bluuebunny/crossref_metadata_2025_split huggingface dataset:
276. Factors Predicting Bacterial Coinfection in Hospitalized COVID-19 Patients
Authors: Guo Yi , Cowman Kelsie , Bao Hongkai , Chen Victor , Kim Mimi , Xie Xianhong , Chang Mei H , Bartash Rachel , Azeem Meena , Nori Priya 
Published: December 2022

Abstract

Background
Despite multiple studies indicating a low prevalence of bacterial coinfection in coronavirus disease 2019 (COVID-19) patients, the majority of hospitalized COVID-19 patients receive one or more antibiotics. Patients with coinfection usually have multiple risk factors and poor clinical outcomes.

Methods
A retrospective case control study was conducted comparing clinical characteristics and antimicrobial use in hospitalized adult COVID-19 patients with bacterial co-infections vs. randomly selected patients without co-infections (matched on month of admission). The study was conducted at three hospitals within the Montefiore Medical Center, Bronx, NY between March 1, 2020 and October 31, 2020. A multivariable logistic regression model was developed to assess the relationship of each predictor variable with coinfection status. Secondary outcomes included hospital mortality, antibiotic days of therapy (DOT), and C. difficile infection.

Results
A total of 150 patients with coinfection and 150 patients without co-infection were included in the analysis. Table 1 summarized baseline characteristics and risk factors. The multivariable logistic regression model indicated that presence of a central line (OR=5.4, 95% CI: 2.7-11.1), prior antibiotic exposure within 30 days (OR=5.3, 95% CI: 2.8-10.0), prior ICU admission (OR=3.6, 95% CI: 1.7-7.6), steroid use (OR=2.7, 95% CI: 1.4-4.9), and any comorbid condition (OR=2.7, 95% CI: 1.4-5.2) were significantly associated with the development of coinfection (table 2). Mortality was higher in patients with coinfection (56% vs. 11%, p &lt; 0.0001) (table 3). Average antibiotic DOT was 10.5 in coinfected patients compared to 4 in non-coinfected patients, (p &lt; 0.0001). Forty-one percent of coinfected patients had a multidrug resistant organism isolated. C. difficile rate was higher in coinfected patients (4% vs. 0%, p=0.03).

Conclusion
As the healthcare community contends with a 3rd year of COVID-19 pandemic, understanding risk factors most predictive of bacterial coinfection can guide empiric antimicrobial therapy and targeted stewardship interventions. Ideally, co-infection risk scores are developed which may be useful for future inpatient surges.

Disclosures
Yi Guo, PharmD, BCIDP, Merck: Grant/Research Support Kelsie Cowman, MPH, Merck: Grant/Research Support.
286. Prevalence and Clinical Outcomes of COVID-Associated Pulmonary Fibrosis
Authors: Vogler Andrew J , Garcia Anselmo , Mafi Neema , VanDenBerg Chad M , Huang Vanthida 
Published: December 2022

Abstract

Background
Pulmonary fibrosis (PF) is a well-known consequence of severe lung disease and is associated with permanent changes as well as irreversible pulmonary dysfunction. The development of PF in patients infected with COVID-19 has been documented in multiple studies and case reports. However, prevalence and outcomes associated with PF have not been well established. Therefore, we sought to evaluate the prevalence and clinical outcomes of PF among patients infected with COVID-19.

Methods
This is an observational cohort study from January 2020 – January 2022. We collected data from adult patients diagnosed with COVID-19 who had at least two separate computerized tomography (CT) scans. Patients were grouped based on whether evidence of developing PF, defined by clinical radiological parameters, were seen on CT. The initial CT must be negative for PF to be included. We collected the following information: baseline characteristics, secondary infection, mortality, and treatments. The primary objective was to determine the prevalence of PF among COVID-19 patients. Secondary objectives were to evaluate the differences in 30-day all-cause mortality; intensive care unit (ICU) mortality; and prevalence of secondary infections.

Results
A total 161 patients were COVID-19 positive with multiple CT scans; 27 (16.8%) had signs of PF while 134 (83.2%) did not. Of the patients with signs of PF, 13 (48.1%) were male (mean age of 57 years) and 13 (48.1%) were admitted to the ICU. There was no difference in secondary bacterial infection between fibrotic and non-fibrotic patients (55.6% vs 38.5%, p=0.20). The most common bacterial infection among PF patients was caused by S. aureus (26.7%). The most common infection type among PF patients was nosocomial pneumonia (46.7%). Mortality at 30-day was higher in the fibrotic patients, 70% vs 24.2% (p&lt; 0.01). The ICU mortality trended higher in the fibrotic group (69.2% vs 36.6%, p=0.124), although it was not statistically significant.

Conclusion
Pulmonary fibrosis can be fatal as a complication of COVID-19. Further investigation is warranted to evaluate the outcomes of PF in patients with COVID-19.

Disclosures
All Authors: No reported disclosures.
287. Procalcitonin and D-dimer levels at baseline, but not CRP, were informative of COVID-19 hospitalization outcomes
Authors: Mathew Trini , George Julie , Yost Christine N , Deebajah Mustafa , Johnson Paul C , Huang James , Carpenter Christopher F 
Published: December 2022

Abstract

Background
The WHO estimates 512 million cases of COVID-19 and 6.2 million deaths globally as of May 4th, 2022. In Michigan (MI), the first case was diagnosed March 10th, 2020. We describe here outcomes of COVID-19 patients cared for in a large tertiary hospital in 2020 spanning two surges based on baseline lab values for C-reactive protein (CRP), Procalcitonin (PC), and D-Dimer (DD).

Methods
After IRB approval, adult patients diagnosed via PCR with COVID-19 during the two surges in 2020 and admitted to Beaumont Hospital, Royal Oak, an 1,131 beds tertiary care referral center in MI, were reviewed. Demographic, clinical and laboratory characteristics were obtained from the EMR. ICD-10 classification diagnoses were utilized to identify comorbidities, and patient BMIs were based on the admission values in the EMR. Outcomes were defined as death during current admission, transfer to nursing home or other facility, or discharge home. Using a tree-based model and the combined levels of the three labs we defined a hierarchy of four lab levels, each progressively having increased risk of death. We then analyzed the outcome for the four levels, adjusting for time period (surge), age, sex, race, BMI and comorbidities. Data was analyzed using SAS statistical software version 9.4 (SAS Institute).

Results
A total of 2197 patients were identified from March through December 2020, of whom 1118 had CRP, PC and DD available at baseline. The mean age was 66.7 years (SD 16.1) for the cohort in first surge (March-June), and 66.4 (15.6) in the latter surge (July-December, Table1). More patients had a PC of &gt;0.5 in the first surge (25.7%) than the second (13.2%). After adjusting for all other factors, the hierarchical lab levels are significantly associated with outcomes. Of note, baseline CRP value was not informative. Compared to the 2nd level (Table 2), the lowest level (PC &lt; 0.1) has significantly lower odds of death [OR=0.37, 95% CI (0.19, 0.73)], while the highest level, (DD &gt;1000 and PC ≥ 0.26) has significantly higher odds of death [OR=3.01, 95% CI (1.59, 5.72)].

Conclusion
Baseline PC and DD, but not CRP, were informative in determining risk of death and can assist clinicians determine possible outcomes during COVID-19 hospitalization.

Disclosures
Christopher F. Carpenter, MD, MHSA, Atox Bio: Advisor/Consultant|GSK: Advisor/Consultant|Iterum Therapeutics: Advisor/Consultant|Takeda: Advisor/Consultant.
293. Risk factors for COVID-19 associated pulmonary aspergillosis (CAPA) in severe COVID-19 and impact of airborne fungal contamination within negative pressure isolation room
Authors: Lee Jung Ah , Ahn Sanggwon , Ju Lee Se , Kim Jinnam , Lee Ki Hyun , Kim Chang Hyup , Yeom Joon-sup , Ku Nam Su , Jeong Su Jin , Kim Jung Ho , Ho Hwang Jung , Yong Dongeun , Choi Jun Yong , Ahn Jin Young 
Published: December 2022

Abstract

Background
COVID-19 increase the risk of invasive pulmonary aspergillosis. However, the risk factors and fungal origin of COVID-19 associated pulmonary aspergillosis (CAPA) is not fully defined yet. We aim to identify the risk factors for CAPA in severe COVID-19 and evaluate association between fungal contamination within the air of negative pressure rooms and diagnosis of CAPAs.

Methods
We performed a retrospective case-control study to identify risk factors for CAPA with 420 severe COVID-19 patients from March 2020 to January 2022 who admitted to a tertiary care hospital in South Korea. CAPA was defined with modified AspICU criteria. Control, matched by admission date and severity of COVID-19 at admission, was selected for each case. Air sampling and fungal culture was done on Jan 2022 with a microbial air sampler (MAS-100NT) at 11 spaces in the COVID-19 designated isolation ward including 9 negative pressure isolation rooms (IRs). A cross-sectional comparison between rooms with and without airborne fungal contamination was performed.

Results
A total of 420 COVID-19 patients were hospitalized during the study period, and 51 patients were diagnosed with CAPA (prevalence 12.14%, incidence 6.26 per 1000 patient•day). Multivariate analysis showed that older age (odds ratio [OR] 1.051, 95% confidence intervals [CI] 1.006-1.009, p=0.025), mechanical ventilator use (OR 2.692, 95% CI 1.049-6.911, p=0.04), and lymphopenia (OR 4.353, 95% CI 1.727-10.975, p=0.02) were independent risk factors for CAPA. (Table 1, 2) Aspergillus spp. was identified within the air from 7 out of 11 spaces including 6 IRs and 1 doctors’ room. (Figure 1). All 6 IRs with positive aspergillus culture were being occupied by patients at least 8 days. Among 6 patients, 3 had already been diagnosed with CAPA whereas the other 3 were not diagnosed with CAPA through the observation period. Among 4 patients in isolation rooms without airborne aspergillus contamination, one patient had been diagnosed as CAPA before air sampling. (Table 3).

Conclusion
Association between CAPA and airborne aspergillus contamination within the negative pressure room could not be demonstrated in this study. Rather than environmental factors, patient factors such as older age, ventilator care, and lymphopenia were found to be associated with CAPA diagnosis.

Disclosures
All Authors: No reported disclosures.
295. SARS-CoV-2 Associated Multisystem Inflammatory Syndrome in Adults (MIS-A): a Multicenter Case Series.
Authors: Trigueros Ricardo , Denmeade Travis , Pannebaker Danielle , Maves Ryan C 
Published: December 2022

Abstract

Background
MIS-A frequently presents with symptoms including fevers, cardiovascular, gastrointestinal mucocutaneous, and neurologic involvement in both children and adults. Predominantly occurs in previously healthy children and young adults, disproportionately affecting individuals of African,Latino and Asian descent. Represents one of the most significant and yet under-recognized clinical consequences of SARS-CoV-2 infection.

Methods
A retrospective review was performed of the identified MIS-A cases admitted to two institutions between January 2020-December 2021. Included cases required evidence of present or previous SARS-CoV-2 infection by either PCR or antigen testing; and meeting the CDC definition for MIS-A. After case identification, we collected clinical and laboratory data to analyze demographics, clinical symptoms, laboratory result, imaging, length of hospitalization and therapeutic interventions.

Results
Ten cases were identified in the established period of time. The average interval to hospital admission was 31days. Clinical symptoms included fever, malaise, gastrointestinal complaints, dyspnea, diffuse rash. Males outnumbered females in a ratio of 7:3,with African American and Latino patients comprising 80% of the cases. All patients had elevated inflammatory markers and the most commonly manifesting organ dysfunction was cardiovascular system.

Conclusion
This case series helps reinforce the characterization of an as yet incompletely understood and challenging clinical syndrome, providing insight to guide diagnosis and treatment of MIS-A. A greater understanding of MIS-A may facilitate earlier syndromic recognition in order to improve outcomes, reduce unnecessary antimicrobial use, and reduce costs.

Disclosures
Ryan C. Maves, MD, AiCuris: Grant/Research Support|Sound Pharmaceuticals: Grant/Research Support|Trauma Insights, LLC: Advisor/Consultant.
296. SARS-CoV-2 Illness Severity and Early Hospitalization Outcomes in a Multicenter Prospective Cohort Study Among Veterans
Authors: Ross Jennifer M , Sugimoto Jonathan D , Timmons Andrew , Moore Kathryn , Adams Jonathan , Wilson Deanna , Liu Cindy H , Deardoff Katrina V , Korpak Anna , Chang Kyong-Mi , Cho Kelly , Crothers Kristina , Gaziano Michael , Holodniy Mark , Hunt Christine M , Isaacs Stuart N , Jones Barbara E , Le Elizabeth , Shah Javeed , Smith Nicholas L , Lee Jennifer S 
Published: December 2022

Abstract

Background
Over 600,000 SARS-CoV-2 infections and 20,000 deaths have occurred among users of the Veterans Health Administration, the US’s largest integrated health care system. We explored early outcomes of SARS-COV-2 infection in Veterans.

Methods
An ongoing, prospective longitudinal cohort study of Veterans ages ≥ 18 enrolled 1,826 participants (29.0% inpatient; 49.1% vaccinated; 68.3% SARS-CoV-2-positive; 85.0% male, mean age = 57.1 years) seeking inpatient or outpatient care after SARS-CoV-2 testing at 15 Department of Veterans Affairs medical centers in July 2020 to February 13, 2022. Using multivariable regression, we estimated relationships of baseline demographic characteristics, COVID-19 vaccination, and clinical history to illness severity and cumulative length of hospital stay within 60 days of study entry. Illness severity was defined by a Veterans Affairs adaptation of the WHO COVID-19 severity scale and included 4 levels (mild, moderate, severe, or death). We derived the Charlson co-morbidity index (CCI) and other baseline characteristics from electronic health data and study questionnaires, and reported qualitative SARS-CoV-2 IgG responses using inpatients’ study-collected blood specimens.

Results
High CCI scores (≥ 5) occurred in 47 (42.7%) vaccinated SARS-CoV-2-positive inpatients and 47 (21.2%) unvaccinated. Severe illness occurred in 17 (15.5%) vaccinated inpatients, 37 (16.7%) unvaccinated inpatients, 4 (0.9%) vaccinated outpatients, and 3 (0.7%) unvaccinated outpatients. Eleven (10%) of 110 vaccinated SARS-CoV-2-positive inpatients died, as did 15 (6.8%) of the 222 unvaccinated. In SARS-CoV-2-positive inpatients, a one-step higher CCI was associated with more severe illness (aOR 1.10, 95% CI 1.01-1.20) and more hospitalization days (aIRR 1.06, 95% CI 1.03-1.10), adjusting for vaccination status. Respectively, 93% of vaccinated and 63% of unvaccinated SARS-CoV-2 positive inpatients with baseline antibody results had an anti-spike IgG response.

Conclusion
In an ongoing longitudinal cohort study of COVID-19 in US Veterans, comorbidity burden was higher among vaccinated than unvaccinated inpatients and was associated with more severe illness and hospitalization days, independent of vaccination status.

Disclosures
Christine M. Hunt, MD, MPH, Adaptive Phage Therapeutics: Advisor/Consultant|Akebia: Advisor/Consultant|Galmed: Advisor/Consultant|Otsuka: Advisor/Consultant|Palladio: Advisor/Consultant.
299. Systems immunology profiling of treatment-naïve children with multisystem inflammatory syndrome
Authors: Zheng Hong , Yonker Lael , Donado Michele , Solomon Ben , Boribong Brittany , Gernez Yael , Maecker Holden , Sigal Natalia , Kinane Bernard , Arvin Ann , Khatri Purvesh , Weinacht Katja 
Published: December 2022

Abstract

Background
Multisystem inflammatory syndrome in children (MIS-C) is a severe post-infectious complication occurring weeks after SARS-CoV-2 infection. The exact mechanisms leading to immune dysregulation and organ damage remain incompletely understood. Progress in understanding the immunopathology underlying MIS-C has been halted by limited availability of pre-treatment patient samples and confounding effects of immunomodulatory treatment on previously studied specimens.

Methods
In this study, we have restricted enrollment to treatment-naïve patients with MIS-C and used a systems biology approach combining CyTOF, single cell transcriptomics, serum cytokine profiling and T cell receptor sequencing to dissect how immune responses in children with MIS-C differ from children with mild SARS-CoV2 infection, adults with severe COVID-19 and healthy individuals. We also integrated single cell transcriptomics datasets from post-treatment MIS-C samples to study how immune responses change along disease course.

Results
We identified increased activation markers and antigen presentation across multiple immune cell types in MIS-C patients from both CyTOF and single cell transcriptomics data. Importantly, in PBMCs of MIS-C patients, we identified a distinct subset of proinflammatory monocytes, with increased expression of interferon gamma response genes combined with a signature of enhanced complement expression, antigen processing and presentation, which was not observed in post-treatment MIS-C samples. Interestingly, this monocyte population bears resemblance to a subset of monocytes that emerges after the BNT162b2 mRNA vaccine booster. In addition, in PBMCs of MIS-C patients, we identify increased proportion of proliferating T/NK cells, suggesting distinct T cell expansions in MIS-C. T and NK cells in MIS-C samples also showed increased cell cytotoxicity markers.

Conclusion
Taken together, treatment-naïve MIS-C samples display distinct monocyte clusters, activated antigen presentation and complement expression, and increased T and NK cell cytotoxicity, which may account for the clinical presentation of MIS-C.

Disclosures
Purvesh Khatri, PhD, Cepheid, Inc.: Advisor/Consultant|Inflammatix, Inc.: Advisor/Consultant|Inflammatix, Inc.: Inflammatix is in negotiations to license the 9-gene signature discussed here.|Inflammatix, Inc.: Stocks/Bonds.
300. Trends in electrocardiographic and cardiovascular manifestations of patients hospitalized with COVID-19
Authors: Ngiam Jinghao Nicholas , Goh Wilson , Sim Meng Ying , Chhabra Srishti , Liong Tze Sian , Chew Nicholas W S , Chai Ping , Yeo Tiong Cheng , Cross Gail Brenda , Tambyah Paul Anantharajah , Sia Ching Hui 
Published: December 2022

Abstract

Background
Early in the coronavirus disease 2019 (COVID-19) pandemic, a low incidence of cardiovascular complications was reported amongst hospitalised patients with COVID-19 in Singapore. Little was known about the trend of cardiovascular complications as the pandemic progressed. As such, we sought to examine the evolving trends in electrocardiographic and cardiovascular manifestations in patients hospitalised for COVID-19 infection.

Methods
We examined the first 1781 consecutive hospitalised patients with polymerase chain reaction (PCR) confirmed COVID-19 in a tertiary academic centre. We divided the population based on those who had an abnormal electrocardiogram (ECG) and those who had a normal ECG, comparing the baseline characteristics and outcomes between the 2 groups. Cardiovascular complications such as acute myocardial infarction, stroke, pulmonary embolism, myocarditis and mortality were also examined over time.

Results
Of the 261 (14.7%) patients presenting with abnormal ECG, they were more likely to be symptomatic with complaints of breathlessness, palpitations and chest pain. Sinus tachycardia was the most common arrhythmia. Troponin I levels (41.6±264.3 vs 97.0±482.9, p=0.047) and C-reactive protein levels (20.1±50.7 vs 13.9±24.1 µmol/L, p=0.003) were significantly higher amongst those with abnormal ECGs at presentation, with a higher prevalence of myocarditis (1.9% vs 0.5%, p=0.021), pulmonary embolism (1.9% vs 0.3%, p=0.009) and acute myocardial infarction (1.1% vs 0.1%, p=0.025). Over time, there was a trend towards a higher proportion of hospitalised patients with cardiovascular complications.
Baseline characteristics of hospitalised patients with COVID-19, with or without abnormal ECG at presentation
Changes in percentage of hospitalised patients with COVID-19, experiencing cardiovascular events (acute myocardial infarction, stroke, myocarditis, pulmonary embolism and death) over time

Conclusion
A baseline ECG at presentation is a simple test that provides valuable information on potential cardiovascular complications in the context of COVID-19. Although the prevalence of abnormal ECGs is relatively low, it appears to be increasing over time amongst hospitalised patients with COVID-19.

Disclosures
All Authors: No reported disclosures.
301. Use of a multiplex PCR assay for detection of respiratory co-infections in COVID-19 hospitalized non-ICU patients: an ace up a clinician’s sleeve
Authors: Louka Christina , Velentza Lemonia , Rekleiti Nektaria , Apanomeritaki Anastasia , Mamali Vasiliki , Stamati Alexandra , Linardaki Garifallia , Gerakari Styliani , Digalaki Katina , Giannitsioti Efthymia , Chrysos Georgios , Zarkotou Olympia 
Published: December 2022

Abstract

Background
Bacterial co-infections in COVID-19 patients represent a significant challenge for clinicians and can impact outcomes. Rapid identification of bacterial co-pathogens improves management, and is crucial to avoid inappropriately administered antimicrobials. We evaluated the use of a multiplex PCR assay in the early detection of respiratory co-infections in COVID-19 hospitalized patients.

Methods
The study included non-ICU patients with high clinical suspicion of respiratory co-infection. Lower respiratory tract samples (sputum/bronchial secretions), were analyzed using BIOFIRE® FILMARRAY® pneumonia panel plus [(bioMerieux, USA), FA]. Specimens were considered as acceptable based on Gram stain. Conventional cultures were also performed.

Results
A total of 28 samples from 27 patients (20 males, median age 60 years, IQR 49-71) were analyzed. 8/27 patients were intubated, 5 were treated with high flow nasal canula oxygenation and 11 with high or low oxygen mask. 18 patients received dexamethasone. Co-infection was detected in 17/27 patients (62.9%). 11 specimens were collected in less than 48 hours from admission and no target was identified in 6/11. Detected pathogens and AMR genes, per sample tested, are presented in the table. Bacterial pathogens and any AMR genes were detected in 15 and 4 samples, respectively, leading to modifications of antimicrobial treatment. The semi-quantitative results along with patients’ clinical presentation assisted with differentiation of bacterial colonization versus infection, especially in cases where multiple targets were identified. De-escalation was implemented for 12 patients, for whom no co-infection or a viral co-pathogen (n=2) was detected. One patient was co-infected with another Coronavirus; further analysis, using the FA respiratory panel, detected Human coronavirus HKU-1 along with SARS-CoV-2. Median time until discharge or death was 13.5 days (IQR 9-24). Overall mortality was 33.3%.
Detected pathogens, microbial load and AMR genes, per sample tested.

Conclusion
Implementation of FA assay proved effective for the rapid detection of respiratory co-infections in COVID-19 non-ICU patients. Molecular panel-based assays can contribute to timely adaptation of antimicrobial treatment, benefiting patient management and antibiotic stewardship strategies.

Disclosures
All Authors: No reported disclosures.