Objective: To determine the epidemiology and impact of co-infection on COVID-19 pneumonia in critical care setting. Methods: This was a single center- retrospective study of COVID-19 patients, who were admitted to intensive care unit between March 2020-April 2021. Only patients with microbiological evaluation of blood, respiratory, or urine culture data were included. Community onset bacterial co-infection (COI) was defined as infection diagnosed within 48 hours and hospital acquired bacterial infection (HAI) after 48 hours of hospital admission. Both COI and HAI were further categorized into respiratory, blood or urinary sources. Demographics, laboratory and hospitalization outcomes were compared between patients with and without COI and HAI. Results: Among the 141 patients, COI was found in 25/132 patients (19%) and HAI in 41/109 patients (38%). COI was associated with younger age, lower body mass index (BMI) and being from nursing or long- term care facility. HAI was associated with longer length of hospital stay (29 vs 15 days). Staphylococcus aureus pneumonia (31.3%) and Pseudomonas aeruginosa pneumonia (40.0%) were the most common cause of COI and HAI respectively. Overall, gram negative bacteria predominated in both community and hospital acquired pneumonia. Candida was the single most common cause of blood stream infection in HAI (23%). The hospital survival was not significantly different with or without COI. Conclusion: In the critical care setting, a significant proportion of patients with COVID-19 had COI and HAI, especially patients from nursing or long-term care facility. Antibiotic coverage for COI and HAI pneumonia should account for the increase in prevalence of Staphylococcus aureus and Pseudomonas aeruginosa respectively.

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Background There is a paucity of data relating to pediatric subacute or chronic hematogenous osteomyelitis (SCHO), non-hematogenous osteoarticular infections (NHO), and osteoarticular hardware infections (HI). A comparative analysis of the entire spectrum of pediatric osteoarticular infections was conducted to identify distinguishing clinical features and biological markers.Methods Using ICD9/10 code searches, we identified pediatric patients ≤18 years of age at Hasbro Children’s Hospital (2006–2016) and Nationwide Children’s Hospital (2015–2016) with osteoarticular infections. Cases of Lyme arthritis or ENT-related infections were excluded. Eligibility criteria were confirmed by reviewing medical records and clinical and laboratory data were collected systematically.Results428 children met inclusion criteria: 211 (49%) had acute hematogenous osteomyelitis (AHO), 61 (14%) suppurative arthritis (SA), 42 (10%) SCHO, 60 (14%) NHO, and 54 (13%) HI. The age distribution differed significantly across the five infection types: AHO (median, 9.2 years), SA (5.0), SCHO (10.2), NHO (11.5), and HI (14.5); P < 0.001. Median initial CRP values were significantly higher (P < 0.001) in AHO (65 mg/dl) and SA (44) compared with SCHO (15), NHO (15) and HI (24). An ESR >19 mm/hours at presentation was more sensitive than a CRP >8.0 mg/dl in identifying SCHO (80% vs. 64%; P = 0.035). Bacteremia occurred more frequently in AHO (42%) and SA (25%) compared with SCHO (7%), NHOI (5%) and OHI (4%); P < 0.001. Patients with HI had significantly more complications as reflected by more ICU admissions (33% vs. ≤3% for other groups), and longer antibiotic treatment durations (median, 65 vs. ≤37 days for other groups); P < 0.001 for each comparison. S. aureus was the most common organism isolated for all infections, but the proportion of other Gram- and Gram-negative pathogens was significantly higher in SCHO, NHO, and HI compared with AHO and SA (P < 0.001). The ratio of MSSA to MRSA among isolates was 3:1, and did not differ significantly across the infection types.Conclusion SCHO, NHO, and HI commonly present with minimal evidence of inflammation, and differ in the spectrum of causative pathogens compared with AHO and SA. Further studies are required to optimize the diagnosis and management of non-acute, non-hematogenous osteoarticular infections.Disclosures All authors: No reported disclosures.

BackgroundThe rate of Haemophilus influenzae type b (HIB) infections has decreased dramatically since the use of HIB vaccines in infants and children. The current prevalence of invasive HIB infections and those due to non-type b H. influenzae is not fully known. The objective was to describe the cases of all invasive H. influenzae infections and describe the spectrum and severity of clinical disease.MethodsRetrospective study of all hospitalized patients with culture-proven invasive Haemophilus influenzae infections at Nationwide Children’s Hospital, Columbus, Ohio, from 2009 to 2018. The electronic health records were reviewed for pertinent demographic, clinical, laboratory data, and outcomes.ResultsThere were a total of 59 culture-proven H. influenzae infections of which 12 were excluded due to insufficient patient data. The remaining 47 patients (32 [68%] male; 30 [64%] white, 8 [17%] African-American) and their culture results are provided in Table:Haemophilus influenzae Infections in 47 Patients: Culture ResultsType a N = 1 (%)Type bN = 3(%)Encapsulated non-b N = 11(%)Not typeableN = 30(%)Not typedN = 2(%)TotalN = 47(%)<6 months0007(23)1(50)8(17)≥6–12 months1(100)2(67)7(64)7(23)017(36)>1–5 years01(33)4(36)6(20)1(50)12(25)>5–8 years0008(26)08(17)>8–17 years000000≥18 years0002(6)02(4)Blood only1(100)1(33)4(36)27(90)2(100)35(75)CSF only01(33)0001(2)Both Blood and CSF01(33)5(45)006(13)Both CSF and Peritoneal Fluid0001(3)01(2)Both Blood and Synovial Fluid002(18)002(4)Both Blood and Eye Discharge0002(6)02(4)Virus Coinfection1(100)3(100)3(27)14(46)1(50)22(47)Bacteria Coinfection01(33)05(16)2(100)8(17)Death0001(3)01(2)There were 14 (30%) patients with pneumonia and bacteremia, 6 (13%) with meningitis and bacteremia, 2 (4%) with only meningitis, 1 (2%) with bacteremia/meningitis and septic hip, 2 (4%) septic arthritis with bacteremia, 1 (2%) with periorbital cellulitis and bacteremia, and 21 (45%) with only bacteremia. Of the 3 cases of H. influenzae type b, 2 had not been vaccinated while 1 received only 1 dose of HIB vaccine.ConclusionInvasive H. influenzae infections were associated with substantial morbidity and a 2% case-fatality rate.Disclosures All authors: No reported disclosures.