Background Characterization of COVID-19 vaccine breakthrough infections are limited. We aim to characterize breakthrough infections and identify risk factors associated with outcomes. Methods This was a retrospective case series of consecutive fully vaccinated patients with SARS-CoV-2 in a multi-center academic center in Southeast Michigan, between December 30, 2020 and September 15, 2021. Results 982 patients were identified; mean age was 57.9, 565 (59%) were female, 774 (79%) white, 255 (26%) healthcare workers (HCWs). Median number of comorbidities was 2; 225 (23%) were immunocompromised. BNT162b2 was administered to 737 (75%) individuals. Mean time to SARS-CoV2 detection was 135 days. The majority were asymptomatic or exhibited mild-to-moderate disease, 154 (16%) required hospitalization, 127 (13%) had severe-critical illness, and 19 (2%) died. Age (odds ratio [OR] 1.14 [95% CI, 1.04-1.07]; p<0.001), cardiovascular disease (OR 3.02 [95% CI, 1.55-5.89; p=0.001), and immunocompromised status (OR 2.57 [95% CI, 1.70-3.90]; p<0.001) were independent risk factors for hospitalization. Additionally, age (OR 1.06 [95% CI, 1.02-1.11]; p=0.006) was significantly associated with mortality. HCWs (OR 0.15 [95% CI, 0.05-0.50]; p = 0.002) were less likely to be hospitalized, and prior receipt of BNT162b2 was associated with lower odds of hospitalization (OR 0.436 [95% CI, 0.303-0.626]; p<0.001) and/or death (OR 0.360 [95% CI, 0.145-0.898]; p=0.029). Conclusion COVID-19 vaccines remain effective at attenuating disease severity. However, patients with breakthrough infections necessitating hospitalization may benefit from early treatment modalities and COVID-19 mitigating strategies, especially in areas with substantial or high transmission rates.

Background Although COVID-19 vaccines are very effective, vaccine breakthrough infections have been reported, albeit rarely. When they do occur, people generally have milder COVID-19 illness compared to unvaccinated people. A total of 10,262 (0.01%) SARS-CoV-2 vaccine breakthrough infections had been reported as of April 30, 2021. The objective of this study was to evaluate the effectiveness of COVID-19 vaccines and characterize breakthrough infections in our patient population. Methods This was a retrospective review of all consecutive COVID-19 vaccine breakthrough infections at Henry Ford Health System (HFHS) in metropolitan Detroit, Michigan, from December 17, 2020 to June 7, 2021. Centers for Disease Control (CDC)'s breakthrough infection definition (detection of SARS-CoV-2 RNA or antigen in a respiratory sample ≥14 days after completion all recommended doses of COVID-19 vaccine) was used to identify cases. Vaccination status was extracted from the electronic medical records using Epic™ SlicerDicer. Results A total of 228,674 patients, including healthcare workers (HCW), were fully vaccinated in our healthcare system. We evaluate 299 patients for breakthrough infection but only 179 (0.08%) patients met the definition; 108 (60%) were female with median age of 59, 60 (33%) were HCW, and 11 (6%) were immunocompromised. The majority (92%) were asymptomatic (62 or 35%) or had mild/moderate illness (102 or 57%); 14 (8%) had severe or critical illness. The status of one patient was unknown. Of those who were symptomatic, 24 (13%) required hospitalization, and 3 (2%) required intensive unit care. One patient admitted for heart failure exacerbation died unexpectedly prior to being discharged. Nine had previous COVID-19 within 4 months but only one was symptomatic; this likely represented residual shedding in the asymptomatic patients. Conclusion COVID-19 vaccine was very effective among our patients and breakthrough infections were rare. Moreover, the vaccine reduced disease severity and mortality. Efforts should aim to increase vaccine uptake. Disclosures All Authors: No reported disclosures

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Background Recent publications suggest that central line-associated bloodstream infection (CLABSI) rates have increased in US hospitals during the COVID-19 pandemic. The objective of this study was to evaluate the impact of COVID-19 pandemic on CLABSIs. Methods This was a retrospective cross-sectional study comparing CLABSI rate per 1,000 central line (CL) days, blood culture (BC) utilization rate per 1,000 CL days, CL utilization rate per 1,000 patient days, Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at an 877-bed tertiary care hospital in Detroit, Michigan. CLABSI, and BC and CL utilization rate were extracted from the electronic medical record (Epic™ Bugsy). SIR and SUR data were extracted from National Healthcare Safety Network (NHSN). Results The average CLABSI rate per 1,000 CL days increased 24% from 1.66 to 2.06. Twenty percent of patients were hospitalized for COVID-19. The BC utilization rate per 1,000 CL days decreased from 0.43 to 0.32 with a 26% reduction. However, CL utilization increased by 28% from 0.25 to 0.32 (Figure 1). However, CLABSIs due to common commensals decreased from 13.8% to 10.9%. The SIR increased significantly from 1.055 to 1.795 (P-value 0.008), resulting in a 70% increase. The overall SUR also increased from 0.900 to 0.988 (P-value < 0.001). Figure 2 is a control chart of the CLABSI rate from July 2019 to April 2021. Figure 1. CLABSI, blood culture utilization and central line utilization rates pre-and during COVID-19 pandemic Figure 2. CLABSI control chart pre-and during COVID-19 pandemic Conclusion During the COVID-19 pandemic, there was a significant increase in CL utilization, CLABSI rate, SIR and SUR likely due to higher acuity in COVID-19 patients despite a decrease in BC orders. Disclosures All Authors: No reported disclosures