Colonization with Multidrug-Resistant Bacteria in the First Week of Life among Hospitalized Preterm Neonates in Serbia: Risk Factors and Outcomes

The aim of this prospective cohort study was to determine the prevalence of gut colonization with multidrug-resistant (MDR) bacteria, risk factors for colonization, infection risk, and outcomes among preterm neonates hospitalized at a tertiary-care center in Serbia. During the period from December 2017 to April 2018, 103 neonates were screened for rectal carriage at admission and on the seventh day of life. Characterization of MDR strains was done by conventional microbiology and molecular methods. Out of 61 (59.2%) colonized neonates, 12 (11.6%) were found colonized at admission, while 49 (47.6%) became colonized at the study site. Among a total of 72 MDR isolates, extended-spectrum beta-lactamase (ESBL)-producing enterobacteria prevailed (56/72, 77%), followed by Acinetobacter baumannii (14/72, 19%). The majority of ESBL-producing strains carried multiple genes (blaTEM/blaCTX-M-15 or blaTEM/blaSHV). Longer previous hospitalization and delivery by cesarean section were associated with MDR colonization, while mechanical ventilation was a risk factor for colonization at the study site. Infections due to MDR bacteria were more frequent among colonized than non-colonized neonates, but not significantly, and mortality was low (1%) in the studied neonates. These results indicate that hospitalized preterm neonates in Serbia are rapidly colonized with a diversity of MDR species and resistance phenotypes/genotypes.

555 Torsade-de-pointes electrical storm late after treatment with hydroxychloroquine and azithromycin for COVID-19

A 78-year-old woman was admitted to our hospital due to multiple brief episodes of transient loss of consciousness. She was recently hospitalized elsewhere for SARS-CoV-2 infection and she had been discharged two days before. During the previous hospitalization she had been treated with hydroxychloroquine 400 mg twice daily on Day 1, followed by Hydroxychloroquine 400 mg daily together with azithromycin 500 mg daily for 7 days, leading to symptomatic resolution and two consecutive negative RT-PCR tests at discharge. Her medical history included dilated cardiomyopathy and in 2017 she underwent CRT-D implantation for primary prevention; over the past 3 years, she did not experience any ICD intervention. Her home therapy included amiodarone, bisoprolol, warfarin, and trazodone. Baseline ECG obtained 6 month before admission is shown in Figure 1, Panel A. On admission, her ECG showed sinus bradycardia with biventricular pacing and significant QT prolongation (i.e. 640 ms, Figure 1 B). On day 2 of hospitalization, she reported multiple brief episodes of transient loss of consciousness. An interrogation of her device revealed 27 torsade-de-pointes episodes in a 48-hour period, treated with 11 shocks. All episodes were preceded by a variable period of bigeminal rhythm due to one or two premature ventricular beats coupled to the prolonged QT segment of the preceding basic beat in a ‘short-long-short’ sequence (Figure 2). The patient experienced a torsade-de-pointes TdP during COVID-19 disease. She had multiple concomitant factors for QT prolongation (TISDALE SCORE 13): mainly, female sex, cardiac disease, inflammation, electrolyte imbalances and multiple QT-prolonging drugs. Amiodarone and bisoprolol were subsequently stopped and potassium and magnesium were supplemented, with rapid resolution of torsade-de-pointes. No more episodes of TdP were detected after two weeks of hospitalization. The remote monitoring assessment of her device did not show any further episodes during subsequent follow-up. To our best knowledge, this is the first ICD-documented report of a TdP electrical storm in a COVID-19 patient, treated with HCQ/AZT, who had multiple concomitant factors for QT prolongation. 555 Figure 1

1142. A multicenter cohort study to identify differences between methicillin-susceptible and methicillin-resistant Staphylococcus aureus infections in pediatrics in Bogotá, Colombia, 2014-2018

Background The epidemiology of methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus in pediatrics has changed in recent years. MRSA infections have been reported to be more severe than MSSA. Methods Multicenter retrospective cohort, in 6 pediatric hospitals in Bogotá, Colombia, between January 1, 2014, and December 31, 2018, 1 isolate was included for patient from the same origin. Infections were classified into: SSTI, osteoarticular, bacteremia, or pneumonia.The objective is to establish differences between clinical, laboratory, and outcomes of MSSA and MRSA infections, according to origin of the infection in a pediatric population from Bogotá, Colombia. Results 551 patients were included; 211 (38%) MRSA and 340 (62%) MSSA, in total 703 cultures. Figure 1. Some risk factors were statistically associated with MSSA: Heart disease (3.3% Vs. 0.5%) neurologic disease (5.9% vs. 2.4%), surgery in last 6 months (11% vs. 5%), use of vascular or external devices (3% vs 11%) and previous hospitalization >3 days (11% vs 17%) Table 2. In 84/159 (52%) cases, bacteremia was associated with osteoarticular infection (OI), 19/159 (13%) with pneumonia, 21/159 (13%) with SSTI, 14/159 (9%) with other foci, 21/159 (13%) were primary. Independently of the origin, PICU admittance was more frequent in MRSA (52% vs. 28), as well as mechanical ventilation (MV) (30% vs. 13%) and inotropic support (IS )(38% vs 17%). Of 136 osteoarticular infections, 59 (43,4%) were MRSA and 77 (56,6%) MSSA. MRSA isolates required more than 3 surgical procedures (45% vs 24%), more PICU admittance (36% vs. 12%) and IS (27% vs. 5%). Complicated pneumonia was more frequently associated to MRSA in comparison with MSSA (57% vs. 23%). In pneumonia, MRSA also was significantly associated with PICU. (74%vs 50%), MS (61%vs 32%), and VS (52% vs 27%). SSTI was not associated with greater severity or worse outcome (PICU, MV, IS) according to S. aureus susceptibility. Table 3b. Infection groups depending on the presence or not of resistance Conclusion MRSA was associated with more severe course in bacteremia, OI and pneumonia. It is interesting that some classically risk factors associated with MRSA infections were found to be related to MSSA. In general, with SSTI exception, MRSA increase risk of PICU, mechanical support and inotropic support in a pediatric population in Bogotá, Colombia. Disclosures Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Sandra Beltran, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses)

Clostridium Difficile and COVID-19: General Data, Ribotype, Clinical Form, Treatment-Our Experience from the Largest Infectious Diseases Hospital in Western Romania

Background and Objectives: In Coronavirus Disease 2019 (COVID-19), which is caused by the infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the clinical manifestations are primarily related to the pulmonary system. Under 10% of cases also develop gastrointestinal events such as diarrhea, nausea, vomiting and abdominal pain. Materials and Methods: We conducted an observational, retrospective study in the Infectious Diseases Clinic of ‘’Victor Babes’’ Hospital, Timis County, in order to assess the incidence, outcome and risk factors for Clostridium Difficile infection (CDI) in COVID-19 patients. Results: Out of 2065 COVID-19 cases, hospitalized between 1st September 2020 and 30th April 2021, 40 cases of CDI were identified with 32 cases of hospital-onset of CDI and eight cases of community-onset and healthcare-associated CDI. By randomization, polymerase chain reaction ribotyping of Clostridium Difficile was performed in six cases. All the randomized cases tested positive for ribotype 027. The percentage of cases recovered with complications at discharge was higher among COVID-19 patients and CDI (p = 0.001). The in-hospital stay, 36 days versus 28 days, was longer among COVID-19 patients and CDI (p = 0.01). The presence of previous hospitalization (p = 0.004) and administration of antibiotics during the hospital stay, increased the risk of CDI among COVID-19 patients. The mean adjusted CCI at admission was lower among controls (p = 0.01). In two cases, exitus was strictly CDI-related, with one case positive for 027 ribotype. Conclusions: CDI has complicated the outcome of COVID-19 patients, especially for those with comorbidities or previously exposed to the healthcare system. In the face of the COVID-19 pandemic and the widespread, extensive use of antibiotics, clinicians should remain vigilant for possible CDI and SARS-CoV-2 co-infection.

COVIDNearTerm: A Simple Method to Forecast COVID-19 Hospitalizations

COVID-19 has caused tremendous death and suffering since it first emerged in 2019. In response, models were developed to help predict the course of various disease metrics, and these models have been relied upon to help guide public health policy. Here we present a method called COVIDNearTerm to ``forecast'' hospitalizations in the short term, two to four weeks from the time of prediction. COVIDNearTerm is based on an autoregressive model and utilizes a parametric bootstrap approach to make predictions. We evaluated COVIDNearTerm on San Francisco Bay Area hospitalizations and compared it to models from the California COVID Assessment Tool (CalCAT). We found that that COVIDNearTerm predictions were more accurate than the CalCAT ensemble predictions for all comparisons and any CalCAT component for a majority of comparisons. For instance, at the county level our 14-day hospitalization median absolute percentage errors ranged from 16% to 36%. For those same comparisons the CalCAT ensemble errors were between 30% and 59%. COVIDNearTerm is also easier to use than some other methods. It requires only previous hospitalization data and there is an open source R package that implements the algorithm.

Patterns of cardiac involvement in patients with long COVID syndrome using cardiovascular magnetic resonance

Background Long COVID (LC) is an increasingly recognized late complication of COVID-19 infection. Cardiovascular involvement has also been implicated, however, the type and extent of the underlying cardiovascular injury remains unknown. Purpose To evaluate the association between ongoing symptoms and findings with cardiovascular magnetic resonance (CMR) in consecutive patients recently recovered from COVID-19 illness. Methods Prospective observational cohort study of patients recently recovered from COVID-19 illness and no previously known cardiovascular disease were included between April 2020 and April 2021. Demographic characteristics, cardiac blood markers, and CMR imaging a minimum of 4 weeks from the diagnosis were obtained. Results Of the 389 included patients, 192 (49%) were male, the mean (±standard deviation) age was 44 (±13) years and 61 (16%) required hospitalization during the acute illness. The median (IQR) time interval between COVID-19 diagnosis and CMR was 94 (71–165) days. 298 (77%) of patients continued to experience ongoing cardiovascular symptoms (long COVID, LC), including dyspnea, palpitations, atypical chest pain and fatigue at the time of CMR at least 4 weeks after the infection. In most patients, the symptoms were only effort related 137 (46%), whereas in 98 (33%) the symptoms affected the activities of daily life; 10 (3%) had severe and debilitating symptoms at rest. Compared to those with no LC (NLC, n=91), LC patients were more commonly hospitalized, had significantly higher native T1, native T2, and showed pericardial enhancement and effusion (Figure 1). There were no differences in cardiac biomarkers, left ventricular (LV) and right ventricular ejection fraction and mass. Proportionally, men and women were similarly affected (n=144 (73%) vs. n=157 (80%), p=0.18). Previous hospitalization was associated with hypertension and ongoing detectable troponin. LC status was associated with previous hospitalization and CMR findings of raised native T1 and native T2, and in females also pericardial enhancement. Severity of symptoms were associated with increased native T1 and T2 and decreased end-diastolic volume, whereas cardiac function showed no significant difference. Conclusions In this cohort of patients recently recovered from COVID-19 infection, ongoing cardiovascular symptoms were common. The LC status was related to previous hospitalization and CMR imaging findings of myopericardial inflammation. The extent and type of cardiovascular findings was associated with the severity of symptoms. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The German Heart Foundation (Deutsche Herzstiftung) and Bayer AG, Leverkusen, Germany Figure 1

Assessment of Mother-to-Child transmission of Hepatitis C Virus in Egyptian Pregnant Women

Background The World Health Organization (WHO) has an ambitious plan to eliminate HCV by 2030. This new approach was fueled by increased appreciation of the global morbidity and mortality caused by hepatitis C, and the remarkable recent treatment developments. Objectives To assess the mother-to-child transmission of hepatitis C virus in Egyptian pregnant women to inform on screening policies and strategy development. To measure prevelance of hepatitis C virus infection in pregnant women Methods The current study was conducted to six thousand and seven hundred and thirty four (6734) women delivered in El Demerdash Maternity Hospital in the period from January 2018 till June 2018. Collection of detailed data from Patients files and divided them into non screened and screened by antibodies and who do PCR for HCV and data of their neonatal outcome Results Comparison according to HCV PCR regarding labor characteristics show that cases with positive HCV PCR significantly had more frequent CS. Logistic regression for risk factors for HCV PCR among the studied cases show that only Previous hospitalization and previous transfusion were significant risk factors for positive HCV PCR. Conclusion Previous hospitalization and previous transfusion were significant risk factors for positive HCV PCR. Pregnants with positive HCV PCR significantly had more lower hemoglobin than non-infected pregnant one and previous abortion and hospitalization may play a role in that.

Khat Chewing and Relapse in Peoples With Serious Mental Illness At Amanuel Mental Specialized Hospital: Comparative Study

Background people with serious mental illness using illicit drug exhibit poorer outcomes. But until now little is known about the impact of khat in thiss patient group. This study tried to assess the effect of khat chewing on relapse in people with serious mental illness. Method This is cross sectional comparative study involving 405 khat chewers and 400 non chewer people with serious mental illness. The study took three month involving interview (patient and care giver) and chart review. The study used Oslo Social Support Scale; Alcohol, Smoking, Substance Involvement Screening Test and questionnaire which include sociodemographic characteristics, illness related factors and relapse history. Result The study found that prevalence of relapse was higher in khat chewes than in non chewers (22% Vs 13%, p = 0.001) in people with serious mental illness. Additionally, the prevalence of relapse was also increased as the risk from use of khat was increased. In the khat chewer group previous hospitalization histories and presence of stressful life situation were the factor associated with relapse. On the otherhand treatment interruption, sleep disorder and previous hospitalization were the factors associated with relapse in non khat chewer people with serious mental illness. Conclusion Khat chewing poses additional burden for the already debilitating disease. Patient care should consider khat chewing as one of the components for intervention.

Post-COVID Syndrome. A Case Series and Comprehensive Review

The existence of a variety of symptoms with a duration beyond the acute phase of COVID-19, is referred to as post-COVID syndrome (PCS). We aimed to report a series of patients with PCS attending a Post-COVID Unit and offer a comprehensive review on the topic. Adult patients with previously confirmed SARS-CoV-2 infection were systematically assessed through a semi-structured and validated survey. Total IgG, IgA and IgM serum antibodies to SARS-CoV-2 were evaluated by an electrochemiluminescence immunoassay. A systematic review of the literature and meta‐analysis were conducted, following PRISMA guidelines. Univariate and multivariate methods were used to analyze data. Out of a total of 100 consecutive patients, 53 were women, the median of age was 49 years (IQR: 37.8 to 55.3), the median of post-COVID time after the first symptoms was 219 days (IQR: 143 to 258), and 65 patients were hospitalized during acute COVID-19. Musculoskeletal, digestive (i.e., diarrhea) and neurological symptoms including depression (by Zung scale) were the most frequent observed in PCS patients. A previous hospitalization was not associated with PCS manifestation. Arthralgia and diarrhea persisted in more than 40% of PCS patients. The median of anti-SARS-CoV-2 antibodies was 866.2 U/mL (IQR: 238.2 to 1681). Despite this variability, 98 patients were seropositive. Based on autonomic symptoms (by COMPASS 31) two clusters were obtained with different clinical characteristics. Levels of anti-SARS-CoV-2 antibodies were not different between clusters. A total of 40 articles (11,196 patients) were included in the meta‐analysis. Fatigue/muscle weakness, dyspnea, pain and discomfort, anxiety/depression and impaired concentration were presented in more than 20% of patients reported. In conclusion, PCS is mainly characterized by musculoskeletal, pulmonary, digestive and neurological involvement including depression. PCS is independent of severity of acute illness and humoral response. Long-term antibody responses to SARS-CoV-2 infection and a high inter-individual variability were confirmed. Future studies should evaluate the mechanisms by which SARS-CoV-2 may cause PCS and the best therapeutic options.

N18 Multidisciplinary team importance in the view of the patients with Inflammatory Bowel Disease in Brazil

Background Inflammatory Bowel Disease (IBD) is characterized by intestinal chronic inflammation that comprehend Crohn’s disease (CD) and ulcerative colitis (UC). Continuous care is essential. Constant contact with the multidisciplinary team (MDT) and its quality of care interferes with treatment adherence and patients’ quality of life (QoL). MDT must be composed by at least gastroenterologists, coloproctologists, nutritionists, nurses and psychologists. The study evaluated the importance of MDT in the patients view. Methods A cross-sectional, descriptive study was developed, including 94 patients from a Brazilian IBD reference center. Clinical data and the MDT relevance were evaluated. MDT importance was assessed through a questionnaire developed for the research with the answers: nothing important, unimportant, important and very important for each professional. The patients listed professionals in order of importance. QoL was assessed by IBDQ. Treatment adherence and disease knowledge were assessed by Morisky and CCKNOW questionnaires respectively. Results A total of 54 patients with CD and 40 with UC were included, 59.57% female and 53.19% with comorbidities. Previous hospitalization was reported by 54.26% and 36.17% were submitted by previous surgery. The majority referred previous consultation with a gastroenterologist (95.74%) and less than half with nutritionist (47.87%), IBD nurse (43.62%), psychologist (43.62%) and coloproctologist (23.40%). Gastroenterologist was considered important or very important by all patients, coloproctologist by 97.15%, IBD nurse 94.36%, endoscopist nurse 86.16%, stomatherapist 78.19%, nutritionist 88.46% and psychologist 80.55%. Regarding the order of importance, patients reported the gastroenterologist (87.50%) as the most important, followed by the coloproctologist (16.67%) and IBD nurse (14.10%). Patients with CD had more appointments with IBD nurse compared to UC patients (p = 0.007). QoL was considered excellent or good (64.51%). Drug adherence was low in 58.89% of patients. Knowledge about the disease was considered low (2.65 ± 1.65 points), being higher in patients with CD (p = 0.04). Conclusion Although the service has MDT, not all patients had the opportunity to visit all professionals. The lack of contact with the entire team, especially with the nurse, can reflect on low medication adherence and disease knowledge, impacting on disease control and QoL. Holistic patient care is recommended, emphasizing the importance of all professionals in the MDT for all patients with IBD.