bluuebunny/crossref_metadata_2025_split huggingface dataset:
205. IL-1 β gene (+3954C/T, exon 5, rs1143634) and NOS2 (exon 22) polymorphisms associate with early aseptic loosening of hip and knee arthroplasties but not with implants infection
Authors: Lopez-Anglada Esteban , Collazos Julio , Montes Angel Hugo , Perez-Is Laura , Perez-Hevia Imanol , Jimenez-Tostado Sergio , Suarez-Zarracina Tomas , Alvarez Victoria , Valle-Garay Eulalia , Asensi Victor 
Published: December 2022

Abstract

Background
Aseptic prosthetic loosening (APL) and prosthetic joint infections (PJI) are frequent complications of hip and knee implants. Polymorphisms of cytokines and nitric oxide (NO), key inflammatory molecules in APL and PJI pathogenesis, could explain individual susceptibility to these complications.

Methods
Three cytokines (IL-1-a, IL-1-β, TNF-α) and two nitric oxide synthase (NOS2, NOS3) genes polymorphisms were genotyped in 77 APL and 117 PJI patients and 145 controls with aseptic hip or knee implants lasting &gt; 16 years. Plasma cytokines and nitrate-nitrite (NOx) levels were measured.

Results
The TT genotype and T allele of the (+3954C/T, exon 5, rs1143634) IL-1β polymorphism were more frequent in APL patients compared to controls (p=0.03 and p=0.02, respectively). No genotypic associations in PJI patients were observed. S. epidermidis was their most frequently isolated microorganism (39.3%). Plasma IL-6, TNF-α and NOx were significantly different between APL and controls (p&lt; 0.0001). Plasma IL-1β and IL-6 were significantly higher in APL T allele carriers vs. non-carriers (p&lt; 0.03). Knee implant (HR 2.488, 95% CI 1.307-4.739, p=0.005), male gender (HR 2.252, 95% CI 1.121-4.525, p=0.023), carriages of the TT genotype of the (+3954C/T) IL-1β polymorphism (HR 3.704, 95% CI 1.274-10.753, p=0.016) and AA genotype of the (exon 22) NOS2 polymorphism (HR 3.509, 95% CI 1.266-9.709, p=0.016) were independently associated with a shorter implant survival by Cox regression.

Conclusion
Genotyping of IL-1β (+3954C/T, exon 5, rs1143634) and NOS2 (exon 22) polymorphisms could be useful as predictors of early hip or knee APL.

Disclosures
All Authors: No reported disclosures.
228. Infection Control Cluster Randomized Control Trials and Healthcare Facility Participation: A Need for Readiness Assessment
Authors: Ray Cara E , McKinley Linda , Keating Julie , Baubie Kelsey , Safdar Nasia 
Published: December 2022

Abstract

Background
Validated tools to evaluate organizational readiness exist within the implementation science literature, but readiness assessments for healthcare organization participation in cluster randomized control trials (CRCTs) have not been developed. CRCTs have been important for increasing the evidence base for infection control. This study describes complex contextual factors that can impact participation in a multi-site infection control CRCTs within the VA healthcare system.

Methods
To assess study participation eligibility and feasibility, a survey of ten inpatient acute care patient units within five VA healthcare facilities was conducted to evaluate standard eligibility criteria such as facility and patient unit demographics, infection rates, and letters of support from leadership. With study delays we began conducting readiness evaluations through email communications and conference calls. We identified several metrics of readiness including competing priorities, identification of champions/ stakeholder engagement, and research infrastructure.

Results
Our Initial survey metrics received from facilities interested in study participation were efficient in detecting study eligibility but lacked efficiency to detect study feasibility. Later metrics identified barriers to feasible study implementation (i.e., readiness), primarily competing priorities, specifically due to the pandemic. Other barriers included the lack of research infrastructure and lack of champion identification/stakeholder engagement. These contextual factors were generally elicited through ongoing communication rather than from the initial survey assessment.

Conclusion
Organizational readiness can delay or impede important infection control CRCTs. This study exemplifies the complexity of healthcare organizations participation in clinical studies that may not be addressed in existing readiness tools or assessments. The emergence of the covid pandemic amplified the importance of identifying a wide range of contextual factors that need to be captured in ongoing assessments for readiness. An essential first step in developing organizational readiness tools and assessments is to identify and define readiness constructs in complex changing healthcare settings.

Disclosures
All Authors: No reported disclosures.
242. Association Between Procalcitonin and Antimicrobial Usage in Patients with COVID-19
Authors: Aly Mahmoud H , Cani Eris , Raymond Lendelle , Zeana Cosmina 
Published: December 2022

Abstract

Background
Patients with COVID-19 disease often receive antibiotics to treat suspected bacterial coinfections. Procalcitonin (PCT) is a biomarker used for suspected bacterial infections. The objective of this study is to evaluate the association between PCT and the use of antimicrobials in COVID-19 patients.

Methods
This was a retrospective, cohort study of adult patients admitted with confirmed COVID-19 from March 30, 2020 to March 30, 2021. Data collected included demographics, baseline inflammatory markers including initial PCT and C-reactive protein (CRP) values, past medical history, initiation of empiric antibiotics, mechanical ventilation, in-hospital mortality, days of antibiotic therapy, and length of hospital stay (LOS). Univariate analyses were utilized to assess for any significant differences in demographics based on predefined initial PCT groupings (&lt; 0.25 ng/ml (group 1), 0.25-0.49 ng/ml (group 2), and ≥ 0.5 ng/ml (group 3)). Multivariate analyses were performed to evaluate for any differences between initial PCT values and in-hospital mortality, LOS, and days of antibiotic therapy.

Results
Out of 149 patients, 61.7% had an initial PCT value &lt; 0.25 ng/ml, 17.45% had an initial value of 0.25-0.49 ng/ml, and 20.8% had an initial value ≥ 0.5 ng/ml. A total of 145 patients (97%) received empiric antibiotics. Univariate analysis among the three groups displayed a difference in the initial CRP value, which was higher in groups 2 and 3 versus group 1 (p &lt; 0.001). Regression analysis controlling for initial CRP value found that patients in groups 2 and 3 had a higher duration of antibiotic therapy compared to group 1 (12 and 11 versus 8 days) (p &lt; 0.001) and a longer LOS (17 and 15 vs 12 days) (p = 0.009). More patients (34.6%) were mechanically ventilated in group 2 compared to group 1 (14.1%) and group 3 (22.6%) with a trend toward significance (p = 0.059). Multivariate analysis found no significant association between PCT levels and mortality. The rate of in-hospital mortality in patients receiving invasive ventilation was higher in groups 2 and 3 (78% and 86%, respectively) compared to group 1 (54%, p &lt; 0.001).

Conclusion
When controlling for CRP, an initial PCT value &gt; 0.25 ng/ml was associated with increased days of antibiotic therapy and longer duration of hospital stay in COVID-19 patients.

Disclosures
All Authors: No reported disclosures.
244. Bacterial co-infection in COVID-19: an analysis of a National Cohort of Hospitalized U.S. Veterans
Authors: Khader Karim , Li Haojia , Jones Barbara E , Rubin Michael , Haroldsen Candace , Willson Tina M , Effiong Atim , Cole Jessica , Zhang Yue 
Published: December 2022

Abstract

Background
Bacterial co-infection has been reported with COVID-19, but the extent of co-infection nationally is unclear. We sought to describe the temporal and spatial trends in bacterial co-infection across the US among COVID-19 positive admissions to Veterans Affairs (VA) hospitals.

Methods
This retrospective cohort study included patients admitted to VA hospitals from March 1, 2020 through May 31, 2022 with a positive COVID-19 test within the previous 14 days and up to 2 days after admission. We summarized temporal and spatial patterns of bacterial co-infection, defined as a positive clinical microbiology culture for the bacterial pathogens listed in Table 1, defined as either community-onset (COI, within 2 calendar days of admission), or hospital-onset (HOI, &gt; 2 calendar days after admission). We performed a univariate analysis including facility and patient factors and generated descriptive statistics to describe the frequency of occurrence over time and space overall, and within each organism.
Organisms Table 1:List of organisms included in our study

Results
By the end of June 2021, there were 35,299 hospitalizations observed from 33,383 patients admitted with positive COVID-19 tests in VA. Co-infection was detected among 7.4% of hospitalizations (2.9% for COI and 4.7% for HOI). VA patients older than 70, Asian or unknown race, higher Charlson Comorbidity Index were more likely to experience HOI and COI. Facility-level rates of HOI and COI over the study period presented substantial geographic variability, ranging from 0 to 45.5 per 1000 patient days and from 0 to 6.98 per 100 hospitalizations for HOI and COI, respectively [Fig 1]. Between March 2020 and June 2021, monthly facility-level rates of HOI and COI also varied substantially within and between facilities [Fig 2]. Average monthly co-infection rates increased in the first three months of the pandemic, with HOIs subsequently declining gradually and COIs remaining stable across VA. The correlation coefficients between hospital mortality and facility-level co-infection rates for HOI and COI ranged from –0.5 to 0.7 [Fig 3].
Spatial variation Fig 1:Plot for spatial distribution across VA facilities of HOIs and COIs, measured as Co-Infections per 100 patient hospitalizations
Temporal variation Fig 2:Plot for temporal distribution across VA facilities of HOI and COI, measured as Co-Infections per 100 patient hospitalizations
Mortality correlation Fig 3:Plot for spatial distribution of the correlation coefficients between hospital mortality and HOI and COI

Conclusion
Bacterial co-infection was infrequent during hospitalization with COVID-19 in the VA healthcare system, and has mild to moderate association with hospital mortality. However, substantial geographic and temporal variation was observed.

Disclosures
Karim Khader, PhD, BioFire Diagnostics: Grant/Research Support.
246. Cardiac involvement in children with multisystem inflammatory syndrome (MIS-C) following infection with different SARS-CoV-2 variants
Authors: Pinninti Swetha , Hebson Camden , Trieu Connie , Boppana Sushma , Buchfellner Markus , Yarbrough April , Poole Claudette , Ross Shannon , James Scott H , Hutto Cecelia , Boppana Suresh 
Published: December 2022

Abstract

Background
MIS-C is a hyper inflammatory condition following SARS-CoV-2 infection. Although COVID-19 infection rates and severity have varied based on circulating SARS-CoV-2 variants, it is unclear if cardiac involvement in MIS-C varies following infection with different SARS-CoV-2 variants. The objective of this study is to describe the severity of cardiac involvement in children with MIS-C following three different waves of SARS-CoV-2 infections.

Methods
Children hospitalized with a diagnosis of MIS-C were enrolled in a prospective observational study. Demographic, clinical, laboratory (troponin I and B-type natriuretic peptide (BNP)), electrocardiogram (EKG) and echocardiogram (ECHO) data for children diagnosed between 4/20 and 12/21 and followed at 1- and 6-months was analyzed. The cohort was divided into 3 groups to represent cases that followed infection with the Wuhan (4/20-10/20, group 1), Alpha (B.1.1.7, 11/20-7/21, group 2) and Delta (B.1. 617.2, 8/21-12/21, group 3) variants. Cardiac involvement during hospitalization and follow-up was compared between the groups.

Results
The cohort includes 131 children with MIS-C (32, 61 and 38 in groups 1, 2 and 3, respectively) with a median age of 10 years. Two-thirds were male (66.4%) and 49.6% were Black. Elevated BNP and troponin I levels were seen in 82% and 52.7% of children at initial diagnosis. A third of the cohort had at least one abnormal EKG finding. The proportion of children with abnormal laboratory and EKG findings was not different between the groups. Decreased left ventricular function on ECHO was seen in 25% (33/131) of the cohort with similar distribution among the three groups (p = 0.79). Trivial-small pericardial effusions were detected in 22% (29/131). Coronary artery abnormalities were detected in 11.45% (15/131), a majority in group 1 (25%; 8/32). At 1- and 6-monthfollow-up visits, BNP and Troponin I were normal in all children. At the 6-month follow-up visit, EKG was normal in all and ECHO was normal in 37/41 children with trivial to mild valvular regurgitation in four children.

Conclusion
In this single center prospective study, while a significant proportion of children with MIS-C had evidence of cardiac involvement at diagnosis, most resolved on follow-up demonstrating good outcomes.

Disclosures
Claudette Poole, MD, Therapy Brands: Stocks/Bonds Scott H. James, MD, Bayer: Advisor/Consultant|Pantheon Biosciences: Grant/Research Support Suresh Boppana, MD, Merck, Inc: Advisor/Consultant|Merck, Inc: Grant/Research Support|Pfizer: Grant/Research Support.
252. Clinical Outcomes and Risk Factor of Severe Disease in Young Adult Patients Compared with Middle-Aged Patients Who Infected with COVID-19: A Large Cohort Study in Tertiary Hospital
Authors: Noopetch Preudtipong , Benchamanon Rutporn , Kongsuwan Samerjan , Chai-adisaksopha Chatree 
Published: December 2022

Abstract

Background
Coronavirus disease 2019 (COVID-19) is increasing rapidly among young adults in worldwide. Our knowledge, COVID-19 was more severe in elderly patients. Only few studies described clinical and outcome of young adults with COVID-19 infection. A recent large retrospective data in US found increasing severity of COVID-19 in young adults due to obesity, hypertension, and diabetes, however there is lacking Asian ethnicity in this study. We aimed to evaluate clinical outcome of COVID-19 infection in young adult and middle-aged group.

Methods
A cohort study was carried out in 10,072 patients with confirmed COVID-19 infection were admitted to Hatyai hospital, Songkhla, Thailand from 1 April 2021 to 31 December 2021. We collected data directly from patient and medical record. The results of primary objective were compared young adults and middle-aged patients and secondary objective were analyzed risk factor of severe COVID-19 among young adult patients by multivariable logistic regression analysis.

Results
The preexisting disorders were significant more observed in middle-aged group. Obesity was the most common in both group, 540 [(11.66%) and 800 (14.17%) patients; p&lt; 0.001] in young adult and middle-aged group respectively. Diabetes and hypertension were frequently observed in middle-aged group. Severe pneumonia was found [500 (9.19%) compared with 99 (2.14%); (adjusted odd ratios (aORs) 2.75; 95% confident interval (CI) 2.18 – 3.49) p&lt; 0.001] patients in middle-aged group and young adult group. mortality rate was more in middle-aged group [91 (1.67%) and 11 patients (0.24%); [aORs 4.08 (95%CI 2.12 – 7.87) p&lt; 0.001]. The risk of severe pneumonia among young adults group. Diabetes was the most increased risk (9 (9.09%) patients in severe pneumonia [aOR 16.27 (95%CI 5.82 – 45.5; p-value&lt; 0.001)].

Conclusion
Data from our study was different than another. In US or Europe young adult was increased severity of COVID-19 due to their pre-existing disease (obesity, diabetes, and hypertension). But in Asian population co-morbidity not much as in US or Europe therefore middle-aged group still had more severe COVID-19 than young adults. The factor contributing to the severe COVID-19 among young adult group, diabetes was the most common and followed by cardiovascular disease and HIV infection.

Disclosures
All Authors: No reported disclosures.
256. Coinfection and Secondary Bacterial Infection in Hospitalized Patients with COVID 19 in a Fourth Reference Level Institution in Colombia: Incidence, Microbiology and Bacterial Resistance.
Authors: Pabon Patricia Reyes , Pabon Patricia Reyes , Pulido Natalia Cordoba , Alvarez luisa Jimenez , Sierra Claudia 
Published: December 2022

Abstract

Background
The presence of coinfection and superinfection in hospitalized patients with COVID 19 varies, ranging between 3-14% in case of bacterial coinfection and 3 - 58% for superinfection. The objective of the study is to describe the incidence, type of infection and etiology in a cohort of patients with COVID 19 who required hospitalization.

Methods
A retrospective series of adult patients with a confirmed diagnosis of COVID 19 who required hospitalization in the general ward or ICU and who presented coinfection or superinfection, between March and November 2020. The clinical and microbiological characteristics of patients who presented coinfection or superinfection are described

Results
During the study period, 788 patients with COVID 19 who required hospitalization were evaluated. 6.2% presented coinfection, 49 coinfections were documented, 84% detected in patients who required admission to the ICU.
The coinfections detected were pneumonia 74%, tracheitis 11%, urinary tract infection 2% and soft tissue infection 2%. Gram negative bacilli were isolated in 58% of cases (K. pneumoniae, H. influenzae, E. cloacae, E. coli), 29% were gram positive (S aureus. S pneumoniae, S. agalactiae). Among gram negative bacilli, 12% showed resistance to 3 generation cephalosporins (3GCephR), no resistance to carbapenems (CR) was found.
Superinfection was detected in 18%, with 142 documented infectious events. 98% were hospitalized in the ICU with a mean hospitalization time of 9 days at the time of infection diagnosis.
The most frequent infections were tracheitis 49%, pneumonia associated with mechanical ventilation 21%, bloodstream infections 17%, pneumonia 8%, catheter-associated bacteremia 3.6%, urinary tract infection 0.7% and others 0.7%.
80% were gram negative (K. pneumoniae, E. coli, E. cloacae, P. aeruginosa), 16% gram positive and fungi 4% Among the isolated gram negative bacilli, 3% showed 3GCephR and 9% were CR. Table 1.Types of superinfection and microbiological isolation

Conclusion
The incidence of coinfection in patients with COVID 19 in this series is similar to that reported in the literature. Superinfection occurred in 18% of hospitalized patients, the majority hospitalized in the ICU. 78% of superinfections were from the respiratory tract. Gram-negative bacilli are the most frequently isolated germs in superinfection, with CR of the 9%.

Disclosures
All Authors: No reported disclosures.
265. Cryptococcal disease in Covid-19 infection: Case series from South Texas
Authors: Babar Sumbal , Restrepo Marcos I , Ford Delvina , Cadena-Zuluaga Jose 
Published: December 2022

Abstract

Background
Covid-19 infection is associated with a lack of immune resilience that may be magnified using immunomodulators to suppress the cytokine storm, facilitating the emergence of opportunistic infections. We describe five cases of cryptococcal infection complications among Covid-19 hospitalized patients.

Methods
This was a retrospective cohort study based on chart review performed at the Audie Murphy Veteran Affairs Hospital from 8/2020 to 8/2021; a level 1A facility with 232 beds and an active bone marrow transplantation program. We included patients aged ≥ 18 with a diagnosis of Covid-19 and subsequent Cryptococcal infection based on cultures or antigen testing.

Results
Our patients were all male with ages ranging between 64 to 80 years. Three had underlying type II diabetes, hypertension, and two had end-stage renal disease. Only one had underlying immunosuppression with hydroxychloroquine for rheumatoid arthritis and one had underlying cirrhosis. Four patients had disseminated disease/fungemia while one had localized pulmonary disease. All the cases had low CD4 counts (158-300) and low CD8 counts (92-290). Two of the fungemia cases were diagnosed by blood culture and the other two by serum cryptococcus antigen test. All the patients had received corticosteroids with or without remdesivir, while one received additional tocilizumab, one baricitinib and one convalescent plasma infusion. Four cases of fungemia received liposomal amphotericin B and three of them received additional flucytosine. The patient with cryptococcal pulmonary disease received only fluconazole. Four patients expired at 28 days after diagnosis, only one recovered and is still alive at 1-year follow up. Table 1.Case details.
ESRD: end stage renal disease; DM-2: diabetes mellitus type ; HTN: hypertension; A-fib: Atrial Fibrillation; HFpEF: heart failure with preserved ejection fraction; PVD: peripheral vascular disease; RA: rheumatoid arthritis; PTSD: post traumatic stress disorder; BPH: benign prostatic hyperplasia; CAD: coronary artery disease; HLD: hyperlipidemia; CVA: cerebrovascular accident.

Conclusion
Cryptococcus infection has been described among patients with Covid-19 during the pandemic. This may be due to immunosuppression caused by the Covid-19 infection and its related-treatments. Most of our patients presented with disseminated cryptococcus infection complicating covid-19 with resulting high mortality rates. Low CD4/CD8 counts and corticosteroid use were documented in all cases. Further studies are needed to better characterize at-risk patients for cryptococcal infection that may benefit from cryptococcal prophylaxis.

Disclosures
All Authors: No reported disclosures.
281. Not the sharpest of tools: Procalcitonin and bacterial co-infections in patients admitted with COVID-19
Authors: Mena Lora Alfredo J , Herald Fischer , Lindsey Brenna , Echeverria Stephanie , Lira Sorel , Burgos Rodrigo M 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has caused record breaking hospitalizations due to respiratory failure. A major challenge in the management of COVID-19 is the difficulty distinguishing COVID-19 from other causes of lower respiratory tract infections (LRTIs) that may require antimicrobial use (AU). Procalcitonin (PCT) has been used to differentiate viral from bacterial causes of LRTIs and clinicians have relied on PCT to use or withhold antimicrobials. However, the utility of PCT in the setting of COVID-19 remains unclear. We seek to define the role of PCT in patients admitted with COVID-19.

Methods
Retrospective cohort study of COVID-19 inpatients with PCT ordered at a 151-bed urban community hospital from March 2020-March 2022. Ranges of PCT were categorized as high ( &gt;5 µg/L), medium (0.25-5 µg/L), and low (&lt; 0.25 µg/L) risk of infection. Co-infection was defined as presence of clinical and microbiological evidence of infection in blood (BSI) or in sputum within 7 days of admission. Late infections were excluded

Results
Of a total 262 cases, 154 (58%) were low-risk, 43 (16%) medium-risk, and 63 (24%) high-risk (Figure 1). AU in the low-risk category was 29% (45), followed by 29% in the moderate and 36% in high-risk categories. 1 BSI caused by Klebsiella pneumoniae in the low-risk category and 1 LRTI caused by Streptococcus pneumoniae in the high-risk category were found, representing 0.6% and 1.5% of samples in those categories. Total documented infection was 0.7% for all cases. Figure 1.Procalcitonin levels and co-infections in patients admitted with COVID-19 pneumonia.

Conclusion
PCT has limited utility in COVID-19. Co-infection rates on admission are exceedingly rare, representing &lt; 1% of our cohort. Only 2 documented infections were found, 1 of which was in the low-risk category. Thus, PCT was commonly elevated without documented infection. Though rare, a co-infection can occur without elevation of PCT. As described in the 2019 IDSA Community Acquired Pneumonia Guidelines, the use of PCT is of limited utility and may confound providers towards using or deferring antimicrobials inappropriately. This remains true in COVID-19. Antimicrobial stewardship programs should advise against its routine use.

Disclosures
All Authors: No reported disclosures.