Rothiamucilaginosa, previously known as Stomatococcus mucilaginous, resides in the oral cavity and respiratory tract as part of the normal flora [1]. It is a gram-positive, cocus-shaped bacterium. The bacterium is considered an emerging opportunistic pathogen in patients with chronic immunosuppressive diseases. Most of these reports were described in severe neutropenia or hematological cancer patients but less frequently in immune-competent hosts. We report two cases of endocarditis and meningitis due to R. mucilaginosain non-neutropenic hosts.

Background (i) Remdesivir (RDV) shortens recovery time among COVID-19 patients in an inpatient setting. (ii) Treatments for outpatients diagnosed with COVID-19 are limited. (iii) In early 2021, there was a national surge in COVID-19 hospitalizations, which resulted in hospital bed and staff shortages. (iv) In the face of this pandemic surge, we piloted a program to expand our RDV treatment capacity by establishing an off-label, outpatient infusion tent (OIT) for patients with severe COVID-19. (v) This is a retrospective, descriptive report examining the safety and efficacy of this program, with outcomes of interest being 30-day mortality and hospital admission within the subsequent 30 days Methods (i) The OIT, consisting of 11 chairs capable of treating 35 patients per day, was operational from January 1 to February 19, 2021. (ii) Patients were referred to the outpatient RDV program primarily from urgent care (UC) and the emergency department (ED), and from the inpatient setting to complete therapy. Patients received at least one dose prior to referral. (iii) Eligibility criteria included a confirmed COVID-19 diagnosis, radiographic evidence of viral pneumonia, and an oxygen saturation less than or equal to 94 on room air. (iv) Exclusion criteria included pregnancy, sepsis, end-stage renal disease or GFR < 30, hepatitis with transaminases 10 times the limit of normal. Patients with BMI > 40, age > 75, chronic lung disease, dementia, were considered on a case by case basis. (v) Patients received dexamethasone and deep vein thrombosis prophylaxis Results (i) A total of 88 patients received 258 infusions. The average number of outpatient infusions per participant was 2.9. (ii) Four out of 88 patients died (4.5%) within 30 days of first dose in the infusion tent. No deaths occurred in the outpatient setting. (iii) Fourteen out of 88 patients were admitted to the hospital within the subsequent 30 days (15.9%). (iv) 11/14 admissions (78.6%) were due to progression of COVID-19. There were no admissions due to adverse drug reactions Table 1. Patient Characteristics Table 2. Admissions Within Subsequent 30 Days Conclusion Mortality rate in outpatients with severe COVID-19 treated with RDV was similar to that reported in inpatients. In this cohort of patients with severe COVID, a majority (84.1%) avoided hospitalization while still receiving appropriate treatment. Results suggest RDV can be safely delivered to outpatients with severe COVID-19. Disclosures All Authors: No reported disclosures

BackgroundAn estimated 1.7 million adults in the United States develop sepsis and nearly 270,000 Americans die because of sepsis annually. A diagnosis of sepsis increases hospitalization costs, antibiotic usage, and mortality. Admissions for sepsis account for a high proportion of 30-day readmissions, creating a major financial burden for the healthcare system. However, reliable measurement of sepsis incidence remains challenging given increasing clinical awareness, changes in diagnosis/coding practices and changing definitions. We thus sought to evaluate sepsis readmissions and coding practices at 2 community hospitals (226, 99 beds).MethodsA total of 997 hospitalizations occurred at both institutions with a primary diagnosis of sepsis from January 30, 2018–December 31, 2018; out of which 130 were readmitted within 30 days.An Infectious Disease trained physician reviewed all 130 index admissions and readmissions. Sepsis was defined as per the Centers for Medicare and Medicaid Services (CMS) sepsis-1 mandate: 2 of 4 SIRS criteria + suspected infection.ResultsAll 130/130 (100%) index hospital admissions had a primary discharge diagnosis of sepsis, out of which only 85/130 (65%) met criteria for sepsis. While coded as sepsis, in 45/130 (35%) cases no infectious etiology was found. Among 130 readmissions 51 (39%) truly met criteria for sepsis. The infectious etiologies of index admissions included urinary tract infections (UTI) (18), pneumonia (16), bacteremia (16), abscess (9), Clostridium difficile infection (CDI) (8), cellulitis (5), neutropenic fever (5), cholecystitis (4), meningoencephalitis (1), candidemia (1). Readmissions that met criteria for sepsis included pneumonia (10), UTI (8), abscess (7), CDI (5), bacteremia (5), osteomyelitis (4), cellulitis (4), neutropenic fever (3), candidemia (2), and cholecystitis (2).ConclusionShockingly 35% of the index admission cases were misdiagnosed as sepsis and as high as 61% on re-admissions. Increasing clinical awareness and compliance with CMS may have led to overdiagnosis and treatment of sepsis. Given the significant treatment and prevention initiatives that are being undertaken; reliable sepsis definition and coding is warranted for accurate surveillance purposes.Disclosures All authors: No reported disclosures.

Background The COVID-19 pandemic has negatively affected our healthcare system. Our hospitals have reached maximum capacity on several occasions. Because of the need to make beds available to new patients, some patients with severe COVID-19 who were on low flow O2 supplementation have been discharged home prior to completion of the standard (≥ 5-day) RDV course. To date, data are limited regarding clinical outcomes on these patients. Because of this, we conducted a retrospective study to assess the clinical outcomes of patients who received an abbreviated treatment course of RDV. Methods Retrospective (chart review) study Subject population All nonpregnant adult patients who were hospitalized at Kaiser Permanente Riverside Medical Center and Kaiser Permanente Moreno Valley Medical Center in 2020 with severe COVID-19 who required low flow O2 supplement during hospitalization who received RDV and discharged from hospital alive. Severe COVID-19 = positive SARS-CoV-2 PCR + evidence of lung involvement on lung imaging (X-ray or CT) + O2 saturation ≤ 94% on room air or requirement of O2 supplement. Inclusion criteria Age ≥ 18 years; Hospitalized with severe COVID-19; Given RDV Exclusion criteria Pregnancy; O2 requirement > 6 L including high flow and mechanical ventilation (noninvasive or invasive); discontinuation of RDV due to adverse effects Figure 1. Patient Section. Results Mortality rate: no difference (2.1% vs 1.8%, p=0.84). 30 day post-discharge ED visit: twice more likely in the abbreviated RDV group as compared to the group receiving the standard duration (16.1% vs 8.5%, p=0.03). 30 day readmission: almost 10 times more likely in the abbreviated RDV group as compared to the group receiving the standard duration (11.9% vs 1.2%, p=< 0.001). Table 1. Patient's Characteristics Table 2. Clinical Outcomes. *8 Patients Who Died Within 30-Day from Discharge Were Excluded Conclusion Though there is no difference in 30 day mortality rate, the patients who received the abbreviated RDV course are twice more likely to have ER visit and 10 times more likely to have readmission within 30 day post discharge despite more patients in the abbreviated course receiving steroids. The findings suggest that completing an at least 5-day course of RDV may be beneficial even in patients who demonstrate a clinical response earlier in course. Disclosures All Authors: No reported disclosures