bluuebunny/crossref_metadata_2025_split huggingface dataset:
203. When rapid molecular blood culture testing fails to identify the organism: microbiology and patient outcomes
Authors: Marshall MaryBeth , Kale-Pradhan Pramodini , Hejnar Anna , Smith Evelynne , Giuliano Christopher , Harriott Melphine , Priziola Jennifer , Johnson Leonard B 
Published: December 2022

Abstract

Background
Verigene™ is a rapid nucleic acid test used to optimize antibiotic selection on positive blood cultures but it does not detect all pathogens. The purpose of this project was to describe the organisms Verigene™ could not identify as well as the clinical outcomes of the patients.

Methods
This was a single-center, retrospective cohort study of patients who received a Verigene™ non-detected result from 5/19/20-6/30/21. The primary objective of this study was to identify the organisms and secondary objectives included any changes in antimicrobial therapy after the test result, appropriateness of change in therapy, discharge disposition, and 30-day readmission rate.

Results
A total of 85 of 958 (8.9%) Verigene results were non-detected during the time period. Among the 85 results included for the primary objective, six were determined to be contaminants by the clinicians. Among the remaining 79 results, 44 were anaerobic bacteria, 11 Serratia species, and 24 were other miscellaneous bacteria. Therapy was changed in 62 (78.5%) after the Verigene result. Overall antibiotic regimens were deemed appropriate after antibiotic changes were made from the final culture result in 70 of 79 (88.6%) cases. Twenty five of 79 (31.6%) patients died in the hospital. Among the 54 patients discharged, 11 (20.3%) were readmitted within 30 days including five (9.2%) due to infection. No cases of infectious readmission were due to the prior episode of bacteremia.

Conclusion
The majority of Verigene results that were not able to be identified were later identified to be anaerobic bacteria and Serratia species which are known limitations of the test. While most patients received appropriate therapy, there was a high mortality and readmission rate. Further studies should be performed to confirm this observation.

Disclosures
All Authors: No reported disclosures.
208. Clinical outcomes of empirical versus pre-emptive broad spectrum antifungal therapy in patients with acute myelogenous leukemia receiving antimold prophylaxis
Authors: Oh Sang-Min , Lee Chan Mi , Choi Seong Jin , Lee Eunyoung , Kang Chang Kyung , Moon Song Mi , Choe Pyoeng Gyun , Song Kyoung-Ho , Park Wan Beom , Bang Ji Hwan , Kim Eu Suk , Park Sang Won , Kim Hong Bin , Kim In Ho , Kim Nam Joong , Oh Myoung-don 
Published: December 2022

Abstract

Background
Since antimold prophylaxis has been widely used in induction chemotherapy for acute myelogenous leukemia (AML), it should be re-evaluated whether broad spectrum antifungal therapy should be empirically used in prolonged febrile neutropenia. Therefore, we compared clinical outcomes of empirical versus pre-emptive antifungal therapy in patients with AML receiving antimold prophylaxis.

Methods
From September 2016 to December 2020, all adult AML patients (≥ 18 years) receiving antimold prophylaxis who had febrile neutropenia for ≥ 4 days during induction or re-induction chemotherapy at Seoul National University Hospital were retrospectively reviewed. They were classified into the empirical group (therapeutic broad spectrum antifungal agents had been used without evidence of invasive fungal infection [IFI]) or the pre-emptive group (antimold prophylaxis had been maintained until the emergence of IFI’s evidence). We compared clinical outcomes between the two groups after propensity score matching.

Results
A total of 229 chemotherapy episodes, 36 in the empirical group and 193 in the pre-emptive group, were analyzed. In the pre-emptive group, broad spectrum antifungal therapy was administered in 45 (23.3%) episodes. After 1:3 matching with age, gender, induction or re-induction chemotherapy, and worst qSOFA score at febrile neutropenia, incidence of proven or probable IFI (0/36 [0%] in the empirical group vs. 5/97 [5.2%] in the pre-emptive group, P=0.323) and all-cause mortality (3/36 [8.3%] in the empirical group vs. 4/97 [4.1%] in the pre-emptive group, P=0.388) were not different between the two groups.

Conclusion
Clinical outcomes of empirical versus pre-emptive broad spectrum antifungal therapy were comparable in patients with AML receiving antimold prophylaxis. Broad spectrum antifungal therapy could be delayed until the emergence of evidence of IFI, in the current era of antimold prophylaxis.

Disclosures
All Authors: No reported disclosures.
213. Prophylactic oral vancomycin for Clostridioides difficile in allogeneic hematopoietic stem cell transplant recipients
Authors: Ogawa Lauren , Wright Kaylor , Luk Alfred 
Published: December 2022

Abstract

Background
Allogeneic hematopoietic stem cell transplant (alloHSCT) recipients are at substantial risk for Clostridioides difficile infection (CDI) due to prolonged hospitalization and alteration of the intestinal mucosa and gut microbiota from conditioning regimens, antimicrobials, and immunosuppressants. CDI in alloHSCT recipients has also been associated with higher rates of acute graft versus host disease (aGVHD). Review of the literature revealed that three institutions have published studies demonstrating oral vancomycin prophylaxis prevents CDI. However, more studies are needed to evaluate the impact of prophylaxis on CDI incidence, resistant infections, and other transplant-related outcomes.

Methods
We conducted a retrospective review to compare the effectiveness of prophylactic oral vancomycin versus no prophylaxis in 40 alloHSCT recipients in the prevention of CDI at our institution. The prophylactic intervention was initiated June 2020, and 20 patients have undergone alloHSCT as of April 2022. Patients received twice daily oral vancomycin starting the day of admission for transplant until discharge. The prophylaxis group was compared to a control group of 20 consecutive alloHSCT recipients prior to initiation of the intervention. The primary outcome was the incidence of CDI. Secondary outcomes included incidence of vancomycin resistant enterococcus (VRE) infection and incidence of aGVHD.

Results
During admission for transplant and at +100 days post-transplant, 5/20 (25%) of patients in the control group developed CDI compared to 0/20 (0%) in the prophylaxis group (p=0.0471). Prophylaxis was not associated with higher rates of VRE infection through day +100 post-transplant (2/20, 10% vs 0/20, 0%, p=0.487). Use of oral vancomycin was not associated with increased incidence of aGVHD, which occurred in 10/20 (50%) of patients in the control group versus (7/20) 35% in the prophylaxis group (p=0.523).

Conclusion
Prophylaxis with oral vancomycin was associated with a significant reduction in CDI. Use of prophylaxis was not associated with an increased risk for VRE infection and there was no change in incidence of aGVHD. Our review supports the use of prophylaxis, and we will continue to monitor for resistant infections and evaluate the impact on survival.

Disclosures
Alfred Luk, MD, Karius: Grant/Research Support.
224. Effect of a Mobile App Chatbot and an Interactive Small Group Webinar on COVID-19 Vaccine Intention and Confidence in Japan: A Randomized Clinical Trial
Authors: Yamada Yuji , Tomoi Hana , Nishina Yuka , Harada Ko , Tanaka Kyuto , Sasaki Shugo , Inaba Kanako , Mitaka Hayato , Takahashi Hiromizu , Passanante Aly , Lin Leesa , Lau Eric , Wu Joseph , Naito Toshio , Larson Heidi , Kobayashi Takaaki 
Published: December 2022

Abstract

Background
Little is known about how social media platforms can be used to increase COVID-19 vaccine intent. We aimed to investigate the effect of social media-based interventions on vaccine hesitancy in Japan.

Methods
We conducted a three-arm randomized controlled trial between 5 November 2021 and 9 January 2022. Japanese aged 20 or above who had not received any COVID-19 vaccine and did not intend to be vaccinated were randomly assigned to one of the following three groups: (i) a control group (with no intervention), (ii) a group with a free chatbot in a popular messenger app called ‘LINE,’ which provided general information on COVID-19 vaccines and (iii) a group with free webinars where healthcare professionals interactively provided participants with the information on COVID-19 vaccines. The vaccine intention (VI) and three pre-defined Vaccine Confidence Index (VCI), including the importance, safety, and effectiveness of COVID-19 vaccines, were compared.

Results
1,158 persons were included, and the baseline characteristics and demographics were balanced across three groups (Table 1). Among 386 persons assigned to the chatbot group, 231 (59.8%) accessed the chatbot and answered the post-survey. The post-survey revealed no significant difference in VI or VCI between the chatbot group and the control group (Table 2). Among 386 persons assigned to the webinar group, 207 (53.6%) attended webinars and answered the post-survey. The post-survey revealed no difference in VI between the webinar group and the control group. However, the VCI for the importance and the effectiveness significantly increased in the webinar group. There was no difference in VCI for the safety. VCI for the importance and the effectiveness in the control group decreased without any intervention during the study period.
Vaccine intention and confidence after interventions Table 1Table 2

Conclusion
While this study demonstrated that neither the chatbot nor the webinar changed VI, VCI for the importance and the effectiveness significantly increased with the webinar intervention. Interactive webinars with live Q and A provided by professionals may have a role in increasing COVID-19 vaccine confidence. Given the degree of vaccine hesitancy worsened over time in the control group, timely intervention is required.

Disclosures
All Authors: No reported disclosures.
261. COVID-19 and Diabetes Mellitus: Glycemic Control and Risk Factors for Mortality, experience from Pakistan.
Authors: Nasim Asma , Kumar Sunil 
Published: December 2022

Abstract

Background
Diabetes mellitus (DM) is a chronic disease characterized by glucose dysregulation by insulin deficiency or resistance. DM is one of the risk factors and found to be associated with high mortality in patients with corona virus disease-19 (Covid-19). There are challenges in managing poorly controlled DM among Covid-19 patients. Our aim is to highlight the effect of Covid-19 and DM on each other by studying glycemic control and risk factors for mortality.

Methods
This study is a single center retrospective observational review from Pakistan. Covid-19 diagnosed patients admitted during the months of March 2020 to March 2021were included. The patients were divided into DM and non-DM. Demographics, clinical variables and outcome were collected and compared between these groups. Glycemic control during hospitalization (blood sugar level fasting and pre-meal twice a day) was noted. Fasting glucose level &gt;120 mg/dl, and random &gt;200 mg/dl were considered as poor glycemic control. Survivors and non- survivors among DM patients were compared.

Results
A total of 366 patients were included in this study, 113(30.87%) were DM and 253(69.12%) were non-DM. Mean age was comparable in two groups, however, patients in DM group were older (age &gt;45 years, p=value 0.039). Significantly more patients with hypertension (p value&lt; 0.001) and ischemic heart disease (p value&lt; 0.001) developed Covid-19 in DM group. There was no difference in mortality among both groups (p=0.29). (Table 1) .In DM patients, the significant risk factors for mortality were age &gt;60years, hypertension and renal disease. High fasting and pre-dinner blood glucose levels (mean) obtained at admission and day 5 were significantly associated with mortality. (Table2).

Conclusion
Diabetic patients with advanced age and concomitant other comorbid conditions is associated with increased risk of death. In diabetic patients, more attention should be focus on dynamic monitoring and strict glycemic control as severe COVID 19 infection and its treatment with steroids can have a negative impact on outcome.

Disclosures
All Authors: No reported disclosures.
277. Frequency of Pneumomediastinum and Pneumothorax in COVID-19 Patients: a Retrospective Cohort Study in a Community Hospital in Evanston, Illinois
Authors: Egoryan Goar , Nava Guillermo Rodriguez , Nava Guillermo Rodriguez , Kishmiryan Armen 
Published: December 2022

Abstract

Background
Pulmonary barotrauma has been increasingly reported as a complication of COVID-19. Although a rare phenomenon, pneumomediastinum has been shown to be more prevalent in COVID-19 patients than in historical patients with adult respiratory distress syndrome.

Methods
We performed a Workbench report to identify 1046 patients admitted to our community hospital in Evanston, Illinois, with a primary diagnosis of COVID-19 from March 1, 2020, to January 31, 2022. Descriptive statistics were used to summarize the data.

Results
The incidence proportion risk was 3.15%. The median age was 66 years (interquartile range [IQR], 49.5 – 75.5 years), 84.8% (28/33) were males, 24.2% (8/33) were Asian, 18.2% (6/33) were White, 18.2% (6/33) were Latinx, and 9.1% (3/33) were long-term care facility residents. Pneumothorax was present in 21 patients (63.6%): unilateral 18/21 (54.5%); bilateral 3/21 (9.1%). Pneumomediastinum was present in 22 patients (66.7%). The median onset time of pneumothorax or pneumomediastinum after COVID-19 onset was 18 days (IQR, 11.5 – 25.5 days). Among 28 (84.8%) patients that required invasive mechanical ventilation (IMV), 6 (18.2%) developed pneumothorax or pneumomediastinum prior IMV; 5 (15.2%) patients developed pneumothorax or pneumomediastinum without IMV. The median onset time of pneumothorax or pneumomediastinum after IMV was 4 days (IQR, 0 – 8 days). Only 4 (9.1%) patients were ultimately discharged, 24 (72.7%) died, 2 (6.1%) were transitioned to hospice care, 3 (9.1%) were transferred to long-term care acute care, and 1 (3%) patient was transferred for ECMO. The fatality rate was higher compared to case reports available in the literature (5/23, 21.7% fatality rate. Table 1).
Available data in the literature per case reports of pneumomediastinum and pneumothorax in COVID-19 patients
Abbreviations: A-fib, atrial fibrillation; CAD, coronary artery disease; CPAP, continuous positive airway pressure, DM, type 2 diabetes; F, female; HLD, hyperlipidemia; HTN, hypertension; IMV, invasive mechanical ventilation; M, male; NC, nasal cannula; NIV, non-invasive ventilation; NRB, non-rebreather mask; OSA; obstructive sleep apnea; PMD, pneumomediastinum; PTX, pneumothorax; yo, years old.

Conclusion
The practitioners have to be alerted of the association of COVID-19 with pneumomediastinum, especially on the fact that this complication may happen in patients who never received mechanical ventilation or positive airway pressure support. Further research is needed into the exact pathogenesis, prevalence of this complication, and the impact on the clinical outcomes.

Disclosures
All Authors: No reported disclosures.
279. Maternal Infection by SARS CoV2 and Clinical Repercussion of the Newborn.
Authors: Casillas Casillas Maria C , Lopez-Enriquez Claudia C , Madrid Tania Salcido 
Published: December 2022

Abstract

Background
Pregnancy confers a higher risk of complications in SARS CoV2 disease as well as in the neonatal stage. Physiological and immunological changes during pregnancy predispose women to have complications in all the respiratory variations and increase maternal-fetal mortality and morbidity; The role of SARS CoV2 infection in newborns of mothers positive for COVID-19 was evaluated, analyzing the clinical consequences in the pregnant patient and the impact on the newborn.

Methods
Descriptive, observational, retrospective study. All pregnant patients with a positive PCR test for SARS CoV2 and newborns treated at the Spanish Hospital, in the period from March 2020 to March 2021, were included, the information provided was collected from the medical history.

Results
We recorded the cases of pregnant patients treated at the Spanish Hospital in the period from March 2020 to March 2021. The population was divided into those with a positive and negative PCR test for SARS Cov2. A total of 561 cases were registered, 35 positive cases for SARS Cov2; positive patients reported a higher presentation of Preeclampsia than patients without infection (p 0.009). The percentage of preterm products in mothers with infection was higher by 20% vs 12%; with the highest number of advanced neonatal resuscitation events. SARS Cov2 infection conditions the presentation of pathologies such as preeclampsia in pregnant women and an increase in preterm birth.

Conclusion
In this study we conclude, comparing with the group of healthy pregnant women with no history of COVID-19, that the products of mothers with a history of SARS CoV2 infection represent a higher risk of prematurity coupled with the risk of other pathologies such as preeclampsia, also in the period neonatal patients required greater support with oxygen, however the rate of severe complications in the newborn is unlikely. The role of maternal protection such as isolation, hygiene and vaccination measures are priority tools to reduce these perinatal pathologies and the risk of contagion.

Disclosures
All Authors: No reported disclosures.
280. Monoclonal Antibodies Against SARS-CoV-2 in Fragile Outpatients: Clinical and Laboratory Risk Factors and Protective Role of Vaccination
Authors: Cavasio Rosario Alessandro , Braccialarghe Neva , Zaçe Drieda , Spalliera Ilaria , Coppola Luigi , Campogiani Laura , Piermatteo Lorenzo , Bellocchi Maria Concetta , Silberstein Francesca Ceccherini , Marco Iannetta , Sarmati Loredana , Andreoni Massimo 
Published: December 2022

Abstract

Background
To cope with the SARS-CoV-2 pandemic, several treatments were studied and out of these, monoclonal antibodies (MAbs) have shown efficacy to prevent the development of pneumonia after the infection

Methods
We conducted a retrospective, single-center study including patients with SARS-CoV-2 infection, treated with MAbs (bamlanivimab/etesevimab (B/E), casirivimab/imdevimab (C/I) or sotrovimab (S)) from March 2021 to February 2022

Results
We included 504 patients with a median age of 62 years (IQR 49-72), 51% were males and 66% had completed the vaccination schedule according to the current Italian regulations. The most frequent eligibility criteria are summarized in figure 1. As for MAbs combination, patients were treated with B/E (54%), followed by C/I (30%) and S (16%). Outcomes are shown in Table 1.
Nasopharyngeal swab (NPS) negativization time had a positive correlation with patients’ age (r=0.16; p=0.001), C-reactive protein (CRP) (r=0.26; p&lt; 0.001) and creatinine values (r=0.22; p&lt; 0.001) assessed at baseline (infusion day). Time to NPS negativization was 6.9 (95% C.I. [4.5-9.2]) days shorter for vaccinated compared to unvaccinated patients (p&lt; 0.001).
Patients treated with C/I had a negative NPS on average 4.5 (95% C.I.= [1.8-7.3] days earlier than patients treated with B/E; patients who received S reached negativization 6.0 (95% C.I.= [2.2, 9.9]) days earlier than those treated with B/E (p=0.004). Patients with positive outcome had a negative NPS on average 14.3 (95% C.I.= [6.8, 23.1)], 25.5 (95% C.I.= [18.9, 33.4] and 68.3 (95% C.I.= [47.7, 90.2]) days earlier than patients who needed hospitalization and patients who died (p&lt; 0.001, p&lt; 0.001, respectively).
Unvaccinated patients had a higher rate of oxygen support need compared to vaccinated ones (p=0.006). Patients with worse outcomes were significantly older and had higher values of CRP and creatinine at baseline (p=0.04, p&lt; 0.001, p&lt; 0.001, respectively)
Percentage of eligibility criteria of our patients
The majority of patients had more than one criterion
Clinical outcome of our patients
Nasopharyngeal swab was repeated weekly, until negative

Conclusion
MAbs reduce the risk of hospitalization in fragile patients. Vaccinated patients had shorter time of NPS negativization and lower probability of hospitalization. Older age, higher CRP and creatinine values assessed at baseline, correlated with worse outcomes. S was the most effective treatment amongst MAbs used in our study

Disclosures
All Authors: No reported disclosures.
284. Post-Acute Sequelae of COVID-19 Two Years After Acute Infection
Authors: Logue Jennifer , Franko Nicholas M , Kemp Megan M , McCulloch Denise J , Chow Eric J , Chu Helen Y 
Published: December 2022

Abstract

Background
The post-acute sequelae of COVID-19 (PASC) includes a constellation of debilitating symptoms after SARS-CoV-2 infection. Much remains unknown about the long-term health burden of COVID-19. We describe the symptom course and quality of life of adults up to 2 years after mild acute COVID-19.

Methods
Adults within 30 days of laboratory-confirmed acute COVID-19 were enrolled as cases from January – September 2020 and followed for 2 years. Demographic and symptom data were collected in an enrollment survey and at 6, 12 and 24 months post-infection. Surveys included vaccination status, symptom course, and quality of life assessments (Fatigue Assessment Scale (FAS) and EuroQual visual analog scale (VAS)). A cohort of SARS-CoV-2 uninfected controls was concurrently enrolled and surveyed. We used descriptive statistics to compare cases and controls and defined a p-value &lt; 0.05 as significant.

Results
A total of 112 of 239 enrolled cases and 44 of 59 controls completed all surveys. Of the 112 cases, 105 (94%) had mild disease. In the 6, 12 and 24 month surveys, 39 (35%), 48 (43%) and 56 (50%) cases indicated at least one persistent symptom, respectively, compared to 4 (9%), 5 (11%) and 6 (14%) controls (Table 1). In all 3 surveys, fatigue and altered smell or taste were the most common post-infection symptoms among cases (Figure 1). At 2 years, 40 (36%) cases reported symptoms were improving or resolved and 30 (27%) reported symptoms continued to wax and wane. Symptoms improved and worsened for 10 and 4 cases, respectively, following a complete SARS-CoV-2 vaccination. 46% reported seeking medical attention for persistent symptoms and 34% of those employed reported symptoms negatively impacted their ability to work. When compared to controls in the 12 and 24 month surveys, cases had a significantly higher mean FAS score (p-value &lt; 0.001 and 0.01, respectively) and significantly lower VAS score (p-value = 0.01 and &lt; 0.001, respectively).
Demographic and Clinical Characteristics of the Study Cohort
a. Time since symptom onset in infected cohort and time since enrollment in healthy controls
b. Other race/ethnicity included American Indian or Alaska Native, Black or African American, Native Hawaiian or other Pacific Islander, and more than 1 race.
Percentage of participants reporting symptoms at 6-, 12-, and 24-months
*

Conclusion
Symptoms associated with PASC were reported up to 2 years after infection with significant impacts on quality of life. These findings underscore the healthcare and societal burdens even after recovery from acute infection. As studies seek to identify the underlying mechanisms of PASC, prevention of acute infection remains the mainstay of COVID-19 burden mitigation.

Disclosures
Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.