bluuebunny/crossref_metadata_2025 huggingface dataset:
P-2296. Risk Factors for Invasive Aspergillus Infections among Lung Transplant Recipients in the Era of COVID-19 Pandemic
Authors: Moffitt Thomas , Nandavaram Sravanthi , Soria Jaime , Myint Thein
Published: January 2025

Background

Invasive aspergillus infection is a major cause of mortality among lung transplant recipients (LTRs). The trends of aspergillus infection appear to be increasing after COVID pandemic.

Methods

A retrospective chart review of all LRTs who developed aspergillus infections was performed at our transplant center from January 2019 to July 2023. Proven aspergillus infection is defined as a positive culture or pathology with abnormal imaging, whereas probable aspergillus infection is an elevated aspergillus antigen with abnormal imaging.

Results

One hundred and thirty-four patients who underwent lung transplantation between January 2019 and July 2023 were followed through December 2023. 21.6% (29/134) and 12.7% (17/134) patients developed proven and probable aspergillus infections, respectively. Although the incidence of proven aspergillus infection has been stable in 2022, the incidence of probable aspergillus infection has increased significantly from 3.6% (1/28) in 2019 to 29% (9/31) (p< 0.01) (Figure 1).

From Jan 2020- July 2023 data analysis, COVID-19 infection was found in 46.2% (18/39) of LTRs diagnosed with aspergillus infection and 45.2% (28/62) of LTRs without diagnosis of aspergillus infection (P=0.92). Of 46 LTRs with COVID-19 infection, 6 (13%) had secondary aspergillus infection.

The clinical characteristics of LTRs with and without invasive aspergillus infection from 2021 to 2023 are shown in Table 1. The risk factors for aspergillus infection include single lung transplant recipients and airway stenosis in multivariate analysis (Table 2). The use of voriconazole was significant for a risk factor in bivariate analysis but not significant in multivariate analysis. Voriconazole prophylaxis was placed for high-risk patients for aspergillus infection.

Inpatient all-cause mortality was 22.86 % in the patients with invasive aspergillus infections compared to 17.54% in LTRs without aspergillosis (p=0.593)

Table 2: Risk factors for Aspergillus infection among lung transplant recipients

Conclusion

The trends of invasive aspergillus infection in LTRs increased from 25% in 2019 to 54.8% in 2022. COVID-19 infection contributed to a slight increase the incidence of aspergillus infection. The risk factors for invasive aspergillosis include single lung transplant recipients and airway stenosis.

Disclosures

All Authors: No reported disclosures
P-2307. Premature Discontinuation of Trimethoprim-Sulfamethoxazole Prophylaxis in Abdominal Transplant Recipients: A Deeper Dive
Authors: Tinkham Tyler T , Ilges Dan , Hudson Madeline R , Votruba Cassandra D , Corey Rebecca , Beemiller McKenna J , Potter Justin M , Gonzalez Alan , Rastegar Ashkan , Lizaola-Mayo Blanca , Kodali Lavanya , Vikram Holenarasipur R
Published: January 2025

Background

Trimethoprim-sulfamethoxazole (TS) prophylaxis can prevent Pneumocystis jirovecii (PCP) and other opportunistic infections (OIs), such as intestinal protozoa, Toxoplasma, Listeria, and Nocardia. We sought to assess the frequency, causative factors, and impact of early TS discontinuation in abdominal SOT recipients.

Methods

This is a single-center, retrospective cohort study of adult abdominal SOT recipients at Mayo Clinic Arizona between 1/1/2021 and 6/30/2023. Objectives included the rate and reasons behind early TS discontinuation and whether TS prophylaxis was reinitiated. Early discontinuation was defined as cessation of TS prophylaxis within 6 months post-transplant for ≥7 days. Secondary outcomes included median duration of therapy, alternative prophylactic agent utilized, and incidence of TS preventable OI. Patients were excluded if they had no TS ordered, died <180 days from transplant, or received a thoracic organ transplant.

Results

942 abdominal SOT recipients were identified. Thus far 171 liver, 11 Kidney, and 29 liver/kidney have been reviewed and included in the current analysis. TS was discontinued early in 60 (28%) patients. Predominant reasons for discontinuation were hyperkalemia (45%), cytopenias (17%), and acute kidney injury (15%). Allergy was the indication for discontinuation in 1 patient. Median duration of TS before discontinuation was 39 days (IQR 66). TS was not resumed in 78% of cases. The predominant reason for non-resumption was alternative prophylaxis with no clear intent to rechallenge TS (70%). The main discontinuation reason had resolved in 70% that stopped due to cytopenias, 67% that stopped due to liver injury, and 96% that stopped due to hyperkalemia. Alternative prophylaxis included pentamidine (50%), dapsone (32%), atovaquone (5%), none (13%). No patients developed PCP or other TS preventable OI during 9-month follow-up post-SOT.

Conclusion

TS is discontinued prematurely in a significant number of SOT recipients and is often not resumed despite resolution of the offending cause. Given its proven track record in preventing several OIs in SOT recipients, providers should document reason(s) for TS discontinuation and consider resumption of TS after reasons for discontinuation resolve.

Disclosures

All Authors: No reported disclosures
P-2317. Risk Factors Associated with post-Hematopoietic Stem Cell Transplant Mortality: Two-Year Cohort in a Public Hospital in Perú
Authors: Agramonte Mario Jeisson , Moscol-Chavez Karol , Aranda-Gomero Lourdes , Wong-Chang Alfredo , Vilcarromero Stalin , Copaja-Corzo Cesar
Published: January 2025

Background

In Latin America, Hematopoietic Stem Cell Transplants have experienced significant growth in recent years, both in terms of quantity and quality. Specialized hospitals and high-level medical centers have been established in several countries, including Perú, to carry out these procedures.

The availability of compatible donors, the experience of the medical team, the condition of the recipient, the stage of the disease, the resources available for monitoring and surveillance of transplant complications are some of the factors involved in the success of the transplant.

This study aims to describe the characteristics and factors associated with mortality in hematopoietic transplant recipients in patients post hematopoietic stem cell transplant attended at a hospital in Peru

sociodemographic characteristics

Methods

Retrospective cohort study, conducted at a hospital in Peru between April and May 2024. We included all patients who underwent hematopoietic stem cell transplant between 2017 and 2022. We evaluated death at one hundred days of follow-up and at two years.

Survival at 100 days post transplant

Results

We evaluated 342 medical records, median age 23 years, 53.5% were women. The most common diagnosis for the transplant was leukemia 83.6%. Mortality in the first 100 days post TPH was 8.2%, and at two years was 30.4%. In the multivariate model and at one hundred days, sepsis HRa: 24.72 (7.95 to 76.85) was associated with death and engraftment to survival HRa: 0.26 (0.07 to 0.93). Regarding mortality at two years, haploidentical transplant HRa:1.92 (1.20 to 3.08), sepsis HRa: 5.36 (2.98 to 9.63), and disease relapse HRa: 4.32 (2.80 to 6.66) were associated with death and engraftment to survival HRa: 0.12 (0.06 to 0.25).

2-year post-transplant survival

Conclusion

Sepsis was the primary risk factor associated with death in the first one hundred days post-transplant. At two years of follow-up, disease relapse and sepsis were the risk factors for death. Hematopoietic stem cell transplant in Peru is performed in few specialized centers and this initial report identifies the need for further interventions to reduce the risk of infection.

Disclosures

All Authors: No reported disclosures
P-2318. Practices Surrounding Peri-Transplant Prevention of Coccidioidomycosis: Preliminary Report from a Survey of California Transplant Centers
Authors: DeVoe Catherine , Fung Monica , Nam Hannah H , Koff Alan , Logan Cathy , Chandran Sindhu , Chang Sandy , Sakoulas George , Schaenman Joanna M , Schwartz Brian S
Published: January 2025

Background

Coccidioidomycosis is a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients. Although existing guidelines address some aspects of pre- and post-transplant testing, prophylaxis, and monitoring, in many cases best practices are unknown, particularly for regions with variable Coccidioides endemicity such as California. This study aims to understand existing coccidioidomycosis prevention strategies at California transplant centers.

Methods

We designed a web-based survey that inquired about California transplant centers’ protocols for pre-transplant coccidioidomycosis testing, post-transplant prophylaxis, and post-transplant monitoring. The Organ Procurement and Transplantation Network website was used to identify adult transplant centers in California that performed at least one SOT in 2023. Primarily pediatric centers were excluded. A transplant infectious disease or transplant physician from each center was invited to complete the survey on behalf of their institution.

Results

Eight out of 15 California transplant centers, representing 68.9% of the total SOT volume for 2023, completed the survey by the time of this report. Types of SOTs performed by the centers are shown in Table 1. All centers had at least one coccidioidomycosis protocol. Many centers had protocols that applied to multiple SOT types; no center had different protocols for the different abdominal transplant types. Details of the seven prophylaxis protocols for abdominal transplants are provided in Table 2. No center recommended Coccidioides-directed prophylaxis for all recipients.

Conclusion

All transplant centers that responded to the survey had at least one coccidioidomycosis protocol, but not all had protocols that applied to all transplant types, and the amount of detail provided by the protocols varied widely. All centers provided some guidance about prophylaxis for recipients from endemic areas, and the majority recommended indefinite prophylaxis for those who were seropositive pre-transplant. Fewer centers provided guidance addressing recipients’ personal history of coccidioidomycosis or donor status. Further research is needed to clarify best practices for reducing coccidioidomycosis after SOT so that approaches can be better standardized.

Disclosures

Catherine DeVoe, MD, AN2 Therapeutics: Grant/Research Support Alan Koff, MBBS, Astra Zeneca: Clinical trial support to institution Joanna M. Schaenman, MD, PhD, FAST, Eurofins Viracor: Honoraria|F2G: Grant/Research Support|MedCure: Advisor/Consultant|Moderna: Clinical trial support to institution|OneLegacy: Advisor/Consultant
P-2321. Role of the Transplant Infectious Disease Physician in Potential Donor Evaluation for Successful and Safe Abdominal Transplantation
Authors: DiStefano Nicholas , Shah Nikita , Natori Yoichiro , Anjan Shweta , Guerra Giselle , Simkins Jacques , Viotti Julia Bini , Morsi Mahmoud , Martin Eric , Venkatatsamy Vighnesh
Published: January 2025

Background

Preventing donor derived infections is critical in solid organ transplant medicine. However, to expand the donor pool, utilizing organs from donors with known infections or at risk of disease transmission with proper prophylaxis and/or treatments is necessary. The purpose of this study is to determine the efficacy and impact of robust transplant Infectious disease (TxID) evaluation for high-risk donors in solid organ transplant centers.

Methods

This is a retrospective study conducted at one of the largest solid organ transplant centers in the US. All electrical medical records regarding donor information and obtained interventions were retrospectively reviewed between June 2023, and March 2024.

Results

During study period, we performed 358 (250, 15, and 93 kidney, kidney-pancreas, and liver) transplants. At the time of organ offer, out of 4,579 total organ offers, 93(2.03%) TxID consultations occurred. The majority of TxID consults were to review positive culture (50/93, 53.8%) and abnormal imaging. TxID declined 19/93 (20.4%) cases due to high risk of infectious disease transmission such as active staphylococcal bacteremia or candidemia. Additional 44 cases were either declined due to other reasons or accepted in other centers. Finally, 30 cases were transplanted and out of those, 22 (73.3%) received prophylaxis. No donor derived infections were noted in those 30 cases. Of note, graft loss or death due to infection within 90 days post-transplant was seen in 10/250, 7/93, and 2/15 for kidney, kidney pancreas, and liver transplants respectively, and none of those cases developed donor derived disease.

Conclusion

Solid organ transplantation helps prolong and improve recipients’ quality of life. Risk assessment, prophylaxis, and monitoring makes it possible to safely accept donors who are considered high risk for infection transmission, while preventing donor derived infections. Early TxID consultation for those cases is crucial.

Disclosures

Yoichiro Natori, MD, Eurofin/Viracor: Honoraria|Nobel Pharma: Advisor/Consultant
P-44. Immunogenicity and Safety of High-dose versus Standard-dose Quadrivalent Inactivated Influenza Vaccine in Patients Living with HIV: A Randomized Controlled Trial
Authors: Laoharattanahirun Nutchaya , Kiertiburanakul Sasisopin , Boonnak Kobporn , Bruminhent Jackrapong
Published: January 2025

Background

Influenza can lead to severe complications in patients living with HIV (PLWH). Annual standard-dose (SD) quadrivalent inactivated influenza vaccine (QIIV) is recommended for PLWH, although it is associated with poor vaccine response. We aimed to investigate the immunogenicity and safety of high-dose (HD) versus SD QIIV in PLWH, as well as safety.

Methods

We conducted a randomized, open-label, controlled trial to compare the immunogenicity of the 2023 southern hemisphere HD QIIV at 60 μg (Efluelda, Sanofi) versus SD QIIV at 15 μg (Fluarix tetra, Sanofi) in patients living with HIV (PLWH) during August and November 2023. Seroprotection (SP), defined as serum hemagglutination-inhibition antibody titers ≥1:40 at 1 month post-vaccination, was assessed. Adverse events (AEs) following vaccination were also evaluated.

Results

We enrolled 110 patients who received the study vaccine, and 103 (52 HD; 51 SD) were eligible for analysis. Among them, 65 (62.1%) were male, with a mean age (SD) of 49.6 (11.2) years and a median CD4 count (IQR) of 555 (418-680) cells/mm3. The integrase strand transfer-based regimen was the most common antiretroviral regimen (57.3%), and the majority had an undetectable HIV viral load (93.2%). Fifty-two (50.5%) achieved SP to all strains (A/H1N1, A/H3N2, B/Victoria and B/Yamagata) after vaccination. Those who received HD QIIV reached SP significantly more compared to SD QIIV (61.5% vs. 39.2%, p = 0.02). In particular, SP to the A/H3N2 strain was significantly greater in the HD QIIV group compared to the SD QIIV group (76.9% vs. 52.9%, p = 0.011). Use of HD QIIV were independent factors for SP to all strains (OR 2.7, 95%CI 1.9-6.1, p = 0.02) and SP to the A/H3N2 strain (OR 3.2, 95%CI 1.4-7.8, p = 0.01). Twenty-nine (57.3%) participants in the HD group reported AEs, including muscle ache (36.5%), pain at the injection site (21.2%), and fever (13.5%). Those were all non-severe and comparable to those receiving SD QIIV.

Conclusion

HD QIIV could offer significantly better immunogenicity across all strains, especially the A(H3N2) strain, compared to SD QIIV in PLWH and should be considered as the preferred influenza vaccine for this population, without safety concerns. TCTR20230501002.

Disclosures

All Authors: No reported disclosures
P-2363. Efficacy Of SARS–CoV-2 Specific Antiviral Therapy for Enteroviral Myalgic Encephalomyelitis/ChronicFatigue Syndrome
Authors: Chia John K , Wang David
Published: January 2025

Background

Etiology remains elusive for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and no treatment exists. Antivirals had no efficacy in randomized clinical trials (RCT) for Epstein-Barr Virus and HHV-6. Enteroviruses (EV) have been implicated, but no antivirals are available. Many patients who received SARS–CoV-2-specific antiviral drugs for acute Covid-19 (COV19) infection experienced significant improvement of prior ME/CFS symptoms. This study summarizes their responses to antivirals for SARS-Cov-2.

Methods

Neutralizing Antibody (NA) for Coxsackievirus B (CVB)1-6 and Echovirus 6, 7, 9, 11, 30 were done by ARUP lab. Enterovirus Protein (EVP) of Peripheral Blood Leukocytes (PBL) was determined by Western Blot. ME/CFS patients fulfilled Canadian consensus criteria, and had either elevated NA for enteroviruses and/or positive EVP in PBL. ME/CFS patients hospitalized for acute COV19 infection and patients without COV19, were given 5-10 days of IV Remdesivir (Rem) +/- immune modulators. Controls: 20 ME/CFS patients seen concurrently without Remdesivir treatment. Other ME/CFS patients (non-COV19) were given Nirmaltrelvir/Ritonavir (PAX) daily for 10 days +/- one repeat.

The energy index (EI) was monitored by the patients before, during and after treatment. Significant improvement was defined as > 30%.

Results

15/20 (75%) ME/CFS patients – 10/12 hospitalized, 5/8 non-COV19 patients – responded to IV Rem 2-6 weeks after infusions; remission lasted 6-8 weeks to 6-9 months before relapse. Of Controls: 2/20 had mild improvement (< 0.001, X 2 ).

104/200 (52%) of PAX-treated ME/CFS patients improved, often within 2-3 days; all relapsed within days to weeks after treatment. 66%, 33% and 44% of CVB4+, CVB3+, non-CVB3,4+ patients responded to treatment, respectively. EVP decreased and increased with clinical response and relapse.

Conclusion

Rem and PAX demonstrated clinical efficacy in ME/CFS patients with chronic enterovirus infections. Placebo-controlled RCT will be needed to clarify the role of antivirals in ME/CFS.

Disclosures

All Authors: No reported disclosures
P-2364. Estimated Additional Burden Averted for the 2022-2023 influenza season from Use of Cell-Based Influenza Vaccines Compared to Egg-Based Influenza Vaccines Among People 0-64 Years of Age in the United States
Authors: McGovern Ian , Stein Alicia N , Haag Mendel
Published: January 2025

Background

Estimation of burden averted is useful to contextualize the impact of differentiated vaccines. Traditional influenza vaccine production in eggs can introduce egg-adaptive mutations. Cell-based influenza vaccines avoid egg-adaptation, potentially improving match to circulating influenza viruses and thereby vaccine effectiveness (VE). This study modeled the public health impact if all people aged 0-64 years vaccinated in the United States during the 2022-2023 influenza season had received either cell-based inactivated quadrivalent influenza vaccine (ccIIV4) or egg-based inactivated quadrivalent influenza vaccine (IIV4).Table 1:Number of outcomes prevented from use of IIV4 and ccIIV4, individuals 0—64 Years

Methods

The modeling method used by the US Centers for Disease Control and Prevention (CDC) to estimate overall burden averted due to influenza vaccination was extended to a relative VE (rVE) context. The model utilized 2022-2023 CDC data on influenza vaccine uptake, influenza incidence, influenza-related healthcare resource (HRU) use and deaths. CDC estimates of absolute VE (aVE) (any vaccine) were used as the aVE of IIV4. We applied an rVE of 7.7% (0.9 to 13.9%), estimated in a 2022-2023 retrospective test-negative design study. Base-case results were validated with deterministic (DSA) and probabilistic (PSA) sensitivity analyses.Table 2:Number of additional outcomes prevented from use of ccIIV4 compared to IIV4, by age group

Results

Table 1 shows the anticipated number of symptomatic influenza cases and associated HRU and deaths that would have been averted if all vaccinated people 0-64 years of age received either ccIIV4 or IIV4 and Table 2 shows the additional burden averted by age. Use of ccIIV4 would result in prevention of an additional 622,826 symptomatic illnesses, 307,682 outpatient visits, 3,680 hospitalizations, 559 intensive care unit (ICU) admissions, and 127 deaths compared to IIV4. DSA results showed that the rVE estimate was associated with the most variability, followed by influenza-related HRU and deaths. Mean PSA results were all within a 0.1% difference of base-case results.

Conclusion

Use of ccIIV4 instead of IIV4 during the 2022-2023 influenza seasons in the US would have had a substantial public health impact on the population 0-64 years of age due to prevention of an additional 622,826 symptomatic illnesses as well as proportionate reductions in associated HRU and deaths.

Disclosures

Ian McGovern, MPH, CSL Seqirus: Employee|CSL Seqirus: Stocks/Bonds (Public Company) Alicia N. Stein, MBiostats, PhD, CSL Seqirus: Employee|CSL Seqirus: Stocks/Bonds (Public Company) Mendel Haag, PhD, PharmD, CSL Seqirus: Employment|CSL Seqirus: Stocks/Bonds (Public Company)
P-46. A Comparative Analysis of Vaccine Uptake in Face-to-Face vs. Virtual Care for Active Duty Air Force Members Living with HIV
Authors: Wurtz Paul J , Finney Laquonda , Yabes Joseph
Published: January 2025

Background

Military regulation requires US Air Force (USAF) members living with HIV receive Infectious Disease evaluation at the Medical Evaluation Unit (MEU). With a worldwide distribution of the USAF, telehealth utilization began in 2020 with improvements in clinical outcomes and decreased costs. However, not all facets of care are easily amenable to telehealth. We aimed to review differences in vaccination rates since transition from face to face (F) to virtual (V) visits.

Methods

All USAF active-duty members with incident HIV diagnosis between 2018 and 2023 were included. Only airmen stationed local to the MEU were evaluated F after 2020. Demographic, and clinical information was compiled. Vaccines of interest were selected according to current guidelines: human papilloma virus (HPV), meningococcal ACWY, pneumococcal, recombinant zoster and Mpox vaccines. Vaccine completion rates and time from HIV diagnosis to first vaccine dose was compared between groups.

Results

All 108 patients were male. Forty-four percent of visits occurred F and 56% were V. Median age was similar, 27 years for F and 26 years for V (p=0.84). Overall, demographics were not significantly different between groups (Table 1). Initial CD4 count was lower among those who received V care (472 vs 567; p=0.01). It took longer for patients to receive their first vaccine dose with V visits compared to F visits (99 vs 3 days; p< 0.01) (Table 2). Likewise, days from HIV diagnosis to first dose of vaccine administration was longer with V visits compared to F (134 vs 36; p< 0.01). Vaccine completion rates varied by type. Pneumococcal and HPV completion rates were higher in the F group compared with V group (p=0.02). Completion rates of the meningococcal ACWY primary series were similarly higher in the V group 92% vs 55%; p=< 0.001). Mpox completion rates were higher with F visits but not statistically significant (8% vs 3%; p=0.4). Recombinant zoster vaccine completion rates were nearly identical (22% vs 23%; p=0.96).

Conclusion

Vaccination rates were lower and took longer among USAF personnel who underwent V visits compared to F. As healthcare systems increasingly employ telehealth, future studies should investigate provider and patient attitudes on vaccine counseling during V visits to ensure the delivery of high-quality care in the virtual era.

Disclosures

All Authors: No reported disclosures
P-48. Uptake of pneumococcal vaccination after invasive pneumococcal diseases in two centers in northern Italy
Authors: Ponta Giacomo , Roberto Raccagni Angelo , Carletti Silvia , Mauri Carola , Morena Valentina , Gemignani Nicole , Pontiggia Silvia , Ripa Marco , Castagna Antonella , Piconi Stefania
Published: January 2025

Background

Aim of this study is to evaluate factors associated with uptake of pneumococcal vaccination after invasive pneumococcal disease (IPD). Since pneumococcal infection doesn’t protect from future ones, vaccination is recommended in patients who recover from IPD.

Table 1

Population's characteristics.

Methods

Retrospective, bicenter cohort study of patients hospitalized with invasive pneumococcal disease at IRCCS San Raffaele Hospital (Milan, Italy) and ASST Manzoni Hospital (Lecco, Italy) between January 1st 2015 and December 31st 2019. Patients older than 18 years with positive blood or cerebrospinal fluid cultures for Streptococcus pneumoniae were included. Patients who died before discharge and whose vaccinal record and discharge documentations were not available were excluded. All vaccination data were retrieved through Italian national vaccination portal (SIAVR). Follow-up data were updated until March 31st, 2024.

The characteristics of patients who were vaccinated (VAX) and were not vaccinated (UNVAX) after the event were compared using the chi-square test for categorical variables and the Mann-Whitney U-test for continuous variables.

Table 2

Characteristics of vaccination cycles.

Results

The characteristics of the 211 included patients are described in table 1, completed vaccination cycles in table 2. Only 26 patients (12.3%) received an indication at discharge to get vaccinated for S. pneumoniae, and 47 (22.2%) patients were vaccinated during the observation period, after a median of 6.6 (2.3-29.9) months after the event. There was no difference in age between the two groups (70.7 [60.1-78.4] vs 69.5 [58.8-78.5], p-value=0.82), while a greater proportion of VAX patients was male (33 [70.2%] vs 86 [52.4%], p-value=0.03). Charlson comorbidity index was similar between the two groups (5 [3-6] vs 5 [3-6], p-value=0.845), but a significant higher percentage of VAX patients had lymphoma (8 [17%] vs 8 [4.9%], p-value=0.006). Patients who received an indication to vaccinate were significantly more likely to receive pneumococcal vaccination (16 [34%] vs 10 [6.1%], p-value< 0.001).

Conclusion

Our cohort revealed low pneumococcal vaccination uptake, with inadequate frequency of vaccination indication at discharge. Reinforcing prevention culture among patients and physicians is imperative.

Disclosures

Antonella Castagna, MD, Bristol-Myers Squibb: Advisor/Consultant|Gilead Sciences, Inc.: Advisor/Consultant|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Honoraria|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Janssen: Honoraria|Merck Sharp & Dohme: Advisor/Consultant|Merck Sharp & Dohme: Grant/Research Support|Merck Sharp & Dohme: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria
P-61. Perceived Importance of Adult Immunizations among HIV Providers in New Orleans, Louisiana
Authors: Yau Tat , Edwards Blane , Richey Lauren
Published: January 2025

Background

Immunizations are key to primary care for people with HIV (PWH). Unfortunately, immunization rates among PWH are reportedly low. In addition to patients’ preferences, limited time and acute issues, knowledge gap and beliefs about vaccine among clinicians could negatively impact their recommendations, which would ultimately affect vaccine uptake for PWH.

Table 1

Survey results about perceived importance of vaccines of interest for people with HIV in different age groups prior to (pre-test) and after (post-test) education session

Methods

This was a clinical quality improvement project at HIV Outpatient Program (HOP) at University Medical Center, New Orleans in 2023. A pretest survey was conducted to evaluate providers’ perceived importance of the vaccines of interest for PWH in different age groups: aged 19 to 26, 27 to 45, and 65 or above. Participants were asked to rank the vaccines on a scale of 0 to 3: 0 means the vaccine is not indicated; 1 means the vaccine is optional; 2 means the vaccine is important; and 3 means the vaccine is very important. The pre-test was followed by an educational session to review updates of adult immunizations tailored to PWH. Following this a post-test survey was collected to assess changes in perceived importance among participants.

Image 1

Perceived importance of immunizations among PWH aged 19 to 26

Results

12 physicians participated in this study. Participants’ perceived importance of most immunizations improved after education (table 1 and figure 1-3). The perceived most important vaccines after education, defined by a score of 2.5 or above, were: meningococcus, hepatitis B, hepatitis A, HPV, and pneumococcus vaccines among PWH aged 19 to 26; hepatitis B, pneumococcus, hepatitis A, meningococcus, and COVID-19 vaccines among PWH aged 27 to 45; pneumococcus, COVID-19, herpes zoster, hepatitis B, and influenza vaccines among PWH aged 65 or above. There was a statistically significant increase in the perceived importance of HPV vaccines among PWH aged 19 to 26 after education. In addition, all participants thought pneumococcus vaccine is very important (score of 3 in both pre and posttests) for PWH aged 65 or above.

Image 2

Perceived importance of immunizations among PWH aged 27 to 45

Conclusion

Educational training among HIV providers raised awareness of the importance of immunization. After the training session, we noticed a 46% increase in total number of PWH aged 19 to 26 who completed HPV vaccine series. Similar approach could be implemented to general practitioners to improve vaccine uptake in primary care.

Image 3

Perceived importance of immunizations among PWH aged 65 or above

Disclosures

All Authors: No reported disclosures
P-69. What if? Opportunities for IV to PO Antibiotic Transition in Bone and Joint Infection Treatment
Authors: Price Graham , Dance Makeisha , Jackson Patrick E H , Medler Corey
Published: January 2025

Background

Historically, bone and joint infections have been treated with intravenous (IV) antimicrobials. IV to oral (PO) antibiotic transition implementation differs among institutions and prescribers. This practice has increased in recent years as new literature has demonstrated comparable efficacy of PO and IV treatment. Use of outpatient IV therapy often necessitates using a central line. This introduces additional risks, particularly line-related complications such as clots and central line infections. The purpose of this project was to identify opportunities for transitioning from IV to PO therapy in patients discharged on IV antibiotics for bone/joint infections at an academic medical center.

Baseline Patient Characteristics

Methods

We performed a retrospective, cross-sectional study of adults discharged on IV antibiotics between January 2020 and December 2023. Inclusion criteria included age ≥ 18 years, patient followed by institutional outpatient parenteral antimicrobial therapy service, and receipt of at least one IV antibiotic for a bone/joint infection. Patients with axial osteomyelitis were excluded. The primary outcome was the percentage of patients with the potential to transition from IV to PO antibiotics. Secondary outcomes included incidence of adverse drug events (ADE).

Results

324 patients were included. Osteomyelitis was the most common infection (48.5%) followed by joint infection (27.5%). Source control procedures were performed for 83% of patients. Cultures were positive in 75% of patients, and Staphylococcus species were the most common pathogens (45%). In total, 237 (73.1%) of patients qualified for a complete PO regimen. Half of patients (50.3%) received at least one PO antibiotic as part of their discharge therapy. Antibiotic changes occurred after discharge in 15.4% of patients, and 21% of patients experienced an antibiotic associated ADE.

Conclusion

Most patients discharged on IV antibiotics for bone/joint infection at this medical center could have received a complete PO regimen. While PO antibiotics are not benign, there is the potential to reduce adverse effects. These findings highlight opportunities for IV to PO transition at discharge and the potential to reduce line associated complications.

Disclosures

Patrick E H Jackson, MD, Gentiva Hospice: spouse employment|Kindred Hospice: spouse employment|Pfizer: Grant/Research Support
P-72. The Evaluation of Pressure Injury Associated Pelvic Osteomyelitis in Patients with Spinal Cord Injuries in a Veterans Affairs Population
Authors: Kanner Esther H , Cusumano Jaclyn A , Johnson-Kunjukutty Swapna , Sherman Olga , Vest Kirsten
Published: January 2025

Background

Limited data, and thus no clinical guidelines, are available for the treatment of pelvic osteomyelitis with associated pressure injuries (PI) in spinal cord injury (SCI) patients. Treatment of SCI patients with PI-associated osteomyelitis at the Veterans Affairs (VA) involves a multidisciplinary team including SCI, infectious disease, wound care, and surgery specialists. Herein we describe the management and outcomes of an SCI cohort with PI-associated pelvic osteomyelitis.

Methods

A retrospective chart review of patients ≥ 18 years of age, with a culture-positive clinical diagnosis of PI-associated pelvic osteomyelitis, treated by the SCI service between January 1, 2018, and October 1, 2023, was conducted. Patient characteristics, treatment choice, duration, and surgical intervention were compared between those with treatment failure versus success. Treatment failure was defined as having either microbiologic relapse, chronic suppressive therapy, or death due to the osteomyelitis during treatment. Differences between groups were assessed by Fisher’s exact test.

Results

A total of 31 patients were identified, the majority were male (97%) with a median age of 66 years (Table 1). There were 17 patients with histopathology analyzed at diagnosis, of which 88% were positive. Majority of the cultures obtained were bone cultures (71%). The cultures were primarily polymicrobial with 45% growing MRSA (methicillin resistant Staphylococcus aureus) and low Pseudomonas aeruginosa rates (13%). Majority of patients underwent surgical debridement (61%) and received prolonged durations of antibiotics beyond 6 weeks (Table 2). A total 8 (26%) patients experienced treatment failure. Surgical management and prolonged durations of antibiotics did not differ significantly between the groups. Patients in the treatment success group had lower rates of beta-lactam as a component of their treatment regimen.

Conclusion

Only a quarter of the SCI patients with PI-associated pelvic osteomyelitis failed treatment. Significantly more patients in the treatment success group had non-beta lactam containing treatment regimens. Larger studies are warranted to shed light on optimal management of pelvic osteomyelitis in this population.

Disclosures

Jaclyn A. Cusumano, PharmD, BCIDP, Basilea Pharmaceutica: Grant/Research Support
P-76. Risk factors associated with Gram-negative early hip and knee prosthetic joint infections: a single-center retrospective cohort study
Authors: Cullen Grace , Gu Yuan , Salinas Jorge , Furukawa Daisuke
Published: January 2025

Background

Prosthetic joint infection (PJI) is a devastating complication of total joint arthroplasty, occurring in 1-2% of all prosthetic joint surgeries. While rare, Gram-negative (GN) bacteria are important causes of PJIs and can be difficult to treat due to increasing antimicrobial resistance. We looked at cases of early PJIs due to GN bacteria in our institution to identify potential risk factors.

Methods

We conducted a retrospective cohort study using the Center for Disease Control’s National Healthcare Safety Network data report of surgical site infections (SSI) for our institution between January 1, 2011 and June 1, 2023. Procedure codes HPRO and KPRO were used to identify total hip (THA) and knee (TKA) arthroplasty cases. Welch two sample t-test and Chi-square tests were used for between-group comparisons of continuous and categorical outcomes, respectively. Multiple logistic regression was used to identify risk factors and estimate adjusted odds ratios (aOR) for GN PJIs.

Results

Our cohort included 17,725 arthroplasty cases, of which 174 developed a SSI of the implanted joint ≤90 days of index surgery, with a cumulative incidence of 0.98%. Of the SSI cases, 34 (20%) isolated GN bacteria while 140 (80%) were caused by other organisms. The most common GN bacteria were E. coli (11), Klebsiella species (8), P. aeruginosa (8). Patients with GN infections were older, with a median age of 70 (IQR 61-76) compared to 65 (IQR 58-70) in the non-GN infections group (p = 0.090). Duration of index surgery was longer in GN infections, with a median duration of 204 minutes (IQR 121-304) compared to 151 minutes (IQR 110-219, p=0.019). There were no differences between GN bacterial infections and infections due to other organisms for sex, American Society of Anesthesiologists physical status score, surgical risk score, body mass index, or history of diabetes. In the logistic regression, age and duration were associated with increased odds of GN infection with an aOR of 1.04 for age (p=0.05) and 1.05 for duration (p=0.003).

Conclusion

The cumulative incidence of SSI of prosthetic hip and knee arthroplasties was low at < 1% with GN infections making up a minority of cases. Age at time of index surgery and duration of surgery were significantly associated with an increased risk of GN bacterial infection.

Disclosures

All Authors: No reported disclosures
P-83. Corynebacterium Striatum, an emerging community and nosocomial pathogen
Authors: Jimenez Dennys , Cadena-Zuluaga Jose , Hoskins Serene , Reveles Kelly
Published: January 2025

Background

Corynebacterium striatum is part of the normal flora of the skin and nasal mucosa. Cases of C. striatum isolates are commonly neglected and assumed as contaminants, but increasing reports suggests it is the causative pathogen in many community and nosocomial infections. The objective of this study was to review and analyze C. striatum isolates from sterile sites over a 12-year period (2011 -2023)

Corynebacterium Striatum, an emerging community and nosocomial pathogen Table 1

Patient's clinical characteristics divided by type of infection (Monomicrobial vs polymicrobial)

Methods

This was a retrospective, observational study of patients with microbiologically confirmed C. striatum diabetic foot infection or osteomyelitis from July 1, 2011 to January 10, 2023 at the South Texas Veterans Health Care System. We screened all microbiology results using Theradoc (Premier Inc. Charlotte, NC) and reviewed the medical records of all patients 18 years or older that meet criteria. We collected epidemiological, radiological, laboratory and clinical data from each case. Additional variables included patient demographics, comorbidities (including Charlson comorbidity index), exposure to healthcare and antimicrobials within 12 months, presence of catheters or implants at the time of admission/infection, hemodialysis, treatment and outcomes. Variables were presented descriptively and compared between monomicrobial and polymicrobial infections using the chi-square or Wilcoxon rank sum test.

Corynebacterium Striatum, an emerging community and nosocomial pathogen Table 1 continuation

Patient's clinical characteristics divided by type of infection (Monomicrobial vs polymicrobial)

Results

There were 185 potential candidates for inclusion, but 53 cases were included for analysis. Patient and infection characteristics are presented in the Table. Median age was 67 years and 98.1% were male. Most infections were osteomyelitis (79.2%) and polymicrobial (67.9%). Most patients had recent hospital admissions/ER visits (56.6%). and antimicrobial use (90.6%) within the last year. Polymicrobial and monomicrobial infections were similar. Antimicrobial susceptibility was available in 5 cases. All isolates were susceptible to vancomycin, daptomycin, and gentamycin. 4 were tested for linezolid and rifampin and they were all were susceptible. Amputation was frequently required in the management of infections (71.7% of cases).

Conclusion

While relatively uncommon, C. striatum can lead to bone and wound infections that can result in poor patient health outcomes. Larger studies are needed to confirm the clinical relevance of this pathogen.

Disclosures

All Authors: No reported disclosures
P-85. Impact of Magnetic Resonance Imaging on Re-Amputation Rates in Diabetic Foot Osteomyelitis
Authors: Chan Arthur , Charles Cassandre , Xu Jiachen , Mergenhagen Kari A , Wattengel Bethany A , O’Leary Ashley , Puckett Andrew , Nasca Joseph , Russo Thomas
Published: January 2025

Background

Diabetic foot infections constitute 20% of hospital admissions and result in 80% of amputations annually. It is noteworthy that diabetes is more prevalent among U.S. veterans compared to the general population due to age, exposure to environmental factors during service, and mental health conditions which can contribute to unhealthy behaviors and increased risk of diabetes. Magnetic resonance imaging (MRI) is considered the imaging modality of choice for evaluating diabetic foot osteomyelitis given its higher sensitivity. A staging MRI, may decrease subsequent amputation rates in diabetics with osteomyelitis.Table 1:Patient characteristics and comorbiditiesMRI=magnetic resonance imaging, MI=myocardial infarction, CHF=congestive heart failure, PVD=peripheral vascular disease, CVD=cardiovascular disease, DM=diabetes mellitus, COPD=chronic obstructive pulmonary disease, PUD=peptic ulcer disease, HIV=human immunodeficiency virus

Methods

A retrospective chart review was conducted to analyze the risk of re-amputation in patients with diabetic foot osteomyelitis hospitalized between 2005 and 2022. Patients with and without MRI guided treatment were compared. The primary outcome was the rate of re-amputation at specific time intervals: 30-day, 60-day, 180-day, and 365-day. Charlson Comorbidity Index scores were calculated for all patients, and a multivariable logistic regression was used to calculate odds ratios and confidence intervals. Veterans were included if they had a diabetic foot infection complicated by osteomyelitis, and requiring amputation. Patients were excluded if they had an initial above-the-knee amputation (AKA) or below-the-knee amputation (BKA), since these are generally definitive treatment for osteomyelitis.Table 2:Treatment CharacteristicsMRI=magnetic resonance imaging, MSSA=methicillin susceptible Staphylococcus aureus, MRSA=methicillin resistant Staphylococcus aureus

Results

There were 1,463 patients based on ICD-10 codes, of which 475 patients underwent amputation. MRI guided therapy occurred in 106 patients. Multivariable logistic regression analysis revealed a 10-fold decrease in the odds of re-amputation within 30 days (OR=0.1; CI 0.01-0.72), a 3-fold decrease within 60 days (OR=0.32; CI 0.13-0.83), and a 2-fold decrease within the 180-day and 365-day (OR=0.51; CI 0.28-0.94 and OR=0.52; CI 0.3-0.9, respectively) intervals when MRI guidance was utilized.Table 3:Bivariate analysis of re-amputationsMRI=magnetic resonance imaging

Conclusion

These findings suggest that incorporating a pre-amputation MRI into the diagnostic and treatment approach for osteomyelitis associated with diabetic foot infections may reduce the risk for subsequent amputations.Table 4:Multivariable analysis of re-amputationsMRI= magnetic resonance imaging

Disclosures

All Authors: No reported disclosures
P-95. Predictors of bloodstream infection and its impact on mortality in septic arthritis: A 15-year review
Authors: Lee Yongseop , Chan Kim Yong , Seong Jaeeun , Ahn Sangmin , Han Min , Ah Lee Jung , Ho Kim Jung , Young Ahn Jin , Su Ku Nam , Yong Choi Jun , Yeom Joon-sup , Jin Jeong Su
Published: January 2025

Background

Septic arthritis is often complicated by bloodstream infection (BSI), which can lead to metastatin infections and sepsis. In this study, we aimed to identify risk factors for septic arthritis-related BSI and assess its impact on clinical outcomes.Table 1.Comparison of clinical characteristics of septic arthritis patients with and without bloodstream infection.

Methods

A retrospective review spanning 15 years (January 2009 to May 2023) was conducted on patients diagnosed with septic arthritis. Data from patients with positive synovial fluid cultures were analyzed.Table 2.Laboratory and microbiologic findings of patients with septic arthritis according to bloodstream infections.

Results

Among 456 patients with septic arthritis, 16.8% (n=77) developed BSI. The 90-day mortality rate was significantly higher in patients with BSI compared with those without BSI (14.3% vs. 5.3%, P=0.004). Staphylococcus aureus was the most commonly identified organism in synovial fluid cultures and was associated with an increased risk of BSI (adjusted odds ratio [aOR], 2.20; 95% confidence interval [CI], 1.15-4.34; P=0.019). Independent risk factors for BSI included higher Sequential Organ Failure Assessment (SOFA) score (aOR, 1.23; 95% CI, 1.06–1.44; P=0.009), lymphopenia (aOR, 2.84; 95% CI, 1.38–6.15; P=0.006), and elevated C-reactive protein (CRP, mg/dL) levels (aOR, 1.07; 95% CI, 1.05–1.10; P< 0.001). Age ≥70 years (aOR, 3.96; 95% CI, 1.49–11.85; P=0.009) and higher SOFA score (aOR, 1.36; 95% CI, 1.12–1.67; P=0.002) were significant predictors of 90-day mortality, although BSI itself was not.Table 3.Multivariable analysis of risk factors for bloodstream infection and 90-day mortality in patients with septic arthritis.Variables with a P-value <0.05 in the univariable analysis were included in the multivariable analysis.

Conclusion

Mortality in patients with septic arthritis was primarily associated with systemic sepsis resulting from BSI rather than the BSI itself. Understanding the relationship between septic arthritis-related BSI and clinical outcomes can aid physicians in managing systemic infections and improving patient care.Figure 1.Distribution of causative organisms of septic arthritis.

Disclosures

All Authors: No reported disclosures