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Introduction: The COVID-19 pandemic caused significant changes in delivery of healthcare. Telemedicine emerged as a popular option. Numerous studies demonstrate a favorable opinion of telemedicine from patient and physician perspectives. What factors make it more efficient and effective This study explores how type of office visit impacts attitudes towards telemedicine and affects patient's preferences for future visits. Method(s): Surveys were delivered by mail or in person to 1,100 randomly selected patients of Sierra Nevada Gastroenterology, a community-based practice in Grass Valley, CA. Each patient (pt) had a telemedicine visit (TMV) from April 2020-October 2021. Three hundred twenty surveys were returned completed. Surveys contained a 5-point Likert scale set of questions rating the quality, communication, compassion, thoroughness and convenience of TMV. In person visits (IPV) were then directly compared to TMV for the same qualities. Demographics were recorded (Table 1). Surveys were separated into 3 categories based on type of visit: new complaint (NC), follow-up of existing problem (FU), procedure-related visit (PRV). Statistical analysis and chi-square test were used to determine statistical significance. Result(s): Quality, communication, thoroughness and compassion during TMV rated high with Likert scores of 4.3-4.7 (= 0 strongly agree) for all groups. Comparing the 3 groups (NC, FU, PRV) with chi-square testing, no statistical difference in ratings was seen. FU pts had the highest Likert scores in all categories. Pts with new complaints preferred IPV over TMV for quality, communication, thoroughness and compassion, which was rated statistically significantly higher (P< 0.05). TMV was favored for convenience in all groups with highest ranking in FU pts (73%). Conclusion(s): This study showed type of office visit did not affect satisfaction or ratings of TMV. However, type of visit did reveal preferences for either IPV or TMV. Pts with NC preferred IPV and felt compassion is important and delivered more effectively in person. This suggests non-verbal communication such as body language, facial expression and tone is conveyed more effectively in person than over phone or video calls. FU or PRV pts rated TMV as more convenient and preferable over IPV for future visits, suggesting that pts with stable or less acute problems prioritize convenience over other factors when selecting type of visit. Further studies are needed to determine what other factors will influence and improve quality of TMV.
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Background: People experiencing homelessness (PEH) are vulnerable to COVID-19 transmission due to substance use, congregate living conditions, and underlying medical conditions. Yet, little is known about factors impacting drug use disorder among PEH during COVID-19 pandemic. The purpose of this study was to identify correlates associated with substance use disorder among PEH, both those who were diagnosed with COVID-19 and those who tested negative or never tested. Methods: A cross-sectional, structured survey was administered to PEH (N = 102) who were recruited from sheltered and unsheltered settings. Descriptive analysis, t-tests, Fisher's exact test or chi-squared test, and bivariate and multiple linear regression were conducted. Results: PEH with a COVID-19 diagnosis included male gender, and Latino race/ethnicity (p <.05). Moreover, substance use disorder scores (p -.037) and days on the street were negatively associated with COVID-19 (p <.001). Multivariable analyses revealed a significant positive relationship between days slept on the street and substance use disorder (p <.001), and a significant negative relationship with alcohol use (p <.05);COVID-19 remained negatively associated with substance use disorder, but it was not significant. Conclusions: This study provides evidence about correlates of drug use disorder among PEH. More studies are needed to understand successful individual and system-level strategies for reducing drug-related problems during COVID-19. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.
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The COVID-19 pandemic has taken business uncertainty to an unprecedented level and put business agility and leadership under harsh tests, confronting a diverse and complicated stakeholder reality. Through original interview data and case studies from the hospitality industry in Taiwan collected and compiled since the beginning of the COVID-19 pandemic in 2020, the present research explores how strategic agility can be built, fostered, and enhanced through responsible leadership and CSR initiatives during a time of grand challenges in the hospitality industry. We also discuss and highlight the role played by one stakeholder, namely, the local government, in contributing to strategic agility through reinforcing and possibly enabling responsible leadership during hardships. This paper sheds light both empirically and theoretically on the roles played by business leaders in contributing to strategic agility, which, in turn, helps to build a more socially responsible organization. © 2023 by the authors.
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Objective: The objective of this study was to analyze changes in the frequency and incidence of dry eye disease (DED) and screen exposure times during the onset of online courses, moreover, compare these changes between sexes. Secondarily, correlate online courses screen exposure times with the severity of DED symptoms. Method(s): Four identical surveys, each containing the ocular surface disease index (OSDI) which quantifies DED symptom severity, and questions which categorized screen exposure times, were applied throughout 6 weeks. University students who had transitioned from face-to-face courses to online platforms were included in the study. Result(s): DED frequency among the 97 subjects (54 women and 43 men) peaked on week 4 (82.47%). OSDI scores significantly increased throughout the study (p < 0.0001) (baseline, 27.01 +/- 17.55 versus Week 6, 37.17 +/- 24.64), reflecting symptom worsening along an incidence of 8.5%. This worsening of symptoms occurred with women (p < 0.0001), while, in male subjects, it did not (p = 0.11);significant differences between sexes were found during the baseline (p = 0.01), Week 2 (p = 0.02), and Week 6 (p = 0.008), but not on Week 4 (p = 0.11). Online courses onset significantly increased screen exposure time (p < 0.0001). The baseline hours were 25.52 +/- 11.33 and peaked on Week 2, being 34.62 +/- 10.90. OSDI scores and online courses exposure times correlated significantly (Week 2, R = 0.265;Week 4, R = 0.262;and Week 6, R = 0.205). Conclusion(s): University students suffer from severe DED symptoms, which correlate with online courses onset. Educational institutions should foster ocular health.Copyright © 2022 Authors. All rights reserved.
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Background. Public clonotypes, antibodies against specific antigens in unrelated individuals that have genetic similarities, have been shown in a variety of infections, including SARS-CoV-2 and HIV. Likely, there are shared antibody responses between individuals for many infections. To explore antibody responses that would coincide with specific infectious diseases that may set off chronic illnesses, such as Multiple Sclerosis or Alzheimer's disease, defining the background shared clonotypes is needed to differentiate disease from normal background public clonotype responses. Methods. Heavy chain variable sequences were retrieved from public biorepositories (Bioproject PRJNA486667) composed of 43 healthy persons, and two groups of HIV infected persons;114 with broadly neutralizing antibodies and 91 without broadly neutralizing antibodies. We utilized the Immcantation package of software run on our SUNY Buffalo computational cluster. After PRESTo annotation, duplicate sequences were collapsed and sequences of only single counts were removed. Clonal groups were determined using ChangeO requiring IGHV, IGHJ, and CDR3 amino acid sequence to be perfectly matched. Figures and statistics were generated with immcantation, excel, and graphpad prism 8. Results. 244850 heavy chain sequences from 43 healthy controls were compared for exact matches to predicted germline variable segment and CDR3 amino acid sequence and identified 0.23% as public clonotypes. Comparison to 205 HIV + individuals (a total of 1.4 million comparative sequences) showed that 2.35% of heavy chain sequences were seen in more than one individual. Generally, public clonotypes had shorter CDR3s (peak of 9 amino acids). VH 3-9, 3-30 and 4-34 were the most commonly used variable segments in public clonotypes. Common exact match CDR3 sequences using a variety of variable sequences, including an 11 amino acid CDR3 sequence motif, were also discovered. Conclusion. This early work has identified several public clonotypes that are shared among subjects who are HIV positive and otherwise healthy people. Defining the sequences commonly seen between individuals can assist in specifying antibody responses specific to disease states from larger sequence databases.
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Genome analysis benefits precise medical care, wildlife conservation, pandemic treatment (e.g., COVID-19), and so on. Unfortunately, in genome analysis, the speed of data processing lags far behind the speed of data generation. Thus, hardware acceleration turns out to be necessary. As many applications in genome analysis are memory-bound, Processing-In-Memory (PIM) and Near-Data-Processing (NDP) solutions have been explored to tackle this problem. In particular, the Dual-Inline-Memory-Module (DIMM) based designs are very promising due to their non-invasive feature to the cost-sensitive DRAM dies. However, they have two critical limitations, i.e., performance bottle-necked by communication and the limited potential for memory expansion. In this paper, we address these two limitations by designing novel DIMM based accelerators located near the dis-aggregated memory pool with the support from the Compute Express Link (CXL), aiming to leverage the abundant memory within the memory pool and the high communication bandwidth provided by CXL. We propose BEACON, Scalable Near-Data-Processing Accelerators for Genome Analysis near Memory Pool with the CXL Support. BEAC-ON ad-opts a software-hardware co-design approach to tackle the above two limitations. The BEACON architecture builds the foundation for efficient communication and memory expansion by reducing data movement and leveraging the high communication bandwidth provided by CXL. Based on the BEACON architecture, we propose a memory management framework to enable memory expansion with unmodified CXL-DIMMs and further optimize communication by improving data locality. We also propose algorithm-specific optimizations to further boost the performance of BEACON. In addition, BEACON provides two design choices, i.e., BEACON- D and BEACON-S. BEACON-D and BEACON-S perform the computation within the enhanced CXL-DIMMs and enhanced CXL-Switches, respectively. Experimental results show that compared with state-of-the-art DIMM based NDP accelerators, on average, BEACON-D and BEACON-S improve the performance by 4. 70x and 4. 13x, respectively. © 2022 IEEE.
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Background: Extracorporeal Membrane Oxygenation (ECMO) is being increasingly used among critically ill patients some of whom have multiple organ failure and need concurrent use of continuous renal replacement therapy (CRRT). Limited data are available regarding outcomes among such patients. Method(s): We report retrospective data on patients who were treated with ECMO with or without CRRT over a period of 36 months (Jan 2019 - Mar 2022) at hospitals within a single integrated healthcare system in Pennsylvania. Patients with end stage renal disease were not eligible to receive ECMO within this system. Result(s): 166 patients were treated with ECMO of whom 50 (30.1%) received CRRT during the course of their treatment. Mean age of patients on ECMO was 52.1 years (interquartile range 43-64), 68.1% were male;and 23.5% had Covid-19. Reasons for ECMO included cardiac arrest (43%), post cardiac surgery (18%), acute respiratory distress syndrome (38%) and transcatheter aortic valve placement (2%). Patients received either Venoarterial (VA) ECMO (45.8% patients;mean age 60.0) and its variant extracorporeal cardiopulmonary resuscitation (eCPR) (9.6%;mean age 50.9) or Venovenous (VV) ECMO (44.6%;mean age 44.4). A comparison among patients who needed CRRT versus those who did not is provided in figure 1. 38% patients who received CRRT survived to discharge compared to 62.9% who did not receive CRRT (p=0.003) Conclusion(s): Nearly 1 in 3 patients treated with ECMO needed CRRT at some point during their care. Patients who needed CRRT on ECMO were significantly less likely to survive to discharge. Nephrology service was involved in the care of ECMO patients from the beginning in some cases. However, there remains a need for early multi-disciplinary care for critically ill patients requiring ECMO therapy. (Table Presented).
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Background: Diagnostic stewardship modifies the ordering, performing, and reporting of diagnostic tests to optimize clinical care and infection prevention while conserving healthcare resources. Timely and accurate diagnosis of respiratory virus infections can optimize the use of antibiotics, antivirals, ancillary tests, and inpatient beds. Influenza-like illnesses (ILIs) are frequently caused by viruses. However, before COVID-19, specific antiviral medication was commonly used only for the treatment of influenza virus infections. Methods: Eskenazi Health (EH) had 2 respiratory PCR assays: influenza/RSV ($58.18 per assay) and a 20-pathogen respiratory pathogens panel (RPP) ($129 per assay). An inpatient ILI algorithm was developed and implemented in the electronic health record (EHR) in October 2018 to guide the selection of the appropriate assay (Figure 1). Ambulatory testing defaulted to the influenza/RSV assay. Prescribers retained the ability to override recommendations. We performed a retrospective chart review of all orders for RPP and influenza/RSV assays before implementation of the ILI algorithm (October 1, 2017, to September 30, 2018) and after implementation (October 1, 2018, to September 30, 2019). The primary end point was the number of RPP assays ordered. The secondary end point was the appropriateness of RPP assays ordered (ie, met ≥1 criteria) and number of influenza/RSVs assays ordered with virus detected. Results: Before the implementation of the intervention, 1,882 orders were reviewed. After implementation 1,621 orders were reviewed. All influenza/RSV and RPP assays were included if they were ordered between October 1, 2017, and September 30, 2019, at EH. There were no exclusion criteria. After implementation, RPP assays decreased ~40% (Table 1), with associated cost savings of $35,368.68 (22.6% of total assay costs;$163,742.88 before implementation and $128,374.20 after implementation). Although some of this reduction could be attributed to the lower number of overall assays ordered, the 40% reduction in RPP assays exceeded the 14% decrease in overall orders, demonstrating improvement in utilization of RPP assays. A corresponding increase in influenza/RSV assay orders was not observed;both groups had similar total influenza/RSV orders. Both groups also had similar percentages of viruses detected with influenza/RSV and RPP (33% before vs 31% after). After implementation, 1,522 (94%) of 1,621 orders followed the recommendations of the ILI algorithm (Table 2). Several prescribers ordered influenza/RSV despite the patient meeting criteria for RPP assay;of these 26 assays, 4 (15%) resulted in virus detection. Of the 73 instances in which prescribers bypassed recommendations for the influenza/RSV assay and ordered an RPP assay, 14 (19%) of the assays resulted in virus detection;only 1 of 14 was a virus that would have been detected by the influenza/RSV. We were unable to identify any trends that would assist in developing additional order questions to capture these patients. Conclusions: Implementation of the ILI algorithm was associated with high adherence, improvement in the appropriateness of ordering, and significant cost savings.Funding: NoDisclosures: NoneFigure 1.Table 1.Table 2.
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Purpose: Liver transplant (LT) recipients have a decreased response to 2 doses of SARS-CoV-2 vaccine compared to the general population, so we aimed to understand response to a third dose to inform vaccination strategies. Method(s): LT recipients in our observational cohort who received 3 homologous mRNA vaccines and available antibody levels pre- and post-dose 3 (D3) were identified. Those who reported a prior COVID-19 diagnosis or used belatacept were excluded. The peak anti-spike antibody level collected between the second (D2) and third dose (D3), was compared to the antibody level at 1 month post-D3. Samples were tested with Roche Elecsys Anti-Sars-CoV-2 enzyme immunoassay (EIA) (positive >=0.8 U/mL) or EUROIMMUN EIA (positive >=1.1 AU). Result(s): 146 participants completed 3 homologous doses of BNT162b2 (53%) or mRNA-1273 (47%) vaccines between 5/15/2021 - 11/8/2021. The median (IQR) time of peak pre-D3 antibody collection was 89 (31, 104) days post-D2. The median time of 1-month post-D3 antibody collection was 30 (23, 33) days. The median time between D2 and D3 was 168 (149-188) days. Overall, 125/146 (86%) were seropositive pre-D3, and 139/146 (95%) were seropositive post-D3 (Figure 1). There were no seroreversions post D3, and among the 21 seronegative recipients pre-D3, 14 (67%) seroconverted post-D3. Risk factors significantly associated with persistent seronegativity post-D3 were less time since LT (1.3 vs 6 years, p=0.042), mycophenolate use (100% vs 37%, p=0.001), BNT162b2 series (100% vs 50%, p=0.01), and pre-D3 seronegative status (86% vs 10%, p<0.001). Conclusion(s): Most LT recipients have excellent responses to a third homologous mRNA vaccine dose, greater than that seen in other transplant recipients. Persons seronegative after D2, however, show weaker response and may remain at high risk for SARS-CoV-2 infection despite D3.
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Purpose: Kidney transplant recipients taking belatacept (KTR-B) have poor immune response to two-dose SARS-CoV-2 vaccination. We sought to characterize the impact of an additional vaccine dose on plasma neutralizing capacity and cellular responses as compared to that of KTRs controls (KTR-C) not taking belatacept. Method(s): Within an observational cohort, we tested 26 KTR-Bs and 27 KTR-Cs for anti-spike antibody responses before and after a third SARS-CoV-2 vaccine dose (D3) using two clinical assays (Roche Elecsys anti-S Ig and EUROIMMUN anti-S1 IgG). For a subset of 5 KTR-Bs and for all KTR-Cs we used a research assay (Meso Scale Diagnostics V-Plex [MSD]) to further assess anti-spike and RBD IgG, as well as surrogate plasma neutralizing activity (% ACE2 inhibition) versus the ancestral and delta variants. For 3 KTR-Bs, post D3 T cell response was assessed via IFN-y ELISpot and deemed positive if spot forming units > 20 per million PBMC and stimulation index > 3. Result(s): KTR-Bs had significant lower clinical anti-spike seroconversion than KTR-Cs (31% vs 74%, p=0.001) after D3 despite similar demographics, clinical factors, and vaccines administered (Table 1). No KTR-B (0/5) was seropositive by MSD anti-spike or anti-RBD IgG (Figure 1). % ACE2 inhibition versus the ancestral variant was significantly lower in KTR-Bs than in KTR-Cs (Median [IQR] 5.2 [2.8, 6.5] vs 12.5 [7.7, 23.9], p<0.01);all KTR-Bs were below a level consistent with detectable neutralizing antibody. All tested KTR-Bs (3/3) had a negative ELISpot, consistent with negligible cellular response. Conclusion(s): These results suggest minimal humoral or cellular immunogenicity of additional vaccine doses for KTR-Bs and indicates the need for alternative strategies to improve vaccine response such as immunosuppression alteration or use of passive immunoprophylaxis with monoclonal anti-spike antibody to improve protection versus SARS-CoV-2.
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Purpose: nti-spike antibody response to SARS-CoV-2 vaccination is diminished in LT recipients compared to the general population so understanding durability for those that do respond is critical to mitigating risks of infection. We measured serial antibody titers in LT recipients for 6 months after two-dose mRNA vaccine series to describe kinetics and sero-reversion rates. Method(s): LT recipients without known prior COVID-19 had anti-spike antibody testing at 1, 3, and 6 months after the second dose of mRNA vaccine (D2) using two commercial assays (Roche Elecsys anti-receptor binding domain immunoassay (EIA) [positive >=0.8 U/mL] or EUROIMMUN anti-S1 EIA [positive >=1.1 AU]). We compared titer distributions over time and identified factors associated with sero-reversion. Result(s): 180 LT recipients received BNT162b2 (48%) or mRNA-1273 (52%) 2-dose series between 1/7/2021-5/7/2021. At 1 month post-D2 (n=173), 146 (84%) had positive antibody levels at a median (IQR) of 30 (28, 32) days post-D2. At 3 months post-D2 (n=164), 149 (91%) had positive levels at a median of 92 (90, 96) days post-D2. At 6 months post-D2 (n=73), 62 (85%) had positive levels at a median of 180 (176, 185) days post-D2. Among the 66 seropositive at 1 or 3 months post-D2, 58 (88%) remained seropositive by 6 months post-D2. Neither age, years since transplant, vaccine type, nor mycophenolate (MMF) use were associated with sero-reversion, though there was a trend toward more triple immunosuppressive use (25% vs 3%, p=0.07). Of those Roche-tested, the median anti-RBD levels were >=250 U/mL (14, >=250;n=120) at 1 month post-D2, >=250 U/mL (58, >=250;n=113) at 3 months, and >=250 U/mL (30, >=250;n=49) at 6 months . Of those EUROIMMUN-tested, the median anti-S1 levels were 7.25 AU (4.31, 8.71;n=53) at 1 month, 5.71 AU (1.27, 7.90;n=51) at 3 months, and 1.73 AU (0.76, 6.01;n=25) at 6 months. Conclusion(s): Overall, most LT recipients demonstrated 6 month durability of anti-spike antibody following vaccination, but a subset did sero-revert, potentially associated with heavier immunosuppression. Further investigation into clinical consequences of waning antibody levels is key to guide timing of additional vaccine doses.
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Purpose: Mycophenolate mofetil (MMF) use is associated with decreased antibody response to the SARS-CoV-2 mRNA vaccine series in heart and lung transplant recipients (HLTRs). Higher MMF doses have been associated with poor immunogenicity in kidney transplant recipients, but limited data exist on HLTRs. We evaluated the relationship between daily MMF dose and vaccine-induced antibody response in HLTRs. Method(s): HLTRs (n= 212) from an observational cohort were categorized by daily MMF doses (None, Low: <1000mg, Moderate: 1000-2000mg, High: >=2000mg). Semi-quantitative antibody testing was performed at 1, 3, and 6-months post-dose 2 (D2) using the Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay (EIA), testing for antibodies to SARSCoV2 spike protein receptor binding domain, and the EUROIMMUN EIA, testing for S1 domain of SARS-CoV-2 spike protein. Multivariable Poisson regression was used to estimate the risk of a negative antibody response with increasing MMF dose. Result(s): At the time of vaccination, 94 (44.3%) HLTRs reported receiving no MMF, 33 (15.6%) reported a low dose, 54 (25.7%) reported a moderate dose, and 31 (14.8%) reported a high dose regimen. There were statistically significant differences in the number of participants on mTOR inhibitors and Triple immunosuppression among the groups but the participants in all 4 dose categories were otherwise comparable (Table 1) The risk ratio of a negative post-D2 titer with low, moderate and high dose regimens compared to no MMF was 0.65 1.15 2.05 (p=0.63), 1.34 2.043.10 (p=0.001) and 1.83 2.77 4.21 (p<0.001) after adjusting for age, sex, vaccine type, time since transplant, and corticosteroid use. Conclusion(s): HLTRs taking MMF >1000mg/day are at higher risk of remaining seronegative after mRNA vaccination, with evidence of a dose-nonresponse effect. The findings support the exploration of whether targeted MMF reduction strategies in HLTRs increase SARS-CoV-2 vaccine immunogenicity. (Table Presented).
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Purpose: To compare antibody response to a third dose (D3) of SARS-CoV-2 vaccine in solid organ transplant recipients (SOTRs) with negative or low-positive antibody levels after 2-dose mRNA vaccination across D3 platforms. Method(s): From our observational study, 532 SOTRs who developed suboptimal antibody responses to 2-dose mRNA vaccination (Roche<50 U/mL or EUROIMMUN <1.1 AU) were selected. Belatacept recipients and persons with any COVID-19 diagnosis were excluded. We compared post-D3 antibody levels among SOTRs who received an mRNA vaccine for D3 (n=487) versus Ad.26.COV2.S for D3 (n=45). Poisson regression with robust standard error was used to study the association between vaccine platform and seroconversion, adjusting for immunosuppression, age, time since transplant, and liver transplant status. Result(s): Pre-D3, 342 SOTRs (64%) were seronegative, of whom 107 (31%) developed high-positive antibody levels post-D3. In contrast, of the 190 (36%) with low-positive pre-D3 antibody levels, 172 (91%) were high-positive post-D3 (Figure 1). Among SOTRs seronegative pre-D3, 1.8x more Ad.26.COV2.S D3 recipients seroconverted compared to mRNA D3 recipients (49.7% vs 27.8%, Fisher's exact=0.014) (Figure 2). Among the pre-D3 seronegative group, there was a 2x higher chance of developing high-positive post-D3 levels with Ad.26.COV2.S compared to mRNA D3 (IRR =1.42.02.9, p<0.001). This was despite the Ad.26. COV2.S D3 group having fewer younger patients and liver transplant recipients, factors that are associated with higher odds of positive antibody response. 165 SOTRs (31%) remained seronegative after D3 (22% of Ad.26.COV2.S recipients vs 32% of mRNA recipients). Conclusion(s): Heterologous boosting with Ad.26.COV2.S may be a promising vaccination option for SOTRs with poor response to the 2-dose mRNA series, particularly among those who are seronegative. (Table Presented).
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SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: SARS-CoV-2 has been associated with co-infecting pathogens, such as bacteria, viruses, and fungi. Little has been reported about community acquired atypical bacterial co-infections with SARS-CoV-2. We present a case of a patient with recent COVID-19 pneumonia and diagnosis of Legionella and Mycoplasma pneumonia, in addition of E. coli and C. perfringens bacteremia, that emphasizes SARS-CoV-2 impact in human immunity and the need to consider community acquired infections. CASE PRESENTATION: A 64-year-old male with history of hypertension, alcohol use disorder, iron deficiency anemia, and recent COVID-19 pneumonia presented to the ED with shortness of breath, dark urine, and increased confusion. The patient was admitted to the hospital a week prior with COVID-19 pneumonia and acute kidney injury. He received dexamethasone, remdesivir, and IV fluids. After 8 days, he was discharged home. Upon evaluation, he was afebrile and normotensive, but tachycardic, 129/min, on 4 L of nasal cannula sating 100%. On exam, the patient was oriented only to person and had decreased breath sounds bilaterally. Labs revealed an elevated WBC, 15.3 K/mcL, with left shift, low Hgb, 7.8 g/dL, with low MCV, 61 fL, increased BUN/Cr, 56 mg/dL and 2.8 mg/dL, and an abnormal hepatic panel, AST 121 U/L, ALT 45 U/L, alkaline phosphatase 153 U/L. Ammonia, GGT, CPK and lactic acid were within normal range;but the D-dimer and procalcitonin were elevated, 4618 ng/mL and 25.12 ng/mL, respectively. A urinalysis showed gross pyuria, positive leukocyte esterase and mild proteinuria. CT head showed no acute abnormalities, but the chest X-Ray revealed a hazy opacity in the left mid and lower lung, followed by a CT chest that demonstrated peripheral and lower lobe ground glass opacities and a CT abdomen that showed right sided perinephric and periureteral stranding. Given increased risk for thromboembolism, a VQ scan was done being negative for pulmonary embolism. The patient was admitted with acute metabolic encephalopathy, acute kidney injury, transaminitis, pyelonephritis and concern for hospital acquired pneumonia. Vancomycin, cefepime and metronidazole were ordered. HIV screen was negative. COVID-19 PCR, Legionella urine antigen and Mycoplasma IgG and IgM serologies were positive. Blood cultures grew E. coli and C. perfringens. Infectious Disease and Gastroenterology were consulted. The patient was started on azithromycin and a colonoscopy was done showing only diverticulosis. After an extended hospital course, the patient was cleared for discharge, without oxygen needs, to a nursing home with appropriate follow up. DISCUSSION: Co-infection with bacteria causing atypical pneumonia and bacteremia should be considered in patients with recent or current SARS-CoV-2. CONCLUSIONS: Prompt identification of co-existing pathogens can promote a safe and evidence-based approach to the treatment of patients with SARS-CoV-2. Reference #1: Alhuofie S. (2021). An Elderly COVID-19 Patient with Community-Acquired Legionella and Mycoplasma Coinfections: A Rare Case Report. Healthcare (Basel, Switzerland), 9(11), 1598. https://doi.org/10.3390/healthcare9111598 Reference #2: Hoque, M. N., Akter, S., Mishu, I. D., Islam, M. R., Rahman, M. S., Akhter, M., Islam, I., Hasan, M. M., Rahaman, M. M., Sultana, M., Islam, T., & Hossain, M. A. (2021). Microbial co-infections in COVID-19: Associated microbiota and underlying mechanisms of pathogenesis. Microbial pathogenesis, 156, 104941. https://doi.org/10.1016/j.micpath.2021.104941 Reference #3: Zhu, X., Ge, Y., Wu, T., Zhao, K., Chen, Y., Wu, B., Zhu, F., Zhu, B., & Cui, L. (2020). Co-infection with respiratory pathogens among COVID-2019 cases. Virus research, 285, 198005. https://doi.org/10.1016/j.virusres.2020.198005 DISCLOSURES: No relevant relationships by Albert Chang No relevant relationships by Eric Chang No relevant relationships by KOMAL KAUR No relevant relationships by Katiria Pintor Jime ez