bluuebunny/crossref_metadata_2025 huggingface dataset:
P-2156. Impact of Metagenomic Next-Generation Sequencing of Plasma Cell-Free DNA on Infectious Diseases Management in Adult and Pediatric Patients
Authors: Tholt Olivia , Hammer Katie Lynn , Gajurel Kiran , Buckley Kevin S , Lefemine Amanda
Published: January 2025

Background

Plasma metagenomic next-generation sequencing (mNGS) is a noninvasive diagnostic test that uses cell-free DNA to identify a variety of pathogens. mNGS has the potential to identify difficult to detect pathogens and avoid invasive procedures while ensuring appropriate antibiotic use. However, the broad range of organisms detected makes it difficult to discern pathogens from colonization. The impact and ideal patient population for this test remain uncertain.Figure 1. Reason for Ordering mNGSNote: patients could have more than one reason for ordering mNGS

Methods

This was a retrospective evaluation of adult and pediatric patients who had mNGS ordered during their admission at Atrium Health's Carolinas Medical Center or Levine Children's Hospital from July 2019 through July 2023. The aim of this study was to characterize the use of mNGS including patient demographics, testing indication, result concordance with conventional testing and clinical impact of results. Figure 2. Suspected Site of InfectionNote: patients could have more than one suspected site of infection

Results

A total of 67 adult and 44 pediatric patients were included with 72 and 50 mNGS orders, respectively. Most of the patients were immunosuppressed including 72% of adult and 94% of pediatric patients. The most common reasons for ordering mNGS were probable infection with negative cultures, rule-out infection, and lack of improvement on current therapy (Figure 1). The suspected sites of infection are shown in Figure 2. There were 48 adult patients and 23 pediatric patients with a positive test. Of those that were positive, the results were fully concordant with conventional testing for 13% of adult and 26% of pediatric patients. At least one organism detected by mNGS was suspected to be the causative pathogen in 69% of adult and 43% of pediatric positive tests. Clinical impact was largely uncertain, and a negative impact was not identified in either group. The adult group had a positive impact in 33% of patients compared to 12% of pediatric patients. The most common positive impacts were confirmed and new diagnosis of which the most frequent suspected sites were cardiac and respiratory.

Conclusion

mNGS was used primarily in immunocompromised patients with suspected, indeterminant infections. This data suggests mNGS may assist in the identification of organisms causing deep-seated infections or infections caused by pathogens otherwise difficult to detect but remains non-contributory to management in a majority of cases.

Disclosures

All Authors: No reported disclosures
P-2160. Where Does Karius Testing Have a Clinical Impact? A Retrospective Analysis of Next Generation Sequencing
Authors: Prado Antonio , Ewens Elise , Shephard Emily , Bhagat Hita , Won Regina
Published: January 2025

Background

Karius testing, a commercially available microbial cell-free DNA assay, has emerged as a new diagnostic tool for clinicians, particularly for management of culture negative infections and in immunocompromised patients. There remains uncertainty regarding the clinical impact of next-generation sequencing in patient management.

Figure 1

Methods

This was a retrospective multi-site observational cohort study over a five-year period from 2018 to 2023 at a community hospital system. Patients were included if they had a Karius test ordered with results available to treating clinicians during the time period. The primary outcome was a change in clinical management defined as either the addition or removal of antibiotics, based on results from Karius testing.

Results

391 patients met inclusion criteria, with 283 (72%) in immunocompetent and 108 (28%) in immunocompromised patients. An infectious diseases (ID) consult was obtained in 355 (91%) cases. Fifty-two percent of Karius tests were positive, with an average of 1.1 pathogens reported. Concordance rate between positive cultures and Karius results was 12%. Pneumonia (24%), fever of unknown origin (FUO) (18%), and endocarditis (17%) were the most common indications for Karius orders (Fig 1). Testing changed management in 19% of all included individuals, and in 18% of immunocompromised patients. Karius testing was most impactful in neutropenic fever and endocarditis with 27% and 22% respectively changing management and least impactful when ordered for joint infection, where 12% resulted in a change in management (Fig 2).

Conclusion

The Karius test changed antibiotic treatment in 19% of patients. It was most clinically relevant in neutropenic fever and endocarditis management. Even with our sizeable sample population including both immunocompromised and immunocompetent patients across a large, multi-site community hospital system, findings remained consistent compared to other smaller studies. Further investigation would be beneficial to determine how best to incorporate this emerging tool in clinical practice.

Disclosures

All Authors: No reported disclosures
P-2168. The Intervention of Infectious Diseases Physicians Might Enhance the Value of Broad-Range 16S rRNA Gene Polymerase Chain Reaction in the Clinical Aspect
Authors: Fukuoka Risa , Nakagawa Hidenori , Kato Masaru , Shirano Michinori
Published: January 2025

Background

Evaluation of Broad-Range 16S rRNA gene polymerase chain reaction (BRPCR) has been reported to aim in diagnosing infection by detecting and identifying bacterial genes in clinical specimens from patients with suspected infections. However, collecting the right specimens at the right time and determining whether the bacteria detected by BRPCR are the true cause or contamination requires infectious disease expertise. We investigate whether there is an association between the detection of bacteria that caused infection using BRPCR and intervention by Infectious Diseases (ID) physicians.

Methods

We reviewed the patients who underwent BRPCR at Osaka City General Hospital between April 2017 and March 2024. The collected items are age, sex, bacteria detected by BRPCR, determination of whether the bacteria if detected, caused infection, or were contaminated, and with or without the intervention of ID physicians (consultation to ID physicians). Then we analyzed the correlation between the intervention of ID physicians and the identification of the bacteria that caused the infection by BRPCR using Fisher's exact test. We also investigated whether the BRPCR results had affected the final diagnosis.

Results

There was a total of 149 clinical specimens from 138 patients. Of these, 84 (60%) were male, with a median age of 48 years (IQR 6-72). Bacteria were identified in 101 (67.7%) clinical specimens. In 70 specimens of them, the identified bacteria were presumed to have caused the infection. Of the 70 specimens, 56 had interventions by ID physicians. Whereas there were 79 specimens in which bacteria were identified but were presumed to be contaminants, and in which bacteria were not identified, of which 49 had intervention by ID physicians. The results showed an association between the intervention of ID physicians and the identification of the bacteria that caused the infection by BRPCR (p=0.0196). In 29 (19.4%), the final diagnosis changed from infectious to non-infectious based on the results of BRPCR.

Conclusion

Interventions by ID physicians might relate to identifying the bacteria causing an infection using BRPCR, and that might lead to enhancing the value of BRPCR.

Disclosures

All Authors: No reported disclosures
P-2170. CMV T-cell Immunity Panel (TCIP)-Guided Secondary CMV Prophylaxis Duration in Lung Transplant Recipients
Authors: Franceschi Coll Andres E , Diaz Marco Aurelio , Alshaker Hassan , Safiia Jawad , Moshovitis Dimitrios G , Atallah Christine , Sakr Paul , Farmakiotis Dimitrios , Koo Sophia
Published: January 2025

Background

CMV infection is a complication in lung transplant recipients (LTR), with associated morbimortality. There are many antiviral regimens, but extended use can lead to toxicity. The use of a CMV-specific TCIP (CMV inSIGHT, Viracor Eurofins) is being evaluated for CMV risk stratification in solid organ transplantation. In LTR with prior CMV reactivation or infection, it is challenging to determine the duration of secondary prophylaxis using clinical parameters alone. We aimed to assess if TCIP results can guide clinicians on the duration of secondary CMV prophylaxis in LTR.Table 1:Baseline Characteristics.

Methods

A retrospective cohort study in an 826-bed hospital in 55 adults (≥18 years) LTR from 2010-2024 and underwent TCIP to guide the duration of secondary prophylaxis after a prior CMV episode post-transplant (Table 1). We assessed CMV antivirals, TCIP results, post-TCIP treatment decisions, and post-TCIP reactivations. We considered decision-making concordant with TCIP results (TCIP-C) if antivirals were stopped in response to both CD4+ and CD8+ CMV-specific T-cells > 0.20% (a positive result) or continued prophylaxis if both were ≤ 0.20%. We considered decision-making discordant (TCIP-D) if antivirals were continued despite both values > 0.20 or discontinued despite both being ≤ 0.20%.Table 2:IGRA results with either CD4 or CD8 CMV-specific T-cell subpopulations as a threshold.

Results

100 unique TCIP were performed, with TCIP-C in 77 and TCIP-D in 23 (Table 2). In 31 TCIP-positive patients whose antivirals were discontinued, 29 (94%) had no further CMV viremia. In 8 patients with negative TCIP in whom prophylaxis was stopped (mostly due to patient preference), 3 (37%) developed viremia, and in 15 patients with a positive test who continued therapy, 100% had no further viremia. Of the 6 reactivations (1 CMV syndrome in a patient with a positive TCIP, 5 asymptomatic viremia), 4 occurred in patients with a negative TCIP; 3 in patients who stopped antivirals despite impaired immunity. Reactivation risk was higher in TCIP-negative patients discontinuing prophylaxis compared to TCIP-positive patients stopping antivirals (Fisher’s exact p=0.049) or TCIP-negative patients on prophylaxis (p=0.008).

Conclusion

CMV TCIP appears to be a useful adjunct in the management of secondary CMV antiviral prophylaxis in LTR. Prophylaxis can be safely discontinued in most LTR with a positive TCIP result.

Disclosures

Dimitrios Farmakiotis, M.D., Astra Zeneca: Grant/Research Support|Viracor: Advisor/Consultant|Viracor: Honoraria
P-2171. Comparing Saliva and Nasal Mid-turbinate Swabs for Detection of Respiratory Syncytial Virus (RSV), February 1–April 15, 2024, New Vaccine Surveillance Network
Authors: Sasidharan Anjana , Santos Montserrat , Dhar Minati , Maldonado Bri , Clopper Benjamin R , Moline Heidi L , Petty Sydnie , Banerjee Dithi , Selvarangan Rangaraj
Published: January 2025

Background

Current diagnostic methods for RSV and other respiratory viruses primarily rely on reverse transcription polymerase chain reaction (RT-PCR) testing of nasopharyngeal (NPS) or nasal mid-turbinate (MTS) swabs. Recent data in adults suggest saliva increases diagnostic yield of RSV. However, the potential of saliva as a specimen type for detecting RSV in children remains understudied. We compared the diagnostic yield of saliva and paired MTS samples for RSV detection in children.

Methods

Between February 1 to April 15, 2024, a total of 206 paired MTS and saliva samples obtained using the SalivaBio Children’s swab were collected on the same day from subjects under the age of 18 years presenting with acute respiratory illness symptoms. All MTS samples underwent testing using the QIAstat-Dx Respiratory SARS-CoV-2 Panel, which identifies RSV A+B cases. Subsequently, saliva samples from RSV-positive cases identified by MTS testing were extracted using the Kingfisher Apex platform. Positive RSV cases were subtyped by RT-PCR.

Results

Among 206 paired MTS and saliva specimens tested, RSV A/B was detected in 8 MTS and 7 saliva specimens. Saliva detected RSV A/B in 7 out of 8 (87.5%) samples that tested positive by MTS swabs. Both MTS and saliva tested negative for RSV in 197/206 specimens tested. The median (IQR) Ct values for paired MTS swabs and saliva samples were 25.05 (21.82 – 32.72) and 31.9 (27.45 – 34.48), respectively. The sample missed by saliva had a high Ct value of 36.6. Saliva detected an additional RSV-A positive case with a Ct value of 33.03, which was negative by the MTS swab. Overall concordance of saliva with MTS was 99% (204/206).

Conclusion

Although the number of RSV detections was low, preliminary findings from this analysis suggest high concordance between MTS and saliva for detection of RSV but that the addition of saliva does not increase diagnostic yield in children.

Disclosures

Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Grant/Research Support|Abbott: Honoraria|BioMerieux: Grant/Research Support|Cepheid: Grant/Research Support|Diasorin: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Luminex: Grant/Research Support|Qiagen: Grant/Research Support
P-2172. Development of a Point-of-Care Diagnostic for Congenital Cytomegalovirus
Authors: Monk Chandler H , Zwezdaryk Kevin J
Published: January 2025

Background

Cytomegalovirus (CMV), is the most common congenital infection in the United States. Congenital CMV (cCMV) affects 3-6 per 1000 live born infants yearly. Up to 80% of cCMV cases are asymptomatic but can result in long term sequelae, including sensorineural hearing loss. Despite improved diagnostic strategies and therapeutics, universal screening programs are not standard care. Our laboratory is addressing this gap by designing a novel isothermal CRISPR-based point-of-care assay for cCMV. Preliminary studies using laboratory samples and conditions have demonstrated the feasibility of our approach.

Methods

A CRISPR-Cas12a CMV specific detection system was designed against the CMV gene UL123 (immediate-early gene 1; IE1). Briefly, CMV was spiked into nuclease-free water samples and DNA was isolated using commercial kits. DNA was then amplified using standard PCR techniques. Amplified viral DNA was added to a reaction containing CRISPR-Cas12a, a fluorescent detection probe, and CMV UL123 guide RNA. The reaction was incubated at 37°C for 20 minutes. Fluorescent intensity of CMV spiked samples was compared to a no template control. The positive cutoff was calculated using the mean of the no template control + 3*SD.

Results

Using this strategy, we observed a limit of detection at 10 infectious units/mL of CMV. There was no cross reactivity to other alpha- or betaherpesviruses. This was repeated using CMV-spiked human serum, saliva, and urine samples, which resulted in a similar limit of detection. To further improve our assay, we replaced the DNA isolation and PCR steps with an isothermal one-pot reaction, using a UL123 padlock probe based rolling circle amplification system. Employing this strategy, we can detect CMV in samples in 2 hours at 37°C, without the need for DNA isolation, prior amplification, or the use of PCR equipment. This approach was validated by designing targets to detect Epstein Barr Virus (EBV).

Conclusion

We continue efforts to validate our isothermal point-of-care diagnostic to encourage cCMV universal screening implementation.

Disclosures

All Authors: No reported disclosures
P-2174. Politics and Money? Mpox Vaccine Coverage in the US: A Study in Healthcare Variation
Authors: Kang HeeEun , Rovelsky Suzette , Kang Nam Hoon , Talbot Elizabeth A , Murphy Richard A
Published: January 2025

Background

During the United States (US) mpox outbreak of 2022-2023, the federal government distributed mpox vaccines (JYNNEOS) to individual states for distribution to at-risk persons. For local distribution, there was no immediate federal funding available. The vaccines were not commercially available. Vaccination data was reported to states’ public health and the Centers of Disease Control and Prevention. There was considerable variation in vaccine coverage across different states.

Mpox vaccine coverage and associated factors for US states.

Methods

Using public data, we sought to identify state-level factors associated with full mpox vaccine coverage (two doses), including: political identity, public health spending, public health staffing, diversity index, poverty rate, percentage of population at-risk, and mpox cases. Data sources were: 2020 presidential election result, Association of State and Territorial Health Officials, 2020 US Census, and the CDC. Univariate and multivariable linear regression was performed using all studied variables. P-value of < 0.05 was used to note statistical significance.

Factors associated with mpox vaccine coverage: univariate linear regression.

Results

Nationally, average full mpox vaccine coverage for at-risk persons was 21%. Univariate analysis showed that Republican political status was associated with lower JYNNEOS vaccine coverage. Higher coverage was associated with higher public health spending per capita, increased diversity index, higher proportion of at-risk population, and greater number of absolute mpox cases. Multivariable analysis showed the following: Republican states achieved -5.65% lower vaccine coverage (p=0.036), each $1 increase in public health spending increased vaccine coverage by 0.05% (p=0.000), each additional MSM++ (men who have sex with men [MSM] on HIV pre-exposure prophylaxis plus MSM with HIV) per 1,000 people increased vaccine coverage by 1.5% (p=0.000), and each additional mpox case increased vaccine coverage by 0.003% (p=0.032). Multicollinearity check showed low correlation among tested variables.

Factors associated with mpox vaccine coverage: multivariable linear regression.

Conclusion

Higher mpox vaccine coverage was achieved in US states with Democratic political orientation, higher public health funding, higher proportion of at-risk population, and higher mpox cases. Additional analyses toward equitable vaccine access are needed.

Disclosures

All Authors: No reported disclosures
P-26. Increasing HPV Vaccination Rates in an Underserved Urban Population
Authors: Wang Heather M , Voss Shirin , Viswanathan Divya , Tangella Nikita , de Silva Piyumika , Walsh Jared
Published: January 2025

Background

Uninsured individuals are found to have lower rates of human papillomavirus (HPV) vaccination initiation compared to insured patients. Our primary care clinic is based in an urban setting, and is primarily comprised of non-English-speaking and uninsured individuals. Previous review of the clinic’s HPV vaccination rate showed 13% of patients were fully vaccinated against HPV and 24% were partially vaccinated, lower than the national rates of 21.5% and 39.5%, respectively. This study aimed to improve the rate of HPV vaccination to meet the national average.

Methods

This retrospective chart review evaluated all males age 18-21 and females age 18-26 who attended a primary care visit at our clinic between January 1st 2021 to February 29th 2024. A quality improvement initiative was implemented from January 1st, 2023 to November 1st, 2023, and included educating the medical team, crafting informational pamphlets, and fostering discussions with patients. HPV vaccination rates were examined pre-intervention (January 1st, 2023-January 1st, 2023) and post-intervention (November 1st, 2023 to February 29th, 2024.

Results

379 patients were included in the pre-intervention group: 311 (82%) female, 68 (18%) male, and 93 patients were included post-intervention: 84 (90%) female and 9 (10%) male. The rate of patients fully vaccinated against HPV increased from 13% (n=51/379) from the pre-intervention group compared to 27% (n=27/93) in the post-intervention group. The rate of unvaccinated patients decreased from 63% (n=240/379) to 34% (n=32/93). This change in vaccination rates was statistically significant (p< 0.01).

Conclusion

Implementation of a quality improvement initiative to educate the medical staff and patients allowed for a statistically significant increase in the rate of HPV vaccination in an urban primary care practice. Continued collection of vaccination data from our clinic will allow for further guidance on how to target vaccine uptake in this population.

Disclosures

All Authors: No reported disclosures
P-27. Impact of RSV( respiratory syncytial virus) Infection at ALM-VA
Authors: Gondalia Ivanshi , Cadena-Zuluaga Jose , Ford Delvina
Published: January 2025

Background

RSV infections, known for their respiratory complications, present a unique challenge in healthcare settings. Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults, resulting in approximately 60,000–160,000 hospitalizations and 6,000–10,000 deaths annually among adults aged ≥65 years

Methods

Retrospective review of the RSV cases from January 1, 2022 to October 27, 2023, at the South Texas Veterans healthcare system. We collected data(age and outcome of patients) from Theradoc (infection control surveillance tool used for surveillance) on positive RSV patients seeking care at South Texas Veterans Health Care System including the age of the positives, whether they had respiratory symptoms, were admitted to the hospital, and whether this admission was related to the respiratory symptoms.

Results

130 patients with positive RSV( by Biofire or Fluvid RSV PCR) were studied. The mean age of the population was 61.7 years, with a standard deviation of 15.8 and a median of 63.

Out of these, 73.8%(96/130) had only upper respiratory symptoms( Per CDC definition includes: rhinorrhea, cough, sneezing, nasal congestion) and 17.6% (23/130) had lower +/- upper respiratory symptoms.( Lower respiratory symptoms were defined as Tracheobronchitis, pneumonia, exacerbation of COPD, asthma, exacerbation of cardiac or neurological illness)

21.5%(28/130) of them were admitted due to some other reason but were found to be positive for RSV and 10.7%(14/130) of them were admitted due to RSV.

Almost 61% (79/130)of them were aged 60 and above and out of those, RSV was the reason to seek care in 83.5%(66/79) of them. 83.3% (55/66) of them had upper respiratory symptoms and almost 26% of them had lower +/-upper respiratory symptoms.

Almost 30%(23/79) of the patients over the age of 60 were admitted and RSV was the reason for admission in 53% (14/23) of them.

Variables included the age of the positives, whether they had respiratory symptoms, were admitted to the hospital, and whether this admission was related to the respiratory symptoms

Conclusion

This project's findings will contribute to promoting the vaccination against RSV in patients older than 60 years of age and improving patient outcomes.

Disclosures

All Authors: No reported disclosures
P-2202. Immune response after hepatitis B vaccination among healthcare providers in Uzbekistan
Authors: Ibragimov Rafail , Horth Roberta , Nabirova Dilyara , Denebayeva Alfiya , Kurbanov Botirjon
Published: January 2025

Background

About 2.5 million people in Uzbekistan have Hepatitis B virus (HBV). Mass HBV vaccination of healthcare providers was conducted in 2015 and 2022. Post-vaccination immunity testing was never performed. We aimed to estimate post-vaccination immune response and determine associated factors.Table 1.HBV tests and intepretation

Methods

We conducted a cross-sectional study in Tashkent in 2023. Participants were randomly-selected from a database of providers vaccinated in the 2015 and 2022 campaigns. Interviews and blood collection for hepatitis B surface antigen, anti-HBs, and core antigen testing was performed at the workplace (Table 1). We assessed differences in mean titers using the Kruskal-Wallis test and factors associated with protective immune response (anti-HBs ≥10mIU/mL) using multivariable Poisson regression expressed as adjusted prevalence ratios (aPR).Table 2.Characteristics of healthcare providers vaccinated against HBV, Uzbekistan

Results

Of 334 participants, 61% were vaccinated in 2015 and 39% in 2022 (Table 2). Average age was 40 years old (interquartile range:35–49 years), 87% were female, 52% were nurses, 53% worked in hospitals, and 9% had current or past HBV infection. Among those without prior infection (n=303), 71% had protective titers. Three-quarters (72%) had completed the entire 3-dose course, 21% had 2 doses, and 7% 1 dose; 41% followed recommended intervals between doses. Mean immune titers differed by age (68 mIU/mL among 19–32-year-olds vs 31 mIU/mL among >42-year-olds, p=0.021). The proportion with protective immunity did not differ by year vaccinated (70% in 2015 vs 71% in 2022), dose number (72% for those with 3 doses vs 67% with ≤2) or dose intervals (74% followed recommendation and 69% didn’t). Nurses and laboratorians were more likely than physicians to have protective immunity (aPR=1.11, 95% confidence intervals [CI]: 1.00–1.24, p=0.042 and aPR=1.13, CI:1.04–1.22, p=0.003, respectively), and primary care workers were less likely than hospital workers to be protected (aPR=0.91, CI:0.87-0.98, p=0.009) (Figure 1).Figure 1.Forest plot of factors associated with protective immunity following HBV vaccination among healthcare providers in Uzbekistan

Conclusion

A high proportion of healthcare providers remained unprotected after HBV vaccination in Uzbekistan, especially hospital workers and physicians. Strategies to increase compliance with vaccination schedules are needed. Adoption of post-vaccination immunity testing policy can identify providers that may require revaccination.

Disclosures

All Authors: No reported disclosures
P-31. Implementation of a Multi-Faceted Intervention to Improve Vaccination Rates in Older Adults
Authors: Archbald-Pannone Laurie , Settle Angie D , Molloy Leah , Simone Laura , Napolitan Chris , Carter Jeffrey D , Maytorena Jacqueline , Pillinger Kelly E
Published: January 2025

Background

Older adults are at high risk for poor outcomes from infectious diseases, yet rates of recommended vaccinations remain low among this age group. This quality improvement initiative aimed to increase vaccination engagement among older adults through patient-provider collaborative learning sessions (CLS) and use of a customized shared decision-making (SDM) tool.

Methods

From 8/23 – 1/24, the CLS and SDM tools were implemented in 6 primary care/geriatric clinics with surveys administered before and after. Healthcare professionals (HCPs) participated in audit-feedback (A/F) sessions to create action plans to improve their clinic’s vaccination rates. Follow-up patient and HCP surveys were administered 4-6 weeks and 90 days later, respectively.

Results

The top reported barriers to vaccination amongst the 133 patients who participated in the CLS were knowing which vaccinations were needed (57%) and paying for vaccines (54%). Following the CLS, patients’ knowledge about hospitalization due to RSV significantly increased from 40% (53/133) to 65% (80/123) (P < 0.001). Additionally, 59% (73/123) of patients stated they now planned to get recommended vaccines. Most patients (67%) listed a strong recommendation from a HCP as the best motivator to getting vaccinated, however, only 33% (8/24) of HCPs perceived that would be important (Figure 1).

Of the 72 patients who used the SDM tool and completed both surveys, only 40% reported being up-to-date on all recommended vaccines and 76% had not received a single dose of the shingles vaccine; 65% had not regularly discussed barriers to vaccination with their HCP. However, after using the SDM tool, 81% of patients reported they discussed their vaccination concerns more or much more than previous visits. Patients were more willing to get vaccinated following use of the SDM tool (72% to 89%, P = 0.01). Of the 14 HCPs who completed follow-up surveys, 57% reported increased vaccination rates following CLS and SDM implementation, with use of SDM (50%) and incorporating presumptive language into vaccine discussions (43%) as the top strategies employed.

Conclusion

Use of multi-faceted strategies to engage older adult patients in vaccine decision-making increased clinic-reported vaccine rates and patient-reported willingness to get vaccinated.

Disclosures

Laurie Archbald-Pannone, MD, MPH, prime, inc: Advisor/Consultant Kelly E. Pillinger, PharmD, AHFS: Contractor
P-33. Vaccine Hesitancy in HIV Patients Following the COVID19 Pandemic
Authors: Kropman Kory , Vahia Amit T , Szpunar Susan M , Johnson Leonard B
Published: January 2025

Background

The prevalence of vaccine hesitancy has been rising over the last several years and was exacerbated by the Covid19 epidemic with the introduction of the novel Covid19 vaccines. There are concerns that immunosuppressed individuals such as HIV patients may also demonstrate vaccine hesitancy to recommended non-Covid19 vaccines. In this study, we evaluated the rate of refusal of non-Covid19 vaccines in the pre- and post-period after release of the Covid19 vaccine.

Table 1

Summary of Vaccination Results. The distribution of the Pre-Covid and Post-Covid Group for each tested vaccine were compared. The direction of the distribution trend is listed and whether or not it was statistically significant (p<0.05)

Methods

We measured and compared the number of vaccines offered and refused at each visit over the total number of visits for 195 outpatients with HIV for 18 months and pre- and post-release of the Covid19 vaccines to the general public. The vaccines studied included the following: tetanus, pneumococcal, shingles, hepatitis A and B, and influenza. The data was collected using hospital records from the electronic medical record as well as Michigan Care Improvement Registry (MICR). Data was analyzed using descriptive statistics and the Wilcoxon signed ranks test. The Mann-Whitney U test, Kruskal-Wallis test and Pearson’s correlation were performed for this vaccine. In all statistical tests, a p-value less than 0.05 was taken to indicate statistical significance.

Results

Collectively, there were more refusals in the period after release of the Covid19 vaccine for non-Covid19 vaccines. This was also the case for all individual vaccines, except hepatitis A. There was an overall statistically significant difference (p < 0.001) in the distribution of vaccine refusals between the pre-Covid19 and post-Covid19 period. This was observed for the pneumococcal (p=0.026), hepatitis B (p=0.035), and shingles vaccine (p < 0.001) respectively.

Conclusion

This study provides evidence that there is an increase in non-Covid19 vaccine hesitancy following the release of the Covid19 vaccine among HIV outpatients. Larger studies should be performed to confirm this observation.

Disclosures

All Authors: No reported disclosures
P-2282. Infectious Complications Following Lung Transplant for COVID-19 Related Respiratory Failure
Authors: Kapur Nandita , Birk Navina K , Jayaprakash Rachna , Khalil Basmah , Singh Rajan , Hanna Zachary W , Ramesh Mayur , Alangaden George J
Published: January 2025

Background

Lung transplantation (LT) is a potentially life-saving treatment option for COVID-19 related irreversible respiratory failure. Early outcomes for 1-year survival and graft failure rates among LT recipients (LTr) for COVID-19 related respiratory failure is similar to LTr for non-COVID etiologies. However, the infectious, real-world analysis of complications following LT among LTr for COVID-19 related respiratory failure in comparison to LTr in COVID-19 unrelated respiratory failure has not been described. Our objective was to compare the post-LT infectious complications among LTr for COVID-19 related and unrelated respiratory failure.

Methods

We analyzed all consecutive LT done at Henry Ford Health System from January 2020 to October 2023. All patients received standard antimicrobial prophylaxis. Demographic data was obtained. The primary outcome was the rate of any infectious complication within one year from transplantation. Secondary outcomes were rates of specific infections, time to infection, and all-cause mortality at 30 days, 90 days, and 1- year.

Results

A total of 98 lung transplantations were done at our center from January 2020 to October 2023. COVID-19 related LTr accounted for 11% of transplants. Median time of follow up was 365 days (187-365). COVID-19 related LTr were younger (median 53 vs. 64 years [p 0.02]) and predominantly white race (p < 0.01). Comorbidities amongst both groups were similar. Rates of post-LTr infectious complications were similar among the two groups, 66% overall. Time to first infection was shorter in the COVID-19 related LTr cohort, however this did not reach significance. Pleuropulmonary infections predominated overall (47%). All-cause post-LT mortality was similar in both groups (Table 1).

Conclusion

Patients receiving LT for COVID-19 related respiratory failure have similar, high rates of infectious complications compared to patients with non-COVID-19 related etiologies, but mortality remains low. LT for COVID-19 related respiratory failure is an acceptable modality of treatment.

Disclosures

Mayur Ramesh, MD, AstraZeneca: Advisor/Consultant|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant
P-2283. Reversing Antimicrobial Resistance (AMR) in Febrile Neutropenia. Is it Possible?
Authors: Bansal Nitin , Sachdeva Ishita , Bhurani Dinesh , Agarwal Narendra
Published: January 2025

Background

Multi-drug resistance in gram-negative bacilli is major cause of concern in managing patients with febrile neutropenia particularly among hematology-oncology patients. Reversing AMR has never been demonstrated previously in this setting.

Table of various parameters comparing Cohort A and B

Methods

This retrospective study compares clinical and microbiological outcomes of patients admitted to hematology-oncology unit of a tertiary care center in India with febrile neutropenia and gram-negative bacteremia. Patients admitted from April 2019- April 2020 were included in Cohort A and April 2023-April 2024 were included in Cohort B.

Bar diagram showing change in resistance pattern in two cohorts

Results

A total of 212 patients (Cohort A: 114, Cohort B 98) were included in this study (Table 1). Mean age (53 ± 21.2 years vs 46.5 ± 17.5; p = 0.417) and gender distribution (females: 40.3% vs 36.7%; p = 0.58) were comparable and so was distribution of malignancies. Mean Sequential Organ Failure Assessment Score (6 ± 2.29 vs 5 ±3.50; p = 0.245), mean Charlson co-morbidity Index (3 ± 2.4 vs 3 ± 2.1; p = 0.65), mean Pitts Bacteremia score (1 ± 1.46 vs 1 ± 1.58; p = 0.334) and 30 day crude mortality (28.7% vs 28.6%; p = 0.935) were not statistically significant between the two cohorts. Incidence (Figure 1)of carbapenem resistance (CR) Klebsiella pneumoniae (56 (90.3%) vs 16 (47.1%); p < 0.01), CR E. coli (14 (43.7%) vs 6 (23.1%); p = 0.099) and DTR (difficult-to-treat) Pseudomonas aeruginosa (10 (83.3%) vs 2 (10.0%); p < 0.01) significantly reduced in Cohort B as compared to Cohort A. Involvement of Infectious Disease (ID) service, following antibiotic stewardship (AMS) team advice, improved diagnostic facility and infection control were major interventions during the study period.

Conclusion

This study highlights that incorporating ID service and following AMS activities along with other infrastructure development can reverse AMR in high risk setting like febrile neutropenia among hematology-oncology patients.

Disclosures

All Authors: No reported disclosures
P-2289. Gut Colonization With Multidrug-Resistant Organism And Its Impact On Bloodstream Infection In Children With Hematological Malignancies, A Prospective Observational Study
Authors: Khedr Reham , Abdelwahab Nadine , Kadry Dalia , Hamdy Rana
Published: January 2025

Background

Preventing infections due to MDR pathogens is particularly important in the era of MDR pathogens. Once colonization with an MDR strain occurs, the risk of subsequent infection is exceptionally high in neutropenic patients. For carbapenem-resistant Enterobacteriaceae, rectal colonization by resistant pathogens was followed by BSIs in 45% of neutropenic patients. The association between colonization and subsequent infection has been reported for many MDR bacteria, such as VRE, ESBL-producing Enterobacteriaceae, P.aeruginosa, S. maltophilia, and carbapenem or colistin-resistant K. pneumoniae

Methods

A prospective observational study was conducted at the National Cancer Institute on 70 children with hematological malignancies. Rectal swabs were collected at admission and weekly to screen for MDRO colonization. Demographic, clinical, and microbiological data were collected.

Results

At admission, 60% of children were colonized with MDROs. The most common MDROs were Escherichia coli (66%) [with CRE comprising 60% and ESBL 40%], Klebsiella CRE (16%), and methicillin-resistant Staphylococcus aureus (MRSA) (5%). Risk factors for MDRO colonization included previous antibiotic exposure, intensive chemotherapy, and prolonged hospitalization. During the study period, (28%) of the children developed BSI. Of these, (60 %) were caused by MDROs. MDRO colonization was significantly associated with an increased risk of MDRO BSI. Also, intrabdominal infection (Typlitis ) and Perianal Infection were reported in 15% and 14% of the MDRO-colonised children.

Conclusion

Gut colonization with MDROs is common in children with hematological malignancies and is associated with an increased risk of MDRO BSI. Strict infection control measures and judicious antibiotic use are crucial to prevent MDRO colonization and subsequent BSI in this vulnerable population.

Disclosures

All Authors: No reported disclosures
P-2293. Does Granulocyte-Macrophage Colony-Stimulating Factor as Adjunctive Therapy Affect Mortality in Patients with Hematologic Malignancies?
Authors: Snellings Robin , Wurster Sebastian , Matsuo Takahiro , Jiang Ying , Cho Sung-Yeon , Kontoyiannis Dimitrios P
Published: January 2025

Background

Invasive pulmonary aspergillosis (IPA) remains a major cause of illness and death in neutropenic patients (pts) with hematologic malignancies (HM). Because outcomes of IPA are mostly host-driven, adjunct host-targeted immunotherapies such as granulocyte-macrophage colony-stimulating factor (GM-CSF) have been used in cases of refractory or high-risk IPA, though the impact of GM-CSF on outcome remains unclear.

Methods

We reviewed records of all consecutive pts with HM and microbiologically documented IPA from sputum or bronchoalveolar lavage culture at MD Anderson Cancer Center (January 2016 - October 2021). Independent risk factors of 42-day (d) mortality and the impact of GM-CSF on outcomes were analyzed using multivariate Cox regression analysis.

Results

Of the 106 included IPA pts, 52 (49%) had leukemia/myelodysplastic syndrome and 54 (51%) had lymphoma/myeloma; 85 (80%) had active malignancy at IPA diagnosis (Figure 1). Thirty-two pts (30%) had a history of hematopoietic stem cell transplant and 37 (35%) had neutropenia < 100/µL at IPA diagnosis. Thirty-five pts (33%) received adjunct GM-CSF (Figure 1), started at a median of 3 d after initiating antifungal therapy (interquartile range [IQR] 1 – 18). The median duration of adjunct GM-CSF was 7 d (IQR 2 – 15). Forty-two-day all-cause mortality after IPA diagnosis was high (47%) and comparable in pts receiving GM-CSF and those who did not (51% vs. 45%, p = 0.54). Independent predictors of 42-d mortality were active HM (adjusted hazard ratio [aHR] 3.83, p = 0.026), neutropenia < 500/µL (aHR 1.83, p = 0.045), and albumin < 3 g/dL (aHR 2.45, p = 0.004) at IPA diagnosis (Table 1). Considering these co-variables and the timing of GM-CSF, the impact of adjunct GM-CSF on 42-d mortality remained insignificant (p = 0.19) in the multivariate Cox regression model (Table 1).

Conclusion

In a setting of significant IPA burden (i.e., culture-proven disease, neutropenic malnourished pts with active HM) and high overall mortality, adjunct GM-CSF therapy did not affect IPA outcomes. Early culture-independent biomarker-driven IPA diagnosis and immune markers for assessment of the host’s net state of immunosuppression will be pivotal to evaluate whether early preemptive deployment of host-targeted immunomodulators improves IPA outcomes in pts with HM.

Disclosures

Sebastian Wurster, MD, MSc, Astellas Pharma: Grant/Research Support|Gilead Sciences: Grant/Research Support Dimitrios P. Kontoyiannis, MD, AbbVie: Advisor/Consultant|Astellas Pharma: Advisor/Consultant|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Cidara Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Knight: Advisor/Consultant|Merck: Advisor/Consultant|Scynexis: Advisor/Consultant
P-2295. Risk Factors for and Impact of Enteric Gram-negative Infections on Lung Transplant Clinical Outcomes
Authors: Gupta Simran , Hernandezv Acosta R Alfonso , Chamberlin Elene , Woehl Ella , Connolly Erin M , O’Neill Audra , Coppolino Antonio , Sharma Nirmal , Baden Lindsey R , Woolley Ann E
Published: January 2025

Background

Bacterial infections such as Pseudomonas aeruginosa (PsA) and S. aureus lead to increased morbidity post-lung transplant. Less is known about the impact of enteric gram-negative (GNR) infections. This study’s aim was to assess risk factors for developing GNR infections within 6-months of transplant and associated 1-year outcomes compared to lung transplant recipients (LTR) with other bacterial infections or uninfected LTR.

Table 1

Characteristics and Outcomes of LTR with post-transplant GNR infections, other bacterial infections, and no infection

Methods

A single-center retrospective study of LTR between January 2017 and October 2023 was performed. Donor/recipient characteristics, microbiologic data, and 1-year clinical outcomes were analyzed.

Results

During the study period, 327 patients had a lung transplant with a greater than 30-day survival. 77 (23%) had GNR infections, 64 (20%) had either PsA, S. aureus, or Streptococcal infections (infect), and 186 (57%) did not have a bacterial infection within 6-months post-transplant. The GNR infections were: 18% Enterobacter cloacae complex, 16% E.coli, 25% Klebsiella sp., 7% Acinetobacter sp., 1% Serratia sp., 1% Citrobacter sp., 7% Burkholderia sp., 19% Stenotrophomonas sp., 6% others. Infections included: 19% bacteremia, 91% pneumonia, 5% empyema, 4% mediastinitis, 1% other. Donor, recipient, and perioperative characteristics were similar amongst the cohorts. A similar proportion of LTR donors were colonized with GNR, PsA, and S. aureus in the 3 cohorts pre-transplant. A greater proportion of the GNR cohort had delayed chest closure, required dialysis, mechanical ventilation, and/or ECMO for >48 hours, and had a longer ICU and index hospitalization compared to the other cohorts [Table 1]. The median time to infection was similar for the GNR and infect cohorts (52 and 51 days), but a greater proportion of the GNR cohort developed chronic kidney disease or respiratory failure. 6-month and 1-year survival were less in the GNR cohort but not statistically significant.

Conclusion

LTR with more complicated post-operative courses were more likely to develop enteric GNR infections which led to increased post-transplant morbidities. Pre-transplant GNR colonization was not a risk factor for GNR infection post-transplant. Strategies to minimize post-transplant enteric GNR infections need further study.

Disclosures

All Authors: No reported disclosures
P-2316. Comparing Whole Blood and Plasma Samples to Monitor EBV and CMV after transplantation
Authors: Fukuda Yuto , Torii Yuka , Iwada Ken-ichi , Haruta Kazunori , Yamaguchi Makoto , Suzuki Takako , Narita Atsushi , Muramatsu Hideki , Ogura Yasuhiro , Takahashi Yoshiyuki , Ito Yoshinori , Kawada Jun-ichi
Published: January 2025

Background

Viral reactivation may occur after hematopoietic stem cell transplantation (HSCT) or solid organ transplantation owing to immunosuppression and can lead to severe consequences. Routine weekly monitoring using quantitative PCR is recommended for cytomegalovirus (CMV) after both allogeneic HSCT and solid organ transplantation and for Epstein–Barr virus (EBV) after allogeneic HSCT. However, the sample type most suitable for monitoring remains unclear.

Methods

This retrospective analysis included 54 patients who underwent weekly viral monitoring using whole blood samples after HSCT or liver transplantation at the Nagoya University Hospital, Japan from January to December 2021. Whole blood and plasma samples were compared for their respective EBV and CMV DNA loads in the weekly serial samples from patients who tested positive for EBV or CMV at least once during the weekly virus monitoring. Subsequently, the dynamics of viral DNA were analyzed between the two sample types.

Results

Based on whole blood samples, EBV DNA was detected in 22 patients, whereas CMV DNA was detected in 24 patients. Both EBV and CMV were detected in 13 patients. A total of 164 and 183 pairs of whole blood and plasma samples, respectively, were compared for EBV and CMV DNA. EBV DNA was detected more frequently in whole blood (55%) than in plasma (18%). The detection rate of CMV DNA was similar between the two sample types. The correlations between the viral loads in the two sample types were 0.515 and 0.688 for EBV and CMV, respectively. Among paired samples in which EBV DNA was detected in whole blood, the plasma EBV detection rate was significantly higher in patients who underwent hematopoietic stem cell transplantation than in those who underwent liver transplantation (42% vs. 19%, p = 0.022). After the week with the highest viral load in whole blood, subsequent trends in viral load exhibited similar patterns in both EBV and CMV DNA levels in both whole blood and plasma samples.

Conclusion

The EBV detection rate was higher in whole blood, and a high correlation was observed between CMV DNA loads in whole blood and plasma samples. These results indicate that whole blood is useful for monitoring both EBV and CMV, whereas plasma is a potential alternative sample for monitoring CMV.

Disclosures

All Authors: No reported disclosures