioides difficile infection within 60 days.

Results
A total of 113 patients were included in the study, of those, 44 patients had a negative viral respiratory panel and 69 patients had a positive viral respiratory panel. The patient population was predominantly male (53%), with a median age of 69 years. The RT PCR negative group had a higher proportion of patients with COPD and CHF compared to the RT PCR positive group (84% vs 38%, p&lt; 0.001 and 50% vs. 28%, p=0.018, respectively). The primary outcome of median duration of antibiotics was significantly lower in the RT PCR positive group (0 [0-5] days vs. 6 [0-8] days, p=0.0001). There were no statistically significant differences observed between groups for any of the secondary outcomes.

Conclusion
A viral respiratory panel is a safe tool for de-escalation of inappropriate antibiotic use in patients with respiratory tract infections.

Disclosures
All Authors: No reported disclosures
2624. The Usual Suspects: A Retrospective Analysis of Pediatric Respiratory Viral Testing During the Pandemic
Authors: Cazali Iris , Erdmenger Diego , roldan Karin 
Published: November 2023

Abstract

Background
Contention measures implemented during the pandemic drastically changed the epidemiology of viral respiratory infections. Some reports have shown a sharp decrease in Emergency department visits for respiratory illnesses in the first months of the pandemic with an increase in Respiratory Syncytial Virus (RSV) and Enterovirus (EV) in subsequent months.
The concern caused by COVID-19 during the beginning of the pandemic may have led healthcare professionals to underdiagnose other respiratory viral infections. The aim of this study is to evaluate the behavior of viral infection through the pandemic.

Methods
A retrospective analysis was conducted to determine temporal changes in respiratory panel use and viral epidemiology in the pediatric ED from 2018 to 2022. Medical records were used to determine ICU admission and mortality in those with a positive respiratory panel.

Results
During the study period, a total of 10,000 respiratory PCR panels were performed in the pediatric ED. There was a significant increase in mean number of panels performed per year during the pandemic period compared to two years prior (2899 vs 198 panels/year). However, the Positivity rate decreased considerably during the pandemic (38.27% vs. 63.54%).
Of the 10,000 panels performed, COVID-19 was identified in in 993 cases (9.93%), while other respiratory viruses were identified in 31.27% of cases. The most prevalent virus identified were EV (n=1411, 14.9%) and RSV (n=483, 5.1%). These viruses also had the highest rate of ICU admission and mortality.
Patients that tested positive for COVID-19 had a lower rate of ICU admission compared to those infected by other viruses (RR=0.88; CI95%=0.78-0.99). Additionally, the mortality rate associated with COVID-19 was significantly lower than that of other viruses (RR=0.62; CI95%=0.49-0.79).
PCR Panel Positivity Rate and Viral Infections in Pediatrics ED from 2018-2022
PCR viral panel tests performed, positive tests, and viral isolates from 2018 to 2022

Conclusion
The pandemic increased the use of PCR testing for respiratory illnesses, providing a better picture of seasonal epidemiology of viral infections. Although COVID-19 infection in children was a major of concern, this report shows that throughout the pandemic other viruses were more prevalent and significantly more severe. This study serves as a reminder than even in times of emerging infections, healthcare professionals shouldn’t forget the usual causes of infection.

Disclosures
All Authors: No reported disclosures
151. Gastrointestinal infections among US Veterans in the era of multiplex PCR testing
Authors: Munir Maryam , Thorne Monique , Psevdos George 
Published: November 2023

Abstract

Background
Infectious gastroenteritis remains a common cause of morbidity in the US. While stool culture had been the standard tool for microbiological diagnosis, known for its time consuming and often lower yields, rapid diagnostic tests have now been developed. Individual and multiplex gastrointestinal (GI) polymerase chain reaction (PCR) are commercially available that can provide rapid and accurate results. We reviewed the GI infections in US Veterans (VET) assessing the use of GI PCR

Methods
Retrospective chart review from 10/1/2021 to 3/31/2023 of US VET at Northport VAMC who had positive results on Biofire® GI PCR panel; positive ova and parasites (O+P), positive stool cultures, C-difficile GDH/toxin B assays and H.pylori stool antigens

Results
In the study period there were 264 GI PCR and 224 O+P tests. 86 VET had GI infections. GI PCR identified 26 viral infections with norovirus being the most common. 16 coinfections identified. The median age was 58.5 years. 77% White, 19% Black. 81 were men. 78/86 had presented with diarrhea, 31 with abdominal pain/dyspepsia. 30 VET were treated as inpatient. 18/86 had Diabetes, 32, GERD, 11 Asthma, 13 COPD, 45 HTN, 46 HLD, 3 HIV, 20 CAD, 7 with malignancies (carcinoid, MALT lymphoma, Non-Hodgins lymphoma, lung, tonsil, prostate, multiple myeloma). 25 VET had recent exposure to antibiotics. 10 had recent travel. 59 received antibiotic therapy. 25 had prior history of C. difficile infection (CDI). Of the 30 positive tests by GI PCR, 19 were clinically treated for CDI: 14 with oral vancomycin 5 with fidaxomicin. Of the 6 campylobacter infections by GI PCR, 4 were confirmed by culture. Of the 2 positive vibrio spp by GI PCR: one vibrio cholera was not confirmed by culture and toxin assay (this patient was not included in the analysis); the other vibrio spp by PCR, culture confirmed V. parahaemolyticus. 1 VET with multiple myeloma and CDI died due to multiorgan failure. One dual infection with salmonella and Yersinia by PCR: only salmonella (non typhi) was confirmed by culture
GI Infections
Travel History, Co-Infections

Conclusion
GI PCR can offer a rapid diagnosis for viral etiologies and can be more sensitive as compared to culture for campylobacteriosis. However, vibrio and Yersinia spp results would need to be confirmed by culture. Also diagnosis of CDI would need interpretation of GDH/toxin and clinical judgement

Disclosures
All Authors: No reported disclosures
2632. Duration of viable SARS-CoV-2 shedding in immunocompromised COVID-19 patients during the widespread vaccination era
Authors: Kanai Osamu , Fujita Kohei , Hata Hiroaki , Odagaki Takao , Mio Tadashi 
Published: November 2023

Abstract

Background
Individuals with COVID-19 who are immunocompromised have been reported to experience prolonged shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to those who are immunocompetent. However, it remains unclear how long viable SARS-CoV-2 shedding persists in immunocompromised individuals during the era of widespread vaccination against COVID-19. This study aimed to evaluate the association between the duration of viable SARS-CoV-2 detection among immunocompromised individuals and their COVID-19 vaccination status.

Methods
We retrospectively reviewed patients who admitted to our institute for COVID-19 treatment between November 2022 and March 2023. We defined immunocompromised individuals as those who had received corticosteroids, immunosuppressants, or cytotoxic chemotherapy. We performed daily COVID-19 rapid antigen detection tests (RAD) on immunocompromised patients from 10 days after the onset of COVID-19 until two consecutive negative results were obtained.

Results
Among 181 patients admitted for COVID-19 treatment, 22 immunocompromised patients participated in this study. Of these, 14 (64%), 6 (27%), and 10 (46%) patients received corticosteroids, immunosuppressants, and cytotoxic chemotherapy, respectively. Twelve (55%) patients were fully vaccinated. Nine (41%) patients required oxygen therapy for respiratory failure. All patients received antiviral therapy, with 5 (23%), 12 (55%), 5 (23%) patients receiving remdesivir, ritonavir-boosted nirmatrelvir, and molnupiravir, respectively. Three (14%) patients died from COVID-19. The median duration from COVID-19 onset to confirmation of negative RAD or death was 15.5 (interquartile range: 12 to 17) days. Until 20 days after the onset of COVID-19, 17 (77%) patients had achieved two consecutive negative RAD results. There was no association between vaccination status and the duration of positive RAD results (p = 0.59) or the proportion of patients achieving negative RAD results within 20 days of COVID-19 onset (P &gt; 0.99).

Conclusion
Most immunocompromised COVID-19 patients in our hospital achieved two consecutive negative RAD results within 20 days of COVID-19 onset. Vaccination status was not associated with the duration of detectable SARS-CoV-2 shedding.

Disclosures
All Authors: No reported disclosures
2635. Introduction of point-of-care testing for respiratory viruses in congregate living facilities
Authors: Tan Charlie , Ofner Marianna , O’Brien Jacyln , Chan Christina , Kozak Robert , Thomas Neethu , Candon Heather , Chan Adrienne , Leis Jerome A 
Published: November 2023

Abstract

Background
Timely diagnosis of viral respiratory infection is critical to control respiratory viral transmission in congregate care facilities. We conducted a quality improvement study to assess whether a point-of-care (POC) testing for detection of respiratory viruses could improve time to outbreak measures in congregate living facilities.

Methods
We implemented a POC cartridge based nucleic acid amplification test platform, which detects SARS-CoV-2, influenza A, and respiratory syncytial virus, at one long-term care home and three retirement homes between December 1, 2022 and April 15, 2023. Residents with respiratory symptoms underwent paired testing, whereby nasopharyngeal swabs were tested first on POC, then on multiplex respiratory virus panel (MRVP) polymerase chain reaction at an external laboratory. We determined difference in turn-around time (TAT), as well as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), using MRVP as the reference standard. We also compared time to outbreak declaration (from MRVP result) to five other congregate care facilities without access to POC testing.

Results
A total of 189 tests were performed using POC testing, of which 39.7% (75/189) were positive. SARS-CoV-2 was the most common virus identified (90.7%, 68/75). Median difference in TAT between POC and MRVP was 34.0 hours (IQR 21.8–43.5 hours). Sensitivity, specificity, PPV and NPV of POC were 0.88, 0.87, 0.83 and 0.90, respectively. There were six outbreaks during the study period (all SARS-CoV-2), of which two were declared based on POC result alone, before MRVP was resulted. Median time to outbreak declaration from MRVP result for the remaining four outbreaks was 6.6 hours (IQR 4.6–9.2 hours). In comparison, there were nine outbreaks at the non-POC comparator facilities; median time to outbreak declaration was 15.2 hours (IQR 5.5–26.0 hours).

Conclusion
We demonstrated the feasibility of implementing a POC platform in congregate living facilities for identification of respiratory viral infection. The improved TAT resulted in more expedited detection and declaration of outbreaks.

Disclosures
Jerome A. Leis, MD MSc FRCPC, Ontario Hospital Association, Ministry of Attorney General of Ontario, Seneca College: Expert Testimony
2645. Severe Human Parainfluenza Virus-associated Pneumonia in Adults, Seoul, South Korea, 2010-2019
Authors: Park Joung Ha , Hong Sang-Bum , Huh Jin Won , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Sung Heungsup , Doh Kyung Hyun , Kim Sung-Han , Lee Sang-Oh , Kim Yang Soo , Lim Chae-Man , Koh Younsuck , Choi Sang-Ho 
Published: November 2023

Abstract

Background
Human parainfluenza virus (HPIV) is a major cause of acute respiratory tract infections such as croup in children and pneumonia in immunocompromised patients. HPIV infections are generally regarded as mild and self-limiting in adults, however, HPIV-associated pneumonia is increasingly reported in adults. To the best of our knowledge, data on the epidemiological and clinical characteristics of severe HPIV-associated pneumonia in adults are limited. Therefore, we investigated the epidemiological and clinical characteristics and outcomes of severe HPIV-associated pneumonia over ten years in a large cohort of critically ill adults with severe pneumonia requiring intensive care.

Methods
This sutdy was performed as a part of a prospective observational cohort study regarding severe virus-associated pneumonia at the 28-bed medical intensive care unit (ICU) at a 2,700-bed hospital, in Seoul, South Korea. Patients with severe HPIV-associated pneumonia were enrolled in this study, and the clinical data of these patients were analyzed. To describe the clinical outcomes of severe HPIV-associated pneumonia, we compared the HPIV-associated pneumonia outcomes with those of severe influenza virus-associated pneumonia.

Results
A total of 143 adult patients with severe HPIV-associated pneumonia were identified. HPIV is the most common cause (25.2%) of severe viral hospital-acquired pneumonia (HAP), and it is the third most common cause (15.7%) of severe viral community-acquired pneumonia. The median age of the patients was 61.6 years old. Almost patients (97.2%) had comorbidities, and hematologic malignancy (35.0%), diabetes mellitus (23.8%), and structural lung disease (21.0%) were common cormobidities. About half of the patients (54.5%) had co-infections at the time of ICU admission. The 90-day mortality was comparable with that of severe influenza virus-associated pneumonia (55.2% vs 48.4%, p = 0.22). The use of ribavirin was not associated with lower mortality. Fungal co-infections were associated with higher mortality (82.4% [14/17]).

Conclusion
In conclusion, HPIV was the leading cause of severe viral HAP with substantial mortality, comparable to that of influenza virus-associated penumonia. Fungal co-infections contributed to the high mortality rates.

Disclosures
All Authors: No reported disclosures
2654. International Multi-Center Study Comparing the Effect of Obinutuzumab or Rituximab Treatment in Hematological Patients on COVID-19 Outcomes During the Omicron Surge
Authors: Shafat Tal , Grupel Daniel , Porges Tzvika , Belkin Ana , Deri Ofir , Oster Yonatan , Zahran Shadi , Horwitz Ehud , Horowitz Netanel A , Khatib Hazim , Batista Marjorie , Cortez Anita , Brosh-Nissimov Tal , Segman Yafit , Ishay Linor , Cohen Regev , Atamna Alaa , Spallone Amy , Chemaly Roy F , Ramos Juan Carlos , Chowers Michal , Rogozin Evgeny , Carmi-Oren Noga , Keske Şiran , Barchad Orit Wolfovitz , Nesher Lior 
Published: November 2023

Abstract

Background
Hematological malignancy (HM) patients treated with anti-CD20 monoclonal antibodies are at higher risk for severe COVID-19 and adverse outcomes. A previous single-center study showed worse outcomes in patients treated with obinutuzumab than those treated with rituximab.

Methods
This is an international, multi-center population-based study across 15 centers (Israel, USA, Spain, Brazil, and Turkey). We included patients with HM treated with obinutuzumab or rituximab between December 2021 and June 2022, when Omicron lineage variants were dominant.

Results
We collected data on 1049 patients, of which 761 (73%) received rituximab. Of the rituximab group, 191 contracted COVID-19 compared to 104 in the obinutuzumab group (fig 1). COVID-19 patients in the obinutuzumab group were younger (mean age of 61±11.7 vs. 64 ±14.5 years, p=0.037), had more favorable HM diagnosis (aggressive lymphoma: 7.7% vs. 67.0%, p&lt; 0.001), and were on maintenance therapy at COVID-19 diagnosis (62.4% vs. 36.2%, p&lt; 0.001). Severe COVID-19 occurred in 31.7% (n=33) of patients in the obinutuzumab group and in 22.0% (n=42) in the rituximab group (fig 2). In a multivariable analysis for severe COVID-19, adjusted for Charlson co-morbidity index, HM status, and tixagevimab/cilgavimab (T-C) prophylaxis, we observed an odds ratio of 2.06 (95% CI 1.11-3.81, p=0.021) for obinutuzumab treatment. Prophylaxis with T-C was protective (OR 0.32 95% CI 0.10-0.99, p=0.048). In the secondary outcomes analysis, more patients with COVID-19 in the obinutuzumab were hospitalized (51.9% vs. 35.1% p=0.005), required ICU admission (13.5% vs.5.3%, p=0.014), with a non-significant difference in COVID-19 related mortality (n=11, 10.6% vs. n=12, 6.3%, p=0.189).

Conclusion
This international, multi-center cohort study demonstrates that despite younger age and more favorable HM diagnoses, patients receiving obinutuzumab had more severe COVID-19 outcomes than those receiving rituximab. Our findings underscore the need to evaluate the risk-benefit when considering obinutuzumab therapy for HM patients and re-emphasize the crucial role of pre-exposure prophylaxis with effective anti-SARS-CoV-2 monoclonal antibodies during high transmission in the community.

Disclosures
Roy F. Chemaly, MD/MPH, Eurofins-VViracor: Grant/Research Support|Karius: Advisor/Consultant
2656. Longitudinal Trends in Attributable Causes of Death Among US Veteran Patients with Documented SARS-CoV-2 Infection between January 2021 and March 2023
Authors: Trottier Caitlin A , La Jennifer , Li Lucy , Fillmore Nathanael , Monach Paul , Branch-Elliman Westyn , Doron Shira 
Published: November 2023

Abstract

Background
COVID-19 was the third leading cause of death in the US in 2020, and as of April 2023, &gt;1,000,000 deaths have been attributed to this disease. With widespread immunity and medical countermeasures, the attribution of a death to COVID-19 has become more complex. The aim of this study was to examine the trends in the proportion of deaths attributed to COVD-19 in both vaccinated and unvaccinated patients following a documented positive SARS-CoV-2 test.

Methods
We used an electronic tool, developed using a chart reviewed sample of national Veterans Affairs (VA) data and validated on manually adjudicated cases at Tufts Medical Center, to classify deaths as attributable to COVID-19; both deaths in which COVID-19 contributed and was the primary cause of death were captured by the tool. The tool comprises a 3-point index (remdesivir, dexamethasone, baricitinib, or tocilizumab receipt; hypoxemia with SpO2 &lt; 90% or supplementary oxygen &gt; 2L), for which a score 2-3 has a high positive predictive value (PPV, 0.82-0.95) for COVID-19-related death. We then applied the tool to classify all known deaths among VA patients within 30 days of a positive SARS-CoV-2 test between January 2021 and March 2023 to measure longitudinal trends.

Results
A decrease in the proportion of deaths attributable to COVID-19 between August 2021 and March 2023 was identified (p-value for trend, &lt; 0.001). Despite an overall higher number of deaths attributable to COVID-19 in the vaccinated population (6081 versus 4697, and 2650 versus 488 in the 12 months starting March 2022, Figure 1), the proportions of deaths attributable to COVID-19 (Figure 2) was similar in both cohorts, trending from &gt; 70% to &lt; 50%.

Conclusion
Throughout the pandemic, there have been a myriad of measures used to guide the ongoing public health response including case rates, hospitalization rates, and death rates. Because chart review is the only way to more definitively determine whether a hospitalization or death is directly or indirectly caused by COVID-19, much of the data, obtained through more crude means, lack accuracy. Our electronic tool gives a closer approximation to what is obtained by chart review than the other commonly used measures and reveals that overall, the proportion of attributable deaths has universally decreased.

Disclosures
Paul Monach, MD, PhD, HI-Bio: Advisor/Consultant Westyn Branch-Elliman, MD, MMSc, Gilead Sciences: Grant/Research Support
2658. Mortality among children hospitalized with suspected pneumonia during the COVID-19 pandemic in India (PREVAIL study)
Authors: Yang Yangyupei , Knoll Maria D , Agarwal Anurag , Manchanda Vikas , Higdon Melissa , Dayal Rajeshwar , Agarwal Arti , Chaurasia Deepti , Shrivastav Jyotsna , Dhingra Dhulika , Qureshi Shariqa , Sharma Rajni , Choudhary Richa , Bhattacharyya Subhashish , Saha Sudip , Mehta Kayur , Shet Anita 
Published: November 2023

Abstract

Background
COVID-19 has indirectly led to excess deaths attributable to other illnesses. Pre-pandemic studies in India have shown mortality rates of 3-12% amongst young children hospitalized with suspected pneumonia. Here, we describe mortality among young children hospitalized with pneumonia during the COVID-19 pandemic.

Methods
Children aged 1-35 months hospitalized with suspected pneumonia were enrolled prospectively across six sites in India. Demographic and clinical information were obtained, and children were followed until 90 days after hospital discharge.

Results
Between October 2020 and November 2022, 4,517 children with suspected pneumonia were enrolled and 4,443 (98.4%) with known mortality status were included in this analysis. Monthly average enrollment was 104 before and during the SARS-CoV-2 peak Delta period (April–June 2021) and 213 post-peak-Delta period (July 2021–November 2022). 71% had WHO-defined severe pneumonia, 26% had SpO2&lt; 90% at admission, 39 of 3000 tested were SARS-CoV-2 positive, and 17% left against medical advice (LAMA). Of 723 total deaths (case fatality ratio (CFR)=16%), 42% were detected in-hospital, 23% occurred within 48 hours after discharge/LAMA, and 35% occurred 2-90 days after discharge/LAMA. CFR was higher among children before and during than post Delta peak (28% vs. 11%, p&lt; 0.001) but average number of deaths per month was similar (28.2 vs. 27.6). Mortality was higher in LAMA cases (32% vs. 5.3%, p&lt; 0.001) and accounted for most (57%) post-hospitalization deaths.

Conclusion
A high CFR (16%) was observed for young children hospitalized for pneumonia in India, with 58% of deaths occurring after discharge. Deaths were higher during the-Delta and Delta wave wave of the COVID-19 pandemic. Although very few children had COVID-19, pandemic-related restrictions and late presentation to healthcare may have contributed to high mortality from pneumonia.

Disclosures
All Authors: No reported disclosures