bluuebunny/crossref_metadata_2025_split huggingface dataset:
283. Post COVID-19 syndrome and quality of life impairment in a cohort of severe COVID-19
Authors: Roman-Montes Carla M , Guaracha-Basañez Guillermo A , Flores-Soto Yesenia C , Gonzalez Maria Fernanda , Ponce-de-leon Luis Alfredo , Tamez-Torres Karla M , Sifuentes-Osornio José 
Published: December 2022

Abstract

Background
Post-COVID-19 syndrome occurs usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis (WHO definition, 2021). Our objective was to describe the prevalence, type, and duration of symptoms and their impact on the quality of life of patients hospitalized for COVID-19.

Methods
A cross-sectional descriptive study was done, digital informed consent was obtained. Patients with a history of hospitalization for COVID-19 between March 2020 and October 2021 were invited to answer electronically an adaptation of the questionnaire for the identification of post-COVID-19 syndrome and the instrument EuroQol-5D (quality of life). Both were performed at 3, 6, 9 and 12 months after the initial evaluation for COVID-19.

Results
We included 246 patients, of whom 76% (187/246) met the definition of post-COVID-19 syndrome, 54% were men, with a median age of 50 years (IQR 41-63). Sixty-three percent (117/187) of post-COVID-19 syndrome patients described a worse health status (OR 9.2, 95% CI 4.1-22.6, p=&lt; 0.0001). The median time to symptoms onset after hospital discharge was 1 day (IQR 1-20), and the median duration of symptoms was 150 days (IQR 90-225). The most frequent symptoms were dyspnea 75% (141), arthralgia 71% (132), fatigue 68% (127), hair loss 60% (112), myalgia 53% (99), sleep disturbances 52% (97), dizziness 47% (88), and palpitations 41% (76) (Figure 1).
Regarding quality of life, the post-COVID-19 syndrome patients presented a lower visual analog scale of the EQ-5D versus the group without syndrome (80mm [IQR 70-90] vs. 89.5mm [IQR 75-90], p=0.05). All five dimensions of the quality of life were affected in the post-COVID-19 syndrome group; and dimensions of pain/discomfort, usual activities, and anxiety/depression showed a statistical difference (Fig 2). Figure 1.Frequency of symptoms in Post-COVID-19 syndrome.Figure 2.Distribution of the EQ-5D dimensions affected.
Euroqol (EQ)-5D:Specific instrument to describe and value health-related quality of life.

Conclusion
Post-COVID-19 syndrome occurred in 76% of hospitalized patients, with prolonged duration and quality of life impairment. Dyspnea was the most frequent symptom. Timely diagnostic and therapeutic intervention is required.

Disclosures
All Authors: No reported disclosures.
291. Retrospective Study on Bacteremia in COVID-19 Patients in the Delta and Omicron Era
Authors: Park Sunghee , Kim Tark , Choo Eun Ju 
Published: December 2022

Abstract

Background
The coronavirus disease 2019 (COVID-19) outbreak reached peak levels in South Korea as the Delta variant, dominant from late August until the end of 2021, was rapidly overtaken by the Omicron variant at the start of 2022. In studies conducted near the start of the pandemic, the occurrence of bacteremia in COVID-19 patients was relatively low. We aimed to determine if there was a change in the rate of bacteremia in COVID-19 patients with the progression of the pandemic.

Methods
We performed a retrospective study of patients who were diagnosed with COVID-19 at a referral hospital between September 2021 and March 2022. Blood culture results were recorded, along with demographic characteristics and clinical outcomes. Contamination was considered when a single blood culture was positive for coagulase-negative staphylococci (CoNS), Corynebacterium species, or Bacillus species. Clinically relevant bacteremia was defined as bacteremia due to clinically significant pathogens between 7 days before COVID-19 diagnosis to 14 days after diagnosis.

Results
Among the 360 patients included in the study, 46 cases from 43 (11.9%) patients were considered to be clinically relevant bacteremia. Enterococcus faecalis (17.4%) and CoNS (17.4%) were the most common pathogens, followed by Acinetobacter baumannii (15.2%), Staphylococcus aureus (10.7%) and Escherichia coli (10.7%). The median number of days from COVID-19 diagnosis to identification of bacteremia was 2 days. There was no significant difference in the rate of bacteremia between the Delta (September-December 2021) and Omicron variant eras (January-March 2022) (12.2% vs. 11.7%, P = .88). In the subgroup analysis of patients who received more than 2 days of intensive care, there was no statistical difference in the rate of bacteremia (14.5% [9/62] in the Delta variant era vs. 16.9% [14/83] in the Omicron variant era; P = .70). Mortality was significantly higher in patients with clinically relevant bacteremia (48.8% vs. 19.2%, P &lt; .001).

Conclusion
Many COVID-19 patients had bacteremia in the Omicron variant era, especially in the intensive care unit. Clinicians should suspect bacterial co-infection when a COVID-19 patient is clinically aggravated.

Disclosures
All Authors: No reported disclosures.
294. Risk factors of COVID-19 associated pulmonary aspergillosis in a high endemic setting and development of a bedside clinical risk prediction score.
Authors: Moni Merlin , John Teny M M , Moosa Abdul Razak , Kulirankal Kiran G , Edathadathil Fabia , Dipu T S 
Published: December 2022

Abstract

Background
India has a high burden of invasive fungal infections. Although invasive aspergillosis was also reported during the COVID-19 pandemic, the real world data on the risk factors and outcome of CAPA are limited. Our aim is to determine risk factors and clinical outcomes of CAPA and develop a prediction model for patient stratification.

Methods
A retrospective, case-control study was conducted at a 1300-bedded South Indian tertiary care academic centre from June 1st, 2020 to May 31st, 2021. CAPA cases were defined by 2020 ECMM/ISHAM consensus criteria as possible, probable, and proven infection. Age and admission period matched control group with COVID-19 but without aspergillosis was selected in a 1:1 ratio. A risk scoring stratification for CAPA was developed based on the significant CAPA risk factors using logistic regression model. Figure 1:Receiving operating characteristic curve of CAPA incidence score for predicting CAPA in the study cohort

Results
95 CAPA cases, of which 75(79%) were probable and 20(21%) possible, were diagnosed during the study period. 84(88.4%) patients had moderate to severe COVID-19, and 75(78.9%) were treated with steroids, most commonly dexamethasone (Table 1). The time from COVID-19 diagnosis to CAPA was 13 days (IQR 12). 40(42.1%) of patients were on mechanical ventilation at CAPA diagnosis. Outcome measures (MV, NIV and hospital/ICU stay) were significantly higher in CAPA patients compared to controls(Table 2). Neutropenia, use of steroids, broad spectrum antibiotic use, fluconazole prophylaxis and absence of co-infecting pathogen were found to be significant factors associated with CAPA(p&lt; 0.05) (Table 3). An optimal risk score of ≥10.00 predicted CAPA with a sensitivity of 84.2% and a specificity of 59% with an area under the curve of 0.77 (PPV=67.23%, NPV=78.87%)(Fig 1). 75(78.9%) patients had positive serum aspergillus galactomannan with an average value of 1.89±1.65. 28-day (41.1% vs 33.7%, p=0.13) and 6-week all cause-mortality (48.4% vs 37.9%, p=0.07) were higher, but not statistically significant, for CAPA. Table 1:Baseline characteristics and risk factorsTable 2:Primary and secondary outcomesTable 3:CAPA incidence scoring table
Significant univariate variables were included in the multivariate logistic regression model and predicted probabilities based on the beta co-efficients of the significant variables in the model were transformed to generate CAPA incidence score for patients.

Conclusion
Risk factors of CAPA in Indian were similar to those reported previously in other countries. CAPA can be seen in severe COVID-19 patients who are not mechanically ventilated. A CAPA risk scoring system, that needs external validation, is a simple and feasible tool that could be useful in stratification of patients suspected of CAPA.

Disclosures
All Authors: No reported disclosures.
305. Clinical scoring system to predict viable viral shedding in patients with COVID-19
Authors: Kang Sung Woon , Kim Ji Yeon , Park Heedo , Park Sunghee , Lim So Yun , Bae SeongMan , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Choi Sang-Ho , Lee Sang-Oh , Kim Yang Soo , Park Man-Seong , Yun Sung-Cheol , Kim Sung-Han 
Published: December 2022

Abstract

Background
Centers for Disease Control and Prevention (CDC) recommends 5 to 20 days of isolation for COVID-19 patients depending on symptom duration and severity regardless of genomic PCR results or vaccination history. However, in real clinical practice, more individualized approach is required. We thus developed clinical scoring system to predict viable viral shedding in a given patient by using various factors affecting viable viral shedding.

Methods
We prospectively enrolled adult patients with SARS-CoV-2 infection admitted to tertiary hospital and day care center between February 2020 and January 2022. The daily dense respiratory sampling (i.e. saliva, sputum, or nasopharyngeal swabs) during the hospital and day care center stay were obtained. Genomic RNA viral load and viral culture were performed for these samples. Clinical predictors of negative viral culture results were identified using survival analysis and multivariable analysis.

Results
A total of 612 samples from 121 patients of varying degrees of severity were obtained. Of these, 494 (81%) samples were saliva, 63 (10%) were nasopharyngeal swab, and the remaining 55 (9%) were sputum. Of these 612 specimens, 154 (25%) samples revealed positive viral culture results. Univariate and multivariable Cox's time varying proportional hazard model revealed that symptom onset day, viral copy number, disease severity, organ transplant recipient, gender, and vaccination status were independently associated with viral culture results. We thus developed the 5-factor model from -3 to 3 points: viral copy number (-3 to 3 points depending on copy number), disease severity (1 point to moderate to critical diseases), organ transplant recipient (2 points), gender (-1 points to male), and vaccination status (-2 points to fully vaccinated status). The predictive culture-negative rates were calculated through the symptom onset day and the score of the day the sample was collected. Table 1.Prediction scores for negative viral culture resultsTable 2.Predicted Culture-negative Rates
Values in the table expressed as percentages.

Conclusion
Our clinical scoring system can provide objective probability of negative culture results in a given COVID-19 patient with genomic viral load, and appears to be useful to decide de-isolation policy depending on individualized factors associated with viable viral shedding beyond simple symptom-based isolation strategy by CDC.

Disclosures
All Authors: No reported disclosures.
314. Performance of Saliva Compared to Nasopharyngeal Swab in Detection of SARS-CoV-2 at a Field Site in Rural Guatemala Using the Roche Cobas® Liat® Point-of-Care Assay
Authors: Arias Kareen , Díaz Eliceo , Paiz Claudia , Rojop Neudy , Lamb Molly , Barrios Edgar , Mejía Wanda , Mejía Wanda , Gomez Melissa , Asturias Edwin J , Calvimontes Diva , Olson Daniel 
Published: December 2022

Abstract

Background
Saliva samples are less invasive but not considered the gold standard for detecting SARS-CoV-2, and they are not validated for the Roche Cobas® Liat® platform. We aimed to evaluate the performance of a saliva sample compared to nasopharyngeal (NP) swab in the detection of SARS-CoV-2 on the Roche Cobas® Liat® platform at a research site in rural Guatemala.

Methods
Adults in an existing cohort study with influenza-like illness (ILI) provided clinical data and underwent NP swab (Copan) collection by trained nurses. Swabs were immediately placed into universal transport media (UTM), stored at 2-8 °C for less than 30 minutes and then tested on the Cobas Liat platform for SARS-CoV-2. Consenting subjects who had not eaten or drank in the last 2 hours were asked to provide a 5-mL saliva sample directly into an RNAse free container. The saliva sample remained at 2-8 °C for 24 hours, then diluted 1:2 with 0.85% saline (to reduce viscosity) and run on the same assay. We used descriptive statistics to compare the performance of saliva to NP swabs.

Results
Of the 28 subjects screened (1/10/22 - 4/26/22), 23 (82%) were consented and enrolled. The majority of subjects were male (78.3%) with a mean age of 31 years (range: 18-59 years). Of the 23 subjects enrolled, 14 (30.4%) reported fever and cough, 16 (34.8%) reported cough only, 14 (30.4%) reported fever only, and 2 (4.3%) reported cough and nasal congestion. The median symptom duration was 3.0 days (IQR: 1.5-5 days). Of the 23 subjects, 5 (23.7%) tested positive for SARS-CoV-2 in both sample types (NP swab and saliva); 3 (13%) were discordant, including 1 (4.3%) saliva-positive only and 2 (8.7%) NP-positive only. Compared to NP swab, preliminary performance of saliva in detection of SARS-CoV-2 included a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 71.4%, 93.7%, 87%, 83.3%, and 88.2%, respectively. The Fisher’s exact test p-value (0.003) shows concordance between both tests.

Conclusion
Our preliminary results show good precision between NP and saliva samples in detection of SARS-CoV-2 on the Roche Cobas® Liat® platform. Ongoing data collection will provide greater insight on the discordant results, but our findings support the continued use of saliva in the detection of SARS-CoV-2 in this population.

Disclosures
Molly Lamb, PhD, Pfizer: Grant/Research Support Edwin J. Asturias, MD, Curevac: DSMB Member|Fundacion para la Salud Integral de los Guatemaltecos: Board Member|Inovio: DSMB Member|Merck: Honoraria|Pfizer: Grant/Research Support Diva Calvimontes, n/a, Pfizer: Grant/Research Support Daniel Olson, MD, Fundacion para la Salud Integral de los Guatemaltecos: Board Member|Pfizer: Grant/Research Support|Roche: Grant/Research Support.
316. The Value of Monocyte-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Predicting COVID-19 Mortality: A Single-Center Retrospective Study
Authors: Nanas Denise Marie J , Nolasco Marjorie A , Samin Divina Cristy R 
Published: December 2022

Abstract

Background
The quest for an easy yet effective and affordable tool in predicting mortality among COVID 19 patients is one of the major health concerns that should be addressed. In this study, we investigated the role of these hemogram derived ratios- Monocyte-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio and Platelet-LymphocyteRatio in predicting in-hospital COVID 19 Mortality. Objectives of this study aimed to determine the optimal cut-off value of each ratio and compare the values of each ratio in predicting mortality.

Methods
A cross sectional retrospective study utilizing chart review of adult, COVID 19 confirmed patients admitted at Dr. Paulino J. Garcia Memorial Research and Medical Center from July 2020 to July 2021 were analyzed. Complete blood count taken within 24 hours of admission were recorded. The primary outcome was in-hospital mortality. The NLR, MLR and PLR values were computed and were stratified into two groups after determining the optimal cut-off from the receiver operating characteristic curve (ROC) curve.

Results
A total of 226 adult Filipinos with confirmed COVID 19 infection were included. Patients who died had significantly higher mean age (p=0.004), lower mean hospital days (p=&lt; 0.001) and significantly had a higher proportion of diabetes (p=&lt; 0.027) as a co-morbidity. Significantly higher neutrophils (p=&lt; 0.001), lower lymphocytes (p=&lt; 0.001), higher NLR (p=&lt; 0.001), higher MLR (p=0.002) and higher PLR (p=&lt; 0.001) among non-survivors than survivors group. The optimal cutoff value of NLR to predict in-hospital mortality is ≥5.846 with 66.37% sensitivity and 60.18% specificity (AuROC curve of 0.695). The optimal cut off value of MLR is ≥0.4444 and PLR of ≥190.

Conclusion
NLR, MLR and PLR were noted to be consistently high among non-survivors of COVID 19 Infection. These are useful markers in predicting in-hospital mortality. NLR appears to be the best predictor of COVID-19 mortality of the three markers. However, its overall diagnostic accuracy is only considered acceptable at best.

Disclosures
All Authors: No reported disclosures.
324. Detection of Antibiotic Resistance Genes and Associated Genera Direct from Blood Samples by Multiplex PCR and Next Generation Sequencing
Authors: Gamero Daniel , Dabrowski Kelly , DeVito Analisa , Smith Roger , Snyder Jessica L 
Published: December 2022

Abstract

Background
While blood culture and genotypic or phenotypic testing is standard procedure for identification of sepsis pathogens and resistance, blood culture negative sepsis occurs in 40-60% of patients. A culture independent diagnostic can identify pathogens that do not grow in culture and may provide a more sensitive indicator to blood stream infections. Here we discuss an assay that combines multiplex PCR with next generation sequencing (NGS) to detect resistance genes and pathogenic genera directly from whole blood. These genes include mecA, mecC, vanA, vanB, blaKPC, blaOXA-48 family, blaNDM, blaVIM, blaIMP, blaCMY-2, blaDHA, and blaCTX-M-14 and blaCTX-M-15 groups.

Methods
K2EDTA whole blood samples were spiked with low titers of antimicrobial resistant bacterial isolates. Sample processing involved chemical lysis of red blood cells, concentration and mechanical lysis of pathogen cells, and multiplex amplification of resistance genes and 16S rRNA gene. A synthetic DNA oligo was added at a fixed concentration as a read control. Samples were sequenced on Illumina platforms. NGS data was analyzed using a bioinformatics pipeline to process and match sequences to curated databases with BLAST. The number of reads per sequence was normalized by the number of reads for the read control, resulting in a read-control-normalized (RCN) value that could be used to establish positivity cutoffs.

Results
Resistance genes in bacterial pathogen spiked samples were identified at titers ≤ 10 CFU/mL. Owing to a unique dual indexing strategy, cross-reactivity was absent or low enough that cutoffs could be set using RCN values without reducing sensitivity. The expected genus was also detected at ≤ 10 CFU/mL for all samples; however, genera that may be representative of reagent or environmental contamination were observed at levels higher than a universal RCN cutoff in some samples.

Conclusion
We have shown that this NGS assay can detect 13 antimicrobial resistance genes with high sensitivity and specificity direct from blood. Bacterial genera associated with these genes were detected by this assay. As there is a risk of detection of contaminating species with a 16S target, further research into low DNA reagents or environmental controls may be required.

Disclosures
Daniel Gamero, BS, T2 Biosystems, inc: WO2018213641A8, EP3861013A1, WO2020055887A1, WO2020252084A1, WO2020257691A1|T2 Biosystems, inc: Stocks/Bonds Kelly Dabrowski, M.S., T2 Biosystems, Inc: Stocks/Bonds Analisa DeVito, B.S., T2 Biosystems, Inc: Stocks/Bonds Roger Smith, Ph.D., T2 Biosystems, Inc: US20180188195A1, EP3849938A1,WO2020257691A1, WO2020252084A1|T2 Biosystems, Inc: Stocks/Bonds Jessica L. Snyder, Ph.D., T2 Biosystems, Inc: CA3062882A1,US20180171388A1,WO2017180745A1 , EP3861013A1 , AU2020296183A1, WO2020055887A1, WO2020252084A1|T2 Biosystems, Inc: Stocks/Bonds.
338. Epidemiology and Treatment of Invasive Bartonella spp. Infections
Authors: Pizzuti Morgan , Bailey Pamela , Derrick Caroline , Brandon Bookstaver P 
Published: December 2022

Abstract

Background
Serology and PCR testing methods have increased ability to diagnose Bartonella spp. invasive infections. Current treatment recommendations are based primarily on case series and aging data published before newly available diagnostic techniques. These recommendations are limited in safety and effectiveness outcomes. This multicenter, retrospective cohort study describes the epidemiology and treatment outcomes of invasive bartonellosis among patients in the U.S.

Methods
Collaborating sites were selected from SERGE-45 (Southeastern Research Group Endeavor) research network. Data were collected through REDCap. Subjects were screened from adult patients with invasive bartonellosis diagnosis codes, positive Bartonella spp. serologies, PCR, 16/18S tests, cultures, and Karius® tests from blood or tissue between January 1, 2014, and September 1, 2021. Eligible patients had at least one positive test result, evidence of invasive bartonellosis, and received treatment for bartonellosis. Treatment failure was defined as admission or readmission while on treatment, mortality during treatment or within 30 days after end of treatment, required escalation or extended duration of therapy, premature discontinuation of therapy, or necessitated change in regimen. Those not meeting treatment failure criteria were considered treatment success.

Results
Of the 169 patients screened, 32 were included, with 19 having treatment success. Bartonella henselae was the most common causative pathogen (n = 31, 97%). Endocarditis was the most common invasive manifestation (n = 18, 56%). Treatment regimens are displayed in Table 1. Primary reasons for treatment failure included necessitated escalation of therapy during treatment course (n = 4, 30.8%) and discontinuation of therapy due to adverse effect (n = 4, 30.8%).

Conclusion
Doxycycline with rifampin was the most common treatment regimen for invasive bartonellosis, with extended durations used compared to often referenced 6-week courses for invasive infections. It is important to consider adverse drug effects, toxicities, and tolerability in patients being treated for invasive bartonellosis.

Disclosures
P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.