bluuebunny/crossref_metadata_2025 huggingface dataset:
P-552. Viral load non-suppression among adults living with HIV on antiretroviral treatment in Sughd Region, Tajikistan, 2013-2022
Authors: Qurbonov Emomali , Nabirova Dilyara , Horth Roberta , Kubatova Aisuluu
Published: January 2025

Background

Unlike many other regions, Central Asia has an increasing incidence of HIV. Viral load suppression among people living with HIV (PLHIV) is a key strategy for reducing HIV transmission. We conducted a study to identify factors associated with viral load non-suppression among PLHIV on antiretroviral treatment (ART).

Methods

We conducted a retrospective study of adults (≥18 years old) newly diagnosed with HIV from 2013 to 2022 who received ART for 6+ months in the Sughd region. Data were abstracted from the national electronic registry of PLHIV and cross-checked with paper medical and laboratory records. Viral load non-suppression was defined as anyone with >1000 copies per ml after being on 6+ months of treatment. Descriptive statistics were performed to summarize the characteristics of the study participants. Bivariable and multivariable logistic regression was used to identify factors associated with viral load non-suppression. We present adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).Table 2.Factors associated with non-viral load suppression among adults with HIV who received antiretroviral treatment (n=1871), Sughd, Tajikistan, 2013-2022

Results

Of 1,871 people who were on ART for at least 6 months from 2013 to 2022, 11% did not achieve viral suppression. Of people on ART, 57% were male, 38% were migrants, and 68% lived in a rural area. The mean age was 31 years (range: 18-74) and 8% had a history of TB. One-third (32%) had late HIV diagnosis (23% in stage 3 and 9% in stage 4). The majority (94%) were on tenofovir lamivudine/dolutegravir (TDF/3TC/DTG) (Table 1). People diagnosed with stage 4 disease vs stage 1 (aOR=2.4, 95%CI=1.5–3.8; p< 0.01), males vs females (aOR=1.5, 95%CI=1.1-2.0; p=0.03), people who migrated after HIV diagnosis vs non-migrants (aOR=1.4, 95%CI=1.1-2.0; p=0.02), or were not married (single) vs married (aOR = 2.0, 95%CI=1.3–3.2; p=< 0.01) had increased odds of viral load non-suppression. People diagnosed in 2019-2022 had lower odds of viral load non-suppression compared to people diagnosed in 2013-2018 (aOR=0.5, 95%CI=0.4-0.7; p< 0.01) (Table 2).

Conclusion

Level of viral load suppression among people on ART in Sughd region of Tajikistan is below the global target of 95%. Increasing early detection and providing treatment support for groups with higher odds of non-suppression, especially males, migrants and people in later stages of the disease, can help with achieving global targets.

Disclosures

All Authors: No reported disclosures
P-555. Use of Long-Acting Cabotegravir/Rilpivirine in People Living with HIV with Renal Transplantation
Authors: Bchech George , Oehler Cassandra , Ma Qing , Carpenter Jennifer , Sureshkumar Kalathil , Rothman Ryan , Tives Debra , hsiao Chiu-bin
Published: January 2025

Background

Cabotegravir/Rilpivirine (CAB/RPV) represents a novel combination of long-acting injectable antiretroviral therapy (LAIART). Although the unique benefits of LAIART have been demonstrated in large clinical trials among people with HIV, including a favorable safety profile, few drug-drug interactions, and viral control without a daily oral pill requirement, evidence of LAIART use among PWH diagnosed with end-stage chronic kidney disease (CKD) and during kidney transplantation (KT) remains sparse.

Detailed timeline of all 3 patients in the study.

Methods

A phase IV clinical trial CAPRI (NCT05601128) was designed to evaluate the pharmacokinetics and safety of long-acting CAB/RPV among PWH with CKD >= stage 4 or ongoing hemodialysis. Three enrolled participants were included, in this analysis because of their KT status, of them, one KT before the trial and two KT during the trial. The peri- and post-operative effects of CAB/RPV LA were evaluated focusing on viral load, CD4+ counts, and potential drug interactions. According to protocol, CAB/RPV PK samples were obtained and planned to be measured and analyzed.

Results

All three participants have been virally suppressed (< 50 copies/ml) by CAB/RPV LA with stable CD4+ counts while maintaining appropriate graft function during 12months of study period. The timeline for each participant was depicted in the Figure and details were summarized in terms of virologic and immunologic outcomes as well as renal function at different study periods. CAB/RPV LA was well tolerated, without major related adverse events noted. The renal function was significantly improved, dialysis free, in two participants receiving KT during the trial whereas it remained stable, dialysis free, in the participant with prior KT. The reported tacrolimus trough concentrations were maintained within the therapeutic range to protect the graft function.

Conclusion

The safety and efficacy of CAB/RPV LA have been observed in these participants, supporting its potential use among those with severe renal impairment and kidney transplantation. Additional advantages including lack of adherence barriers and low drug interaction potential are likely to increase viral suppression and improve overall quality of life in this special population.

Disclosures

Chiu-bin hsiao, MD, Viiv, Gilead: Grant/Research Support
P-558. Long-acting Injectable Cabotegravir/Rilpivirine Plus Subcutaneous Lenacapavir Effective in People with HIV with Viremia and Cabotegravir or Rilpivirine Resistance-Associated Mutations
Authors: Brock James B , Denson Racolesha , Herrington Peyton , Hickman Melissa , King Heather , McIntosh Regan , Musa Sirna , Sanders Courtney , Walker Holly , Hickman Aubri
Published: January 2025

Background

Long-acting antiretroviral regimens have the potential to achieve virologic suppression in people unable to maintain adherence to daily oral antiretroviral therapy (ART). Long-acting injectable cabotegravir/rilpivirine (LAI CAB/RPV) is currently the only complete long-acting regimen and is recommended by IAS-USA for select patients with viremia. However, resistance-associated mutations (RAMs) among treatment-experienced people with HIV are common, precluding use of LAI CAB/RPV. LAI CAB/RPV plus subcutaneous lenacapavir (LEN) may provide therapeutic options for people with poor long-term adherence and cabotegravir or rilpivirine RAMs.Table 1.NNRTI Mutations by Patient

Methods

Patients at UMMC’s Adult Special Care Clinic were selected for LAI CAB/RPV plus LEN by a multidisciplinary panel. Criteria for selection included recurrent viremia despite intensive case management strategies, presence of historical or current RAMs to CAB or RPV, and partially- or fully-active cabotegravir based on mutation scores. Patients began therapy with LEN and LAI CAB/RPV on the same day. The prescribed regimen consisted of CAB/RPV 600/900 mg intramuscular at months 0 and 1 followed by every 2 months and LEN 600 mg oral daily x 2 days and 927 mg subcutaneous every six months. No oral lead-in of CAB/RPV was administered, and oral LEN was administered via directly-observed therapy.

Results

Nine patients were treated with LAI CAB/RPV plus LEN at UMMC. Mean baseline viral load was 36 251 copies/mL. All patients had RPV RAMs. One patient had CAB RAMs (N155H, T977A) conferring low-level resistance to CAB. The follow-up period ranged from 24-36 weeks. All patients maintained viral loads < 200 copies/mL during follow-up. Patients with baseline CD4 < 200 cells/µL demonstrated 208% increase in absolute CD4 count. No treatment-emergent resistance has occurred to date.

Conclusion

LAI CAB/RPV plus LEN achieved virologic suppression for up to 36 weeks of follow-up in PWH with incomplete adherence to oral ART and mutations to CAB or RPV. Further follow-up and larger sample size will be needed to determine long-term durability of this combination. Additional combinations of long-acting ART are vitally needed to achieve virologic suppression for all.

Disclosures

All Authors: No reported disclosures
P-561. Long-Acting Cabotegravir and Rilpivirine in HIV Individuals Over 60 years: a Real-World Study (RELATIVITY Cohort)
Authors: Troya Jesús , Bernal Enrique , Morano Luis , Montes Marisa , Galindo María José , Crusells María José , Torralba Miguel , Santacreu Mireia , Losa Juan Emilio , de Zárraga Miguel , Aguilera María , Cabello Noemí , Martín Patricia , Masiá Mar , Cabello Alfonso , Sepúlveda María Antonia , Carmen Fariñas Maria del , Santiago Alberto Diaz-De , Vivancos María Jesús , Llenas Jara , Carmen Montero María del , de la Calle Beatriz , Calderón Ruth , Mar García María del , Cecilio Álvaro , Pedrero Tomé Roberto , Buzón-Martín Luis
Published: January 2025

Background

The switching strategy to long-acting cabotegravir and rilpivirine (CAB+RPV) has emerged as a standard approach for people living with HIV (PLWH), offering high efficacy, safety, and convenience rates. Nevertheless, there is a scarcity of data regarding older PLWH, an important and growing population with physiological differences and arising comorbidities.

Methods

We conducted a multicenter, non-controlled, retrospective study on HIV virologically suppressed individuals who switched to long-acting CAB+RPV. We evaluated demographic and clinical factors associated with this switch in individuals over 60 years of age.

Results

The study included 154 individuals from 27 hospitals in Spain, representing 12.8% of the Relativity cohort, which comprised 1204 individuals. The median age was 63 years (range: 61 to 68), with 77.9% being men. 89.5% were Spaniards, followed by South Americans (6.5%). HIV transmission ocurred via HSH in 42.6% of cases and heterosexual in 27.7%. Comorbidities were present in 70.1% of individuals, with 17.5% having three and 3.9% having four. The most prevalent comorbidities were dyslipidemia (45.5%), high blood pressure (32.5%), and osteoporosis (19.5%).

The HIV infection median time was 22 years (range: 13 to 31), the antiretroviral therapy median time was 18 years (range: 11 to 24), and the median time of viral suppression was 12 years (range: 8 to 17). 24.5% were in CDC stage C3. The nadir CD4+ cell count was 240 (range: 111 to 374) cells/mm³, and 5.8% had previous virological failure with resistance mutations in 100% (NRTI, PIs or both). ART before switching included DTG/3TC (31.8%), DTG/RPV (28.6%), BIC/FTC/TAF (16.2%), DRV/c/FTC/TAF (5.2%), and EFV/FTC/TDF (1.9%). The main reasons for switching were patient request (43.5%), improvement in quality of life (35.7%), and simplification (23.4%). The efficacy rate at week 28 was 100%, with no discontinuations.

Conclusion

In a real-life setting, switching to long-acting CAB+RPV proves to be a viable option for individuals over 60 years old, with long-standing HIV infection and a high burden of baseline comorbidities, demonstrating sustained virological control over the initial 28 weeks of this treatment. Therefore, it should also be offered to older patients, even if they have multiple treated comorbidities.

Disclosures

All Authors: No reported disclosures
P-563. Low level viremia is associated with viral non-suppression within 96 weeks among adolescents with perinatally acquired HIV: a prospective cohort study
Authors: Paredes Jose Luis , Bemplidaki Danai , Dzavakwa Nyasha V , Chisenga Molly , Filteau Suzanne , Gregson Celia L , Kasonka Lackson , Kranzer Katharina , Banda-Mabuda Hildah , Mujuru Hilda , Redzo Nicol , Bandason Tsitsi , Rowland-Jones Sarah , Schaible Ulrich E , Simms Victoria , Ferrand Rashida
Published: January 2025

Background

Viral suppression, defined as having a viral load (VL) < 1,000 cop/mL is used as the threshold for antiretroviral treatment (ART) changes in WHO guidelines. It is unclear whether those with low-level viremia (LLV) (VL 60-999 cop/mL) and undetectable (VL< 60) have different HIV-related outcomes. This study investigated factors associated with having viral non-suppression (≥1000 copies/ml) within 96 weeks among adolescents with perinatally-acquired HIV in Zimbabwe and Zambia with viral suppression (< 1000 copies/mL) at baseline.

Methods

Longitudinal analysis of data from a trial using vitamin D and calcium supplementation on adolescents with perinatally-acquired HIV aged 11-19 years established on ART for > 6 months. Participants were enrolled from public-sector HIV-clinics in Harare and Lusaka and VL were measured at baseline, 48 weeks and 96 weeks. Those who completed follow-up until 96 weeks and were virally suppressed at baseline were included in this analysis. Enhanced adherence counselling was provided to those with viral non-suppression at 48 and 96 weeks. Multivariate Poisson regression was used for analysis of the association of viral-non suppression with VL at baseline, adjusting for age and sex a priori.

Results

A total of 656 who had a VL< 1000 at baseline and complete follow-up were included in this analysis. Median age was 15.2 years, 54.6% were female, 90 (13.7%) had viral non-suppression within 96 weeks: 49 (7.5%) at week 48, and 43 (6.6%) at week 96. Viral non-suppression occurred among 18/54 (33.3%) of those who had LLV at baseline in comparison to 72/602 (12.0%) of those that were undetectable at baseline. Adjusting for age and sex, those with LLV were 2.3 times more likely to have viral non-suppression within 96 weeks (adjusted risk ratio 2.32, 95%CI 1.53-3.51) in comparison to those undetectable. In univariate analysis, country, age, sex, being enrolled in school and baseline ART regimen were not associated with having viral non-suppression within 96 weeks of follow up.

Conclusion

Adolescents with LLV are at higher risk of viral non-suppression within 96 weeks than those with undetectable VL, with implications for HIV transmissibility, resistance to ART and HIV-related clinical outcomes.

Disclosures

All Authors: No reported disclosures
P-573. Analysis of Cabotegravir-Rilpivirine Use in HIV Patients at MedStar Washington Hospital Center
Authors: Koutsoupias Panagiotis , Wortmann Glenn , French Kimberly , Navigator Treatment
Published: January 2025

Background

Intramuscular cabotegravir-rilpivirine (CAB-RPV) is a long-acting antiretroviral for the treatment of HIV which can be administered every 1-2 months. Registration trials demonstrated the non-inferiority of CAB-RPV versus oral antiretroviral therapy, but data on the ‘real world’ performance of CAB-RPV is sparse. In addition, these trials required HIV virologic suppression (viral load (VL) < 50 copies/mL) with oral medications before transitioning to CAB-RPV. Small studies have reported success when CAB-RPV was started in patients with detectable viremia, and our study sought to build on those findings.

Methods

Descriptive, retrospective study based on patients who began treatment with CAB-RPV between May 2022-Nov 2023. Virologic undetectability (VL < 50 copies/mL), suppression (VL 51-200 copies/mL) and virologic failure (VL > 201 copies/mL) at last measurement are described among patients with a VL < 50 copies/mL, 51-200 copies/mL or >201 copies/mL at baseline.

Results

42 patients are included in the analysis with a median age of 42 (range 27-80). The cohort was 93% African American, 60% male and 81% received Medicare/Medicaid or both as their primary insurer. Median CD4 count was 861 (range 15-1827) and median viral load was 40 copies/mL (range < 20-294,000). Among 38 patients with a baseline VL of < 50, 34 maintained viral undetectability, 1 become virally suppressed (VL=60) and 3 did not have results available due to recently starting CAB-RPV. One patient with baseline viral suppression (VL=90) became virally undetectable. Two patients with baseline virologic failure (VL 1,210 and 7,200) became virologically undetectable. One patient with baseline virological failure (VL=294,000) developed resistance shortly after starting therapy.

Conclusion

Similar to data in registration trials, CAB-RPV maintained viral suppression in 100% of patients who were at least virally suppressed at baseline. Two patients with virological failure at baseline achieved virological suppression, adding to data that CAB-RPV may be beneficial in patients who are unable to adhere to oral antivirals. One patient with baseline virological failure and high viral load quickly developed resistance after starting therapy, supporting data that CAB-RPV needs to be used carefully in certain populations.

Disclosures

All Authors: No reported disclosures
P-614. Acceptance of vaccination - strategies for populations of Ukrainian children migrating to Poland
Authors: Dzielska Anna , Kleszczewska Dorota , Lewtak Katarzyna , Mazur Joanna
Published: January 2025

Background

The presence of a significant number of refugees from Ukraine in Poland creates a need to understand and improve the immunisation status of children in this population. UNICEF and WHO data indicate potential challenges in maintaining adequate vaccination coverage in the refugee population. In this context, this study aims to identify factors influencing vaccination decisions among parents of Ukrainian children living in Poland. The main objective of this project is to increase vaccination coverage among Ukrainian children (0-5 years) in Poland.

Methods

A pilot study to identify the main barriers and determinants of vaccination decisions among parents of newly arrived war migrants from Ukraine was conducted online and included a group of 187 refugees from Ukraine, most of whom were women. Participants in the study were analysed in terms of their barriers and concerns about vaccinating their children.

Results

Preliminary results of the survey indicate that the main sources of information about vaccination for Ukrainian parents are doctors and the media. The most commonly reported barriers include difficulties in accessing health services, lack of knowledge about vaccination schedules, and language barriers. Concerns about returning to Ukraine and lack of information about the effects of vaccines are also important. Based on the findings, a behaviour change strategy based on the COM-B theoretical model and a systems approach is proposed. The implemented education and outreach activities, supported by media campaigns and psychosocial support, should aim to increase the capability, motivation and opportunity of Ukrainian parents to make informed decisions about vaccination. Between 24.02.2022 and 31.01.2024, 37,315 Ukrainian children aged 0-5 years were vaccinated in Poland.

Conclusion

The effectiveness of interventions should be further investigated; however, the available evidence suggests that a comprehensive approach involving a variety of systems can contribute to improving the immunisation status of children among the Ukrainian refugee population in Poland.

Disclosures

All Authors: No reported disclosures
P-620. High Risk, Low Compliance: Surprising Post-Pandemic Influenza Vaccine Trends in a Children's Hospital
Authors: Leyden Brianna , Gornick Wendi , Tran Martin T , Singh Jasjit
Published: January 2025

Background

Post-pandemic, the CDC reports a decline in influenza vaccinations in children 6 months to 17 years by 6.3% from 2019-2020 to 2022-2023. We describe concerning widespread declines in our institution in inpatient influenza vaccinations, outpatient oncology influenza vaccine rates in those receiving active chemotherapy, and employee vaccinations. We present these trends in the context of local influenza epidemiology, influenza admissions, and reasons for refusal.

Methods

Our institution, a free-standing children’s hospital, collected inpatient influenza vaccinations based on calendar years 2019-2023 and influenza admission rates over winter seasons 2018-2019 to 2022-2023. Additionally, employee vaccination rates, including reasons for refusal, were collected fall/winter 2018-2019 to 2023-2024. Lastly, oncology clinic influenza vaccination rates among the high-risk patients receiving active chemotherapy were collected from Sept-Dec 31 2020-2023.

Results

Although influenza admissions plummeted from 302 in winter 2019-2020 to 0 in winter 2020-2021, these admissions have since rebounded (Fig. 1). While inpatient influenza immunizations have continued to decline to a low of 0.0029 vaccines/patient day, they are now outpaced by influenza admissions at 0.0037 admissions/patient day (Fig. 2). This trend in decreased vaccines is echoed in oncologic patients on active chemotherapy, with non-medical refusals increasing from 5% in 2020 to 16% in 2023, and in employees, with refusals increasing from 1.9% in 2019 to 5.3% in 2024 (Fig. 3). Although employee rates for medical exemption are consistent, non-medical reasons for refusals have increased 6-fold from 2019 to 2024 (Fig. 4).

Conclusion

We saw a decline in influenza vaccine rates for hospitalized patients, immunocompromised outpatient oncology patients on active chemotherapy, and employees, despite increased influenza burden in the community post-pandemic. The latter were almost exclusively due to non-medical reasons for refusal. Further study needs to be done to elucidate post-pandemic vaccine trends and identify missed opportunities for immunization, particularly in high-risk patients and their contacts, with emphasis on bolstering influenza vaccine confidence in not only patients, but staff.

Disclosures

All Authors: No reported disclosures
P-631. RSV Prophylaxis with Nirsevimab in Infants: Systematic Review of Early Real-World Evidence on Effectiveness and Impact
Authors: Wick Moritz , Meyer Anna C , Damm Oliver , Wülfing Annika , Martyn Oliver , Kramer Rolf , Knuf M
Published: January 2025

Background

Respiratory syncytial virus (RSV) is a leading cause of respiratory tract infections and hospitalizations among infants worldwide. In 2023, the universal RSV immunization of all infants with the novel monoclonal antibody nirsevimab was introduced in several countries. This systematic review aims to summarize early real-world evidence on achieved immunization rates as well as on the impact and effectiveness of nirsevimab prophylaxis among infants.

Methods

A systematic literature search for full-text publications was conducted in the databases PubMed and Embase. The review included observational studies that investigated the impact or effectiveness of nirsevimab in routine use. Clinical research, decision analytic modeling studies, and studies describing the disease burden of RSV without direct reference to nirsevimab use were excluded.

Results

Five studies fulfilled the inclusion criteria, including one from the United States (US), one from Luxembourg, and three studies from different regions in Spain. Population-wide immunization rates were reported in Luxembourg and several Spanish regions, all exceeding 80%. Four studies estimated the effectiveness of nirsevimab in preventing RSV-related hospitalizations, including two population-based cohort studies and two case-control studies. The effectiveness of nirsevimab in preventing RSV-related hospitalizations was calculated at 88.7% (95%-CI: 70-96), 84.4% (95%-CI: 77-90), and 82.0% (95%-CI: 66-90) in the Spanish studies and 90% (95 %-CI 75-96) in the US. While no effectiveness estimate was reported in Luxembourg, the number of RSV-related hospitalizations among infants under 6 months decreased by 69% after nirsevimab introduction compared to the same period of the previous year.

Conclusion

High uptake was observed in both Luxembourg and Spain. Despite methodological differences between studies and varying implementation strategies between countries, observed effects of recommending nirsevimab to all infants were largely consistent. International evidence suggests that nirsevimab substantially reduces RSV-related hospitalizations and thus relieves the burden on healthcare systems during the RSV season.

Disclosures

Moritz Wick, MSc, Sanofi: Employee|Sanofi: Stocks/Bonds (Public Company) Anna C. Meyer, PhD, Sanofi: Employee Oliver Damm, PhD, Sanofi: Employee Annika Wülfing, PhD, Sanofi: Employee and may hold stocks Oliver Martyn, MPH, Sanofi: Employee of Sanofi|Sanofi: Stocks/Bonds (Public Company) Rolf Kramer, PhD, Sanofi: Employee of Sanofi|Sanofi: Stocks/Bonds (Public Company)
P-650. In vitro Activity of Cefiderocol and Comparator Agents Against Global Enterobacterales Isolates From Hospitalized Patients with Pneumonia Collected as Part of the SENTRY Surveillance Program (2020-2022)
Authors: Bryowsky Jason J , DeJonge Boudewijn L , Nguyen Sean T , Maher Joshua , Mendes Rodrigo E , Longshaw Christopher M , Takemura Miki , Yamano Yoshinori
Published: January 2025

Background

The in vitro activity of cefiderocol (CFDC) and comparator agents was evaluated against Enterobacterales isolates collected from patients with pneumonia during 2020-2022 as part of the SENTRY Antimicrobial Surveillance Program.

Methods

5,793 Enterobacterales (40.5% Klebsiella spp., 19.6% E. coli, 13.6% Serratia spp., 11.6% Enterobacter spp., 5.1% Proteus spp., 5% Citrobacter spp., 4.6% other) were collected from pneumonia patients and tested for susceptibility (%S) using CLSI broth microdilution with cation-adjusted Mueller-Hinton broth (CAMHB) or iron-depleted CAMHB for CFDC. Comparator agents included β-lactam/β-lactamase inhibitor (BL/BLI) combinations ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), imipenem-relebactam (I-R) meropenem-vaborbactam (M-V), piperacillin-tazobactam as well as meropenem (MEM), cefepime and ceftazidime . Susceptibility was interpreted according to 2024 CLSI|FDA, and EUCAST breakpoints. Carbapenem resistant Enterobacterales (CRE) was defined as resistant to imipenem and MEM. Multidrug-resistant (MDR) Enterobacterales was defined as nonsusceptible to at least 1 drug from ≥3 classes and extensively drug resistant (XDR) as susceptible to ≤2 classes per 2024 CLSI criteria.

Results

47% and 53% of isolates were from North America and Europe, respectively. CFDC, MEM, CZA, I-R and M-V all showed high susceptibility against all Enterobacterales isolates ( >94/ >97 %S using CLSI|FDA/EUCAST breakpoints). Against CRE, CFDC (99.7/83.5 %S CLSI|FDA/EUCAST) was the most active agent while CZA was the second most active (74.7%S CLSI|FDA and EUCAST). CFDC, CZA, I-R, M-V were most active against MDR isolates ( >93/ >94 %S CLSI|FDA/EUCAST) however, CFDC (94.4/81.1 %S CLSI|FDA/EUCAST) was the only agent with appreciable activity against XDR isolates.

Conclusion

CFDC demonstrated high in vitro activity against Enterobacterales isolated from hospitalized patients with pneumonia, including MDR and XDR isolates. Susceptibility for comparator agents, comprising BL/BLI combinations, was generally lower against isolates with CRE and XDR phenotypes. CFDC represents an important treatment option for pneumonia infections caused by Enterobacterales with presumed or defined CRE, MDR, or XDR phenotypes.

Disclosures

Jason J. Bryowsky, PharmD, MS, Shionogi: Employee Boudewijn L. DeJonge, PhD, Shionogi Inc.: Employee Sean T. Nguyen, PharmD, Shionogi Inc.: Employee Rodrigo E. Mendes, PhD, GSK: Grant/Research Support Christopher M. Longshaw, PhD, Shionogi BV: Employee Miki Takemura, n/a, Shionogi & Co., Ltd.: Employee Yoshinori Yamano, PhD, Shionogi & Co., Ltd.: Employee
P-652. Evaluation of Empiric Antibiotic Use for Community Acquired Pneumonia
Authors: Plechot Kamryn , Lee Helen , Park Steven
Published: January 2025

Background

Pneumonia is one of the most common infections resulting in hospitalization. Timely and appropriate empiric antibiotic treatment is crucial to improve prognosis in patients with community-acquired pneumonia (CAP). However, the use of empiric broad spectrum antibiotics is associated with serious consequences including development of antibiotic resistance and unintended adverse drug reactions. The Infectious Diseases Society of America (IDSA) guideline for the treatment of CAP recommends evaluation of specific risk factors to determine the need for empiric broad spectrum antibiotic coverage. The purpose of this study is to evaluate empiric antibiotic adherence to the IDSA CAP guideline.

Methods

This single center retrospective cohort study evaluated hospitalized adult patients aged 18 years and older who were started on empiric antibiotics for treatment of CAP in the emergency department. Patients were excluded if they were transferred from an outside hospital or were admitted with COVID-19. Baseline characteristics recorded included categorization of non-severe vs severe pneumonia, risk factors for multi-drug resistant organisms, empiric antibiotic therapy, and culture results. The primary outcome evaluated the percentage of patients who received appropriate empiric antibiotic treatment for CAP according to the IDSA guideline.

Results

A total of 150 patients were included in this study. Approximately 35% of patients presented with severe community acquired pneumonia. The initial antibiotic regimen administered in the emergency department for treatment of suspected CAP was consistent with the IDSA CAP guidelines in 48% of cases. Within twenty-four hours after admission, nearly 25% of cases were optimized to guideline directed therapy. Of the patients with positive culture results, empiric antibiotics were optimized within approximately 48 hours.

Conclusion

More than half of patients who were started on empiric antibiotics for CAP received broad spectrum antibiotics that were not indicated according to the IDSA guidelines. Most patient’s antibiotic regimen was optimized according to the guidelines within 48 hours. Additional stewardship efforts should be implemented in the emergency department to reduce empiric broad spectrum antibiotic use.

Disclosures

All Authors: No reported disclosures
P-655. Validation Of DRIP Score And Derivation of Local Score Predicting Multi-Drug Resistant Pathogens in Patients with Community Acquired Pneumonia
Authors: Ibragimova Nayle , Siegrist Emily A , Sassine Joseph , Neely Stephen , McCloskey Cindy B , White Bryan
Published: January 2025

Background

A subset of patients with community acquired pneumonia (CAP) may develop pneumonia due to multi-drug resistant organisms (MDROs), and identifying risk factors for MDROs can be challenging. The 2019 CAP guideline recommends using “locally validated risk factors” to determine the need for empiric treatment of MDROs. The Drug Resistance in Pneumonia (DRIP) score is a commonly used tool to predict MDROs in CAP and was validated in various institutions. We performed this study to validate the performance of the DRIP score in our patient population and to derive a local risk prediction score.

Methods

This was a retrospective chart review of patients with positive cultures from respiratory samples, blood, or pleural fluid for organisms known to cause pneumonia with data obtained from March 1, 2021 to January 31, 2023. Data on disease severity, comorbidities, previous hospitalizations, prior antibiotic use, and history of infections with MDROs were used to locally validate the DRIP score, and to derive local risk prediction score using logistic regression.

Results

Utilizing data from 201 patients, the DRIP score demonstrated a sensitivity of 52%, specificity of 86%, positive predictive value (PPV) of 74%, and negative predictive value (NPV) of 70% for an MDRO as the microbiological etiology of CAP, using a threshold of > 4 points. Logistic regression analysis showed that history of infection with MDROs within 1 year, antibiotic use within 60 days, tube feeding, and chronic pulmonary disease were additional local risk factors in predicting CAP caused by an MDRO with a sensitivity of 49%, specificity of 86%, PPV of 73%, and NPV of 68%.

Conclusion

At our institution the DRIP score performed with lower sensitivity and lower NPV than the original DRIP validation study. The locally derived score based on the above 4 risk factors also demonstrated decreased performance. These findings may represent limitations of retrospective design where previous antibiotic history, hospitalization, and laboratory data were not always available, resulting in false-positive and false-negative results. Additionally, a proportion of false-negative results occurred in patients who had a post-influenza or post-COVID-19 secondary bacterial pneumonia due to methicillin-resistant Staphylococcus aureus.

Disclosures

Joseph Sassine, MD, Ansun BioPharma: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|Community Infusion Solutions: Grant/Research Support|F2G: Grant/Research Support|Shionogi: Grant/Research Support Bryan White, PharmD, BCPS, BCIDP, Melinta: Advisor/Consultant|Shionogi: Grant/Research Support
P-669. Characteristics of hospitalized adult patients with hMPV infection in the post-covid era
Authors: Pyrpasopoulou Athina , Zarras Charalampos , Kouroupis Dimitrios , Michailidou Chrysi , Soukiouroglou Prodromos , Pateinakis Panagiotis , Mpani Konstantina , Terzaki Maria , Molyvas Dimitrios , Vagdatli Eleni
Published: January 2025

Background

Human Metapneumovirus (hMPV) is a recently described respiratory tract virus with significant morbidity among children of younger age. The widespread molecular diagnostic testing has identified hMPV as an important pathogen of the upper and lower respiratory tract even in adults, especially the older and immunosuppressed. The aim of this study was to identify patients hospitalized with hMPV infection and describe their characteristics.

Methods

Rhinopharyngeal samples of admitted patients with respiratory tract infection in the years 2021-22, 2022-23 and 2023-24 from October 1st – March 31st were tested by multiplex PCR analysis (Film array Respiratory panel, Biomerieux, France). Positive patients aged >18 years for hMPV were included in the analysis. Demographic data, clinical and laboratory characteristics were recorded, and correlated with the duration of admission.

Results

In total, 1993 samples were tested (76 in 2021-22, 554 in 2022-23, and 1363 in 2023-24). Among those, 0, 13 and 8 adults were found to be positive respectively, 8 male and 13 female with a mean age of 68,1 years (±17,8). Upon admission, 52,4% of the patients had pulmonary infiltrates on X-Ray. Median CRP was 101,1mg/L (nv < 5mg/L). In 39,1% of the patients another pathogen was isolated from clinical samples (in 4 patients from urine, in 2 from sputum and in 2 from blood cultures). All patients received antibiotics, 61,9% systemic steroids and 81,0% inhaled bronchodilators. One patient aged 94 years died. CRP levels were not associated with the detection of other pathogens (p=0,485). Mean duration of admission (7,3±4 days) was not associated with age. The co-isolation of other pathogens, and CRP levels tended to correlate with longer duration of hospitalization (p=0,100, and p=0,068 respectively), Table I.

Conclusion

HMPV is implicated in respiratory tract infections. Clinical presentation is associated with respiratory distress with significantly elevated inflammatory markers, requiring inhaled bronchodilators and systemic steroids. The significant majority of the patients recovers without sequelae.

Disclosures

Athina Pyrpasopoulou, MD PhD, Gilead: Honoraria|Pfizer: Honoraria
P-673. Respiratory Syncytial Virus (RSV) Hospitalizations During Off-Season Months Among Infants in US
Authors: Law Amy W , Lin Jay , Judy Jennifer , Cane Alejandro D , Pugh Sarah J
Published: January 2025

Background

The CDC currently recommends two prevention options to help protect infants against RSV-associated lower respiratory tract disease during a typical RSV season, defined as October through March. However, annual and geographic variability in RSV seasonality exists. The study evaluated the burden of RSV hospitalizations occurring outside a typical season (i.e., April – September).

Methods

Infants aged < 12 months old hospitalized with RSV were identified from the PINC AI Healthcare Database (7/1/2018 to 6/30/2023) for this descriptive cohort study. Because age is reported in years, a prior birth hospitalization record was required to determine age in months for RSV hospitalization. A surveillance year was defined by the period of July 1 of each year to June 30 of the following year. Monthly RSV hospitalizations were tallied for each of the 9 U.S. census divisions and by age group (< 3, 3-5, 6-8, 9-11 months). Seasonality of RSV cases among all infants < 1 year, regardless of the ability to identify age in months, was evaluated as a sensitivity analysis.

Results

A total of 56,425 RSV hospitalizations were identified among infants < 1 year of age, of which, 36% (n=20,531) of patients had a birth record. RSV hospitalization counts during the 5 surveillance years were 4,574 (2018/19), 4,926 (2019/20), 452 (2020/21), 4,344 (2021/22), and 6,235 (2022/23). Overall, 22% (n=4,510) of RSV hospitalizations occurred during off-season months, with 83% of these off-season cases occurring in June – September across various divisions (Fig. 1). Of all RSV hospitalizations that occurred during off-season, 45.5% (n=2,054) were among infants < 3 months. Seasonal patterns were similar across age groups (Fig. 2). A sensitivity analysis showed consistent seasonal patterns among all infants < 1 year of age.

Conclusion

This large-scale, real-world database analysis showed over 1 in 5 infants hospitalized with RSV were infected during off-season with varying rates by geography. The current recommendations may limit protection options for infants exposed to RSV outside the typical season.

Disclosures

Amy W. Law, PharmD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Jay Lin, PHD, MBA, Pfizer: Advisor/Consultant Jennifer Judy, MS, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Alejandro D. Cane, MD, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company) Sarah J. Pugh, PhD, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company)
P-675. Online Clinician Education Curriculum Results in Performance Changes in Clinical Practice for Recommending Available Respiratory Syncytial Virus Vaccines in Older Adults
Authors: Nair Arun S , Capparelli Catherine , Misiuta Iwona
Published: January 2025

Background

This study examined whether online continuing medical education (CME/CE) focused on evidence-based best practices for recommending available respiratory syncytial virus (RSV) vaccines would result in improved understanding of adults disproportionally affected by RSV, the clinical guidance of available vaccines, and communication strategies to encourage older adults to get vaccinated for RSV.

Methods

Clinicians who participated across a curriculum of 3, live and online, 30-minute CME/CE video discussions between experts. Performance was assessed by inviting learners to complete a survey 30-60 days post-education, identifying practice changes and the degree to which clinicians experience barriers to those changes. The data was collected from 12/29/2023 to 04/04/2023.

Results

There were 13,232 learners consisting of PCPs, Pharmacists, Advanced Practice Providers, and others who completed the survey. The analyses from the program showed that ∼90% of learners made a practice change or had practices reinforced due to education. Five key practice changes to recommending available RSV vaccines included:

Educate eligible patients/caregivers on the risk of RSV in older adults (93% PCPs, 93% Pharm, 95% NPs/Nurses, 92% PAs)

Recommending available RSV vaccines for older adults (93% PCPs, 93% Pharm, 95% NPs/Nurses, 93% PAs)

Use alternative communication methodologies with patients (15% PCPs, 21% Pharm, 14% NPs/Nurses, 16% PAs)

Collaborate with different members of the patient’s care team (11% PCPs, 22% Pharm, 13% NPs/Nurses, 16% PAs)

Some of the practice barriers identified by the learners include:

Lack of clear recommendations from evidence-based guidelines

Lack of time to educate patients on the importance of getting vaccinated for RSV

Patient concerns/questions regarding available RSV vaccines

Organizational limitations to providing the vaccine

Conclusion

The practice changes identified in this assessment provide compelling evidence that participation in online CME/CE prompts adoption of changes in practice related to RSV vaccination. Future education is needed to address the barriers identified in this assessment.

Acknowledgement:

This education was supported by an independent educational grant from Pfizer Inc. and in partnership with Immunize.org

Disclosures

All Authors: No reported disclosures
P-676. Risk Factors Associated with Longer Hospital Stay in Elderly Patients with Respiratory Syncytial Virus Infections
Authors: Bhargava Ashish , Szpunar Susan M , Sharma Mamta , Saravolatz Louis
Published: January 2025

Background

Annually, 3-7% of healthy older patients and 4-10% of high-risk adults develop respiratory syncytial virus (RSV) infections. Elderly patients above 65 years of age, with congestive heart failure, chronic lung disease, or weakened immune systems are at high risk for severe RSV infections. Little is known about the factors that are associated with the length of hospital stay (LOS) among these elderly individuals.

Methods

A multicenter historical cohort study was conducted on elderly patients ( >65 years of age) hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in Southeast Michigan between January 2017 and December 2022. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Electronic medical records were reviewed after IRB approval. LOS was categorized as below the mean LOS or at the mean and above. Data were analyzed using Student’s t-test, the chi-squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0.

Results

Of 239 patients, the mean (sd) age of the cohort was 78.3 + 8.4 years, 157 (65.7%) were female and 176 (73.6%) were white. The mean body mass index (BMI) was 29.5 + 8.8 kg/m2. The mean Charlson Weighted Index of Comorbidity (CWIC) score was 2.4 + 2.0. The mean hospital LOS was 7.5 + 5.1 days. Prolonged LOS was noted in 89 (37.2%) patients. Factors associated with longer LOS ( >7.5) in univariable analysis were chronic lung disease, solid tumors, CWIC score, smoking status, home oxygen, oxygen requirement during hospitalization, qSOFA, abnormal admission chest x-ray (CXR), lower respiratory tract infection, and respiratory failure requiring intubation. The multivariable logistic regression revealed that predictors for prolonged LOS among elderly patients were smoking status (OR, 2.2; 95% CI 1.2-4.0), abnormal admission CXR (OR, 2.1; 95% CI 1.2-3.7), and respiratory failure requiring intubation (OR, 9.4; 95% CI 2.6-34.4).

Conclusion

Our study finds that patient’s smoking status, abnormal admission CXR and respiratory failure requiring intubation were significantly associated with prolonged LOS among elderly patients with RSV infections. Knowing these risk factors may help identify patients who would benefit from early interventions to mitigate the duration of hospitalization.

Disclosures

All Authors: No reported disclosures
P-680. Estimated Respiratory Syncytial Virus (RSV)-Related Hospitalizations and Deaths among Adults in Norway between 2010–2019
Authors: Casas Maribel , Molden Tor , Liang Caihua , Bruyndonckx Robin , Biyadgie Ewnetu Worku , Peerawaranun Pimnara , Molalign Moges Solomon , Polkowska-Kramek Aleksandra , Gessner Bradford D , Begier Elizabeth
Published: January 2025

Background

RSV can trigger acute cardiac events and cause respiratory disease in adults, but the true burden of RSV-associated disease and mortality remains largely underestimated due to limited standard-of-care testing and reduced test sensitivity. We retrospectively estimated the incidence of hospitalizations and deaths attributable to RSV in adults in Norway from 2010 to 2019

Methods

Counts of weekly hospitalizations and monthly deaths due to cardiorespiratory (ICD-10 codes: I00-I99, J00-J99), respiratory (J00-J99), and cardiovascular (I00-I99) diseases were obtained from the Norwegian Patient Registry and Norwegian Cause of Death Registry national databases, respectively. A quasi-Poisson regression model was fitted, stratified by age group, to estimate the number of hospitalizations and deaths attributable to RSV while considering temporal trends and virus activity. RSV and influenza hospitalizations in children aged < 2 years and adults aged ≥65 years, respectively, were used as proxies for viral activity. Annual RSV-attributable hospitalization incidence and mortality rates were calculated using populations at risk as denominator.

Results

For all three study outcomes, RSV-attributable incidence and mortality rates increased with age. The highest RSV-attributable rates were observed in patients aged ≥65 years (range from 2010 to 2019 - hospitalizations per 100,000 person-years: 148-265 for cardiorespiratory, 81-143 for respiratory, and 124-221 for cardiovascular; deaths per 100,000 person-years: 19-35 for cardiorespiratory, 11-19 for respiratory, and 10-18 for cardiovascular). In any given year, the RSV-attributable cardiorespiratory disease hospitalization incidence and mortality rates were two times higher than the rates for respiratory disease alone. For the three outcomes, the attributable proportion of RSV hospitalizations was 2 to 3 times higher in adults aged 18-44 years than in those aged ≥65 years.

Conclusion

In Norway, RSV contributes substantially to both respiratory and cardiovascular diseases across all adult age groups, emphasizing the need for effective preventive strategies. Including cardiovascular disease increased measured burden by nearly 2-fold compared to respiratory disease alone.

Disclosures

Maribel Casas, PhD, Pfizer: Advisor/Consultant Tor Molden, PhD, Pfizer: I am an employee of Pfizer Caihua Liang, MD, PhD, Pfizer: Stocks/Bonds (Private Company) Aleksandra Polkowska-Kramek, n/a, Pfizer: employee of P95 which received funding from Pfizer to conduct this study Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company)