318. Description of Patients Readmitted within 30 Days from COVID-19 Hospitalization

Abstract Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to increased hospitalizations and utilization of critical care services. There are few studies describing co-morbidities and demographics associated with patients re-admitted within 30-days of discharge. The purpose of this study is to describe this patient population. Methods This was a single-center, retrospective study at The Ohio State University Wexner Medical Center to identify patients who were admitted secondary to SARS-CoV-2 and required readmission within 30 days due to complications that might be associated with COVID-19. Adults admitted between 3/15/2020 and 11/15/2020 were included in this study. Baseline demographics including age, gender and race in addition to select comorbidities were identified. Results 250 patients were identified who were readmitted for various reasons. Readmitted patients had a median age of 55 years, 44% were male, and 41.2% were Black/African American. 62.4% of the population was obese (BMI ≥30 kg/m2) with 21.6% with a BMI ≥ 40 kg/m2. The top three co-morbidities seen included Diabetes Mellitus (DM) (32.2%), Hyperlipidemia (48.3%) and Hypertension (51.7%). Conclusion Though this study lacked a comparator group, it is clear that patients readmitted with all cause etiologies were disproportionally Black/African-American and obese, with a high prevalence of DM, hyperlipidemia, and hypertension. We recommend close monitoring of patients in these groups to reduce COVID19 readmissions. This is the first step in identifying which patients may be more likely to develop complications and required readmission, the next step is to compare these patients to those that were not readmitted to develop a risk model for readmission. Disclosures Carlos Malvestutto, M.D., Lilly (Scientific Research Study Investigator)Regeneron Inc. (Scientific Research Study Investigator)ViiV Healthcare (Advisor or Review Panel member) Mohammad Mahdee Sobhanie, M.D., Regeneron (Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator, Was a sub-investigator for Regeneron 2066 and 2069)

Background. Candidemia is a rare but serious complication of SARS-CoV-2 hospitalization. Combining non-culture and culture-based diagnostics allows earlier identification of candidemia. Given higher reported incidence during COVID-19 surges, we investigated the use of (1-3)-β-D-glucan (BDG) assay at our institution in those who did and did not develop candidemia.
Methods. Retrospective study of adults admitted to The Mount Sinai Hospital between March 15-June 30 2020 for SARS-CoV-2 infection, with either ≥1 BDG assay or positive fungal blood culture. Data was collected with the electronic medical record and Vigilanz. A BDG value ≥ 80 was used as a positivity cutoff. Differences in mortality were assessed by univariate logistic regression using R (version 4.0.0). Statistical significance was measured by P value < .05.
Results. There were 75 patients with ≥1 BDG assay resulted and 28 patients with candidemia, with an overlap of 9 between the cohorts. Among the 75 who had BDG assay, 23 resulted positive and 52 negative. Nine of 75 patients developed candidemia. Of the 23 with a positive assay, 5 developed candidemia and 18 did not. Seventeen of the 18 had blood cultures drawn within 7 days +/-of BDG assay. Four patients with candidemia had persistently negative BDG; 2 had cultures collected within 7 days +/-of BDG assay. With a cut-off of >80, the negative predictive value (NPV) was 0.92. When the cut-off increased to >200, NPV was 0.97 and positive predictive value (PPV) was 0.42. Average antifungal days in patients with negative BDG was 2.6 vs. 4.2 in those with a positive. Mortality was 74% in those with ≥1 positive BDG vs. 50% in those with persistently negative BDGs. There was a trend towards higher odds of death in those with positive BDG (OR = 2.83, 95% CI: 1.00-8.90, p < 0.06).
Conclusion. There was substantial use of BDG to diagnose candidemia at the peak of the COVID-19 pandemic. Blood cultures were often drawn at time of suspected candidemia but not routinely. When cultures and BDG were drawn together, BDG had a high NPV but low PPV. High NPV of BDG likely contributed to discontinuation of empiric antifungals. The candidemic COVID-19 patients had high mortality, so further investigation of algorithms for the timely diagnosis of candidemia are needed to optimize use of antifungals while improving mortality rates. Disclosures.

Background. Invasive fungal infections (IFI) are emergent complications in SARS-CoV-2 infection. We aimed to describe the epidemiology, characteristics and outcome of IFI during the pandemic.
Methods. Between March 2020 and April 2021, patients admitted to the Intensive Care Unit (ICU) in a COVID-19 center in Mexico City who developed IFI were included. COVID-19 associated pulmonary aspergillosis (CAPA) was defined according to the ECMM/ISHAM criteria. Demographic and clinical data were obtained from the electronic medical record. Descriptive analysis was made. The study was approved by the Institutional Review Board.

Conclusion.
We found 9% incidence of IFIs in critically-ill COVID-19 patients with high mortality. The majority received steroids, had obesity and had a prolonged hospital stay. Most had possible CAPA. An outbreak of fluconazole-resistant C. parapsilosis was found.
Disclosures. All Authors: No reported disclosures