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1.
Frontiers in Microbiology ; 13, 2022.
Article in English | EMBASE | ID: covidwho-1822384

ABSTRACT

Serological testing is recommended to support the detection of undiagnosed coronavirus disease 2019 (COVID-19) cases. However, the performance of serological assays has not been sufficiently evaluated. Hence, the performance of six severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binding antibody assays [three chemiluminescence (CLIAs) and three lateral flow immunoassays (LFIAs)] and a surrogate virus neutralization test (sVNT) was analyzed in a total of 988 serum samples comprising 389 COVID-19-positives and 599 COVID-19-negatives. The overall diagnostic sensitivities of CLIAs and LFIAs ranged from 54.2 to 56.6% and from 56.3 to 64.3%, respectively. The overall diagnostic specificities of CLIAs and LFIAs ranged from 98.2 to 99.8% and from 97.3 to 99.0%, respectively. In the symptomatic group (n = 321), the positivity rate increased by over 80% in all assays > 14 days after symptom onset. In the asymptomatic group (n = 68), the positivity rate increased by over 80% in all assays > 21 days after initial RT-PCR detection. In LFIAs, negatively interpreted trace bands accounted for the changes in test performance. Most false-positive results were weak or trace reactions and showed negative results in additional sVNT. For six binding antibody assays, the overall agreement percentages ranged from 91.0 to 97.8%. The median inhibition activity of sVNT was significantly higher in the symptomatic group than in the asymptomatic group (50.0% vs. 29.2%;p < 0.0001). The median times to seropositivity in the symptomatic group were 9.7 days for CLIA-IgG, 9.2 and 9.8 days for two CLIAs-Total (IgM + IgG), 7.7 days for LFIA-IgM, 9.2 days for LFIA-IgG, and 8.8 days for sVNT-IgG, respectively. There was a strong positive correlation between the quantitative results of the four binding antibody assays and sVNT with Spearman ρ-values ranging from 0.746 to 0.854. In particular, when using LFIAs, we recommend using more objective interpretable assays or establishing a band interpretation system for each laboratory, accompanied by observer training. We also anticipate that sVNT will play an essential role in SARS-CoV-2 antibody testing and become the practical routine neutralizing antibody assay.

2.
Influenza and other Respiratory Viruses ; 2022.
Article in English | EMBASE | ID: covidwho-1822050

ABSTRACT

Based on our national outpatient sentinel surveillance, we have developed a novel approach to determine respiratory syncytial virus (RSV) epidemic seasons in Germany by using RSV positivity rate and its lower limit of 95% confidence interval. This method was evaluated retrospectively on nine RSV seasons, and it is also well-suited to describe off-season circulation of RSV in near real time as observed for seasons 2020/21 and 2021/22 during the COVID-19 pandemic. Prospective application is of crucial importance to enable timely actions for health service delivery and prevention.

3.
Journal of Clinical and Diagnostic Research ; 16(4):DC01-DC05, 2022.
Article in English | EMBASE | ID: covidwho-1818679

ABSTRACT

Introduction: Ever since the Coronavirus Disease 2019 (COVID-19) pandemic hit, there have been constant efforts to develop rapid, sensitive and specific diagnostic methods to detect the virus in order to curb the further spread of the disease. There is an array of tests available for the detection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Time being a very crucial factor, Rapid Antigen Testing (RAT) is very helpful in detecting the virus. Aim: To discuss the importance of rapid testing among symptomatic and asymptomatic cases in different age groups and gender with association to infection. Materials and Methods: This retrospective study was conducted in Department of Microbiology, Autonomous State Medical College and SNM Hospital, Firozabad, Uttar Pradesh, India, from April 2020-August 2021. A total of 16,258 samples were collected from symptomatic patients having Influenza Like Illness (ILI), Severe Acute Respiratory Illness (SARI), those seeking hospitalisation, contacts (symptomatic and asymptomatic) and travellers were subjected to antigen detection by the Standard Q COVID-19 antigen kit following proper precautions. The cases were divided into Group A of patients who presented with symptoms ≤7 days, Group B of patients who presented with signs and symptoms >7 days and group C comprised of asymptomatic patients. The Chi-square test was done to test the statistical significance of association of symptomatic patients with outcome of the antigen test. Results: Of the total 16,258 samples tested, the maximum number of positive cases were found in the age group 30-39 years (p-value <0.05) followed by 20-29 years. The least number of positive cases (six) was found in the higher (90 years) and lower (below 9 years) age groups. No significant impact was found on the positivity rates on the basis of gender. The percentage positivity as detected by rapid antigen was 2% and maximum patients were found in the group having symptoms <7 days (p<0.05). Conclusion: Rapid Antigen Detection Test (RADT) for SARS-CoV-2 is a simple, portable, fast and easy to perform test. It could be easily used in rural areas as it does not require special laboratory set up. It could be used for mass testing and helped as a good epidemiological tool. However, few symptomatic cases which could not be detected by rapid testing had to be cross checked with Real Time-Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Thus, when used in conjunction with molecular methods, the sensitivity of the test increased.

4.
Vaccines ; 10(3), 2022.
Article in English | EMBASE | ID: covidwho-1818219

ABSTRACT

Data about the duration of antibodies after vaccination show that the protection against SARS-CoV-2 infection begins to decline over time. This study aims to determine anti-SARS-CoV-2 anti-S IgG levels in healthcare workers five months after the second vaccination dose. We collected samples from 82 participants who were fully vaccinated with ChAdOx1 nCoV-19 or BBIBP-CorV. We assessed anti-SARS-CoV-2 IgG antibodies using a Euroimmun ELISA and an Abbott Architect ™ SARS-CoV-2 IgG test. Of the 82 participants, 65.85% were seropositive for IgG using ELISA, and 86.59% were positive for IgG according to the Abbott Architect ™ test. Individuals vaccinated with the ChAdOx1 nCoV-19 vaccine had a median anti-S1 antibody level of 1.810 AU/mL [interquartile range (IQR), 1.080–3.7340] and 171.7 AU/mL [79.9–684.6] according to the Euroimmun ELISA and Abbott Architect test, respectively. These tests indicated that people vaccinated with BBIBP-CorV had a median anti-S1 antibody level of 1.840 AU/mL [0.810–2.960] and 126.7 AU/mL [54.9–474.3], respectively. Statistical analysis showed no significant difference between the positivity rates of the vaccinated individuals, either for gender or for age. In addition, we found no significant difference between the two vaccines. Our study provides information on the longevity of the anti-SARS-CoV-2 IgG antibodies in people at least five months after vaccination.

5.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816925

ABSTRACT

Importance: The benefit of routine screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in patients with cancer before cancer-directed therapies is unclear. Herein, we characterize the outcomes of a cohort of cancer patients diagnosed with Coronavirus Disease 2019 (COVID-19) by routine screening in comparison with those diagnosed based on clinical suspicion or exposure history (non-routine screening). Objective: To describe and compare the outcomes of cancer patients diagnosed with COVID-19 on routine screening vs. non-routine screening at a multi-site tertiary cancer center. To identify risk factors for COVID-19-related hospital admission. Design: A multi-site prospective observational study was conducted between March 18 and July 31, 2020. Setting: Three major and 5 satellite campuses of the Mayo Clinic Cancer Center. Participants: Adult patients diagnosed with active cancer within the past five years and confirmed SARS-CoV-2 infection were included. Primary Outcomes and Measures: Clinical and laboratory data were assessed as independent variables. The primary outcome was COVID-19- related hospital admission. Secondary outcomes included intensive care unit (ICU) admissions and all-cause mortality. Results: Between March 18 and July 31, 2020, 5452 patients underwent routine screening in the outpatient setting, 44 (0.81%) were diagnosed with COVID-19. Routine screening detected additional 19 patients from inpatient and pre-procedural settings;161 patients were diagnosed with COVID-19 based on non-routine screening. The median age of the entire cohort at diagnosis was 54 years, and 95 patients (42.2%) were female. COVID-19 related- hospitalization rate (17.5% vs. 26.7%, p=0.14), ICU admission (1.6% vs. 5.6%, p=0.19), and mortality (4.8% vs. 3.7%, p=0.72) were not significantly different between routine screening and non-routine screening groups. In the multivariable analysis, age ≥ 60 years (odds ratio: 4.4, p=0.023) and an absolute lymphocyte count ≤1.4 × 109 /L (odds ratio: 9.2, p=0.002) were independent predictors of COVID-19-related hospital admission. Conclusions and Relevance: The COVID-19 positivity rate was low based on routine screening. Comparing the outcome with the non-routine screening cohort, there was no significant difference. These results led to an important practice change at our cancer center. We currently follow a testing strategy based on symptoms, exposure, risk factors, and clinical judgment.

6.
Revista de la Federacion Argentina de Cardiologia ; 51(1):32-36, 2022.
Article in Spanish | EMBASE | ID: covidwho-1813131

ABSTRACT

Background: Coronavirus disease (COVID-19) is one of the largest pandemics known to date. Elevated troponin can be caused by multiple factors, but its increase is related to adverse outcomes and higher mortality. In the First Argentine Registry of Cardiac Complications in patients with CO-VID-19 (RACCOVID-19) the Argentine Society of Cardiology (SAC) and the Argentine Federation of Cardiology (FAC) data were analyzed. Objectives: The aim of this study was to learn the troponin elevation rate and its relationship with the prognosis of patients included into the RACCOVID-19. Methods: A total of 2750 patients were included in 50 centers in 11 provinces of the country from May 18 to October 31, 2020. Results: Troponin samples were taken from 2378 patients. The positivity rate was 15.2%. The most common cause of troponin elevation was related to infection (inflammatory) followed by heart failure. The group of patients with elevated troponin showed a higher age, predominant male sex, higher rate of history of asthma/COPD, diabetes mellitus, kidney failure and/or dialysis, and more severe forms of COVID-19. Mortality in the registry was 19.3% and 43.3% in patients with troponin elevation (43.8% vs. 13.9%, p < 0.001). Troponin elevation was independently associated with mortality. Conclusions: The RACCOVID-19 registry showed a troponin positivity rate of 15.2%. These patients presented more comorbidities and more severe forms of the disease. The increase in troponin during hospitalization for COVID-19 is independently associated with higher mortality.

7.
European Heart Journal Cardiovascular Imaging ; 23(SUPPL 1):i172-i173, 2022.
Article in English | EMBASE | ID: covidwho-1795322

ABSTRACT

Introduction: The emergence of coronavirus 2019 infection (covid-19) was accompanied by severe social and economic restrictions and applied significant pressure to the healthcare systems. The first pandemic wave started in March to May 2020 and was characterized by the peak of confinement measures and lockdown application. The second wave started in September and peaked in November to December 2020 and was characterized by improved healthcare organization but significant burden for the hospitals and intensive care units. Dobutamine stress echocardiography (DSE) is used for evaluation of ischemia in patients with known or suspected coronary artery disease. Purpose: To compare DSE volume and positivity rates between 2019 and 2020 time periods in a department of a public tertiary hospital. Methods: We retrospectively analysed DSE studies performed in our department in 2020 including the peak of covid-19 restrictions and compared the data to the 2019. Results: Volume of DSE studies decreased from 1516 in 2019 to 996 in 2020 (-34.3%). The study volume reduction was greater in April (-93.7%) and May (-54.5%) when the covid-19 restrictions were at the peak. Great decreases were also recorded in November (-46.8%) and December (-53.5%) when the second wave of covid-19 disease emerged. Conversely, small increases were recorded in September (7.1%) and October (10.6%) (figure 1). Regarding positivity rates, a statistically non-significant increase was recorded (33.6% vs 34.2% in 2019 and 2020 respectively, p = 0.73). Interestingly a statistically significant increase in positivity levels was recorded during the period March to May 2020 compared to the same period of 2019 (44.7% vs 36.9%, p = 0.029). On the contrary, positivity rates were decreased at the period September to December (27.1% vs 34.2%, p = 0.019) (figure 2). Conclusions: Volume of DSE studies was significantly reduced in 2020 when compared to 2019 during respective peaks of the pandemic and the accompanying restriction measures. Positivity rates were higher during the first pandemic wave, possibly due to decreased hospital attendance of mildly symptomatic patients in combination with stricter admission criteria at the emergency department. Lower positivity rates during the second pandemic wave possibly reflect an adjustment of both healthcare systems and patients to the new conditions imposed by the covid-19 pandemic.

8.
Indian J Public Health ; 66(1): 45-48, 2022.
Article in English | MEDLINE | ID: covidwho-1776452

ABSTRACT

Background: Coronavirus disease-19 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious health threat globally. Many countries have seen a two-wave pattern in there reported cases during the period of pandemic. Similarly, our country has reported the first peak between March and October 2020 followed by the second peak between April and June 2021. Objectives: The objective of this study was conducted to describe the spatiotemporal patterns and early epidemiological features of COVID-19 cases from November 2020 to May 2021 in the central (Majha) region of Punjab state of India which was considered as the epicenter of the infection. Methods: The multiplexed real-time reverse transcription-polymerase chain reaction (RT-PCR) method was used to detect SARS-CoV-2, with co-amplification of specific target genes using real-time PCR kits. Results: During the second wave, test positivity rate for COVID-19 in our laboratory (the central region of Punjab) was recorded as 4.8%. The study revealed that an increased sustained proportion of COVID-19 incidence is present in young adult age group (20-39 years) with 8.65% positive rate followed by the older age group and least in young ones. It was observed that during the second wave, more symptomatic individuals are positive (10.26%) alongside it was also observed that male population (5.61%) was more prone to infection in comparison to females (3.78%). Whole-genome sequencing carried out on 120 random samples selected from all the districts of Majha region of Punjab state showed two prominent strains, namely alpha variant (95 cases) and delta variant (19 cases). Conclusion: A higher positivity rate in the second wave demonstrates the rapid spread of the new emerging virus variants and warrants the implementation of strict vaccination regimes and quarantine in the affected region.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Aged , COVID-19/epidemiology , Female , Humans , India/epidemiology , Male , Prevalence , Young Adult
9.
Front Public Health ; 10: 821611, 2022.
Article in English | MEDLINE | ID: covidwho-1776017

ABSTRACT

India experienced a second wave of COVID-19 infection with an unprecedented upsurge in the number of cases. We have analyzed the effect of different restrictive measures implemented in six Indian states. Further, based on available national and international data on disease transmission and clinical presentation, we have proposed a decision-making matrix for planning adequate resources to combat the future waves of COVID-19. We conclude that pragmatic and well calibrated localized restrictions, tailored as per specific needs may achieve a decline in disease transmission comparable to drastic steps like national lockdowns. Additionally, we have underscored the critical need for countries to generate local epidemiological, clinical and laboratory data alongwith community perception and uptake of various non-pharmaceutical interventions, for effective planning and policy making.


Subject(s)
COVID-19 , Public Health , COVID-19/diagnosis , COVID-19/epidemiology , Communicable Disease Control , Humans , India/epidemiology , Policy Making
10.
Indian Journal of Clinical Biochemistry ; 36(SUPPL 1):S87, 2021.
Article in English | EMBASE | ID: covidwho-1767687

ABSTRACT

Objective : In this study, we have assessed the hematological characteristics of the patients. This study aimed to evaluate the accuracy of laboratory parameters in predicting cases with positive RT-PCR for COVID19. Methodology: This was a cross-sectional study that included 32 RTPCR +ve and 64 RTPCR -ve cases over a period of 5 weeks. The blood samples were collected from symptomatic patients who presented to cough OPD. On the day of swab sampling, blood sampling was done for each participant. All tests were performed in an appropriate autoanalyzer after complying with internal quality control. Results: The mean CT value of RT-PCR test was found to be 22.7, while mean PCT value was 0.3 ng/ml. The mean ferritin value came out to be 133.5 ng/ml and mean D-dimer values calculated to be just 1.3 mg/L. The mean LDH and CRP levels were 340.4 IU/L and 12.6 mg/L respectively. The sensitivity and specificity for procalcitonin analysis among these patients were 97% with CI (93.8-100) followed by serum ferritin with 82%, CI (70-94) and CRP levels were having just 77.3%, CI (61.2-93.4). Conclusion: In the current study, the AUC of procalcitonin and serum ferritin were above 0.80;thus, they are effective and have very good predictive value for predicting COVID-19. It seems that these blood laboratory parameters could be used in screening cases with positive RT-PCR for COVID-19. However, serum LDH, D Dimer, and vitamin D levels or liver function tests, renal function tests remain insignificantly linked with covid positivity rate in this study.

11.
Journal of Clinical and Diagnostic Research ; 16(3):OC10-OC15, 2022.
Article in English | EMBASE | ID: covidwho-1761186

ABSTRACT

Introduction: Computed Tomography (CT) chest plays an important role in triaging and managing patients of suspected COVID-19, especially in those where Coronavirus Disease 2019 (COVID-19) report is pending but CT chest has constraints of availability and cost. Chest X-ray (CXR) is a readily available investigation and is cheaper than a CT chest. Hence, any scoring on CXR which proves to be helpful in triaging and managing suspected COVID-19 patients will alleviate the dependency on CT chest. Modified Radiographic Assessment of Lung Edema Score (mRALES) and Brixia scores have been used to assess severity of disease and prognosis in COVID-19 confirmed cases. However, these two scores have never been used as a method to predict the confirmed COVID-19 pateints among the the suspected COVID-19 cases. Aim: To evaluate the role of mRALES and Brixia score along with clinical and laboratory parameters in predicting confirmed positive cases among suspected COVID-19 patients. Materials and Methods: This retrospective cross-sectional, observational study was conducted in Department of Medicine at Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India, from 1st to 15th December 2020. Case records of patients admitted with severe acute respiratory illness (suspected COVID-19) were accessed and used to fill up a proforma where clinical and laboratory parameters were recorded. Chest radiographs (posteroanterior and anteroposterior) of the patients were evaluated to calculate mRALES and Brixia scores. Sensitivity, specificity, positive preditive value and negative predictive value were calculated. The p-value <0.05 was considered as statistically significant. Results: Out of the 113 patients, 62 were males and 51 females. The COVID-19 positivity rate was 15.04% (n=17). Mean age of patients was 52.64±15.63 years. Overall, the mean mRALES and Brixia scores were not statistically different between suspected (mRALES=3.94±2.51, Brixia=7.29±4.642), and confirmed COVID-19 (mRALES=4.25±2.56, Brixia=7.73±4.84) patients. However, in the subgroup of patients with history of obstructive airway disease, Brixia score was significantly higher among COVID-19 positive patients (7.09±4.70) as compared to COVID-19 suspected patients (0.53±4.31). Presence of low TLC {<9550/mm3 with sensitivity of 70.62%, specificity of 67.3%, Positive Predictive Value (PPV) of 26.7% and Negative Predictive Value (NPV) of 92.4%} and low ANC {< 7580/mm3 with sensitivity of 64.7%, specificity of 63.2%, PPV of 22.9% and NPV of 90.5%} significantly predicted the COVID-19 positivity among the suspected COVID-19 patients. Conclusion: mRALES and Brixia scores on CXR are not significantly different between suspected and confirmed COVID-19 patients and hence, cannot be used to judge who among suspected COVID-19 patients will turn out to be COVID-19 positive later. However, a TLC of less than 9550/ mm3 and an ANC of less than 7580/mm3 can predict COVID-19 positivity among suspected patients.

12.
Open Forum Infectious Diseases ; 8(SUPPL 1):S87-S88, 2021.
Article in English | EMBASE | ID: covidwho-1746779

ABSTRACT

Background. The Walter Reed National Military Medical Center (WRNMMC) established a consolidated COVID-19 screening area (CSA) beginning in March 2020 to provide beneficiary and staff testing via a drive-through site. Testing was available to all patients and WRNMMC staff regardless of beneficiary status. Presented is a descriptive analysis of our testing operations and positivity rates within a closed medical system from March 2020 to April 2021. Methods. For quality and process improvement, we compiled daily testing logs from March 2020 to April 2021 from the CSA. These logs included patient demographics, reason for testing, test result, testing platform, and occupational status at the hospital. We determined positivity rates in various subgroups -asymptomatic, symptomatic, pre-operative, in order to track testing use and access. Additionally, we compared the overall positivity rate to the surrounding civilian community by pulling data from the Maryland Department of Health's COVID database. Results. Over the course of nearly 14 months of testing availability, 34,694 beneficiaries were screened with 41,582 individual tests. After May 2020, the monthly overall positivity rate varied from 1.99% to 11.92%, peaking in December 2020 (with high rates in November 2020, 7.52% and January 2021, 9.53%), correlating with or exceeding elevated positivity rates in Montgomery County (November 2020: 4.91%;December 2020: 6.48%;January 2021: 6.51%). When examining only symptomatic individuals, the positivity rate is notably much higher, with monthly rates varying from 6.40% to 21.10%, with a similar peak in December 2020. After full implementation of pre-operative screening for procedures with aerosolization potential in June 2020, the range of positivity rates was 0.28%-1.66%. Since vaccination for COVID-19 became widely available beginning in Feb 2021, the preoperative positivity rate has remained below 0.85%. Conclusion. Our institutional experience is unique in its ability to offer universal access to COVID-19 testing for beneficiaries and staff of the DoD under direction of the ID service. Our process serves as a model for public and occupational health response, and may guide lab resource and real-time staffing management in support of COVID-19 diagnostics at a medical center.

13.
Open Forum Infectious Diseases ; 8(SUPPL 1):S154-S155, 2021.
Article in English | EMBASE | ID: covidwho-1746745

ABSTRACT

Background. Fungal blood cultures (fungal isolators) should be used, if at all, primarily for identification of mold infections. At our institution we noted patients having fungal blood cultures drawn in many other situations, including when the primary team was concerned for candida bloodstream infection. We sought to describe the utility of this practice and of fungal blood cultures in general. Methods. We retrospectively reviewed the results of fungal blood cultures for 2 years, from 3/1/2019-3/1/2021. We evaluated the number of episodes, culture results, whether there was a had prior bloodstream infection, and risk factors for fungal infection including renal replacement (RRT), ECMO, and immunosuppression (IS). Immunosuppression was defined as chronic systemic steroid use, recent receipt of high dose steroids within 2 weeks, history of organ transplantation, history of stem cell transplantation, hematologic malignancies, or receipt of a biologic agent. Results. 187 fungal blood cultures were drawn in 143 patients - 80 cultures in 70 patients from 3/2019-3/2020 and 107 cultures in 73 patients from 3/2020-3/2021. Only 3 patients had positive fungal blood cultures:1 (Candida krusei) from 3/2019-3/2020 and 2 (Candida albicans and Cyrptococcus neoformans) from 3/2020-3/2021;in all 3 cases the organism also grew from standard blood culture isolators. From 3/2019-3/2020, 1/80 cultures were drawn from an individual on ECMO while 15/80 were drawn from individuals on RRT, and 32/80 were in a IS individuals. From 3/2020-3/2021, 45/107 cultures were drawn from an individual on ECMO, 24/107 were drawn in an individual on RRT, and 73/107 were drawn in a IS individuals. The majority of individuals in whom a fungal blood culture was drawn during 3/2020-3/2021 were individuals with COVID-19. Upon chart review most of the cultures were drawn due to concern for candidemia. Conclusion. Fungal blood cultures have an extremely low yield at our institution, with a 1.6% positivity rate over a 2 year period, and all of those cultures were detected by standard blood culture isolators. Most of these cultures were drawn in situations where this test has no utility. Furthermore, the test has limited utility to detect dimorphic and mold bloodstream infections. Restriction of this test may limit inappropriate use.

14.
Open Forum Infectious Diseases ; 8(SUPPL 1):S157, 2021.
Article in English | EMBASE | ID: covidwho-1746744

ABSTRACT

Background. Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are at elevated risk for nosocomial infection. Physiological responses to infection on ECMO are difficult to interpret as many clinical characteristics are controlled by the circuit including temperature. This study aimed to determine the culture positivity rates in patients receiving ECMO with influenza or COVID-19. Methods. A single center retrospective study was performed on all patients who received ECMO support at a single institution between December 2014 and December 2020 with influenza or COVID-19. All cultures ordered were reviewed for indication. Patients with fever without specific clinical syndrome or signs of decompensation, such as increasing vasopressor requirement were included. Infections and contaminants were defined by treatment team. Results. A total of 45 patients received ECMO with an admission diagnosis of influenza or COVID-19 during the study period. This cohort had a median age of 44 (interquartile range (IQR): 36-53) and was predominantly male (84%). The median time on ECMO was 360 hours (IQR: 183-666). 43/137 (31%) of infectious workups were ordered for isolated fever. The most common workup ordered for fever was combination blood cultures (BC) and urine cultures (UC) (13, 30%), followed by combination BC, UC, and respiratory cultures (RC) (11, 26%). Four (9%) infections were identified (3 blood stream, 1 respiratory) and five (12%) cultures grew contaminants (1 blood, 1 respiratory, 2 urine). Culture positivity rate was greatest for BC (3/35, 9%) followed by RC (1/19, 5%), and lowest for UC (0/26, 0%). Conclusion. Although cultures are commonly ordered for isolated fever in patients with influenza and COVID-19 receiving ECMO, culture positivity rate is low. In particular, no urinary tract infections were identified and the screening for urinary tract infection in patients receiving ECMO with isolated fever is not beneficial. Further work identifying signs and symptoms associated with infection is needed to improve diagnostic stewardship in this population that is high risk for nosocomial infections.

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S292-S293, 2021.
Article in English | EMBASE | ID: covidwho-1746613

ABSTRACT

Background. High-quality data are necessary for decision-making during the SARS-CoV-2 pandemic. Lack of transparency and accuracy in data reporting can erode public confidence, mislead policymakers, and endanger safety. Two major data errors in Iowa impacted critical state- and county-level decision-making. Methods. The Iowa Department of Public Health (IDPH) publishes daily COVID-19 data. Authors independently tracked daily data from IDPH and other publicly available sources (i.e., county health departments, news media, and social networks). Data include: number and type of tests, results, hospitalizations, intensive care unit admissions, and deaths at state/county levels. Results. Discrepancies were identified between IDPH and non-IDPH data, with at least two confirmed by IDPH: (1) The backdating of test results identified on May 28, 2020. IDPH labeled results as occurring up to four months before the actual test date. IDPH confirmed that if a person previously tested for SARS-CoV-2, a new test result was attributed to the initial test's date. Corrections on August 19, 2020 increased positivity rates in 31 counties, but decreased the state's overall rate (9.1% to 7.5%). (2) The selective exclusion of antigen test results noted on August 20, 2020. Antigen testing was included in the total number of tests reported in metric denominators, but their results were being excluded from their respective numerators. Thus, positive antigen results were interpreted as de facto negative tests, artificially lowering positivity rates. Corrections increased Iowa's positivity rate (5.0% to 14.2%). In July 2020, the Iowa Department of Education mandated in-person K-12 learning for counties with < 15% positivity. These data changes occurred during critical decision-making, altering return-to-learn plans in seven counties. The Center for Medicare and Medicaid Services' requirements also caused nursing homes to urgently revise testing strategies. Timeline of changes to Iowa state COVID-19 testing through the end of August 2020. Change in positive and overall test results due to IDPH data corrections. These graphs represent the difference in cumulative total reported test results when pulled from the IDPH website on September 29, 2020 compared to data for the same dates when pulled on August 19, 2020 before the announced adjustment. The adjustment and subsequent daily changes in reported data amount to a dramatic change in the number of reported positive cases (A) with an increase of nearly 3,000 cases by April 25, as well as the loss of tens of thousands of data points when tracking total resulted tests (B). Conclusion. Data availability, quality, and transparency vary widely across the US, hindering science-based policymaking. Independent audit and curations of data can contribute to better public health policies. We urge all states to increase the availability and transparency of public health data.

16.
Open Forum Infectious Diseases ; 8(SUPPL 1):S293-S294, 2021.
Article in English | EMBASE | ID: covidwho-1746610

ABSTRACT

Background. Children infected with SARS-CoV-2 often have mild or no symptoms, making symptom screening an ineffective tool for determining isolation precautions. As an infection control measure, universal pre-procedural and admission SARS-CoV-2 testing for pediatric patients was implemented in April and August 2020, respectively. Limited data exist on the utility screening programs in the pediatric population. Methods. We performed a retrospective cohort study of pediatric patients (birth to 18 years) admitted to a tertiary care academic medical center from April 2020 to May 2021 that had one or more SARS-CoV-2 point-of-care or polymerase chain reaction tests performed. We describe demographic data, positivity rates and repeat testing trends observed in our cohort. Results. A total of 2,579 SARS-CoV-2 tests were performed among 1,027 pediatric inpatients. Of these, 51 tests (2%) from 45 patients (4.3%) resulted positive. Community infection rates ranged from 4.5-60 cases/100,000 persons/day during the study period. Hispanic patients comprised 16% of the total children tested, but were disproportionately overrepresented (40%) among those testing positive (Figure1). Of 654 children with repeated tests, 7 (0.1%) converted to positive from a prior negative result. Median days between repeat tests was 12 (IQR 6-45), not necessarily performed during the same hospital stay. Five of these 7 patients had tests repeated < 3 days from a negative result, of which only 2 had no history of recent infection by testing performed at an outside facility. Pre-procedural tests accounted for 35% of repeat testing, of which 0.9% were positive. Repeated tests were most frequently ordered for patients in hematology/ oncology (35%) and solid organ transplant/surgical (33%) wards, each with < 3% positive conversion rate. Notably, no hematopoietic stem cell transplant patients tested positive for SARS-CoV-2 during the study period. Conclusion. The positivity rate of universal pre-procedural and admission SARSCoV-2 testing in pediatric patients was low in our inpatient cohort. Tests repeated < 3 days from a negative result were especially low yield, suggesting limited utility of this practice. Diagnostic testing stewardship in certain populations may be useful, especially as community infection rates decline.

17.
Open Forum Infectious Diseases ; 8(SUPPL 1):S375, 2021.
Article in English | EMBASE | ID: covidwho-1746451

ABSTRACT

Background. Regdanvimab is a monoclonal antibody with activity against SARSCoV-2. A Phase 2/3 study with two parts is currently ongoing and data up to Day 28 of Part 1 is available while the data from 1315 patients enrolled in Part 2 are expected in June 2021. Methods. This phase 2/3, randomized, parallel-group, placebo-controlled, double-blind study with 2 parts is aimed to assess the therapeutic efficacy of regdanvimab in outpatients with mild to moderate COVID-19, not requiring supplemental oxygen therapy. Patients aged >18 with the onset of symptoms within 7 days were eligible to be enrolled. Results. In Part 1, 307 patients (101, 103, and 103 patients in the regdanvimab 40 mg/kg, regdanvimab 80 mg/kg, and placebo groups, respectively) were confirmed to have COIVD-19 by RT-qPCR at Day 1 (or Day 2). Regdanvimab significantly reduced the proportion of patients who required hospitalization or supplemental oxygen therapy compared to placebo (8.7% in the placebo vs. 4.0% in the regdanvimab 40 mg/kg). The difference in events rate was even larger in patients who met the high-risk criteria and confirmed a 66.1% reduction in patients receiving regdanvimab 40 mg/kg (Table 1). The median time to clinical recovery was shortened by 2.9 days (7.18 days for regdanvimab 40 mg/kg and 10.03 days for placebo;high-risk). Also, greater reductions from baseline viral load were shown in regdanvimab groups (Figure 1). The safety results confirmed that the regdanvimab was safe and well-tolerated. Occurrence of adverse events (Table 2) and results of other safety assessments were generally comparable among the 3 groups. The overall rate of infusion-related reaction was low and no serious adverse events or deaths were reported. The anti-drug antibody positive rate was low in the regdanvimab groups (1.4% in regdanvimab vs. 4.5% in placebo), and no antibody-dependent enhancement was reported. Conclusion. Results from the first part of the study indicate that regdanvimab may lower the rate of hospitalisation or requirement of oxygen supplementation, with the greatest benefit noted in patients at high-risk of progressing to severe COVID-19. The second part of the study remains ongoing and blinded. Therefore, results for the primary endpoint are forthcoming and will be presented at IDWeek.

18.
Open Forum Infectious Diseases ; 8(SUPPL 1):S436-S437, 2021.
Article in English | EMBASE | ID: covidwho-1746393

ABSTRACT

Background. The multiplex gastrointestinal pathogen panel (GIP) is a convenient and quick diagnostic test for determining the infectious etiology of diarrhea. It identifies several of the most common pathogens associated with gastroenteritis. However, it is expensive, and test results may not impact care, given that several of the pathogens in the panel are managed expectantly. We describe our experience with a diagnostic stewardship initiative to resolve the overuse of this testing method. Methods. We performed a pre/post study of GIPs ordered for inpatients 18 years old and older from December 19, 2018, to December 18, 2020, at Mayo Clinic hospital in Rochester, Minnesota. GIP orders for inpatients were limited to the first 72 hours of hospitalization starting December 19, 2019. Orders after 72 hours were encouraged to be changed to Clostridioides difficile NAAT testing or sent to an infectious disease provider to override on a case-by-case basis. Our hospitals used BioFire® FilmArray® Gastrointestinal Panel (BioFire Diagnostics, Salt Lake City, Utah). Results. A total of 2,641 GIPs were performed during the study period. There were 1,568 GIPs (3.3/100 hospitalizations) in the pre-intervention period compared to 1,073 (2.6/100 hospitalizations) post-intervention, representing a drop of 21.2%. The most common pathogen detected was C. difficile (toxin A/B) (48.8%, n=402), followed by norovirus (17.5%, n=144). The overall test positivity rate was 27.9% (n=736). The test positivity rate decreased 1.8% from 28.6% (n=448) to 26.8% (n=288) after the restriction (p=0.33). The proportion of C. difficile among all pathogens detected increased from 48.5% to 49.7% (p=0.67). Conclusion. Our study showed that restricting the ordering of GIP to the first 72 hours of hospitalization and directing providers to standalone C. difficile NAAT testing resulted in a reduction of GIPs performed. There were marginal changes in the test positivity rate of GIP. A limitation of our study is that the timing of post-intervention coincided with the COVID-19 pandemic, which had unpredictable effects on hospital practice and patient admissions. Ideally, future quality improvement projects should increase the test positivity of pathogens other than C. difficile while lowering the GIP use in diagnosing C. difficile colitis.

19.
Open Forum Infectious Diseases ; 8(SUPPL 1):S453, 2021.
Article in English | EMBASE | ID: covidwho-1746389

ABSTRACT

Background. Due to COVID-19 gastrointestinal microbiome alterations, COVID-19 can be complicated by Clostridioides difficile infection (CDI). This retrospective cohort study aimed to evaluate the prevalence of Clostridium difficile infection in patients with COVID-19pneumonia Methods. A retrospective cohort study was conducted on PCR Covid-19 positive patients admitted in the ICU from September,2020 to 30th April 2021. All patients in the cohort study were on mechanical ventilation, or at some point during their ICU admission required mechanical ventilation. Hospital-onset (HO-CDI), defined as a positive C. difficile test over 3 days after admission. Results. Overall, during the study period, a total of 240 PCR Covid-19 patients were admitted to the ICU;of these, 11 (4.5%) were COVID-19 CDI positive. Nine were males (81%). The mean hospital stay for these COVID-19 patients was 12 days (range 1-59 days). HO-CDI median day of identification was 12 days. All patients received ≥2 antibiotics and dexamethasone at admission. Compared to historical controls, COVID-19 patients did not have a higher overall CDI positive rate. However, mortality among COVID-19 HO-CDI patients was increased 7/11 (63%). Conclusion. Whether COVID-19 itself increases an individual's risk for CDI remains unclear. Multiple contributing factors drive CDI incidence, severity, and recurrence. Although protective measures such as gowns and gloves during COVID-19 increased, CDI cases in the hospital setting should continue to emphasize the importance of antimicrobial stewardship.

20.
Open Forum Infectious Diseases ; 8(SUPPL 1):S539, 2021.
Article in English | EMBASE | ID: covidwho-1746355

ABSTRACT

Background. We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs. Methods. This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA's CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables;McNemar's test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression. Results. 1721 patients received care;1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0;95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively. Conclusion. Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth.

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