SARS-CoV-2 may activate both innate and adaptive immune responses ultimately leading to a dysregulated immune response prompting the use of immunomodulatory therapy. Although viral pneumonia increases the risk of invasive fungal infections, it remains unclear whether SARS-CoV-2 infection, immunomodulatory therapy, or a combination of both are responsible for the increased recognition of opportunistic infections in COVID-19 patients. Cases of cryptococcosis have previously been reported following treatment with corticosteroids, interleukin (IL)-6 inhibitors, and Janus kinase (JAK) inhibitors, for patients with autoimmune diseases, but their effect on the immunologic response in patients with COVID-19 remains unknown. Herein, we present the case of a patient with COVID-19 who received high-dose corticosteroids and was later found to have cryptococcosis despite no traditional risk factors. As our case and previous cases of cryptococcosis in patients with COVID-19 demonstrate, clinicians must be suspicious of cryptococcosis in COVID-19 patients who clinically deteriorate following treatment with immunomodulatory therapies.
Background The purpose of this study was to compare dalbavancin to standard of care (SOC) for patients with S. aureus bacteremia (SAB) who were unable to receive outpatient parenteral antimicrobial therapy (OPAT) and would otherwise remain hospitalized or require placement into post-acute care facilities. Methods This retrospective cohort compared readmission rates related to the index infection between patients treated with dalbavancin or SOC for SAB between January 1, 2016, and August 31, 2021. Patients at least 18 years old seen by the ID consult service who received at least one dose of dalbavancin or at least one week of SOC parenteral antibacterials as directed therapy for SAB at the time of discharge were included. The SOC group consisted of patients transferred from the main hospital to one of the post-acute care facilities in a surrounding county to complete parenteral antibacterials. Patients were excluded if they were treated for polymicrobial infections with organisms other than S. aureus, had a creatinine clearance less than 30 mL/min, or required renal replacement therapy. The primary outcome was readmission rates within 30 days after completion of therapy. Secondary outcomes included readmission rates within 90 days after completion of therapy as well as antibacterial regimen adherence defined as achieving goal duration of therapy deemed appropriate by the ID consult service. Results During the study period, 27 patients received dalbavancin, and 27 patients received SOC. Baseline demographics were comparable between groups, though more patients in the SOC group had indwelling prostheses or hardware (4% vs 22%). The majority of SAB was caused by MSSA in both groups (56% vs 59%). The most common source was osteoarticular (15% vs 30%) and source control was attempted in a higher percentage of the SOC group who had an identified source (53% vs 86%). Readmission rates in the dalbavancin group were similar to those in the SOC group within 30 days (15% vs 22%, p=0.484) and 90 days (19% vs 22%, p=0.735) after completion of therapy. However, adherence was significantly higher among patients treated with dalbavancin (85% vs 44%, p < 0.05). Conclusion Dalbavancin offers similar clinical outcomes to SOC for patients with SAB who are unable to receive OPAT. Disclosures All Authors: No reported disclosures.
Background Previous studies have observed that multimorbidity, defined as two or more comorbidities, is associated with longer lengths of stay (LOS) and higher mortality in patients with COVID-19. In addition, inequality in social determinants of health (SDOH), dictated by economic stability, education access and quality, healthcare access and quality, neighborhoods and built environment, and social and community context have only added to disparities in morbidity and mortality associated with COVID-19. However, the relationship between SDOH and LOS in COVID-19 patients with multimorbidity is poorly characterized. Analyzing the effect SDOH have on LOS can help identify patients at high risk for prolonged hospitalization and allow prioritization of treatment and supportive measures to promote safe and expeditious discharge. Methods This study was a multicenter, retrospective analysis of adult patients with multimorbidity who were hospitalized with COVID-19. The primary outcome was to determine the LOS in these patients. The secondary outcome was to evaluate the role that SDOH play in LOS. Poisson regression analyses were performed to examine associations between individual SDOH and LOS. Results A total of 370 patients were included with a median age of 65 years (IQR 55-74), of which 57% were female and 77% were African American. Median Charlson Comorbidity Index was 4 (IQR 2-6) with hypertension (77%) and diabetes (51%) being the most common, while in-hospital mortality was 23%. Overall, median length of stay was 7 days (IQR 4-13). White race (-0.16, 95% CI -0.27 to -0.05, p=0.003) and residence in a single-family home (-0.28, 95% CI -0.38 to -0.17, p< 0.001) or nursing home/long term care facility (-0.36, 95% CI -0.51 to -0.21, p< 0.001) were associated with decreased LOS, while Medicare (0.24, 95% CI 0.10 to 0.38, p=0.001) and part-time (0.35, 95% CI 0.13 to 0.57, p=0.002) or full-time (0.25, 95% CI 0.12 to 0.38, p< 0.001) employment were associated with increased LOS. Conclusion Based on our results, differences in SDOH, including economic stability, neighborhood and built environment, social and community context, as well as healthcare access and quality, have observable effects on COVID-19 patient LOS in the hospital. Disclosures All Authors: No reported disclosures
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