Importance SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. Methods RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. Discussion RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options. Registration NCT05172024.
Background Literature shows early intravenous (IV) to oral (PO) antimicrobial transition for infective endocarditis (IE) and bone and joint infection (BJI) is noninferior to prolonged IV antimicrobial therapy. COVID-19 pandemic peaks resulted in critical shortages of staffed hospital beds spurring innovation. Outpatient parenteral antimicrobial therapy (OPAT), a well-established program using prolonged IV antimicrobials, faces challenges such as infusion resource needs and social circumstance limitations. Complex outpatient antimicrobial therapy (COpAT) uses PO in place of IV antimicrobials. We hypothesized rapid adoption of COpAT would decrease hospital length of stay and open beds while retaining satisfactory clinical outcomes. Methods COpAT protocols (Image 1) and guidelines by infection type and isolated organism (Image 2) were created. Hospitalized patients including persons who inject drugs (PWID) were evaluated for IV to PO antimicrobial transition by an infectious diseases (ID) physician and then followed by an ID physician-pharmacist team. Demographic, ID, and clinical outcome data for the first 100 COpAT patients between December 2020 and February 2022 were obtained by retrospective chart review. Image 1.COpAT Inpatient and Outpatient Protocols Image 2. COpAT Guidelines by Infection Type and Isolated Organism MSSA = methicillin-susceptible Staphylococcus aureus; MRSA = methicillin-resistant Staphylococcus aureus; spp. = species; TMP/SMX = trimethoprim-sulfamethoxazole; DS = double strength; SSTI = skin and soft tissue infection; CAP = community-acquired pneumonia Results PWID accounted for 78% of COpAT patients. BJI followed by mixed infection (IE and BJI) was most prevalent (Image 3) with bacteremia in 53% of cases. Staphylococcus aureus was most frequently isolated (Image 4). Oral linezolid and fluoroquinolones, often in combination, were most commonly used. IV and PO antimicrobials were taken for a median 28 and 14 days, respectively. The COpAT program saved 1425 IV antimicrobial and 1363 hospital days. Assuming daily inpatient cost of $2050, cost avoided was $2,794,150. COpAT patients participated in ID follow-up and adhered to PO antimicrobials with low 30-day readmission rates (Image 5). Image 3.Infection TypeImage 4.Isolated Organism CoNS = coagulase-negative staphylococci Image 5.Clinical Outcomes Conclusion In a sample of 100 COpAT patients including PWID, IV to PO antimicrobial transition safely saved hospital days and mitigated critical bed shortages during pandemic peaks. A successful COpAT program requires a multidisciplinary group: close ID physician-pharmacist collaboration extending to OPAT and antimicrobial stewardship teams. With a COpAT program in place, even earlier IV to PO antimicrobial transitions should be studied. Disclosures All Authors: No reported disclosures.
Background With the COVID-19 pandemic, many changes were made in healthcare institutions including but not limited to canceling elective surgeries, limiting face-to-face clinic visits, and implementing visitor restrictions. Phased reopening began at West Virginia University (WVU) Medicine on May 25, 2020. While preparing for transition, concern was raised regarding potential for more employee exposures to persons with SARS-CoV-2 infection. In West Virginia (WV), we did not get the predicted surge of SARS-CoV-2. Current cumulative percent positivity for SARS-CoV-2 PCR in WV is 2332 positives of 133,142 tests (1.75%). We provided appropriate personal protective equipment (PPE), including controlled air purifying respirators for all healthcare workers (HCW) caring for persons with suspected or confirmed COVID-19 from the beginning. Policies requiring masks for all HCW and patients took effect on March 27, 2020 and April 29, 2020, respectively. We hypothesized that due to appropriate PPE use there would be no difference in SARS-CoV-2 antibody positivity in HCW working in high versus low risk areas. Methods Serum samples from 1042 randomly selected HCW across 4 WVU Medicine hospitals, ranging from 170 to 690 beds with 121 cumulative SARS-CoV-2 PCR positive patients at the time of the study, were tested for SARS-CoV-2 IgG between May 26, 2020 and June 5, 2020. Physicians, nurses, and respiratory therapists were characterized as high or low risk based on work location. Environmental services (EVS) workers were included but not risk-stratified. A questionnaire was used to obtain information on demographics, chronic medical conditions, symptoms, and exposures. Results SARS-CoV-2 IgG was positive in 9 of 1042 (0.86%) randomly selected HCW. Seroprevalence was lower in high risk 5/835 (0.60%) versus low risk 4/176 (2.27%) group. This was not statistically significant. No EVS workers tested positive 0/31 (0%). Of 9 HCW who tested positive, 2 had previously tested positive for SARS-CoV-2 PCR. Conclusion SARS-CoV-2 IgG seroprevalence in a large sample of HCW across 4 WVU Medicine hospitals was low (0.86%). Low seroprevalence among HCW in high risk areas may be related to appropriate PPE use. Seroprevalence in HCW not caring for patients with COVID-19 could be from community or other inadvertent exposure. Disclosures All Authors: No reported disclosures
Background Injection drug use is associated with infectious diseases such as endocarditis and osteomyelitis requiring prolonged intravenous (IV) antimicrobial therapy. Few programs offer simultaneous inpatient infectious disease and addiction treatment. WVU Medicine implemented a multidisciplinary Infusion Service (IS) to provide IV antimicrobial therapy while treating substance use disorder. From 2017 through 2019, IS cared for over 840 patients. The aim of this study was to evaluate IS by assessing patients’ perspectives of overall experience, interactions with healthcare providers, and preparation for continued recovery from substance use. Methods Adults ≥ 18 and < 90 years-old with substance use disorder on IS between November 2019 and May 2020 were eligible. Demographic, substance use, and infectious diseases data were obtained by chart review. Confidential surveys with questions about overall experience, interactions with healthcare providers, and preparation for continued recovery were administered during the first week after transfer to IS and again the week of discharge. Results Forty-two patients completed 39 initial and 12 follow up surveys. All used injection drugs, 85.7% (36/42) used opioids and 66.7% (28/42) used methamphetamine. Endocarditis was most common infection (61.9% (26/42)), with Staphylococcus aureus most often isolated (59.5% (25/42)). IS experience and care for infection were excellent or good in 97.4% (38/39) initial and 100% (12/12) follow up surveys. During IS, patients did not perceive being treated differently due to substance use in 94.9% (37/39) initial and 83.3% (10/12) follow up surveys. Before IS, patients perceived being treated differently in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Patients felt IS would help with continued recovery in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Conclusion According to patients’ perspectives, IS is effective in creating a positive overall healthcare experience, reducing stigma associated with substance use, and preparing patients for continued recovery after discharge. This study supports combining inpatient infectious disease and addiction therapy. Infectious diseases providers should be educated about this multidisciplinary approach. Disclosures All Authors: No reported disclosures
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