bluuebunny/crossref_metadata_2025_split huggingface dataset:
507. Impact of COVID-19 variant prevalence on hospitalization rate among individuals receiving monoclonal antibodies within a community health-system
Authors: Arnoczy Gretchen S , Kessell Andrew , Vielbaum Felicia M , Brock Brenda , Carter Rebecca , Scholl Jan M 
Published: November 2023

Abstract

Background
During the COVID-19 pandemic, multiple targeted monoclonal antibodies were used in high risk patients with early COVID-19 to prevent complications. Serving as the primary referral site for a large geographic region in central North Carolina, our rural community health-system administered monoclonal agents to COVID-19 positive patients from December 2020 to November 2022. During this time period three predominate variants emerged (alpha, delta and omicron).
Monoclonal Antibody Infusions at FirstHealth of the Carolinas, December 2020-November 2022

Methods
A retrospective study was conducted at FirstHealth of the Carolinas Moore Regional Hospital examining patients from December 1st, 2020 to November 30th, 2022. All COVID-19 positive patients receiving one of the COVID-19 monoclonal therapies granted emergency use authorization during the study period were included. Patients were sub-divided into three distinct time periods representing different variants based on the prevalent pathogen in our region: December 2020 – June 2021 (alpha); July 2021- December 2021 (delta); January 2022-November 2022 (omicron). Hospitalization rates post monoclonal treatment were compared between time periods.

Results
1820 monoclonal antibody infusions for COVID-19 were administered within the FirstHealth of the Carolinas system in the period studied. Number of infusions were highest during delta with over 60% of the infusions occurring during this period. Hospitalization rates in this group were 3.5% (alpha), 3.5% (delta), and 2.0% (omicron). Vaccination status among individuals getting monoclonal antibody infusions changed over time based on changing infusion criteria and variant prevalence.

Conclusion
In a real world, rural, community health care setting in the Southeast United States - hospitalization rates for high-risk individuals receiving monoclonal antibody infusions for COVID-19 were similar to reported rates and varied by variant prevalence. This is may be due to alterations in variant severity as well as vaccination status of the population.

Disclosures
All Authors: No reported disclosures
513. Evaluating the safety of baricitinib versus tocilizumab in hospitalized patients with COVID-19
Authors: Brickel Kendall , Meyenburg Lyndsi , Rose Dusten T T , Pan Neil 
Published: November 2023

Abstract

Background
Tocilizumab and baricitinib are immunomodulators that combat immune dysregulation observed in patients with COVID-19. To date, no studies have explicitly looked at the safety of baricitinib versus tocilizumab in patients with COVID-19.

Methods
This evaluation is a multicenter, retrospective cohort study of adult patients treated with either baricitinib or tocilizumab for COVID-19 within the Ascension Seton network from May 1st, 2020 - August 31st, 2022. A control group consisted of patients who would otherwise have qualified for treatment but did not receive either agent. The primary objective was the incidence of adverse effects in patients with COVID-19 treated with baricitinib versus tocilizumab. Secondary objectives include rates of thromboembolism, hematologic toxicity, hospital-acquired infection, hepatic enzyme elevation, gastrointestinal perforation, death, and any adverse effect believed to be secondary to or that resulted in the discontinuation of either study medication. A chi-squared test was used to assess the primary outcome. Secondary outcomes were analyzed using appropriate statistical tests.

Results
Of the 737 patient encounters screened, 145 patients were included in each group. Adverse event rates were 112/145 (77.2%) for the baricitinib group and 114/145 (78.6%) for the tocilizumab group (p = 0.78). In the control group, adverse event rates were 86/145 (59.3%), and a Kruskal–Wallis test revealed a difference between the three groups (p = 0.007). Twenty-two (15.3%) of patients who received baricitinib experienced a documented adverse drug reaction based on progress notes from the provider versus one (1.4%) patient in the tocilizumab group (p &lt; 0.001). Baricitinib was associated with significantly higher rates of thrombocytosis (p = 0.008).

Conclusion
Among our study population, baricitinib was associated with increased rates of adverse events documented in progress notes. However, baricitinib was comparable to tocilizumab regarding adverse events, including hepatotoxicity, hematologic toxicities, thrombotic risk, gastrointestinal perforation, hospital-acquired infections, and death. Overall, baricitinib was shown to be a safe alternative to tocilizumab, and patients receiving either agent are at increased risk for adverse events.

Disclosures
All Authors: No reported disclosures
515. The Impact of Prolonged Steroid Use on Critically Ill COVID-19 Patients: A Retrospective Cohort Study
Authors: Han Jaijun , Bae Seongman , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Choi Sang-Ho , Lee Sang-Oh , Kim Yang Soo , Chang Eui Jin , Kim Sung-Han 
Published: November 2023

Abstract

Background
Dexamethasone was found to decrease mortality in COVID-19 patients needing oxygen support. However, there is no clear guidance on the duration of steroid use after 10 days. This study aims to compare clinical outcomes of critical COVID-19 between patients abruptly discontinuing steroids within 10 days and those tapering off beyond 10 days.

Methods
This retrospective cohort study included adult COVID-19 patients with a severity score of 6-9 on the World Health Organization-Clinical Progression Scale (WHO-CPS). Patients were divided into two groups based on the duration of maintaining steroids and compared for clinical outcomes such as incidences of rebound pneumonia and infectious complications, 28-day and in-hospital mortality, and readmission or revisit to the emergency room within three months after discharge. The study used a one-to-one propensity score matching analysis to eliminate potential confounding factors.

Results
There were 121 patients who received dexamethasone for up to ten days and discontinue it abruptly and 139 patients who tapered off steroids after taking dexamethasone for up to ten days. After propensity score matching, 58 patients were included in each group and there was no significant difference in baseline characteristics between both groups. Duration of hospitalization was significantly longer in the steroid-tapering group (median 20.0 days, 95% confidence interval (CI) 13.0-29.0 days) than the group with abrupt discontinuation of dexamethasone (13.0, 95% CI 10.0-17.0) (p&lt; 0.001). Also, there were six cases of rebound pneumonia in each group and 28-day mortality was 10.3% in both groups. Analyses after propensity score matching showed that there was no significant difference in 28-day and in-hospital mortality, the incidence of rebound pneumonia, infectious complications, and readmission or revisit to the emergency room between both groups.
Clinical characteristics of the study patients before and after propensity score matching
Clinical outcomes for the study patients before and after propensity score matching
Survival analysis of 28-day mortality according to steroid tapering in critical COVID-19 patients

Conclusion
Tapering and prolonged use of steroids after administering dexamethasone for up to ten days did not significantly improve the 28-day and in-hospital mortality, the incidence of rebound pneumonia, and readmission or revisit to the emergency room in critical COVID-19 patients with a severity score of 6-9 on the WHO-CPS.
Survival analysis of in-hospital mortality according to steroid tapering in critical COVID-19 patients

Disclosures
All Authors: No reported disclosures
518. Comparable Outcomes of Remdesivir and Sotrovimab among High-risk Patients with Mild to Moderate COVID-19 During the Omicron BA.1 Surge
Authors: Chesdachai Supavit , Rivera (O'Connor) Christina G , Mara Kristin , Teaford Hiliary R , Suarez Maria Gonzalez , Larsen Jennifer J , Ganesh Ravindra , Tulledge-Scheitel Sidna , Razonable Raymund R 
Published: November 2023

Abstract

Background
Two independent placebo-controlled clinical trials conducted prior to SARS-CoV-2 Omicron demonstrated that sotrovimab and remdesivir reduced hospitalization among high-risk outpatients with mild to moderate COVID-19. However, their effectiveness have not been directly compared.

Methods
This retrospective study examined all high-risk outpatients with mild to moderate COVID-19 who received either remdesivir or sotrovimab at Mayo Clinic during the Omicron BA.1 surge from January to March 2022. COVID-19-related hospitalization or death within 28 days were compared between the two treatment groups.

Results
Among 3,257 patients, 2,158 received sotrovimab and 1,099 received remdesivir. Patients treated with sotrovimab were younger (median age, 60 vs. 69 years) and had lower comorbidity (Monoclonal Antibody Screening Score, 5 vs. 6; Charlson Comorbidity Index, 3 vs. 4), but were more likely to be immunocompromised (47.3% vs. 30.2%) than remdesivir-treated patients. The majority (89%) had received at least one dose of COVID-19 vaccine (median, 3 doses [IQR 2-3] for both groups). COVID-19-related hospitalization (1.5% and 1.0% in remdesivir and sotrovimab groups, respectively, p=.15) and mortality within 28 days (0.4% in both groups, p=.82) were similarly low. A propensity score weighted analysis demonstrated no significant difference in the rates of COVID-related hospitalization and death within 28 days between the two groups.

Conclusion
This study demonstrated favorable outcomes that were not significantly different between patients treated with remdesivir or sotrovimab. As sotrovimab is no longer authorized, these results support the continued use of remdesivir for treating high-risk patients with COVID-19 during the current Omicron-predominant epoch.

Disclosures
Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Board Member|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria Maria Gonzalez Suarez, M.D., Ph.D., Gilead: Grant/Research Support Ravindra Ganesh, M.B.B.S., M.D., Alpaca Health: Advisor/Consultant Raymund R. Razonable, MD, Allovir: Endpoint Adjudication Committee|American Society of Transplantation: Board Member|Gilead: Grant/Research Support|Novartis: DSMB|Regeneron: Grant/Research Support|Roche: Grant/Research Support
533. Use of Different Communication Types for Telehealth for COVID-19 During Implementation of a State Telehealth Test to Treat Program in Minnesota
Authors: Lim Sarah , Dubelko Paige , James Walter , McLachlan Erin , Tsay David , Lynfield Ruth 
Published: November 2023

Abstract

Background
Telehealth programs for COVID-19 have expanded and may use multiple types of communication, such as mobile apps, web-based or telephone. Data on use of these communications are lacking, particularly in different age groups. We assessed use of three different communication types during implementation of a test to treat program for COVID-19 in Minnesota.

Methods
Minnesota launched its telehealth program in two phases: Phase 1 (mobile app only) during initial rollout from 12/15/22 – 1/5/23 and Phase 2 (addition of web and phone options) from 1/6/23 – 4/30/23. Data on users of the program were provided by the vendor (Cue Health), including communication type (app, web, phone), number of attempts, antiviral prescription, age, and sex.

Results
Data were available for 2093 patients who completed the intake process between 12/15/22 and 4/30/23, of whom 1928 (92%) completed the consultation process and 1808 (86%) received an antiviral. 60% of users were female. 250 patients (12%) completed the intake more than once on the same day, which may reflect multiple attempts due to technical barriers. During the study period, patients aged 35-44 and ≥ 65 years made up the largest proportion of users by age group (each had 464 patients, each 22% of total, Figure 1). 37% of users accessed the program via the phone and 37% via the app, with 26% using the website. Communication preferences varied by age, with increased use of the phone option in older age groups (54% of ≥ 65 vs 30% of 18-34 years, Figure 2). In comparison to users who made a single attempt, users who made multiple attempts were more likely to be younger (48 vs 51 years, p=0.02), and less likely to be prescribed an antiviral (80% vs 91%, p&lt; .001). Users with multiple attempts were more likely to have used the web option for their first attempt (47% vs 24%, p&lt; .001). Those with multiple attempts generally used the same communication type for all attempts (204/250); of those who switched, the commonest switch was to the phone (39/46).

Conclusion
Of the three communication types, the phone and app options were most popular, with a trend towards more phone use in older age groups. A phone option should be considered in future telehealth initiatives, including as a backup for those with technical barriers to app or web-based communication.

Disclosures
David Tsay, MD PhD, Cue Health: Chief Medical Officer|Cue Health: Stocks/Bonds
535. Risk Factors for Seeking Medical Care Following Monoclonal Antibody Treatment For COVID-19
Authors: MALIK I S M A I L O , Szpunar Susan M , Salaytah Natali , Bhargava Ashish , Sharma Mamta 
Published: November 2023

Abstract

Background
The FDA issued emergency use authorization for neutralizing monoclonal antibodies (mAb) for the treatment of mild-moderate coronavirus disease 2019 (COVID-19) in patients who were at high risk of disease progression.

Methods
In this case-control study, we assessed risk factors for patients with mild-moderate COVID-19 infection treated with mAb on the composite outcome of subsequent evaluation in the Emergency Department (ED) or inpatient admission through December 1, 2020, through May 30, 2022. Cases were patients who failed MAB and visited the ED or were hospitalized within four weeks of their MAB treatment; controls received MAB but did not visit the ED or were not hospitalized within four weeks of MAB treatment. Cases were matched to controls in 1:1 ratio for the patient age ± 5 years. and for the calendar month of positive COVID tests. Data were analyzed using Student’s t-test, the chi-squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0. The study was approved by the Ascension IRB.

Results
Of 212 patients who received mAb treatment, the mean (SD) age was 61.3 (±18) years; 51.8 % (99) were female, and 84.8% (162) white. The mean body mass index of the cohort was 32.6 ± 8.5 kg/m2. Following mAb infusion, 106 cases had a positive composite outcome of interest. Patients with peptic ulcer disease (PUD) (64.4% vs 35.6%; p=0.029), asthma (72.7% vs 27.3%; p=0.024), and chronic lung diseases (12.5% vs 35.5%; p=0.001) were more likely to seek medical care in the ED or hospital post mAb infusion. Alcohol users were less likely to seek medical care following mAb infusion (41.7% vs 58.3%; p=0.013). The number of reported days of symptoms prior to mAb infusion were 5.81 days in cases versus 5.79 days in controls (p=0.98). There were no differences in sex, BMI, tobacco use or vaccinations rates between the two groups. In multivariable logistic regression, factors associated with seeking medical care post mAb infusion were Black race (OR 3.1; 95% CI 1.1-9.2), peptic ulcer disease (OR 3.3; 95% CI 1.1-9.7) and alcohol use at the time of mAb treatments (OR 0.5; 95% CI 0.3-0.97)

Conclusion
Independent risk factors for seeking medical care following mAb treatment for COVID-19 were Black race and peptic ulcer disease while alcohol users were less likely to seek medical care following the mAb infusion.

Disclosures
All Authors: No reported disclosures
541. The Effect of Early Remdesivir Administration in COVID-19 Disease Progression
Authors: Platzer Moritz , Totschnig David , Wenisch Christoph , Zoufaly Alexander 
Published: November 2023

Abstract

Background
Since the global outbreak of SARS-CoV-2, antiviral drugs have played a major role in the treatment of COVID-19 by reducing complications and mortality. Remdesivir is an effective therapeutic option for hospitalized patients with risk for clinical progression with COVID-19 who cannot receive nirmatrelvir/ritonavir mainly because of kidney & liver disease or issues with drug- interactions. Remdesivir can be administered for as long as 7 days after symptom onset according to treatment recommendations, but antiviral treatment work best when given as early as possible. In this study we investigated the impact of timing of remdesivir administration on clinical outcome.

Methods
Retrospective clinical data from consecutive PCR-confirmed SARS-CoV-2 patients who received remdesivir and were hospitalized at the department of infectious diseases, Clinic Favoriten (Vienna) from the 1st of July 2021 until the 31st of April 2022 were analyzed. We divided patients into two groups of early (0-3 days since symptom onset) and late (≥ 4) remdesivir administration. The primary outcome was in hospital disease progression measured according to the WHO COVID-19 Clinical Progression Scale (≥1 point). In a multivariable logistic regression adjusted for age, sex, SARS-CoV2 variant, and COVID-19 vaccination status, clinical outcomes were assessed.

Results
219 patients who received remdesivir could be included in the analysis. The ratio between early and late group was 67.6% to 32.4%. After adjusting for age, sex, vaccination status, and viral variant, patients who received remdesivir more than 4 days after symptom onset tended to have a higher probability of clinical deterioration (OR 2,13 95% CI 0,98 to 4,64, p= 0,056) including a higher probability for high-flow oxygen therapy (OR 2,52 95% CI 1,40 to 4,52, p= 0,002) or being admitted to ICU (OR 4,34 95% CI 1,38 to 13,67, p= 0,012). There was no significant difference in mortality.Table 1.Demographic and Clinical Characteristics of the PatientsTable 2.Clinical outcomes adjusted to age, sex, virus variant and vaccination status

Conclusion
Our data show that the risk for complications of COVID19 including a need for high-flow oxygen therapy and ICU admission is elevated when remdesivir is administered after day 4 in hospitalized patients. This may indicate that patients at increased risk for severe disease who cannot take oral options should receive antiviral therapy with remdesivir as early as possible.

Disclosures
Moritz Platzer, MD, Gilead: Grant/Research Support
542. Evaluation of Remdesivir to the Outcomes of Hospitalized Patients with COVID-19 Infection in a Tertiary Care Hospital in Southern India
Authors: Raju Jomel , Tom Maria 
Published: November 2023

Abstract

Background
Remdesivir was the only antiviral used in the treatment of COVID-19 in the first wave of the COVID-19 pandemic, following the adaptive COVID-19 treatment trial-1 interim analysis report. However, its use in moderate to critical hospitalized COVID-19 patients continues to be controversial. Therefore, through this nested case-control study in a cohort of hospitalized COVID-19 patients, we aimed to evaluate the benefit of RDV in the treatment of moderate to severe COVID-19.

Methods
In a cohort of 1,531 moderate to critical COVID-19 patients, we retrospectively performed a nested case-control study where 515 patients on Remdesivir were compared to 411 patients with no Remdesivir. Cases and controls were matched for age, sex, and severity. The primary outcome was in-hospital mortality and secondary outcomes were duration of hospital stay, need for intensive care unit (ICU), progression to oxygen therapy, progression to non-invasive ventilation, progression to mechanical ventilation, and duration of ventilation.

Results
The mean age of the cohort was 57.05 + 13.5 years. 75.92% were males. Overall, in-hospital mortality was 22.46% (n = 208). There was no statistically significant difference in all-cause mortality among cases and controls (20.78% vs. 24.57%, p = 0.17). Progression to noninvasive ventilation was lower in the Remdesivir group (13.6% vs 23.7%, p &lt; 0.001), however, progression to mechanical ventilation was higher in the Remdesivir group (11.3% vs 2.7%, p-value &lt; 0.001*). In a subgroup analysis of critically ill patients, the use of Remdesivir lowered mortality (OR 0.32 95% CI: 0.13 - 0.75).

Conclusion
Remdesivir did not decrease the in-hospital mortality in moderate to severe COVID-19 but decreased progression to non-invasive ventilation. Its mortality benefit in critically ill patients needs further evaluation. Remdesivir may be useful if given early in the treatment of patients with moderate COVID-19.

Disclosures
All Authors: No reported disclosures
554. Association of emr and mdt Genes in Carbapenem Resistant Acinetobacter baumannii with Clinical Outcome in A Tertiary Care Hospital
Authors: CHAUDHARY M O N I K A , Kumar Deepak , Bohra Gopal Krishana , Midha Naresh Kumar , Meena Durga Shankar , Tak Vibhor , Garg M K , Mohammed Sadik , Rohilla Amit Kumar 
Published: November 2023

Abstract

Background
Carbapenem Resistant Acinetobacter baumannii (CRAB) is one of the most common cause of nosocomial infections in ICUs and associated with high mortality. Because the organism can acquire resistance to multiple drugs by various mechanisms, very few treatment options have been left. We evaluated the genes which conferred multidrug resistance to clinically virulent CRAB isolated from 4 critically ill patients and correlated them with their clinical outcome.

Methods
It was a small prospective study under the Antimicrobial Stewardship Program in a tertiary care hospital of Western Rajasthan, India. It included 4 critically ill patients who were diagnosed with hospital acquired CRAB bactaeremia in the month of October and November 2022. They were admitted in ICU and were on ventilator &gt; 48 hours post admission with no comorbidities. Microbiologically proven CRAB isolated from the blood of these 4 patients were sent for Whole Genome Sequencing(WGS).These samples were sequenced using Novaseq with a read length of 151 bp. 2 different strains of Acinetobacter baumannii were identified in these 4 samples- XH731 and WKA02. Denovo assembled fasta sequence was annotated using Prokka to predict CDS, genes and other features of genome.

Results
Table1 is showing the presence of emr and mdt genes in the CRAB strains isolated from the blood of 4 patients. They are responsible for colistin resistance and multidrug resistance by formation of efflux pumps respectively. CRAB isolated from patient C was having emrA1, emrA2, emrA3, emrA4, emrA5, mdtE, mdtK, mdtA1, mdtA2, mdtA3, mdtA4, mdtC. This patient succumbed to death within 5 days of admission despite of appropriate combination therapy, implying very high virulence of CRAB harboring these genes. Moreover, in patient D extra number of drug resistant genes were found as compared to patient A and B.
Multidrug resistant genes found in CRAB isolated from 4 patients of AICU and their outcome

Conclusion
Increased virulence of CRAB due to its resistance to almost every drug has made its management very difficult. WGS can be used to identify certain genes which may be responsible for rapid progression of disease. Presence of emrA4, emrA5, mdtK, mdtA3 and mdtA4 genes responsible for formation of efflux proteins may be associated with increased mortality as observed in our study.

Disclosures
All Authors: No reported disclosures