bluuebunny/crossref_metadata_2025_split huggingface dataset:
259. Comparison of the causes of death in patients with delta variant versus omicron variant infections
Authors: Reum Kim A , Lee Jiyoung , Park Somi , Kang Sung Woon , Lee Yun Woo , Lim So Yun , Jang Euijin , Bae SeongMan , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Kim Yang Soo , Kim Sung-Han 
Published: December 2022

Abstract

Background
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) variant strain B.1.1.529 (omicron) has been less virulent than SARS-CoV-2 B.1.617.2 variant (delta), but there are limited data on the comparison of the cause of death between delta variant and omicron variant infections. We thus compared the causes of death in COVID-19 patients with the delta variant and omicron variant.

Methods
We retrospectively reviewed the medical records of adult patients with COVID-19 who were admitted at Asan Medical Center, Seoul, South Korea, between July 2021 and March 2022. We divided into delta-variant dominant period (from July 2021 to December 2021) and omicron-dominant period (from February 2022 to March 2022) with the exclusion of January 2022 because this period was overlapping of delta and omicron variant. The causes of death were classified into COVID-19-associated pneumonia, other causes, and indeterminate cause.

Results
A total of 654 patients with COVID-19 were admitted and 42 (6.4%) died during the omicron dominant period (between February and March 2022), while a total of 366 patients with COVID-19 were hospitalized and 42 (11.5%) died during the delta dominant period (between July and December 2021). The primary cause of death was COVID-19-associated pneumonia in 64% (27/42) during the omicron era whereas that was COVID-19-associated pneumonia in 88% (37/42) during the delta era (p value=0.01) (Table 1).

Conclusion
We found that about two thirds of patients with omicron variant infection died due to COVID-19, while the majority of patients with delta variant infection died due to COVID-19.

Disclosures
All Authors: No reported disclosures.
260. Corticosteroid treatment in influenza virus and SARS-CoV-2 co-infected patients
Authors: Swets Maaike C , Russell Clark , Harrison Ewen , Docherty Annemarie , Lone Nazir , Girvan Michelle , Hardwick Hayley , Visser Leonardus , Openshaw Peter , Groeneveld Geert , Semple Calum , Baillie Kenneth 
Published: December 2022

Abstract

Background
Co-infections with SARS-CoV-2 and influenza virus may become more prevalent now that many countries are easing restrictions to reduce the spread of SARS-CoV-2. Co-infected patients are more likely to receive invasive mechanical ventilation (IMV) and have higher odds of in-hospital mortality. In the RECOVERY trial, dexamethasone was found to reduce the risk of 28-day mortality in hospitalised COVID-19 patients. On June 16, 2020, corticosteroids were included in clinical guidelines for the treatment of COVID-19 patients requiring supplemental oxygen. However, corticosteroid treatment in severe influenza virus infection may increase mortality. The effect of steroids in influenza and COVID-19 co-infected patients is unknown.

Methods
Adult patients with RT-PCR confirmed SARS-CoV-2 and influenza virus co-infection were evaluated. Patients without supplemental oxygen during admission were excluded. Patients who were hospitalised prior to June 16, 2020 were included in the ‘early’ group and patients who were hospitalised on or after June 16, 2020 were included in the ‘late’ group.

Results
171 co-infected patients were included, 123 patients in the early group (table 1) and 48 in the late group (table 2).
In the early group, 25 patients received steroids. In the late group, 40 patients received steroids.
In the early group, the proportion of patients who were admitted to critical care was slightly lower in the group that received steroids. IMV was similar in both groups. In-hospital mortality was slightly higher in the group treated with steroids.
In the late group, critical care admission and receipt of IMV were higher in the group not treated with corticosteroids than the group with corticosteroid treatment. In-hospital mortality was slightly lower in the group not treated with steroids.

Conclusion
There are differences between co-infected patients who were treated and not treated with corticosteroids and differences between the early and late groups.
A limitation is that no dates were collected for the start of steroid treatment, making it impossible to draw conclusions on the causality of the need for IMV and treatment with steroids in this analysis. Future research should focus on the effect of steroids in COVID-19 and influenza co-infected patients.

Disclosures
Peter Openshaw, PhD, Bavarian Nordic: Advisor/Consultant|Cepheid: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|Janssen: Advisor/Consultant|Pfizer: Advisor/Consultant Calum Semple, PhD, Integrum Scientific: Scientific Advisory Board|Integrum Scientific: Stocks/Bonds.
262. COVID-19 associated fungal co-infections in Solid Organ Transplant Recipients: A single center case series
Authors: Khatri Akshay M , Simkins Jacques , Sinha Neeraj , Phancao Anita , Ciancio Gaetano , Abbo Lilian M , Guerra Giselle , Natori Yoichiro , Anjan Shweta 
Published: December 2022

Abstract

Background
During the ongoing Coronavirus disease of 2019 (COVID-19) pandemic, there have been increasing reports of viral, bacterial and fungal co-infections. Two COVID-19-associated fungal infections (CFIs) have been identified – COVID-19 associated pulmonary aspergillosis (CAPA) and COVID-19 associated mucormycosis (CAM), but incidence and occurrence in solid organ transplant recipients (SOTRs) is limited. We describe our experience with CFIs in SOTRs with COVID-19.

Methods
In a single center retrospective study at a large volume transplant center in South Florida, USA, we included adult SOTRs (≥18 years) diagnosed with COVID-19 between March 1st 2020 and January 31st 2022, with subsequent diagnosis of CFI. We collected information related to demographics, comorbidities, COVID-19 diagnosis and therapeutics, and CFI diagnostics and management. Data obtained was analyzed descriptively.

Results
We identified 612 SOTRs with COVID-19, of which 23 (3.8%) were diagnosed with CFIs.
The patients were predominantly male (17/23, 73.9%), with median age of 59 years (range 43-79) [Table 1]. Twenty (86.9%) were kidney transplant recipients. Majority of SOTRs had lymphopenia (18/23, 78.3%) with elevated inflammatory markers at time of COVID-19 diagnosis. They received most commonly remdesivir and corticosteroids for COVID-19, with 22 (95.6%) needing intensive care unit admission and 19 (82.6%) needing continuous renal replacement therapy.
CFIs were diagnosed at median 21 days (range, 3-161) after initial COVID-19 diagnosis. Probable CAPA was diagnosed in most patients (16/23, 69.6%), with CAM noted in 1 patient [Table 2]. 34.8% (8/23) had specific fungal species identified, with elevated fungal markers noted in 95.6% (22/23). Concurrent or prior cytomegalovirus DNAemia was noted in 26.1% (6/23). Patients were followed for median 70 days (range, 19-572), with median hospitalization duration 56 days (range, 7-204). Mortality was noted in 73.9% (17/23). Table 1:COVID-19 related clinical characteristics in study patients (N=23)Table 2:CFI-related clinical characteristics in study patients (N=23)

Conclusion
Fungal co-infections were noted in a small proportion of our SOTRs, with poor outcomes. Transplant physicians should have a high suspicion for early diagnosis and treatment of CFI. Further studies are needed to determine predictors for CFI and role for anti-fungal prophylaxis.

Disclosures
All Authors: No reported disclosures.
263. COVID-19 Associated Pulmonary Aspergillosis (CAPA) at a Hospital in Nicaragua: Prevalence and Risk Factors for Mortality.
Authors: López-Gaitán Armando J , Marenco-Avilés Sunaya V , Castillo-Cano Maikelyn A , Porras-Cortés Guillermo D 
Published: December 2022

Abstract

Background
COVID-19 associated pulmonary aspergillosis (CAPA) is a newly recognized clinical entity. Alterations in the mucociliary clearance, epithelial damage, lymphopenia, and the use of steroids and monoclonal antibodies could be contributing factors for the development of CAPA. The aim of this study was to detemine the prevalence of probable CAPA and risk factors for mortality in patients with COVID-19 admitted in one of the main hospitals in Nicaragua.

Methods
This is a retrospective cohort study of patients admitted with the diagnosis of COVID-19 in the Hospital Dr. Fernando Vélez Paiz of Managua, Nicaragua. The criteria of probable CAPA was established using the consensus of ECMM/ISHAM. Serum Aspergillus galactomannan lateral flow assay (IMMY) was determined in patients with suspect of CAPA. An optical index &gt; 0.5 was considered positive. Different clinical and laboratory variables, and clinical outcomes were evaluated.

Results
A total of 325 patients were included in the study. Ninety-one patients were diagnosed with probable CAPA that means a prevalence of 28%. The mean age was 56.6 ± 15.0 years old. The most important identified comorbidities were arterial hypertension (44.2%), diabetes mellitus (29.4%), and COPD (14.8%). Lymphopenia was a remarkable finding (56% of the patients). The most frequent radiological pattern in the chest CT scan were: "crazy paving" (56.0%), ground glass opacities (28.5%), and diffuse reticulonodular infiltrates (10.9%). The mortality rate in the patients with CAPA was 42.9%. The risk factors associated with mortality in the patients with CAPA were: admission to Intensive Care Unit (ICU) (OR: 17.3; CI95%: 3.6-81.9), any chronic medical condition (OR: 9.28; CI95%: 1.13-75.90), COPD (OR: 6.41; CI95%: 1.64-24.90), use of steroids (OR: 5.03, CI95%: 1.55-16.30), lymphopenia &lt; 1,500/mL (OR: 4.92; CI95%: 1.94-12.40), "crazy paving" pattern in CT (OR: 4.92; CI95%: 1.94-12.40), and diabetes mellitus (OR: 3.60, CI95%: 1.41-9.15).
Risk factors identified for mortality in patients with COVID-19 associated pulmonary aspergillosis (CAPA).

Conclusion
The prevalence of probable CAPA in this study is relatively high. The mortality was of 42.9%. Risk factors for mortality were admission to ICU, chronic medical conditions (COPD and diabetes mellitus), use of steroids, lymphopenia, and radiological "crazy paving" pattern in the chest CT-scan.

Disclosures
All Authors: No reported disclosures.
268. Dengue - SARS-CoV-2 co-infection: Experience in hospitalized patients during COVID-19 pandemic
Authors: Rosso Fernando , Zapata-Vasquez Isabel L , Rodriguez Sarita , Martinez Diana M , Agudelo Olga , Robles-Castillo Sebastián , Tejada Alejandro 
Published: December 2022

Abstract

Background
Dengue fever and COVID-19 co-infection constitute a significant public health concern in Latin America, becoming a clinical challenge to distinguish these two entities in early stages of the disease. Clinical outcomes of coinfected hospitalized patients have not been well established.

Methods
A cross-sectional study was conducted. We included suspected patients diagnosed with COVID-19/dengue co-infection admitted at Hospital Fundación Valle del Lili, Cali – Colombia, from March 2020 to March 2021. All dengue patients had positive NS1 and/or IgM dengue antibodies. SARS-CoV-2 infection was confirmed by RT-PCR or antigen rapid test from nasopharyngeal swab. Laboratory and clinical data were recollected from the clinical laboratory database, clinical charts, and institutional COVID-19 registry.

Results
A total of 90 COVID-19 patients were included. 72 patients were confirmed only with COVID-19, and 18 with dengue co-infection. Most patients were male: 46 (63.9%) vs. 13 (72.2%). None of these study patients were vaccinated against COVID-19 or dengue. The median time from symptoms onset and the diagnosis was five days, and fever was the most common symptom for both groups. There were significant differences between COVID-19 patients and coinfected patients regarding presence of dyspnea (22.2% vs. 61.1%; p=0.003), desaturation (13.4% vs. 53.3%; p=0.002) and a higher neutrophil/lymphocyte ratio (NLR) (3.84 vs. 5.59; p = 0.038). The co-infection was associated with a worse presentation of the COVID-19 infection (p=0.002), an increased requirement of initial supplemental oxygen therapy (p=0.007), mechanical ventilation (p=0.0004), ICU management at the admission (p=0.002), and ICU final management (p=0.002). Overall mortality in patients with co-infection was 44.4% vs. 6.9% in only COVID-19 infected patients (p&lt; 0.001).

Conclusion
Despite the pandemic era, the possibility of co-infection of these two entities must be considered. Admitted coinfected patients were associated with worse clinical outcomes and higher mortality. According to our results, patients with co-infection present with severe respiratory symptoms and an elevated NLR. The impact of the Covid 19 vaccination on this coinfection is unknown.

Disclosures
Olga Agudelo, n/a, Fundación valle del lili: Board Member.
270. Secondary bacterial infection in hospitalized COVID-19 patients. Experience in Colombia, South America
Authors: Rosso Fernando , Rodriguez Sarita , Zapata-Vasquez Isabel L , Tafur Eric , Martinez Diana M , Guzmán Tania , Ramírez-Pérez Daniela , Franky-Ortiz Isabella 
Published: December 2022

Abstract

Background
Secondary infections are common among severe COVID-19 patients, increasing complications and mortality risk. These infections are not well characterized in Latin America and the Caribbean.

Methods
A cross-sectional observational study of adult patients with COVID-19 admitted to the hospital Fundación Valle del Lili in Cali-Colombia from March 2020 to March 2021. Demographic data, clinical characteristics, laboratory parameters, and clinical outcomes were collected. We describe secondary infection, antibiotic therapy, and antibiotic resistance profiles. Secondary infection was defined if the diagnosis occurred ≥48 hours after hospital admission for COVID-19.

Results
A total of 2138 patients with COVID-19 were analyzed; 350 (16.3%) presented secondary infection. 60% were male; the median age was 65 years [IQR: 55-72]. Glucocorticoid therapy was indicated in 335 patients (96.3%). 281 received high doses and 54 low doses. Bacterial infections were the most common, affecting 81.3 % of patients, followed by fungal (14.4%) and viral (4.3%) infections. Most bacterial isolates were orotracheal secretion, blood, urine, and bronchoalveolar lavage fluid culture. The three most frequently identified bacteria were Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. Most of the initial isolates were not antibiotic-resistant (75-89.7%). Empiric antibiotic therapy was indicated in 346 patients (98.9%), 268 received carbapenems (76.6%), 267 Vancomycin (76.3%), and 233 cefepime (66.6%). Of the 350 patients, 327 (93.4%) required management in the intensive care unit, and overall mortality was 35.4% (124/350).

Conclusion
Our results showed a lower frequency of secondary infection than previous reports; However, a high frequency of broad-spectrum antibiotics usage was found despite a high prevalence of non-resistant bacteria. Further studies are needed to establish the best approach for antibiotics therapy.

Disclosures
All Authors: No reported disclosures.
272. Do Empiric Antibiotics Improve Outcomes in Clinically Stable Patients Admitted with COVID-19 Pneumonia? Retrospective Cohort Study of 221 U.S. Hospitals, March 1st, 2020-December 31st, 2020
Authors: Lawandi Alexander , Strich Jeffrey R , Li Xioabai , Yek Christina , Warner Sarah , Kadri Sameer S 
Published: December 2022

Abstract

Background
Patients admitted with COVID19 pneumonia often receive initial empiric antibacterial therapy (IEAT) despite a known low probability of bacterial co-infection. However, evidence supporting this practice is lacking. We studied the impact of IEAT on the risk of in-hospital mortality, clinical deterioration and antibiotic-associated risks in stable inpatients with COVID-19.

Methods
Adult inpatients coded for COVID-19 pneumonia stable (no mechanical ventilation or vasopressors) on admission (+1 day) without a clear indication for antibiotics, were identified at hospitals in the Premier Healthcare Database. Patients who received IEAT, defined as the receipt of ≥ 1 antibacterial agent on admission (+1 day), were compared to a control group, using binomial regression with overlap weight matching and downstream adjustment for baseline characteristics (age, gender, race, admission month, surge index, Elixhauser score, any AOFS organ failure POA, ICU admission on day 0 to +2, receipt of remdesivir, corticosteroids, and tocilizumab). The primary outcome was in-hospital mortality or discharge to hospice; secondary outcomes included need for mechanical ventilation on day2+, and rates of non-POA-acute kidney injury (AKI).

Results
At 221 hospitals between March–December 2020, 39,517 (74%) of 53,431 stable COVID-19 admits received IEAT. Patient and encounter characteristics are shown in Table 1. The crude mortality rates were 12.2% in IEAT recipients and 10.9% in controls. In adjusted analysis of patients who survived beyond admission day, mortality was 11.57% (95% CI 11.24-11.90%) in IEAT recipients and 11.23% (95% CI 10.72-11.74) in controls, for a difference of 0.34% (95% CI -0.23-0.91%, p = 0.24). Subsequent mechanical ventilation occurred similarly between groups (5.72% vs. 5.77%, p=0.83). The adjusted rate of AKI was 2.47% (95% CI 2.31-2.64%) in IEAT recipients, and 3.04% (95% CI 2.74-3.35%) in controls, for a difference of -0.57% (95% CI -0.92-0.22%, p = 0.0014). Table 1.Demographics, clinical and hospital characteristics for patients treated with initial empiric antibiotic therapy (intervention) versus those not treated (control).Figure 1.Standardized mean differences in included covariates before and after several matching strategies comparing covariate values for patients treated and not treated empirically with antibiotics

Conclusion
In patients with COVID19 initially admitted to the ward, IEAT was not associated with a reduction in mortality or deterioration requiring mechanical ventilation, but with a clinically insignificant reduction in AKI. Empiric antibiotics can likely be safely withheld in this population.

Disclosures
All Authors: No reported disclosures.
274. Epidemiology and Antimicrobial Treatment Impact of Procalcitonin in Patients with COVID-19
Authors: Conlon Anna , Rao Krishna , Cinti Sandro , Chopra Zoey , Cahalan Shannon E 
Published: December 2022

Abstract

Background
Procalcitonin (PCT) is often measured in patients with signs of bacterial infection. PCT is often elevated in bacterial pneumonia and septic shock and usually low in viral infections. Recent studies have found a correlation between PCT and disease severity in COVID-19, and most patients receive antibiotics despite bacterial co-infection being rare. We sought to characterize PCT trends in COVID-19, assess its relation to bacterial pneumonia, and assess its relation to clinical decision making around antimicrobial use.

Methods
We included patients ≥18 hospitalized at Michigan Medicine (3/1/20–10/31/21), positive for COVID-19, with ≥ 1 PCT measurement. Structured query was used to retrospectively extract data. Patients started on an antibiotic underwent retrospective chart review by 2 reviewers for presence of bacterial pneumonia (bPNA), and were classified as having proven, probable, possible, or no bPNA (Figure 1). Multivariable models controlling for time from start of the pandemic, demographics, and comorbidities were used to determine associations of PCT and bPNA with antimicrobial use. Figure 1:Flow diagram of patients included in analyses

Results
793 patients met inclusion criteria, with 224 (28.2%) initiated on antibiotics. Of these 224, 33 (14.7%) had proven/probable bPNA, 125 (55.8%) had possible bPNA, and 66 (29.5%) had no bPNA. On average, patients had 2.6 ±3.7 (mean ±SD) PCT measurements, with 4.1 ±5.2 if on antibiotics vs. 2.0 ±2.6 if not. Initial PCT was higher in those on antibiotics and highest in those with proven/probable bPNA (Table 1). After adjustment for confounders, initial PCT was associated with antibiotic initiation (OR 1.68, 95% CI 1.47-1.91, p &lt; 0.0001) (Table 2). Initial PCT (RR 1.11, 95% CI 1.03-1.20, p=0.008), change in PCT over time (RR 1.03, 95% CI 1.01-1.05, p=0.007), and bPNA category (RR 1.51, 95% CI 1.23-1.84, p &lt; 0.0001) were associated with antibiotic duration (Table 3). Table 1:Number of PCT measures by antibiotic and bPNA statusTable 2:Multivariable logistic regression model results for covariate associations with antibiotic initiation (n=793)Table 3:Multivariable negative binomial model results for covariate associations with antibiotic duration (n=224)

Conclusion
PCT was elevated in patients with COVID-19, but more pronounced with bPNA. Antibiotics were started in &gt; 25% of patients, regardless of bPNA. PCT trends associate with the decision to initiate antibiotics and treatment duration, independent of bPNA and comorbidities. Future prospective studies should determine if PCT can be used to safely make decisions around antibiotic treatment for bacterial infection during COVID-19.

Disclosures
Krishna Rao, MD, MS, Merck & Co., Inc.: Grant/Research Support|Seres Therapeutics: Advisor/Consultant|Summit Therapeutics: Advisor/Consultant.
278. Long-term impact of pulmonary function among patients recovered from SARS-CoV-2 infection in Lima, Peru: a preliminary analysis of the FUNCTION cohort study
Authors: Cachay Figueroa Rodrigo Antonio A , Watanabe Takashi , Cuno Katiuska , Coombes Carolina , Mejia Fernando , Medina Felix , Gayoso Oscar , Seas Carlos , Otero Larissa , Gotuzzo Eduardo 
Published: December 2022

Abstract

Background
Longitudinal assessment and reversibility of changes in the pulmonary function tests in the post-acute phase of COVID-19 across the whole spectrum of severity of infection is needed to understand the long-term burden of the disease.

Methods
This was a prospective cohort of symptomatic patients with a positive SARS-CoV-2 (molecular or antigenic) test. Participants were divided based on infection severity at baseline as mildly-ill (B1), moderately-ill (B2), severely-ill (B3), critically-ill (B4) (Fig.1). Follow-up consisted of 4 visits: within 7 days from discharge (BL), and at months 1 (M1), 3 (M3), and 6(M6). We report findings up to M3 for participants enrolled August 2021- March 2022. Pulmonary function capacity was assessed with carbon monoxide diffusing capacity (DLCO), spirometry, and 6-minute walk test (6MWT). A DLCO&lt; 80% was considered abnormal and reverted if &gt;80% at follow-up visits.
Study population divided by severity of infection

Results
Out of 206 eligible participants, 110 were enrolled, of which 96 (87%%), 79 (72%), and 52(47.2%) were evaluated at BL, M1, and M3, respectively (Fig.2). Most (67%) participants were male, median age was 37.5 years old (IQR: 28-46.3) and median body mass index was 26.7 (IQR:23.7-30.4). Regarding severity, 39 (41%) participants were classified as critically-ill (B4) at BL. No underlying comorbidities were reported among 63 (66%) participants, while diabetes type 2 (11%), asthma (7%) prior pulmonary tuberculosis (6%) and hypertension (5%) where the most frequent comorbidities overall; 17 (18%) reported smoking exposure. There were significant differences accross severity groups for sex, age, absence of comorbidities, and dyspnea during the acute phase of COVID-19 (Tab.1). At Of the 88 (92%) participants that underwent the pulmonary function tests at BL: 49 (56%) had DLCO &lt; 80% with a tendency to revert across B1-B4 groups at month 3 (Fig.3). Spirometry parameters (Forced Vital Capacity, Forced Expiratory Volume 1, Peak Expiratory Flow) and distance walked on 6MWT were different across groups.
Flowchart of the study population
Demographics of study population stratified by groups of severity
Median DLCO adjusted for hemoglobin value at baseline, month 1 and month 3 visits stratified by groups of severity of infection.

Conclusion
Abnormal DLCO tended to increase and revert to values greater than 80% in the 3-month follow-up period of patients recovered from SARS-CoV-2 infection across severity groups.

Disclosures
All Authors: No reported disclosures.