679. Infective Endocarditis and Septic Emboli-Related Complications; Epidemiology and Impacts on Hospital Outcomes

Abstract Background Infectious endocarditis (IE) remains a disease of high mortality, complications and a severe burden to the healthcare system despite advances in diagnostic techniques and treatments. There are several investigations of IE using a nation-based population cohort, however, with limited focus on septic emboli-related complications. Figure 1. Flowchart of the study cohort. IE=Infective Endocarditis Methods We used the 2016 to 2018 National Readmission Database (NRD) to identify a primary diagnosis of admissions among adults (Age≥18) with IE. International Statistical Classification (ICD-10) codes were used to identify patients with a primary diagnosis of IE who experienced in-hospital septic emboli-related complications. Primary outcomes were mortality, length of stay, total cost and 30-day all-cause readmission. Uni- and Multivariate Linear, Logistic and Cox regression were used to assess statistical significance and a two-sided p-value less than 0.05 was considered significant. Results A total of 30,870 patients were admitted with a primary diagnosis of IE from 2016 to 2018 (December admissions were omitted). After excluding the patients with omitted information, 30,289 patients went into analysis. Baseline characteristics are shown in Table 1. Septic emboli-related complications were seen in 42.6% of the patients; about 10% had central nervous system (CNS) complications, 7% had cardiac complications and 20.2% had respiratory complications. Embolic complications of any kind were associated with higher mortality (Odds Ratio = 2.11 [1.74 – 2.54]), a longer length of stay (5.72 days [5.17 – 6.27]) and higher total costs (21,812 dollars [19,856 – 23,769]) while adjusted for baseline characteristics. Multivariate Cox regression to assess the risk of 30-day readmission was not statistically significant. Predictors of 30-day all-cause readmission among baseline characteristics and subgroups of embolic complications are shown in table 4 and table 5, respectively. Conclusion The prevalence of septic emboli-related complications was up to 42.6% of patients admitted with the primary diagnosis of IE. These complications significantly impact hospital outcomes; including mortality, length of stay and total cost. Further studies are required to clarify the relationship between 30-day all-cause readmissions and embolic complications. Disclosures All Authors: No reported disclosures

. Demographics and swab collection data for 609 participants who provided 663 paired swabs Conclusion. SCNS were associated with higher detection rates compared to HCWC, likely due to the shorter interval between symptom onset and swab collection. Strategies to improve compliance with SCNS and minimize the interval between symptom onset and swab collection are needed to optimize detection of respiratory pathogens in this MHS cohort.

Rapid Molecular SARS-CoV-2 Detection by Abbott ID NOW Is Reliable in Pediatric Patients
Catherine Murphy, MD 1 ; Emily Sheboy Scarcello, MPH 2 ; Sheila M. Nolan, MD, MSCE 3 ; 1 NYMC, Valhalla, New York; 2 BCHP, Valhalla, New York; 3 New York Medical College, Valhalla, New York Session: P-31. Diagnostics: Virology Background. The COVID-19 Pandemic demonstrated the importance of rapid, accurate, point of care testing to control spread of the virus. The availability of this testing has been crucial to re-opening schools, keeping children safely in schools, and returning children to school quickly following illness. The Abbott ID Now molecular assay to detect SARS-CoV-2 was granted Emergency Use Authorization in March 2020. Reports of lower sensitivity compared with conventional PCR prompted some school districts to require confirmatory conventional PCR for negative rapid molecular results to return children to school. In this study we aim to determine the sensitivity and specificity of the Abbott ID NOW molecular SARS-CoV-2 test in a large pediatric primary care practice.
Methods. A retrospective observational study was performed using data from 25 pediatric primary care sites in the Boston Children's Health Physicians network, a large multispecialty pediatric practice in New York and Connecticut. Data were extracted from the electronic health record for all patients 0-22 years of age who had an Abbott ID NOW rapid molecular COVID-19 assay from October 1, 2020 -February 28, 2021. For all patients with rapid tests, we identified patients who had a conventional PCR test sent within 1 day before or 1 day after the ID NOW test. The result of the conventional PCR test was considered the "true" result. All discrepant test results were identified.
Results. During the study period, 14993 patients had ID NOW testing performed. The percent positivity was 8.5%. The percent positivity in our practices paralleled that in the surrounding community throughout the winter surge of COVID-19. 500 patients had confirmatory testing sent within 1 day before or after the ID NOW test (15 positive and 485 negative results). Based on the conventional PCR test results, 2 of 15 positive results were false positive and only 1 of 485 negative results was a false negative, resulting in a sensitivity of 93% and specificity of 99.6%. The false negative result was in a patient with nasal congestion whose mother was COVID positive.
Conclusion. Rapid, molecular, point of care testing is an important tool to identify SARS-CoV-2 in pediatric patients and limit school absences. The ID NOW assay is highly sensitive and specific in a real-world pediatric setting.
Disclosures. All Authors: No reported disclosures Figure 1. Flowchart of the study cohort. IE=Infective Endocarditis

Methods.
We used the 2016 to 2018 National Readmission Database (NRD) to identify a primary diagnosis of admissions among adults (Age≥18) with IE. International Statistical Classification (ICD-10) codes were used to identify patients with a primary diagnosis of IE who experienced in-hospital septic emboli-related complications. Primary outcomes were mortality, length of stay, total cost and 30-day all-cause readmission. Uni-and Multivariate Linear, Logistic and Cox regression were used to assess statistical significance and a two-sided p-value less than 0.05 was considered significant.

Results.
A total of 30,870 patients were admitted with a primary diagnosis of IE from 2016 to 2018 (December admissions were omitted). After excluding the patients with omitted information, 30,289 patients went into analysis. Baseline characteristics are shown in Table 1. Septic emboli-related complications were seen in 42.6% of the patients; about 10% had central nervous system (CNS) complications, 7% had cardiac complications and 20.2% had respiratory complications. Embolic complications of any kind were associated with higher mortality (Odds Ratio = 2.11 [1.74 -2.54]), a longer length of stay (5.72 days [5.17 -6.27]) and higher total costs (21,812 dollars [19,856 -23,769]) while adjusted for baseline characteristics. Multivariate Cox regression to assess the risk of 30-day readmission was not statistically significant. Predictors of 30-day all-cause readmission among baseline characteristics and subgroups of embolic complications are shown in table 4 and table 5, respectively.