bluuebunny/crossref_metadata_2025_split huggingface dataset:
220. Acute kidney injury incidence comparison of vancomycin trough-based vs AUC/MIC monitoring at a tertiary care hospital
Authors: Ruiz Gaviria Rafael E , Ramdeen Sheena , Chou Jiling , Norman Sarah J , Elgendi Sarah H , Llama Adrian , Kitana Farah I 
Published: December 2022

Abstract

Background
Therapeutic drug monitoring (TDM) of vancomycin is a fundamental part of optimizing efficacy and adverse effects. The Infectious Diseases Society of America (IDSA) consensus guidelines recently recommended a change in vancomycin monitoring from trough-based levels to area under the curve/minimum inhibitory concentration (AUC/MIC). The objective of this study was to compare the incidence of acute kidney injury (AKI) utilizing trough vs AUC/MIC vancomycin monitoring.

Methods
This retrospective cohort study included patients ≥18 years old that had received vancomycin for &gt;48 hours. Patients who developed an AKI within 48 hours of vancomycin were excluded. One cohort included patients monitored by vancomycin trough levels from January to June 2019, and the second cohort included patients monitored by AUC/MIC from July to December 2021. The primary outcome was incidence of AKI per Kidney Disease Improving Global Outcomes (KDIGO) definition. Data were analyzed using a multivariate logistic regression model with covariates that are described to be associated with AKI.

Results
A total of 371 patients were included; 229 patients from the trough-based cohort and 142 patients from the AUC/MIC cohort. The incidence of AKI was 20.1% in the trough-based cohort and 13.5% in the AUC/MIC cohort (p=0.153). Around 39% and 30% patients were admitted to the intensive care unit from the trough based cohort and the AUC/MIC respectively. A multivariate logistic regression analysis identified higher odds of AKI among patients with supratherapeutic vancomycin levels regardless of dosing method, OR=5.89 (95% CI 3.03-11.54) ,and the OR comparing trough based dosing with AUC/MIC dosing was OR=1.1 (95% CI 0.58-2.12).

Conclusion
The incidence of AKI was higher in the vancomycin trough-based cohort vs AUC/MIC cohort. The difference was not statistically significant, but these findings are clinically relevant to practice. These findings align with the IDSA guidelines and suggest that vancomycin AUC/MIC monitoring may cause less nephrotoxicity.

Disclosures
All Authors: No reported disclosures.
230. Multicenter Assessment of the Accuracy of MIC Results for Colistin with MicroScan Dried Gram Negative MIC Panels using CLSI Breakpoints
Authors: Riedel Stefan , Traczewski Maria , Beasley Denise , Brookman Regina , Diaz Jose , Lockett Zabrina , Chau Jennifer 
Published: December 2022

Abstract

Background
A multicenter study was performed to evaluate the accuracy of MIC results for colistin on a MicroScan Dried Gram Negative MIC (MSDGN) Panel when compared to results obtained with frozen broth microdilution panels prepared according to CLSI/EUCAST methodology. Note: Colistin is not available in all countries.

Methods
MSDGN panels were evaluated at three clinical sites (including Beckman Coulter) by comparing MIC values obtained using the MSDGN panels to MICs obtained utilizing a CLSI/EUCAST broth microdilution reference panel. The study included 407 clinical isolates tested using the turbidity and Prompt® methods of inoculation. MSDGN panels were incubated in the WalkAway System (35 ± 1°C) and read on the WalkAway System, the autoSCAN-4 instrument, and read visually at 16-20 hours. Frozen reference panels were prepared and inoculated according to CLSI/EUCAST Joint Working Group Recommendations for MIC determination of Colistin (Polymyxin E) and incubated for 16-20 hours and read visually. CLSI M100 ED32 breakpoints (µg/mL) used for interpretation of MIC results were: Enterobacterales ≤ 2 I, ≥ 4 R; P. aeruginosa ≤ 2 I, ≥ 4 R.

Results
Essential, categorical agreement, and categorical errors were calculated using MIC results from WalkAway reads for MSDGN panels in Table 1. All other read methods yielded similar results. Categorical agreement was not calculated for Acinetobacter spp. as MIC only is reported. Table 1- Results

Conclusion
This multicenter study showed that colistin MIC results for Gram Negative bacteria obtained with the MSDGN panel correlate well with MICs obtained using frozen reference panels with CLSI interpretive criteria.
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Disclosures
Stefan Riedel, M.D., PhD., D(ABMM), FCAP, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc. Maria Traczewski, BS, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc. Denise Beasley, BS, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc. Regina Brookman, BS, Beckman Coulter, Inc.: Employee of Beckman Coulter Jose Diaz, BS, Beckman Coulter, Inc.: Employee of Beckman Coulter Zabrina Lockett, PhD, Beckman Coulter, Inc.: Employee of Beckman Coulter Jennifer Chau, PhD, Beckman Coulter, Inc.: Employee of Beckman Coulter.
238. Acalculous Cholecystitis: A Novel and Lethal Unrecognized Complication in Severe CoVID 19
Authors: Pedraza Reyes Carlos A , Zambrano Luisa Rivero , Sosa Garcia Jesus Ojino , Gonzalez Abril Azeneth Sifuentes , Mendez Erick Lopez , Mendez Jorge Oscar Garcia 
Published: December 2022

Abstract

Background
SARS-COV-2 infection is known to cause tissue damage in several organs outside of the respiratory tract. The pathogenesis of tissue damage is hypothesized to be caused by direct viral damage, endothelial injury, and ischemic or thrombotic events. Gastrointestinal symptoms were first characterized mainly as diarrhea and diffuse abdominal pain and discomfort, which can be hard to interpret in the setting of a generalized inflammatory response; gallbladder injury and inflammation causing acute acalculous cholecystitis has been scarcely reported

Methods
Here we discuss five cases of patients presenting with symptoms of cholecystitis. All five patients underwent multiple imaging studies, and all of them were compatible with acute cholecystitis; some of them had an imaging report of lithiasic cholecystitis, while the rest were reported with microlithiasis or biliary sludge. Four out of the five patients underwent laparoscopic cholecystectomy; biopsies were taken, consistently those reported with acalculous cholecystitis. The remaining patient died of CoVID 19 complications prior to surgery, but after a percutaneous cholecystostomy tube was placed.

Results
All these patients have in common the prolonged fasting, because they all required invasive mechanical ventilation, consequently, they all developed multiple focal pneumonia and respiratory distress syndrome. This fast is related to the development of gangrenous ischemia in the gallbladder, which manifests as a late complication due to SARS-CoV-2 infection, in addition to being related to angiotensin-2 converting receptors and virus replication proteins, as well as the pro-inflammatory and hypoxia state that in itself causes the infection (9).
All showed a cholestatic pattern, highlighting that this complication developed in an average time of 3 weeks after the onset of SARS-CoV2 symptoms, in addition to the fact that in most cases a negative test was already shown at the time of the complication.

Conclusion
Acalculous cholecystitis is one of the extrapulmonary complications that has been seen in patients with this infection, not being the most common, but one of those that has generated a higher mortality rate in patients due to its late diagnosis and non-specific clinical picture in certain occasions (9).

Disclosures
All Authors: No reported disclosures.
243. Association Between SARS-CoV-2 Viral Load and Patient Symptoms and Clinical Outcomes Using Droplet Digital PCR
Authors: Hastie Elizabeth , Amogan Harold , Looney David , Mehta Sanjay R 
Published: December 2022

Abstract

Background
Droplet digital PCR (ddPCR) has been shown to be more sensitive and precise in the quantification of SARS-CoV-2 when compared to traditional quantitative RT-PCR. Multiple studies have explored associations between SARS-CoV-2 viral load and patient outcomes; however, few have used ddPCR technology. Here we investigated the associations between viral load measured using ddPCR and clinical presentation and outcomes.

Methods
We performed a retrospective observational study of individuals who tested positive for COVID-19 at the VA San Diego between August 2020 and December 2021. SARS-CoV-2 viral load from nasopharyngeal swabs was determined using ddPCR. Baseline demographics, past medical history, clinical course, and laboratory data were abstracted from the chart.

Results
A total of 696 individuals were included, 86% (n=603) of whom were male. The average age was 50-years-old [range: 19-98]. Three-quarters of individuals (76%, n=528) were unvaccinated at diagnosis. Frequency of comorbidities are shown in Table 1. The majority of individuals developed symptoms with 75% (n=516) reporting respiratory symptoms, 47% (n=317) fever, 34% (n=230) GI symptoms, and 23% (n=161) loss of taste and/or smell. A total of 24% of veterans were evaluated only in the emergency department, 21% (n=149) were admitted to the hospital; 9% (n=60) required ICU level of care, 33% of these (n=20) required intubation, and 16 individuals died during hospitalization.
SARS-CoV-2 log10 viral load was not associated with age, and only a weak correlation was seen with time from onset of symptoms (r2=-0.1, p=0.04). No association was observed between viral load and peak CRP, ferritin, d-dimer, or nadir absolute lymphocyte count. Mean viral load was significantly higher in veterans reporting fever (5.0 vs 5.4, p=0.02) and respiratory symptoms (4.7 vs 5.3, p=0.01). Interestingly, vaccinated veterans also had higher viral loads(5.8 vs 5.0, p&lt; 0.0001).
Baseline characteristics of individuals with COVID-19
Histogram of COVID-19 RNA viral load

Conclusion
Fever and respiratory symptoms were associated with higher viral loads as expected. The association of vaccination with higher viral load may reflect selection bias for infections in the delta wave. Future work will include multivariate analyses to adjust for medical history and timing of sampling.

Disclosures
Sanjay R. Mehta, MD, Zibdy Health: Advisor/Consultant.
248. Change in Incidence of Multisystem Inflammatory Syndrome in Children Across the COVID-19 Pandemic in Chicago — March 2020 – March 2022
Authors: Spencer Hillary , Seo Jennifer , Pacilli Massimo , Robinson Candice L , Matzke Hannah , Joseph Maria , Gretsch Stephanie 
Published: December 2022

Abstract

Background
Peak counts of multisystem inflammatory syndrome in children (MIS-C) have followed each COVID-19 peak by 2–5 weeks. Fewer cases of MIS-C occurred after the Delta-predominant period compared to early waves of the pandemic. The Chicago Department of Public Health analyzed the ratio of MIS-C to pediatric COVID-19 hospitalization by period of variant predominance from March 2020 – mid-March 2022 to evaluate differences by variant.

Methods
MIS-C in Chicago residents was reported using the standard CDC MIS-C case report form. Four periods of COVID-19 infection were identified with dates defined by variant predominance (≥50%); date ranges for corresponding MIS-C periods were defined as starting 21 days after the COVID-19 period (Table 1). MIS-C cases were compared to hospitalizations as a measure of COVID-19 disease activity in children (rather than case counts which are more subject biases inherent in disease testing) among confirmed and probable COVID-19 cases in children ≤21 years reported to CDPH. Ratios of MIS-C cases per 100 corresponding pediatric hospitalizations for each variant period were calculated. Proportions of MIS-C hospitalizations with intensive care unit (ICU) admission, mechanical ventilation (MV), and receipt of vasopressors (VP) were calculated as markers of disease severity in MIS-C for each wave.

Results
90 cases of MIS-C and 1,597 pediatric COVID-19 hospitalizations were reported (Table 2). The overall ratio was 5.6 MIS-C cases/100 pediatric COVID-19 hospitalizations. The first period with predominance of the original lineage had a ratio of 10.2; subsequent periods with variant predominance all had lower ratios. The Delta period had the second highest ratio which was 68% of the first period. Across waves, 74% of MIS-C patients were admitted to ICU (range, 67–82%); 11% underwent MV (range, 0–14%); and 52% received VP (range, 45–71%).

Conclusion
The ratio of MIS-C to pediatric COVID-19 hospitalizations varied by period of SARS-CoV-2 variant predominance. The ratio was highest in the early pandemic. There was no consistent change in MIS-C severity. Further study is needed to determine if the change in ratio is due to increased immunologic exposure (vaccination or previous infection) or if it is variant dependent.

Disclosures
All Authors: No reported disclosures.
249. Characteristics and outcomes of cryptococcosis among patients with COVID-19 compared to non-COVID-19 controls
Authors: Chastain Daniel B , Kung Vanessa , Golpayegany Sahand , Jackson Brittany T , Franco-Paredes Carlos , Thompson George R , Henao-Martínez Andrés F 
Published: December 2022

Abstract

Background
It remains unclear if there is an association between COVID-19 and cryptococcosis. The purpose of this study was to compare demographic characteristics and outcomes of cryptococcosis between patients with COVID-19 to non-COVID-19 controls.

Methods
Patients 18 years and older with cryptococcosis were identified from TriNetX, a global federated research network, and separated into two cohorts based on a diagnosis of COVID-19 within 3 months prior to the index diagnosis of cryptococcosis. The primary outcome was the percent mortality in each group. The secondary outcomes included the proportion of patients in each group who had underlying comorbidities, received immunosuppressive medications, or required hospitalization or ICU admission. Propensity score matching was performed to control for differences between groups based on demographics and comorbidities. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for outcomes, with p &lt; 0.05 as the cut off for statistical significance.

Results
A total of 6252 patients with cryptococcosis were included, of which 4.5% (n=283) had COVID-19 prior to diagnosis of cryptococcosis. Mortality was similar between patients with and without COVID-19 (13% vs 10%, p=0.075). Patients with cryptococcosis and previous COVID-19 were older (55.2 ± 14.5 years vs 52 ± 15.2 years, p=0.0005) and more likely to be non-Hispanic (73% vs 65%, p=0.0049). More patients with COVID-19 had a history of transplant (30% vs 13%, p &lt; 0.0001), malignancy (37% vs 21%, p &lt; 0.0001), and diabetes (35% vs 19%, p &lt; 0.0001), but not HIV (29% vs 31%, p=0.5482). Prednisone and dexamethasone use were higher among patients with previous COVID-19 (32% vs 15%, p &lt; 0.0001 and 17% vs 7%, p &lt; 0.0001, respectively). Hospitalization rates were similar (54% vs 57%, p=0.278), but more patients with COVID-19 required ICU admission (19% vs 11%, p &lt; 0.0001). In propensity score-matched analysis, patients with COVID-19 remained at higher odds of ICU admission (OR 1.85, 95% CI 1.15-2.97, p=0.010), but lower odds of hospitalization (OR 0.57, 95% CI 0.41-0.81, p=0.001).

Conclusion
Patients with COVID-19 who developed cryptococcosis had higher rates of comorbidities, corticosteroid use, and ICU admission but did not experience higher mortality compared to non-COVID-19 controls.

Disclosures
George R. Thompson, III, MD, Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Merck: Grant/Research Support|Pfizer: DSMB|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support.
257. Coinfection Characteristics among Children with COVID-19
Authors: García Itzel Villanueva , Gómez Nancy Evelyn Aguilar , Atri Aarón Espinosa , Márquez Angela Patricia Vedia , Marin Juan Antonio Gallegos , Tepach Ana Ruth Hernández 
Published: December 2022

Abstract

Background
Coinfection in patients with SARS-CoV-2 has been associated with greater complications. We describe the clinical characteristics and outcomes of 126 pediatric patients with COVID-19 and viral, bacterial, or fungal coinfection.

Methods
We retrospectively reviewed and analyzed electronic data of all pediatric patients who tested positive for SARS-CoV-2 from April 16, 2020, to April 15, 2022, in our center. Confirmation of COVID-19 was based on positive RT-PCR. Viral coinfections (VC) were identified using a multiplex RT-PCR respiratory viral panel, bacterial coinfection (BC) was determined by positive bacterial culture (blood, bronchoalveolar lavage, sputum, urine) or clinical/radiological manifestations and antimicrobial assessment by a pediatric Infectious Diseases expert and fungal coinfection (FC) diagnosis based on Consensus definitions of invasive fungal disease.

Results
During the study period, among 400 pediatric patients with COVID-19, 126 children had coinfection. Children &gt;10 years were the most affected age group. Underlying disease was present in 69%, hematological malignancies were the most common (17.5%). BC was detected in 76.9% (n=97), bacterial pneumonia (54.6%) was the main diagnosis, followed by oncologic patients with initial febrile neutropenia and posterior SARS-CoV-2 detection (14,4%). Unusual BC as congenital syphilis w detected; acute appendicitis was the initial presentation of COVID-19 in 8 patients. VC was identified in 15.87% (n=20), prevailing rhinovirus (9.5%) and adenovirus (3.96%), One FC presented as proven pulmonary aspergillosis (0.8%). B-V and B-F coinfection were detected in 2 patients. Fever and cough were the most common symptoms, higher fever &gt;40°C was mostly observed in the BC group (3%). Twenty-seven patients with BC (27.8%) were admitted to intensive care, with the OR 0.7 IR 95% (0.611–1.008), 4.1% died. One ICU admission was observed in the VC group (5%) and all VC cases resolved without complications.

Conclusion
Pediatric patients with COVID-19 coinfection, especially BC were common in our center representing nearly one-third of the infected children, including unusual coinfections. BC was identified as a risk factor for ICU admission OR 0.7 IR 95% (0.611–1.008). Favorable outcomes were observed in most cases.

Disclosures
All Authors: No reported disclosures.
264. COVID-19 Associated Pulmonary Aspergillosis in Intensive Care Patients Based on Duration of Corticosteroid Administration
Authors: Shah Meera D , Christina Gutierrez G , Moote Rebecca , Reveles Kelly R , Hand Elizabeth O 
Published: December 2022

Abstract

Background
Coronavirus disease 2019 (COVID-19) associated pulmonary aspergillosis (CAPA) has emerged as a complication in critically ill COVID-19 patients. Corticosteroids are standard of care for COVID-19 patients. Prolonged corticosteroids have been associated with an increased risk of CAPA, but duration of use associated with this risk remains unknown. The objective of this study was to evaluate if the duration of corticosteroid therapy ≤ 10 days vs &gt; 10 days affects the risk of developing CAPA.

Methods
This single-center, retrospective, cohort study included patients ≥ 18 years old admitted to University Hospital between March 2020 and December 2021, diagnosed with severe COVID-19 pneumonia requiring mechanical ventilation, and who received at least 3 days of corticosteroid treatment. CAPA was defined according to 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus guideline. Baseline characteristics, CAPA, and secondary outcomes were compared using appropriate bivariable analyses. Steroid duration was evaluated as an independent predictor of CAPA in a logistic regression model.

Results
Final analysis included 278 patients (n=169 ≤ 10 days steroid duration; n=109 &gt; 10 day steroid duration). Baseline characteristics were similar between groups, with the exception of acute kidney injury and solid organ transplantation. Median duration of steroids was 6 days in the ≤ 10 day group vs 18 days in the &gt; 10 day group. In total, 20/278 (7.2%) patients developed CAPA. Patients treated with &gt; 10 days of corticosteroid therapy had significantly higher incidence of CAPA (12% vs 4.1%; p = 0.0156) and duration was independently associated with CAPA (OR 3.25, 95% CI 1.03-10.24). Secondary outcomes including inpatient mortality (43.2% vs 77.1%; p &lt; 0.0001), mechanical ventilation free days at 28 (1.5 vs 0; p &lt; 0.0001) and secondary infections (28.4% vs 44.9% p = 0.0220) were all significantly worse for &gt; 10 day corticosteroid cohort.

Conclusion
Duration of corticosteroid treatment &gt; 10 days in critically ill patients is associated with an increased risk of CAPA. Though patients may require corticosteroids for non-COVID-19 indications, clinicians should attempt to limit prolonged courses of corticosteroids in COVID-19 patients.

Disclosures
All Authors: No reported disclosures.
269. Outcomes comparison of hospitalized patients with COVID-19 during the first three pandemic waves. Experience in Colombia, South America.
Authors: Rosso Fernando , Rodriguez Sarita , Beltrán Estefanía , Valencia Alvaro Martinez , Zarama Virginia , Tafur Eric , Guzmán Tania 
Published: December 2022

Abstract

Background
Differences in access to specialized medical care services and their overcrowding due to the pandemic could impact clinical outcomes. Availability of newer treatments, vaccination, and emergence of newer SARS-CoV-2 variants could also explain these differences.

Methods
We performed a single-centered, observational study comparing clinical outcomes of COVID-19 admitted to the emergency department among the first three waves of the pandemic defined as June to August 2020, November 2020 to January 2021, and May to July 2021, respectively. The primary outcomes included intensive care unit admission, invasive mechanical ventilation requirement, hospital length of stay, and hospital mortality categorized by age groups. Effective COVID 19 antiviral therapy and monoclonal antibodies are not available in Colombia. Vaccination was available after March 2021.

Results
Out of a total of 2264 patients were admitted. Fifty-six percent were male, with a median age of 58 years [IQR, 45-70]. A significant increase of patients was seen after each wave: 530 in the first, 568 in the second, and 1166 in the third-wave worsening hospital overcrowding. Patients from the third wave were significantly younger (59 vs. 62 vs. 56 years, p &lt; 0.01). Patients from the first wave had higher proportion of intensive care unit admission (62.83% vs. 51.23% vs. 52.23%, p&lt; 0.01), invasive mechanical ventilation (39.25% vs. 32.22% vs. 31.22%, p&lt; 0.01), and length of hospital stay (9 vs 7 vs 7 days, p&lt; 0.01). Overall, no difference was found in mortality among waves (18.4% vs 19% 18.8%, p = 0.974). However, patients of 70-79 and ≥ 80 had a lower mortality during the third wave (24.4% vs 33.3% vs 19%, p=0.018), (30.6% vs 29.6% vs 23.6%, p=0.018). Vaccination was very low in all the age groups but was higher in elderly patients. Figure 1

Conclusion
Overall mortality did not increase between infection waves, although there was an increase in cases during the third wave. We found a significant decrease in mortality among the elderly. Major efforts of medical teams succeed in containing COVID 19 mortality. Figure 4

Disclosures
All Authors: No reported disclosures.