208. Comparison of Bloodstream Infections in Hospitalized Patients Before and During the COVID-19 Surge in a Community Hospital in the South Bronx: An Observational Study

Background There is a paucity of data of bloodstream infections (BSI) before and during the COVID-19 pandemic. The aim of our study was to compare the incidence and characteristics of blood stream infections (BSI) in hospitalized patients before and during the surge of COVID-19 pandemic in a community hospital in South Bronx. Methods This is a retrospective observational comparative study of adult hospitalized patients with BSI admitted before (Jan 1-Feb 28, 2020) and during COVID-19 surge (Mar 1- May 1,2020). The incidence of BSI, patient demographics, clinical and microbiological characteristics of infections including treatment and outcomes were compared. Results Of the 155 patients with BSI, 64 were before COVID and 91 were during the COVID surge (Table 1). Incidence of BSI was 5.84 before COVID and 6.57 during surge (p = 0.004). Majority of patients during COVID period had ARDS (39.6%), required mechanical ventilation (57%), inotropic support (46.2%), therapeutic anticoagulation (24.2%), proning (22%), rectal tube (28.6%), Tocilizumab (9.9%), and steroids (30.8%) in comparison to pre-COVID (Table 2). Days of antibiotic therapy prior to BSI was 5 days before COVID and 7 during COVID. Mortality was higher among patients with BSI admitted during COVID surge (41.8% vs. 14.1% p < 0.0001). Of 185 BSI events, 71 were Pre-COVID and 114 during surge. Primary BSI were predominant (72%) before COVID contrary to secondary BSI (46%) (CLABSI) during COVID. Time from admission to positive culture was 2.5 days during COVID compared to 0.9 pre-COVID. Majority of BSI during COVID period were monomicrobial (93%) and hospital acquired (50%) (p=0.001). Enterococcus (20.2%), E.coli (13.2%), and MSSA (12.3%) were predominant microbes causing BSI during COVID vs. MRSA (15.5%), Streptococci (15.5%), and S. pneumoniae (14.1%) before COVID (Figure 1). In multivariate logistic regression, Enterococcal coinfection was associated with COVID positivity (OR 2.685, p = 0.038), mechanical ventilation (OR 8.739, p = 0.002), and presence of COPD/Asthma (OR 2.823, p = 0.035). Comparison of Microorganisms Isolated in the BSI X-axis represents the total number of BSI events whereas the number at the end of each bar represents the percentage Conclusion Higher incidence of secondary BSI (CLABSI) due to Enterococcus spp. was observed during the surge of COVID-19 infection in the South Bronx. Breakdown of infection control measures during the COVID-19 pandemic could have been contributory. Disclosures All Authors: No reported disclosures

590. Persisting COVID-19 vaccination hesitancy in the South Bronx

Background Minority groups have the lowest vaccination rates when compared to the overall population. We aim to study the attitudes and perceptions of COVID-19 vaccination, about six months after vaccine rollout in the South Bronx. Methods Cross-sectional anonymized online survey evaluating knowledge, attitude and perception about COVID-19 vaccination using SurveyMonkey™ was conducted in South Bronx community from April - June 2021. Results Of the 281 participants, 67% were Latinx and 16% were African American (AA); 69% (195) were fully vaccinated (FV) and 31% (86) with vaccine hesitancy (VH). The common reasons for hesitancy were “concerns about side effects” (38%), “vaccine is not safe” (27%) and “vaccine was approved too fast” (26%) (p< .001). VH were more likely to rely online/mobile apps (30%) and friends and family (23%) as compared to FV. VH were more likely to be AA, younger age (< 35 yrs), high school or lower education, single, unemployed, without comorbidities, not current on other eligible vaccines, and did not believe “vaccine is necessary to end the pandemic.” Majority of participants from both cohorts trusted their primary care providers. Mistrust with healthcare and pharmaceutical companies was higher in VH (p=0.009). Both groups preferred to continue wearing mask and practice social distancing despite vaccination status. Table 1b: COVID-19 Vaccine Survey Summary Table 1c: COVID-19 Vaccine Survey Participant Characteristics Conclusion Persisting vaccine hesitancy is concerning in minority communities. Identifying the target population and implementation of innovative methods to improve COVID-19 vaccination acceptance leveraging primary care providers would be a possible solution. Disclosures All Authors: No reported disclosures

An Abiding Affection

This chapter provides a brief outline of Esther Zimmer’s early life. Born in 1922 to immigrant Jewish parents who had moved from Manhattan’s Lower East Side to the South Bronx, she demonstrated a talent for languages at an early age, learning biblical Hebrew from her grandfather and later distinguishing herself in Spanish and French. Despite her professors’ expectations that she become a foreign language teacher, Zimmer chose to become a scientist. Her love affair with microorganisms began in the mycology laboratory of the New York Botanical Gardens, her abiding affection for bacteria, especially E. coli K-12, memorialized in the beach house named Kappa Dodici, Italian for K-12. For Esther, this particular bacterial strain displayed the treasures of bacterial sex uncovered by her research. Esther cherished the joy of discovery far beyond academic tenure or recognition. Like renowned physicist Richard Feynman, her prime motivation for doing laboratory research was “the sheer pleasure of finding things out.”

The CGM Experience of Minority Adults With Type 1 Diabetes in the South Bronx

Objective: To describe the state of type 1 diabetes (T1D) in minority adults in the South Bronx, and their experience with continuous glucose monitoring (CGM). Introduction: In a recent analysis of data from the Type 1 Diabetes Exchange Registry, one notable finding was the difference in metabolic control and use of diabetes technology in patients of different socioeconomic status and racial/ethnic backgrounds. With limited data available on Hispanic and Black patients, we sought to examine the use of and experience with continuous glucose monitoring (CGM) in our hospital system, which primarily serves a low-income, minority population in the South Bronx. Methods: 68 adults with T1D who attended the Endocrinology clinic at our hospital from 2017 to 2019 were identified. Patients were contacted by telephone to complete a questionnaire regarding CGM use and satisfaction. A retrospective chart review was conducted to obtain additional demographic and clinical information. Results: Out of 68 patients with T1D in the hospital database who were contacted, 47 patients completed the questionnaire. The age range was 23 to 63 years. 42.6% were male. 59.6% were Hispanic, 19.1% Black/African American (AA), 4.3% Caucasian, and 17% not specified. 87.2% had public insurance. Overall, 48.9% of patients were actively using CGM, 19.1% had discontinued use of CGM, and 31.9% had never used CGM. In Hispanic patients using CGM, mean HbA1C was 8.2% compared to 10.1% in Hispanic non-users. In Black/AA patients using CGM, mean HbA1C was 9.2% compared to 9.9% in Black/AA non-users. Hospitalizations for acute diabetes complications were lower in CGM users (4.3%) compared to non-CGM users (16.7%). Among active CGM users, 74% rated their satisfaction as “extremely satisfied” or “very satisfied.” Perceived benefits included the prevention of hypoglycemia and awareness of inappropriate food intake. Discussion: Our study population, mainly comprised of Hispanic and Black T1D adults, showed a higher CGM utilization rate than previously reported. After stratification by socioeconomic status, CGM utilization was reported to be as low as 16% in Hispanic and 10% in Black patients with household income <$50,000/year in the T1D Exchange Registry. By comparison, 49% of our studied population possessing similar demographics was actively using CGM. This study demonstrated that CGM acceptance was high in this largely minority, low-income population in the South Bronx, and was associated with lower A1C levels, high degree of patient satisfaction and reduction in diabetes-related hospitalizations. However, glycemic control remained suboptimal overall despite CGM access. Additional strategies to optimize the utility of CGM are needed to improve clinical outcomes such as HbA1C levels in minority T1D patients.