bluuebunny/crossref_metadata_2025_split huggingface dataset:
1010. Metronidazole-associated neurologic adverse events: risk factors analysis
Authors: Lee Se Ju , Kim Jinnam , Lee Ki Hyun , Lee Jung Ah , Hyup Kim Chang , Yeom Joon-sup , Choi Jun Yong , Ku Nam Su , Jeong Su Jin , Ahn Jin Young , Kim Jung Ho 
Published: December 2022

Abstract

Background
Metronidazole is a widely used antibiotic to treat anaerobic and protozoal infections. However, neurologic adverse events associated with metronidazole have been reported in case series and case reports. Previous publications implicated that long-term usage and cumulative dose are risk factors for this adverse event. Still, little is known about the risk factor of the metronidazole-associated neurologic adverse events. Therefore, we conducted a retrospective study to investigate the risk factors for the metronidazole-associated neurologic adverse events through a matched case-control study.

Methods
This retrospective study enrolled patients prescribed metronidazole from January 2006 to July 2021 at Severance Hospital, a tertiary hospital in South Korea. Case patients were defined as those who developed central nervous system (CNS) adverse events or peripheral nervous system (PNS) adverse events during the study period with causality assessment. In a 1 to 3 ratio, case patients were compared to a control group of the patients without neurologic adverse events, matched on age and cumulative dose of metronidazole.

Results
92838 patients were prescribed metronidazole during the study period. Among them, 52 patients showed metronidazole-associated neurologic adverse events (39 patients with CNS, 27 patients with PNS adverse events, and 14 patients with both). The proportion of chronic kidney disease (CKD), solid organ transplantation, liver cirrhosis (LC), intravenous (IV) administration of metronidazole, and concomitant use of a proton pump inhibitor was significantly higher in the case group. The body weight, hemoglobin, and serum albumin levels were lower, and Sequential Organ Failure Assessment scores were higher in the case group. Multivariate conditional logistic regression analysis demonstrated LC, CKD, IV administration, and lower body weight as risk factors for metronidazole-associated neurologic adverse events.

Conclusion
In this case-control study, LC, CKD, IV administration, and lower body weight were associated with the metronidazole-associated neurologic adverse events. Prolonged metronidazole treatment in patients with the risk factors requires careful examination for these adverse events.

Disclosures
All Authors: No reported disclosures.
1031. Impact of Meningitis-Encephalitis PCR Panel Testing on Antimicrobial Use in Patients with Suspected Meningoencephalitis
Authors: Rodriguez Julieta , Ahuja Monica , Moore Franklin , Marie Peter St , Lindsey Kristy , Paez Armando 
Published: December 2022

Abstract

Background
Meningoencephalitis continues to be a source of morbidity and mortality in the US despite vaccine development. Traditional culture-based diagnosis is time-consuming and less sensitive than molecular methods. Meningitis-encephalitis PCR panel (MEP) testing of CSF allows for rapid detection of 14 culprit microorganisms.

Methods
A retrospective cohort study was performed at University of Massachusetts Chan Medical School-Baystate in Springfield, MA between May 15, 2015 and May 14, 2017 on encounters among 163 individuals ranging in age from neonates to geriatric patients before and after MEP introduction for clinical practice. One cohort reflected pre-MEP availability and relied on culture and gram stain while another cohort had the MEP available and gram stain/culture. The primary outcomes were (1) MEP effect on antimicrobial de-escalation and (2) total antimicrobial days defined as sum of days on antimicrobial therapy counting each antimicrobial agent separately. Secondary outcomes were (1) length of hospital stay, (2) rate of adverse events associated with antimicrobial use, and (3) determination if adult or pediatric age interplayed with interpretation of MEP results.

Results
Fifty-two percent of the population was 18 years-old or younger. The most common organisms identified were parechovirus and enterovirus. There were 26 positive MEP panels and nine encounters did not de-escalate antimicrobials. Seven of the nine did not de-escalate because there was concern for sepsis or blood culture was positive. The remaining two either started or continued acyclovir for a positive MEP of HSV-2 or VZV. When the MEP resulted positive for bacteria, antimicrobials were modified. Mean time antimicrobial use was less when MEP was available (3.1 vs. 4.8 days) and length of hospitalization was similar (6.1 vs. 6.9 days). Adverse events were minimal in both groups.
Identified Organisms
Microorganisms identified by MEP overall, pediatric, and adult.
Total Antimicrobial Days and Length of Stay by Cohort
Pre-MEP and MEP available cohort distribution on total antimicrobial days and length of stay in pediatric and adult populations.

Conclusion
The data did identify difference in management with interpretation of the MEP for pediatrics (≤ 18 y/o) when compared to adults. Fever in a neonate, or severely ill child led to a 48 hour blood culture rule out prior to any change in antibiotics. Overall, our study showed association of MEP use with early antimicrobial de-escalation that can potentially lead to decreased length of stay and savings in healthcare costs.

Disclosures
All Authors: No reported disclosures.
1034. Risk Score for the Need of Mechanical Ventilation in Adults Presenting with Encephalitis.
Authors: Heck Ashley N , Ramirez Denisse , Ibanez Alejandro Granillo , Hasbun Rodrigo 
Published: December 2022

Abstract

Background
The purpose of this study was to stratify risk subgroups for mechanical ventilation in adults presenting with encephalitis.

Methods
A retrospective observational study of 271 adults ( &gt; 18 years old) admitted with an encephalitis diagnosis according to International Encephalitis Consortium guidelines were enrolled from sixteen hospitals in Houston, Texas between the years of 2005 and 2015.

Results
Mechanical ventilation (MV) was utilized in 91/271 (33.6%) adults with encephalitis and it was associated in hospital mortality (24.2% vs 3.9%, P&lt; 0.001). There were no significant differences in age, race, gender, underlying comorbidities or immunosuppressive conditions, fever, symptoms on presentation, focal neurological deficits, Glasgow coma scale, CSF profile, and abnormal cranial imaging including cerebral edema between patients with or without MV (P &gt;0.05). Risk factors associated with the need for MV included seizures, serum white blood cell (WBC) counts &gt;11,000/mm3, a Sequential Organ Failure Assessment (SOFA) score &gt;3 and abnormal Electroencephalogram (EEG) (P&lt; 0.05). A risk model was created using 3 baseline variables independently associated with MV (P&lt; 0.05): serum WBC count &gt;11,000/mm3, a
SOFA &gt;3 and abnormal EEG. The risk score classified patients into 3 subgroups for the need for MV: low risk [none of the three variables, 1/32 (3.1%)], intermediate risk [1 of the 3 variables, 19/106 (17.9%], and high risk [2 or 3 of the 3 variables, 71/136 (52.2%)].
Risk Classification for Mechanical Ventilation in Patients with Encephalitis.
a Predictors include white blood cell count &gt; 11, Sequential Organ Failure Assessment (SOFA) scores &gt; 3 or abnormal Electroencephalogram (EEG)
Receiver Operating Characteristic (ROC) curve of risk score (Low =0 variables seen in the patients, Intermediate = 1 variable seen, and High = 2 or 3 variables seen).
Area under the curve = 0.728.

Conclusion
This risk score can be utilized by clinicians to assess the need for MV in adults presenting with encephalitis to help stratify patients that require intensive care unit admissions.

Disclosures
Rodrigo Hasbun, MD MPH FIDSA, Biofire: Grant/Research Support|Biofire: Honoraria.
1036. Timing and Use of Adjunctive Steroids in Adults with Bacterial Meningitis: Compliance with International Guidelines.
Authors: Ramirez Denisse , Nigo Masayuki , Hasbun Rodrigo 
Published: December 2022

Abstract

Background
Adjunctive steroids decrease mortality in adults with bacterial meningitis with the exception of Listeria monocytogenes. Steroids given within 20 minutes, 4 hours and 12 hours after the first dose of antibiotic are advocated by the Infectious Diseases Society of America (IDSA), European, and United Kingdom (UK) guidelines, respectively. Compliance with these guidelines in the US is unknown.

Methods
Retrospective observational study of 195 adults with community-acquired bacterial meningitis at 16 hospitals in Houston area from December 2004-May 2019.

Results
Adjunctive steroids were given to 146/195 (75%) of patients and were more likely used in patients with a positive Gram stain, those with pneumococcal etiology, comorbidities, a higher CSF protein and with lower CSF glucose (P &gt;0.05). The percentage of patients with pneumococcal etiology 77%. There was no association between the use of steroids and history of immunosuppression, fever, headache, stiff neck, Glasgow coma scale, seizures, focal neurological exam or serum WBC counts (P &gt;0.05). Out of the 146 patients that received steroids, 28 (14%), 68 (35%), and 106 (54%) received them within 20 minutes, 4 hours or 12 hours after the first dose of antibiotics as per IDSA, European and UK guidelines, respectively. Use of steroids in this study by any timeline was not associated with improved clinical outcomes.

Conclusion
Timing and use adjunctive steroids in adults with bacterial meningitis remain suboptimal in the US and could account for the lack of impact on clinical outcomes.

Disclosures
Rodrigo Hasbun, MD MPH FIDSA, Biofire: Grant/Research Support|Biofire: Honoraria.
1037. Access to hospitalization for patients with severe COVID-19 during the first wave of the pandemic in Caracas, Venezuela.
Authors: Orejas Jose , Forero David , Mendoza Daniela , Omana Oscar , Carrión-Nessi Fhabián S , Landaeta Maria , Diaz Alejandro 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has overwhelmed health systems around the world, causing access problems. The patient referral system in Caracas, Venezuela has no interinstitutional coordination, patients are given a note by the referring center and thereafter seeking care relies on themselves. We studied primarily to what extent the Caracas healthcare system satisfied the demand for hospitalization of severe COVID-19 during periods of congestion, measured in proportion of patients not hospitalized; and secondly how difficult it was for patients with severe COVID-19 to meet their need of hospitalization, measured in number of days and visits made to health centers until hospitalization or desisting from further searching.

Methods
This study was approved by national bioethics committee. We included all symptomatic patients who attended the University Hospital of Caracas COVID-19 testing center, whose nasopharyngeal swab PCR was positive for SARS-CoV-2, and whose SpO2 was 93% or less between 07/01/2020 and 07/24/2020, the period in which we referred patients due to unavailability of beds in our center.

Results
Ninety-four patients were included, 66 (70%) were men, the mean age was 58 years (range, 25-87 years), the median number of comorbidities was 1 (range, 0-3), and the median SpO2 was 90% (range, 30%-93%). Fourty-three (46%) patients were never admitted following referral from our center. Referred patients required a median of 1 day (range, 1-15 days) and 2 visits (range, 1-41 visits) to being admitted, or a median of 2 days (range, 1-17 days) and 5 visits (range, 1-31 visits) to desisting from further searching for admission.

Conclusion
These data show that the healthcare system did not meet the hospitalization needs of half of the patients with severe COVID-19 during the peak of the first wave of the pandemic in Caracas. The data also show that referred patients faced a major delay in being hospitalized, and that referred patients had to perform multiple visits to healthcare centers accross the city as a consequence of insufficient system capacity, increasing their urban mobility and therefore their probabilities of transmitting SARS-CoV-2 to others.

Disclosures
All Authors: No reported disclosures.
1041. Association of SARS-CoV-2 Viral load in COVID-19 at the hospital representation
Authors: Bhargava Ashish , Patel Hemang , Salaytah Natali , Akagi Elisa , Saravolatz Louis , Sharma Mamta 
Published: December 2022

Abstract

Background
The SARS-CoV-2 viral load and its association with COVID-19 severity remain a widely discussed topic with a little or no consensus. With these considerations we aimed to investigate SARS-CoV-2 viral load in the saliva/sputum in COVID-19 patients with varying severity levels.

Methods
A single-center prospective cohort study at Ascension St John Hospital, Detroit, MIchigan was conducted during early January 2021 and September 2021. We recruited 200 subjects with a PCR-confirmed COVID-19 and 18 year of age and older. Further these subjects were divided into mild, moderate, severe and critical cohorts based on WHO defined criteria. Further we collected sputum/saliva samples and measured them for SARS-CoV-2 viral load. .

Results
We recruited 50 patients in each cohort totaling to 200 patients.Our study cohort was made up of 104 (52%) males and 96 (48%) females. We note severity level differences matching with the COVID-19 severity at the hospital presentation.

Conclusion
These results were interesting to provide an insight into COVID-19 severity and clinical representation.

Disclosures
All Authors: No reported disclosures.
1070. Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes
Authors: Guaraldi Giovanni , Milic Jovana , Barbieri Sara , Marchio’ Tommaso , Caselgrandi Agnese , Motta Federico , Beghe’ Bianca , Verduri Alessia , Belli Michela , Gozzi Licia , Iadisernia Vittorio , Faltoni Matteo , Burastero Giulia , Dessilani Andrea , Monte Martina Del , Bacca Erica , Franceschi Giacomo , Yaacoub Dina , Volpi Sara , Mazzochi Alice , Clini Enrico , Mussini Cristina 
Published: December 2022

Abstract

Background
The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC).

Methods
This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: “fit/resilient”, “fit/non-resilient”, “frail/resilient” and “frail/non-resilient”. Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions.

Results
232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Table 1 shows demographic, anthropometric and clinical characteristics, comorbidities and patient-reported outcomes according to four frailty-resilience phenotypes. With regards to study outcomes, Figure 1 depicts in radar graphs, mean scores of each domain of SF-36 (1A), EQ-5D5L (1B) and IC (1C). Figures shows polygon areas for each frailty/resilience phenotypes. Progressive increase of mean scores of each domain are plotted in the vertices of polygons, from the lowest (near the center) in frail and non-resilient, to highest (towards periphery) in fit and resilient. Multivariate logistic analyses were used to identify predictors of the total scores of SF-36 (Figure 2A), EQ-5D5L (Figure 2B) and IC (Figure 2C).

Conclusion
Resilience is complementary to frailty in the identification of clinical phenotypes with different impact on wellness and QoL. Frailty and resilience should be evaluated in hospitalized COVID-19 patients to identify vulnerable individuals to prioritize urgent health interventions in people with PACS.

Funding
This study is supported by a Gilead Sciences Inc. unrestricted grant.

Disclosures
All Authors: No reported disclosures.
1084. Comparison of Pediatric SARS-CoV-2 Infections During Spring 2020 and Spring 2021
Authors: Ngo Lynda , Ericson Jessica E , Gavigan Patrick , Williams Amanda , Kwon Michelle , Musser Leah 
Published: December 2022

Abstract

Background
Data is lacking regarding the clinical manifestations of children with SARS-CoV-2 infection during Spring 2021 and how that clinical presentation compares to children who presented during the early months of the pandemic. We sought to compare the presentation and severity of illness among children with a positive PCR test result for SARS-CoV-2 who presented during the Spring 2020 to those who presented for testing during Spring 2021.

Methods
We identified all patients &lt; 18 years old who had a positive nasopharyngeal polymerase chain reaction (PCR) result for SARS-CoV-2 from 4/1/2020-6/30/2020 and from 4/1/2021-6/30/2021 through a laboratory-based database at a rural academic tertiary care medical center. Data collected included demographics; underlying medical comorbidities; symptoms at the time of SARS-CoV-2 testing; results of SARS-CoV-2 testing and other tests performed at the same time; treatments administered; imaging studies performed; need for hospitalization; and, for those requiring hospitalization, hospital length of stay, and respiratory support. We excluded patients who were hospitalized for reasons other than COVID-19 infection in our hospitalization statistics.

Results
We identified 331 children with a positive SARS-CoV-2 PCR result who met our inclusion criteria. Among children presenting during the Spring 2021 time period, upper respiratory tract infection (URI) symptoms were much less common than those presenting in Spring 2020 (2% vs 19%, p&lt; 0.001). Additionally, fever and cough were more common among children presenting in Spring 2021 (34% vs 22%, p=0.01) (Table 1). Hospitalization for COVID-19 care occurred in 4% of children overall: 3% of children during the Spring 2020 era and 5% of children during Spring 2021, P=0.587 (Table 2).
Self-reported symptoms among children with a positive SARS-CoV-2 polymerase chain reaction test, Spring 2020 vs. Spring 2021.
Association of year, patient, and clinical characteristics with hospital admission for care of COVID-19.

Conclusion
Our study offers insights into the differences in the clinical presentation and outcomes of pediatric patients infected with SARS-CoV-2 during Spring 2020 and Spring 2021, respectively. We found that children infected during Spring 2021 had fever and cough more often and rhinorrhea and nasal congestion less often than children infected during the Spring 2020. Hospitalization was uncommon and was similar in both time periods. Most children requiring hospital admission had an underlying medical comorbidity.

Disclosures
Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant.
1086. COVID-19 in a Comprehensive Cancer Center: 2020-2022
Authors: Mulanovich Patricia , Chemaly Roy F , Granwehr Bruno , McConn Kelly , Assistant Physician , Patel Nina , Assistant Physician , Raad Issam I , Adachi Javier 
Published: December 2022

Abstract

Background
Patients with COVID-19 and underlying malignancies, particularly those receiving immunosuppressive therapy, are at higher risk of severe COVID-19 disease.
Our retrospective cohort study examines the outcomes of COVID-19 infection in patients with different underlying malignancies admitted to a 710- beds comprehensive cancer center during the first 2 years of the pandemic.

Methods
All patients with cancer admitted to MD Anderson Cancer Center with a positive PCR test for SARS-CoV-2 were included in a clinical case registry from 3/22/20 (first hospitalized COVID-19 patient) to 3/31/22. This clinical registry was approved at the beginning of the COVID-19 pandemic by the Quality Improvement Assessment Board at MDACC. Clinical information including type of malignancy, date of admission, length of stay, need for invasive mechanical ventilation (IMV), and in-hospital mortality was obtained from their electronic medical records. Statistical analysis was performed using a two-proportion z-test where p&lt; 0.05 was considered significant.

Results
A total of 1748 patients with cancer and COVID-19 infection were admitted over a 2-year period (3.2% of total hospital admissions during the same period), 49% had hematological malignancies (HM) (see table). Patients with HM had significantly higher readmission rates (17.3% vs 9.1%, p&lt; 0.0001), IMV rates (7.8% vs 4.4%, p=0.0029), and inpatient mortality rates (13.6% vs 7.1%, p&lt; 0.0001). compared to patients with solid tumors (ST). Total mortality rate was 8.8% (154 patients), even higher in patients with different types of HM, such as lymphoma 18.1%, AML 14.2%, MM 8.4%, CML 7.1% while the mortality for ST was 7.1%.
COVID-19 Hospitalized Patients at UT-MDACC (3/22/20-3/31/22)
UT-MDACC: The University of Texas MD Anderson Cancer Center
*p-value &lt;0.01 for z-test of 2 proportions (one-tailed)

Conclusion
HM patients hospitalized with COVID-19 infection had more severe disease and worse outcomes based on readmissions, IMV, and mortality rates. Preventive measures, prompt diagnosis and early treatments should be considered on this patient population.

Disclosures
Roy F. Chemaly, MD/MPH, Karius: Advisor/Consultant|Karius: Grant/Research Support.