bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-663. Evaluating the Effectiveness of a Real-Time Electronic Alert to Monitor the Duration of Antibiotic Therapy in Hospitalized Pneumonia Patients in the Asian Healthcare Setting
Authors: Biju Sanju , Paulson Shon 
Published: January 2025

Abstract

Background
Limiting the duration of antibiotic prescribing to the shortest effective period is recognized as a strategy to mitigate the risk of antibiotic resistance. This study aims to assess the impact of a Real-Time Electronic Alert system designed to monitor the duration of antibiotic therapy in hospitalized pneumonia patients, with the goal of reducing unnecessary antibiotic exposure.

Methods
The intervention involved the implementation of a dashboard capable of generating real-time alerts whenever hospitalized patients diagnosed with community- or hospital-acquired pneumonia received antibiotics for more than five consecutive days. The study was conducted between December 2022 and January 2024 at two medical college hospitals in South Asia. Alerts generated by the dashboard were regularly reviewed by an antibiotic stewardship (AS) team, who intervened when patients exceeded the guideline-recommended duration of antibiotic therapy for pneumonia without additional clinical indications warranting continued antibiotic use. To evaluate the effectiveness of the intervention, the inappropriate duration of antibiotic therapy was compared before and after the implementation of the dashboard. A similar hospital with comparable patient demographics served as a comparative group.

Results
During the intervention period, the AS team reviewed a total of 218 patients flagged by the dashboard, resulting in 117 documented interventions. Reasons for lack of intervention included the presence of additional infection diagnoses necessitating prolonged antibiotic therapy, co-infections, and delayed clinical improvement. Post-implementation, the mean excess duration of antibiotic therapy for pneumonia decreased to 0.48 days compared to the pre-implementation mean of 2.13 days. In contrast, the comparative hospital, which did not employ the alert system, experienced a post-intervention mean excess duration of 1.97 days compared to a pre-intervention mean of 2.04 days.

Conclusion
The pneumonia dashboard represents a potentially valuable stewardship tool for reducing unnecessary antibiotic exposure in pneumonia patients.

Disclosures
All Authors: No reported disclosures
P-686. Risk of COPD Exacerbations, Asthma Exacerbations, and Hospitalizations for Heart Failure after RSV Hospitalization Among US Adults Aged at Least 50 Years
Authors: Singer David , Wang Yan , Wu Aozhou , La Elizabeth M , Gerber Susan , Lee Lydia , Liu Hongjiao , Betts Keith A 
Published: January 2025

Abstract

Background
Older adults and adults with comorbidities are at increased risk of severe respiratory syncytial virus (RSV) disease. Limited data are available on the long-term impact of RSV on comorbid diseases. This study evaluated the association between RSV hospitalization and the risk of future acute disease worsening in adults aged ≥ 50 years.
Figure 1

Methods
This retrospective cohort study analyzed Optum’s de-identified Clinformatics Data Mart Database (CDM) healthcare claims from October 2015 to June 2023. Adults aged ≥ 50 years with ≥ 12 months of continuous enrollment were assigned to cohorts based on RSV hospitalization (RSV cohort), influenza hospitalization (flu cohort), or not having a recent acute respiratory illness (ARI) (controls). Index date was the start of an ARI episode that included hospitalization and an RSV or influenza diagnosis for the RSV and flu cohorts, respectively. Controls were matched 5:1 with the RSV cohort. Outcomes included acute exacerbations of (AE) chronic obstructive pulmonary disease (COPD), AE asthma, and hospitalizations for heart failure (HHF), were measured during the follow-up period (Fig. 1), and analyzed as recurrent events. AE COPD, AE asthma, or HHF risks were compared between the RSV vs influenza and RSV vs control cohorts using the Andersen-Gill formulation of Cox proportional hazards models in the overall population and subgroups.

Results
The study included 14,759, 77,468, and 73,795 adults in the RSV, flu, and control cohorts, respectively (Table 1). Mean cumulative event counts were highest in the RSV cohort (Table 2). In adjusted analyses, adults with an RSV hospitalization had a higher risk of AE COPD (for those with COPD: hazard ratio [HR] = 1.15 vs flu cohort, p &lt; 0.001; HR = 2.78 vs control cohort, p &lt; 0.001), AE asthma (for those with asthma: HR = 1.53 vs flu cohort, p &lt; 0.001; HR = 6.51 vs control cohort, p &lt; 0.001), and HHF (for those with heart failure: HR = 1.08 vs flu cohort, p &lt; 0.001; HR = 3.07 vs control cohort, p &lt; 0.001) (Table 3).

Conclusion
Increased risk of AE COPD, AE asthma, and HHF was observed among adults with RSV hospitalization compared to influenza hospitalization and compared to adults without a recent ARI. These findings build on previous research demonstrating the importance of RSV prevention in older and comorbid adults.
FUNDING: GSK (VEO-000616)

Disclosures
David Singer, PharmD, MS, GSK: employee|GSK: Stocks/Bonds (Public Company) Yan Wang, ScD, Analysis Group: Employee Aozhou Wu, PhD, Analysis Group: Employee Elizabeth M. La, PhD, GSK: employee|GSK: Stocks/Bonds (Private Company) Susan Gerber, MD, GSK: Employee Lydia Lee, PharmD, MS, GSK: Fellowship Sponsorship Hongjiao Liu, PhD, Analysis Group: Employee Keith A. Betts, PhD, Analysis Group: Employee
P-701. Adenovirus associated with acute respiratory illness in Korean military trainees: incidence and adenovirus serotypes
Authors: Heo Jung Yeon , Kwon Soon-Hwan , Jang Jeyoun , Sang Oh Hong , Kim Young Rong , Hyun Hak Jun , Kim Eun Jin , Choi Young Hwa 
Published: January 2025

Abstract

Background
Previous studies suggested that that human adenovirus (HAdV) is the most prevalent in patients with acute lower respiratory tract infection and is the most common cause of pneumonia in Korean military. A sentinel surveillance program was initiated to investigate the incidence of acute respiratory illness (ARI) and characteristics of type-specific HAdV respiratory infections in Korean military trainees.
Weakly incidence of acute respiratory infection per 1,000 persons in military trainees

Methods
To calculate the incidence of ARI, all new trainees with febrile respiratory illness (FRI) who were required to visit the infirmaries at three military training centers were enrolled from September 2016 to August 2017. Of soldiers with FRI, 10 nasopharyngeal or throat swab specimens were weakly collected for for HAdV molecular typing.
Weakly proportion of adenovirus infection in trainees with acute respiratory infection

Results
The incidence of ARI, which was defined as the number of weakly ARI cases per 1,000 trainees, was estimated at 7.5-375.5 cases per 1,000 trainees with peaks between 41th week and 10th week in 2016-17 season. Of 1,079 patients with FRI, HAdVs were detected in 518 (48.0%) patients. HAdV type 55 was the most prevalent virus (98.6%, 511 cases). HAdV type 2 was only identified in 7 cases. Although HAdV associated ARI occurred throughout the year, Patients with HAdV infection were primarily observed during winter and spring. The clinical diagnoses in patients with HAdV associated ARI were almost pharyngotonsillitis (96.3%). Pneumonia (2.2%) was uncommon manifestation. There was no statistically significant difference in demographic characteristics and presenting symptoms and signs between HAdV-positive and HAdV-negative patients.

Conclusion
HAdV-55 was the most prevalent type in Korean soldiers with HAdV-associated ARI. Adenovirus type 55 was revealed to be the most important causative agent of acute respiratory infection in military trainees. Further studies are required to verify which HAdV types are associated with ARI in military recruits.

Disclosures
All Authors: No reported disclosures
P-703. Manifestations of parainfluenza type 4 infections and viral loads in children
Authors: Funakoshi Hanako , Shibata Meiwa , Tame Tomoyuki , kinoshita Kazue , Saitou Osamu , Horikoshi Yuho , Kuruma Kenta 
Published: January 2025

Abstract

Background
Although parainfluenza virus type 4 (PIV-4) typically causes mild respiratory illnesses in children, it can cause severe diseases occasionally. It is not known Whether viral load of PIV-4 could correlate with severity. This study aimed to assess the relationship between PIV-4 viral load and disease’s severity in children.
Viral load and severity
This figure shows the relationship between severity of illness and viral load.There was no correlation between viral load and severity.

Methods
A retrospective study at Tokyo Metropolitan Children's Medical Center from April to October 2023 screened hospitalized children using multiplex PCR. PIV-4 positive samples were assayed for viral load of all detected viruses using real-time PCR. Cases with PIV-4 were included if PIV-4 was only detected or the viral load of PIV-4 was higher than other co-detected viruses. Demographic data, underlying diseases, laboratory, co-infections, diagnoses, and outcomes were collected from electrical charts. Cases with PIV-4 were categorized into mild cases with no oxygen demand, moderate cases with low-flow oxygen demand and severe cases with high flow nasal cannula oxygen or non-invasive/invasive mechanical ventilation or PICU admission.The viral loads of PIV-4 and number of co-infected virus were compared among severity groups.
Characteristics, Symptoms and Laboratory Data of PIV-4 positive patients

Results
Nasal swab samples were collected from 2884 cases. PIV-4 was detected in 185 samples. As 108 cases were excluded for higher viral loads of other viruses, 77 cases were included for analysis. The severity of PIV-4 comprised 37 mild, 24 moderate, and 16 severe cases. The rate of lower respiratory tract infections in mild, moderate and severe cases were 8%, 96%, and 75%, respectively. There was only one PIV-4-related mortality at 28 days. Co-detection with rhinovirus/enterovirus was the most frequent. Median viral loads (log10 copies/mL) in mild, moderate and severe cases were 5.98 (IQR 3.58-6.89), 6.09 (IQR 4.93-6.66) and 5.98 (IQR 3.57-7.03), respectively. No significant correlation was found between viral load and severity, but severity correlated with the number of viral co-infections.
Treatment and Outcome of PIV-4 positive patients

Conclusion
Moderate or severe Pediatric PIV-4 infections primarily show as lower respiratory tract infections, with no relation between viral load and illness severity, though the number of co-infected virus may play a role.
Severity and co-infection viruses

Disclosures
All Authors: No reported disclosures
P-705. Non-Clinicians Effectively Perform Lung Ultrasound in Patients with Influenza-like Illness
Authors: Pauli Liam R , Wilson Claire S , Blair Paul W , Siddarthan Trishul , Herrara Phabiola , Hossen Shakir , McBryde Breana , Zimmerman Lauren , Avornu Gideon D , Rothman Richard E , Hansoti Bhakti , Fong Tiffany 
Published: January 2025

Abstract

Background
Point-of-care ultrasound (POCUS) is a low-cost, portable imaging modality with greater sensitivity than chest x-ray to evaluate acute respiratory infections including influenza-like illness (ILI). However, clinical scale has been limited by the availability of proficient operators and unclear training requirements. We aim to assess the feasibility of implementing study coordinator-performed lung POCUS into a longitudinal study of patients with ILI.

Methods
From November 2021 to December 2023, we conducted an observational study to characterize the pathophysiology of ILI among outpatients. Patients were recruited from two urban academic hospital emergency departments and affiliated clinics. Study coordinators were trained through a 4-hour didactic session reviewing ultrasound physics and lung anatomy and pathology, together with a hands-on training session. Peer proctoring of two POCUS enrollment encounters followed. POCUS lung scans were obtained from patients by study coordinators at their enrollment visit (Day 0) and follow-up visits (Day 7, 14, 28). Scans were evaluated by blinded expert image reviewers. Data was analyzed using descriptive statistics including the proportion of images deemed technically adequate.

Results
Fifteen study coordinators without previous ultrasound experience completed POCUS training over the course of the study. Using a standardized 12-zone imaging protocol, a total of 5311 POCUS lung scans were collected from 340 encounters. POCUS images were reviewed by study physicians and 100% of studies were considered adequate for diagnosis, with 96.0% of individual lung ultrasound clips judged to be technically adequate.

Conclusion
Our study demonstrated that after a 4-hour training session, non-clinical research staff could successfully acquire protocolized lung POCUS images during a 2-year study to longitudinally monitor patients with ILI. This supports the feasibility of implementing POCUS into infectious diseases research and demonstrates the potential effectiveness for training new POCUS users to assess ILI.

Disclosures
Richard E. Rothman, MD, PhD, abbvie: Grant/Research Support|CEPHEID: Advisor/Consultant|CEPHEID: Grant/Research Support|CEPHEID: Honoraria
P-706. Adenovirus Type 21 Outbreak among Haematology and liver transplant patients at a large tertiary care hospital in Singapore
Authors: Foo Mabel Z Q , Chan Darius Y W , Venkatachalam Indumathi , Wong Hei Man , Ying Sim Jean Xiang , Lai Deborah C M , Cui Lin , Ling Moi Lin 
Published: January 2025

Abstract

Background
Human adenoviruses (HAdVs) commonly cause acute respiratory illness, with documented outbreaks in military settings. HAdV infections frequently precipitate severe pneumonia amongst immunocompromised patients, with associated mortality risk. We report a HAdV type 21 infection cluster involving immunocompromised patients at a tertiary care hospital.

Methods
Hospital-onset (HO) adenoviral infection was defined as positive HAdV polymerase chain reaction (PCR) test with corresponding respiratory symptom onset six days after admission. Positive samples were typed in the National Public Health Laboratory by sequencing hexon gene variable regions. Epidemiological investigations were carried out for potential spatiotemporal linkage between these patients for targeted infection prevention interventions.

Results
Between 1st January to 31st March 2024, 21 HAdV-positive cases were identified, with five categorised as HO HAdV. Four patients (80%) had haematological malignancies and one had received a liver transplant 23 days prior to testing positive for HAdV. The mean age of patients was 58.6 years (SD: ± 9.7), with males comprising 60% of the cohort. The median hospital length of stay (LOS) before HAdV positivity was 21 days (range: 6 – 45). Clinical manifestations included fever, shortness of breath, cough, and acute respiratory failure. All patients required Intensive Care Unit (ICU) admission, with an average ICU LOS of 10 days (SD: ± 9.2). Respiratory samples of three patients were typed as HAdV 21, and three had adenovirus DNAemia.
In the identified cluster, the four patients with haematological malignancies shared the same ward, with two overlapping in time but housed in different rooms. The liver transplant patient had overlapping stay in the critical care unit with a patient from the haematology cluster and shared the same mobile chest x-ray machine with two others from the same cluster. All four patients with haematological malignancies experienced same-admission mortality.

Conclusion
Timely symptom recognition and respiratory multiplex panel testing enabled detection of HAdV infection cluster in immunocompromised patients. Early cluster detection and reinforcement of infection prevention measures at risk locations can mitigate transmission of HAdV infections.

Disclosures
Moi Lin Ling, FRCPA, Solventum: Honoraria|Solventum: Educational grant for APSIC projects
P-723. Incidence, Etiology, and Outcomes of Viral Pneumonia in Adults with Cancer at a Tertiary Care Centre in Eastern India: A One Year Prospective Cohort Study
Authors: Malik Simran , Bhattacharya Sanjay , Das Bhattacharya Sangeeta 
Published: January 2025

Abstract

Background
We identified pneumonia in adult cancer patients admitted to the ICU over one year, delineated viral pneumonia, assessed etiology, and studied clinical outcomes.Figure 1:Etiology of pneumonia cases where viruses were detected (n=90)

Methods
Pneumonia cases were clinically and radiologically identified from October 2022-September 2023. Pneumonia was categorized as community-acquired or healthcare-associated. Viral detection was done using Qiagen’s QIAstat-Dx Respiratory SARS-CoV-2 Panel and bioMeriéux’s BioFire® FilmArray® Pneumonia Panel. Bacterial, fungal, and mycobacterial detection involved microscopy, culture, ELISA, PCR, and CBNAATs.
All cases where bacteria, mycobacteria, and fungi were detected along with viruses were assigned “co-infection/ superadded infections". Frequency of pathogens were compared using a modified Z-test. Seasonality was assessed using the chi-square test for homogeneity. Lengths of hospital and ICU stay were compared using linear regression and mortality was compared using logistic regression and Kaplan-Meier survival analysis.Figure 2:Kaplan-Meier survival analysis for pneumonia cases where viruses were detected stratified by etiology

Results
355 cases of pneumonia were identified. Viruses were detected in 90 (25.4%). Of these 40 were viral pneumonia [incidence: 1.8% (95% CI: 1.3-2.4%)] among 2279 in-patients, and 50 were viral co-infections/ superadded infections (figure 1).
Rhinovirus/ enterovirus (27) was the commonest followed by SARS-CoV2 (15), influenza A (12), and RSV A/B (10). RSV A/B was more common in CAP cases (p=0.005). CMV was more common in HAP (p=0.042). Seasonal variation was seen in influenza A/B only with the highest frequency during monsoon (p=0.000).
Aspergillus (23) was most frequently detected alongside viruses, followed by Klebsiella pneumoniae (17), Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter (10 each).
The overall length of hospital stay in this cohort was 16.3 days, length of ICU stay was 9.6 days, and 90-day mortality was 54.4%. Length of ICU stay was higher in viral co-infections/ superadded infections (table 2, figure 2).

Conclusion
Majority of pneumonia cases with viral detection are co-infections/ superadded infections associated with prolonged ICU stay. There is a need for diagnostic stewardship to ensure rapid diagnosis, and appropriate antimicrobial prophylaxis for antibacterial and antifungal cover.

Disclosures
All Authors: No reported disclosures
P-752. Do Antibiotics Improve Wound Necrosis Following Biodegradable Temporizing Matrix (BTM) Placement in Patients with Xylazine-associated Wounds?
Authors: Schultz Sara K , Rae Lisa , Bougazzoul Oumaima 
Published: January 2025

Abstract

Background
Xylazine-associated wounds are a unique wound typology among patients with injection behavior in geographic areas where xylazine has infiltrated the fentanyl drug supply. The use of the dermal substitute biodegradable temporizing matrix (BTM) is being evaluated to promote wound stabilization in the presence of severe soft tissue necrosis, a well-known characteristic of xylazine wounds. The role of antibiotics in the treatment of BTM placement for xylazine wounds is unclear.

Methods
All patients with xylazine-associated wounds who underwent BTM placement at Temple University Hospital since August 2023 were identified. The electronic medical record was used to collect data including demographics, antibiotic course, microbiologic data, discharge disposition, and appearance of the wound. The primary outcome was evidence of less necrotic tissue on a stable wound within 60 days.

Results
A total of 37 patients were identified. 60% of patients had an infectious disease consult. 89% of patients had clinical or radiographic evidence of osteomyelitis underlying their xylazine wound. 25 patients (68%) received antibiotics during their admission for BTM. 15 (41%) of patients received at least 4 weeks of antibiotics. 12 patients (33%) did not receive any antibiotics during their admission. 25% of patients received antibiotics for an indication unrelated to their xylazine wound. Treatment regimens varied and included both oral and intravenous antibiotics. 49% of patients lacked stable housing at the time of discharge. 13 (35%) patients had evidence of less necrotic tissue on a stable wound at 60 days. Of those 13 patients, 9 received antibiotics and 4 received none. Of the patients who received at least 4 weeks of antibiotics, only 11% had evidence of less necrotic tissue at 60 days. Of the patients who received no antibiotics, 8% had evidence of less necrotic tissue at 60 days.

Conclusion
Severe tissue necrosis related to injection of xylaxine requires new treatment paradigms. Our small study questions the utility of prolonged antibiotic treatment courses for patients with xylazine wounds and BTM placement, including in the setting of osteomyelitis, as we did not see high treatment success in these patients.

Disclosures
Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant
P-762. Prevalence and/or Recurrence of Non-Tubercular Mycobacterial Pulmonary Disease in Structural and Airway Lung Disease
Authors: Chowdhury Mohit , Singh Urvashi B , Ray Animesh , Sinha Sanjeev 
Published: January 2025

Abstract

Background
Nontuberculous mycobacterial pulmonary disease (NTM-PD) frequently remains undetected, especially among patients with preexisting respiratory conditions who are prone to develop the disease. This study aims to explore the prevalence, species diversity, and outcomes of NTM-PD in India, an uncharted topic.

Methods
We conducted a prospective observational study, enrolling 69 patients with symptomatic chronic respiratory diseases or a history of Tuberculosis (TB). These patients underwent thorough clinical assessment, chest computed tomography scans, and either a single bronchoscopic sample or three sputum samples for microbiological analysis, along with relevant biochemical investigations. Diagnosis of NTM-PD followed the ATS 2020 diagnostic criteria. The growth of the organism was compared using patented indigenous media with or without p-nitrobenzoic acid.

Results
The prevalence of NTM-PD was 17.4%, with TB affecting 31.9% of cases. Baseline clinical symptoms and their duration showed no statistically significant differences, except NTM-PD patients with hemoptysis had significantly shorter symptom durations than other groups. Isolation rates were notably higher with the patented indigenous media compared to the mycobacterial growth indicator tube for both NTM (100% vs. 33.3%, p &lt; 0.001) and Mycobacterium tuberculosis (M.Tb) (57.1% vs. 47.6%, p &lt; 0.001). NTM-PD patients exhibited a significantly higher proportion of fibro-cavitary disease compared to other groups when comparing radiological findings. After monitoring NTM-PD patients following treatment, one patient (20%) experienced a recurrence of symptoms within six months, rest continue to be under follow-up.

Conclusion
In a high-burden TB setting, clinical suspicion and effort to look for NTM-PD is often low. Our study highlights the high prevalence of NTM-PD in individuals with chronic lung conditions/past history of TB. Patients with NTM-PD show higher rates of fibro-cavitary disease, possibly allowing the NTM to form biofilms and hence lead to relapses. Diagnosis of NTM-PD is thus important, to ensure desired treatment for the recommended duration and a thorough and prolonged post-treatment monitoring due to higher relapse risk.

Disclosures
All Authors: No reported disclosures