bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2197. Pharmacist-Led Hepatitis C Virus Model of Care Effectively CURES Simplified Cases
Authors: Sheehan Lindsey , Wright Maribeth P , Stacey Morgan , Fritz Anthony , Rhudy Christian , Moore Daniel 
Published: January 2025

Abstract

Background
Despite the existence of curative direct acting antiviral therapy, hepatitis C Virus (HCV) prevalence and mortality has increased in many regions of the United States. Existing models of care have failed to yield treatment rates needed for HCV elimination by 2030. In June 2023, we implemented UK-CURES (University of Kentucky - Cascade Utilizing Routinized screening through treatment to Eliminate Syndemics), a novel model of HCV care (Figure 1). This pharmacist-led model utilizes collaborative care agreements to carry out AASLD/IDSA best practices at the point-of-care in an effort to eliminate variation and waste along the HCV cascade.Figure 1.UK-CURES Simplified Treatment Algorithm

Methods
This study is a retrospective descriptive analysis including patients evaluated by the UK-CURES team between 6/1/2023 and 5/1/2024. Patients were excluded from this analysis if they were not eligible for the UK-CURES HCV simplified treatment algorithm. Patient demographics, clinical and operational data were collected from electronic medical record modifications. Patients were considered lost to follow-up if they had not engaged with treatment 120 days and had not completed sustained virologic response (SVR12) laboratory results. Results are summarized with descriptive statistics.

Results
1,428 patients were evaluated by the UK-CURES team, of whom 1,105 were excluded from the treatment algorithm. The primary reason for exclusion was a negative confirmatory HCVRNA laboratory test (n = 579, 52.5%). Of 323 patients treated, demographics and baseline status are displayed in Table 1. Median time from first UK-CURES encounter to treatment order was 2 days, while the median time to first treatment dispense was 12 days (Table 2). Less than half of treated patients were lost to follow-up prior to obtaining SVR12 results (n = 147; 45.5%), and remaining patients are currently engaged in therapy (n = 141; 43.7%) or have completed SVR12 results (n = 35; 10.8%) (Figure 2). 32 patients (91%) were undetectable at SVR12.Figure 2.UK-CURES current patient status and attrition diagram

Conclusion
Our novel pharmacist-led model of care, UK- CURES, improved key performance indicators along the HCV care cascade for simplified cases while maintaining best practices surrounding HCV guidelines. The success of this model has significant implications for future HCV elimination efforts.

Disclosures
Maribeth P. Wright, RPh, CSP, Gilead FOCUS Program: Gilead FOCUS grant support Christian Rhudy, PharmD, MBA, Amgen, Inc.: Grant/Research Support Daniel Moore, MD, MBA, FACEP, Gilead FOCUS: Grant/Research Support
P-2221. Clinical utility and sensitivity of plasma metagenomic microbial cell-free DNA sequencing in children with complicated pneumonia
Authors: Ho Erin C , Asturias Edwin J , Butler Molly , Simmons Dennis , Dominguez Samuel R 
Published: January 2025

Abstract

Background
Etiological diagnostics for children with complicated bacterial pneumonia remain limited and insensitive, and pleural fluid (PF) testing is invasive. Plasma metagenomic microbial cell-free DNA (mcfDNA) sequencing, available by Karius, Inc., is a potentially comprehensive, non-invasive, and efficient diagnostic tool for pediatric pneumonia. However, rigorous studies comparing the real-world performance of mcfDNA to other testing modalities are lacking.

Methods
We compared the performance of the Karius Test (KT) to blood culture, PF culture, and in-house PF PCR assays targeting the most common pathogens in complicated community acquired pneumonia (cCAP), including Streptococcus pneumoniae (Spn), group A Streptococcus (GAS), and Staphylococcus aureus, in immunocompetent children hospitalized with cCAP requiring pleural effusion or empyema drainage at Children’s Hospital Colorado from 2022-2024. We calculated percent agreement across tests and sensitivities using both a composite reference standard and clinical truth. Bacterial pathogens were adjudicated by three infectious disease physicians as probable, possible, or unlikely cCAP pathogens. DNA virus detections on KT were not considered causative of cCAP.

Results
In our cohort of 32 children with cCAP (Table 1), 84.4% (27/32) had at least one probable pathogen identified by KT alone vs. 75% (24/32) by all other testing combined (Table 2). GAS (37.5%) and Spn (31.3%) were the most commonly detected pathogens, and 15.6% had &gt; 1 probable pathogen detected. Compared to a composite reference standard, KT had the highest sensitivity (91.1%), followed by targeted PF PCR assays (67.6%), PF culture (26.5%), and blood culture (12.5%), with similar trends by clinical truth. Positive agreement between KT and PCR + culture was 88.9%. Most KT samples were collected within 5 days of starting effective antibiotic therapy, but KT remained positive even up to 10 days on therapy (Figure 1).

Conclusion
Compared to culture and PF PCR-based testing, KT had higher sensitivity and excellent positive agreement for etiological diagnosis of pediatric cCAP. Early use of KT may be a promising diagnostic strategy, especially in the setting of antibiotic pre-treatment. Further studies are needed to determine KT specificity and clinical impact.

Disclosures
Edwin J. Asturias, MD, Hillevax: Advisor/Consultant|Merck: Advisor/Consultant|Moderna: Advisor/Consultant|Pfizer: Grant/Research Support Molly Butler, PhD, Pfizer: Conference Attendance Samuel R. Dominguez, MD, PhD, BIofire Diagnostics: Advisor/Consultant|BIofire Diagnostics: Grant/Research Support|DelveBio: Grant/Research Support|Karius: Advisor/Consultant|Karius: Grant/Research Support|Pfizer: Grant/Research Support
P-2260. Incidence and clinical characteristics of acute viral infections in the first year after hematopoietic stem cells transplantation. Argentine single center cohort
Authors: Huaier Arriazu Emilio F , Giunta Diego H , Basquiera Ana L , Mañez Noelia , De Boeck Julieta M , Diaz Lobo Emilse D , Rolan Martin A , Visús Mariángeles , del Lujan Sanchez Marisa 
Published: January 2025

Abstract

Background
The incidence and mortality of respiratory virus infections (RVI) in patients receiving a Hematopoietic Stem Cell Transplant (HCT) is variable, and changes depending on place, year and season. They can present as upper respiratory tract infection (URTI) or lower respiratory tract infection (LRTI), with the latter having a worse prognosis. There is no data from Argentina in the adult population. Objectives: estimate the incidence of RVI in the year after HCT and associate risk factors for clinical evolution, progression from URTI infection to LRTI, requirement for Intensive Care Unit (ICU) and mortality.
Flow chart of HCT recipients and respiratory events, with a diagnosis of respiratory viral infection within one year after transplant.

Methods
retrospective cohort study of the population of patients receiving HCT from 11/2011 to 12/2019. The patients were followed for one year, and for one month after each RVI.
Kaplan-Meier curve of the incidence of IRVA according to type of HCT.

Results
Out of 476 HCT with 30.7% allogeneic, 99 confirmed RVI were detected. The Cumulative Incidence at 100 days post-transplant was 1.99 (95% CI 1,0 - 3,95) per 100 patients, while at one year, it was 28.81 per 100 patients (95% CI 24.32 - 33). ,93). The HR of RVI in allogeneic HCT was 2.45 (95% CI 1.72-3.51; p &lt; 0.001) compared to autologous. Also was lower in lymphoma 0.5 (95% CI 0.29 - 0.85) and Multiple Myeloma 0.36 (95% CI 0.22 - 0.58) compared to leukemia (p &lt; 0.001) as the underlying disease. Although there were differences in the clinical status and characteristics evaluated at the diagnosis of RVI, no relevant associations were found at day 7 of follow-up. 53.5% of RVI events presented as URTI, and 16.9% progressed to LRTI. An association was found between male sex, OR of 0.20 (95% CI 0.06-0.73; p&lt; 0.001) and the occurrence of the event beyond 28 days after transplant, 0.27 (95% CI 0.08 -0.95; p=0.045), while RVI in hospitalized patients had an OR of 5.71 (95% CI 1.61-20.24; p=0.006) for progression. Only 16% required ICU, there was an association between age over 65 years, event before 28 days post HCT, myeloablative conditioning, use of corticosteroids at the time of the event, RVI during hospitalization and hypoxemia and requiring ICU. Mortality was 2.1% (95% CI 0.67-6.32) within 30 days of RVI.

Conclusion
The Cumulative Incidence was similar to other reports, however the mortality was lower.

Disclosures
All Authors: No reported disclosures
P-2263. Are you PRePared After Transplant?
Authors: Grabell Jylian , Mishkin Aaron D , Burnell Jacqueline , Altneu Eric 
Published: January 2025

Abstract

Background
Solid organ transplantation (SOT) is a life-saving medical procedure that can improve the quality of life of individuals with end-stage organ failure. Given the scarcity of organs, it is important to safeguard those implanted and prevent infections. Transplant Infectious Disease physicians help mitigate infectious risk both before and after surgery. One important preventable infection is Human Immunodeficiency Virus (HIV). Pre-exposure prophylaxis (PrEP) is effective in reducing the risk of HIV infection. Yet no study has examined PrEP use in SOT patients. The CDC reports that 30% of patients that may benefit from PrEP are prescribed them in the US. No similar statistic exists for SOT patients.
Figure 1
Demographics for SOT patients with possible exposure to HIV. Purple represents those without PrEP. Green represents those with PrEP.

Methods
To obtain quantitative support for further study, a large, multi-center database (Trinetx) was queried. Trinetx contains deidentified data from hundreds of international healthcare organizations (HCOs) dating back about seven years. The retrospective query included 68 HCOs with patients that met the following search inclusion criteria (based on ICD codes): SOT patient without the diagnosis of HIV, prescribed PrEP, and possible exposure risk for HIV.

Results
147,145 SOT patients were identified that did not carry the diagnosis of HIV. Only 160 patients (0.11%) were prescribed PrEP, identified as the following three regimens: tenofovir alafenamide + emtricitabine, tenofovir disoproxil + emtricitabine, or cabotegravir.
To risk-stratify HIV exposure, the original cohort of 147,475 SOT patients without HIV were analyzed with ICD codes for HIV exposure. This search identified 2,565 patients coded for HIV exposure. Given that only 160 patients were prescribed PrEP in the cohort, 2,405 patients may have benefited from PrEP but were not prescribed these medications. Patients on PrEP after SOT were predominantly male (78%) and White/Caucasian (58%). Identifying as Asian was a significant factor in using PrEP after SOT (p&lt; 0.0001). Female gender was a significant demographic not utilizing PrEP despite possible exposure to HIV (p&lt; 0.0001). (Figure 1).

Conclusion
This large database study shows that PrEP is underutilized in SOT patients. Further study—including surveys of sexual practices, provider knowledge, and attitudes towards PrEP, as well as single-center analysis—is needed.

Disclosures
All Authors: No reported disclosures
P-2313. Multinational, Retrospective Study Assessing Outcomes and Healthcare Resource Utilization in Hematopoietic Stem Cell Transplant Recipients with Cytomegalovirus Infection and Refractory, Resistance, or Intolerance to Anti-Cytomegalovirus Treatments: Analysis of Impact of Viremia Clearance on Outcomes
Authors: Davis Kimberly , Mendonça Ines , Bo Tien 
Published: January 2025

Abstract

Background
Cytomegalovirus (CMV) infection is a risk factor for morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. This real-world analysis describes the impact of viremia clearance on outcomes in HSCT recipients with refractory, resistant or intolerant (RRI) CMV infection to anti-CMV agents.

Methods
This multicenter, retrospective chart review study included adult HSCT recipients with RRI CMV infection. Data between 2014 and 2021 were collected from 14 centers in Europe and the USA. The analysis descriptively compared demographics, patient characteristics, clinical outcomes, and hospitalizations in patients who did versus did not achieve viremia clearance during the first RRI CMV episode.

Results
Among 247 patients with a first RRI CMV episode, 145 (59%) achieved viremia clearance and 102 (41%) did not. In patients with vs without viremia clearance, respectively, median age was 53 vs 60 years, and 46% vs 58% were male. Of the 145 and 102 first RRI CMV episodes with vs without viremia clearance, respectively, 52% vs 75% were identified as refractory, 61% vs 31% as intolerant, and 3% vs 9% as resistant (categories not mutually exclusive); 9% vs 15% of patients developed tissue invasive disease. CMV recurrence occurred in 35% vs 37% and graft failure in 3% vs 6% of patients with vs without viremia clearance, respectively (Table). Myelosuppression and nephrotoxicity events during CMV episodes were reported in 54% vs 44% and 26% vs 27% of patients with vs without viremia clearance, respectively (Table). CMV-related hospitalizations with/without emergency department visits occurred in 35% of patients with viremia clearance vs 43% of patients without viremia clearance (Table). Notably, the overall mortality within 1 year of RRI identification in patients without viremia clearance was higher than in those with viremia clearance (68% vs 30%, respectively).

Conclusion
These results highlight the high disease burden in HSCT recipients with RRI CMV infection. In this difficult-to-treat population, the mortality rate was higher in patients without viremia clearance than in patients with viremia clearance.

Disclosures
Kimberly Davis, RPh, MS, Takeda: Employee|Takeda: Stocks/Bonds (Public Company) Ines Mendonça, MSBiostats, CTI Clinical Trial & Consulting Services: Employee (paid to provide consulting services including medical writing and statistical analysis) Tien Bo, PharmD, Takeda: Employee|Takeda: Stocks/Bonds (Public Company)
P-2322. Screening Rates and Clinical Outcomes for Hepatitis Delta in Individuals with HBV Coinfection
Authors: Butt Adeel A , Yan Peng , Shaikh Obaid , Bedimo Roger 
Published: January 2025

Abstract

Background
Hepatitis Delta (HDV) screening is recommended for those with hepatitis B virus (HBV) infection. However, screening rates are not well documented and are far from ideal. Factors associated with screening for HDV, and clinical outcomes among HBV/HDV coinfected individuals are poorly understood. Our aim was to define the screening rates for HDV among HBV infected individuals, and the incidence of various complications among HBV/HDV coinfected individuals in the US VA healthcare system.
Incidence rates for cirrhosis, hepatic decompensation, and hepatocellular carcinoma among those with HBV and HBV/HDV coinfection.

Methods
Within the Veterans Health Administration (VA) national databases, we identified all individuals with HBV (defined as a positive test for HBV surface or “e” antigen, or HBV DNA) between 2002-2023. Screening for HDV was ascertained by serology or HDV PCR testing. Incidence rates for development of cirrhosis, hepatic decompensation (HD), hepatocellular carcinoma (HCC), and death were calculated for those with HBV alone and those with HBV/HDV coinfection.
Kaplan-Meier curves demonstrating progression to cirrhosis, Hepatitis D, and Hepatocellular Carcinoma

Results
Of the 44,951 individuals with HBV, 5,964 (13.3%) were screened for HDV and 180 (3% of those tested) were positive for HDV. Among 38,472 individuals without baseline cirrhosis, the incidence rates/100 person years (95% CI) for cirrhosis, HD, and HCC were 1.03 (0.52,1.53), 1.79 (1.18,2.4), and 1.91 (1.29,2.52) respectively among those with HBV/HDV coinfection compared with 0.60 (0.58,0.63), 0.72 (0.69,0.74), and 0.49 (0.47,0.51) among those with HBV infection alone. Kaplan-Meier curves demonstrated a higher proportion and accelerated progression to cirrhosis, HD, and HCC among HBV/HDV coinfected compared with HBV monoinfected individuals.

Conclusion
There are significant gaps in screening for HDV among HBV infected individuals. Those with HBV/HDV coinfection are more likely to develop serious complications compared with those with HBV alone.

Disclosures
Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support
P-2327. West Nile Virus Disease in the Veterans Health Administration (VHA), 2010-2023
Authors: Lucero-Obusan Cynthia A , Oda Gina , Chung Joyce S , Holodniy Mark 
Published: January 2025

Abstract

Background
Increasing evidence exists that West Nile Virus (WNV) transmission, distribution, and incidence is impacted by climate change. WNV is the most common mosquito-borne disease in the U.S., but there is little data in Veterans. Herein, we describe the epidemiology of WNV in VHA during 2010-2023.

Methods
WNV-coded hospitalizations, visits, and laboratory results were obtained from VHA data sources (1/1/2010-12/31/2023). We included individuals aged 18 years and above with ICD-9/10-CM WNV-coded encounters and/or a positive WNV IgM or PCR result. Data extracted included demographics and geography, diagnosis codes, test results, encounter details, and deaths during WNV-coded hospitalizations. Data were compared to CDC ArboNET.

Results
A total of 1,140 unique patients were identified. Of these, 762 (67%) were via ICD code only, 282 (25%) via ICD code & test result, and 96 (8%) via test result only. Annual case counts fluctuated but generally followed national trends, with highest activity observed in 2012, 2013 & 2018 (Fig. 1). Median age was 66 years and 92.4% were male. The highest proportion of cases were in males age 70+ (36%), which was also most common in ArboNET, although the percentage was lower (13%). 509 (44.6%) were coded as WNV encephalitis/neurologic manifestation and/or tested positive in the CSF, compared to ArboNET where 50.7% were classified neuroinvasive (1999-2022). Prevalence rates per 100,000 VHA population were highest for White (21.2) and American Indian/alaskan Native (AI/AN, 19.6) race and lowest in Asian (4.5). Average Annual case rates were highest in: South Dakota (16), Nebraska (11), North Dakota (6.6), and Colorado (5.1) (Fig. 2). There were 5,149 WNV outpatient visits (923 individuals). For 351 recorded hospitalizations (285 individuals), median stay was 11 days with 66 (18.8%) admitted to intensive care and 29 deaths during a WNV-coded hospitalization (8.3%).

Conclusion
WNV causes substantial morbidity and the burden is likely underestimated as asymptomatic and mild cases may never seek care. VHA WNV activity tracks closely with national CDC ArboNET reporting. Additional targeted education may increase awareness and testing among at risk individuals, particularly in high incidence geographic areas.

Disclosures
All Authors: No reported disclosures
P-73. Pyogenic And Brucellar Spondylodiscitis: Comparative Analysis Of Clinical, Laboratory, And Evolutionary Features
Authors: Hammami Fatma , Rekik Khaoula , Smaoui Fatma , Chakroun Amal , Marrakchi Chakib , Koubaa Makram , Ben Jemaa Mounir 
Published: January 2025

Abstract

Background
Spondylodiscitis is an infection of the vertebral and the intervertebral disc. The clinical presentation varies according to the underlying etiology. We aimed to compare the clinical, laboratory and evolutionary features between pyogenic and brucellar spondylodiscitis.

Methods
We conducted a retrospective study including patients hospitalized in the infectious disease department for pyogenic or brucellar spondylodiscitis between 1998 and 2022.

Results
We encountered 44 cases of brucellar spondylodiscitis (BS) (50.6%) and 43 cases of pyogenic spondylodiscitis (PS) (49.4%). Patients with PS were significantly older (60±16 years vs 50±16 years; p=0.007). A rural origin was significantly more frequent among BS patients (88.6% vs 55.8%; p=0.001). While motor deficit was significantly more frequent among PS patients (33.3% vs 11.4%; p=0.014), nights sweats were significantly more frequent among BS patients (72.7% vs 25.6%; p&lt; 0.001). As to gender, fever and back pain, no significant difference was noted. The lumbar spine was the most affected site among BS group (74.4%) and PS group (72.1%), with no significant difference (p=0.8). Laboratory investigations including white blood cells count (11153±4952/mm3 vs 6719±2910/mm3; p&lt; 0.001), erythrocyte sedimentation rate (84±31mm/h vs 50±33mm/h; p&lt; 0.001) and C-reactive protein levels (108±87mg/l vs 32±28mg/l; p&lt; 0.001) were significantly higher among PS group. Surgical treatment was indicated in 9.3% of PS cases and in 2.3% of BS cases, with no significant difference (p=0.3). Two patients with PS were dead (4.6%). Sequelae were noted among PS cases (41.9%) and BS cases (38.6%), with no significant difference (p=0.7).

Conclusion
Although PS patients were older, presented more frequently with motor deficit and had higher inflammatory markers, the disease evolution was similar in comparison with BS patients.

Disclosures
All Authors: No reported disclosures
P-92. Risk factors, Clinical Manifestations and Management of Vertebral Osteomyelitis due to Coccidioides: a 10-year Retrospective Descriptive Study
Authors: Wolf Sona R , Donovan Fariba , Robishaw-Denton Jacob , Riaz Talha 
Published: January 2025

Abstract

Background
Vertebral osteomyelitis is a severe manifestation of disseminated coccidioidomycosis with limited published data on clinical presentations and outcomes. The purpose of this study was to describe the epidemiology, risk factors, clinical features, management, and outcomes of coccidioidal vertebral osteomyelitis (CVO) among a cohort of patients in an endemic region.

Methods
We conducted a retrospective chart review of patients treated for CVO between 2013 and 2022 at an academic health system in Arizona. Demographic and clinical data were extracted.

Results
Forty-two patients with CVO were identified. The mean age at diagnosis was 36.3 (range, 18.9-73.2 years). Thirty-four (81%) patients were males and 33 (79%) were African American. Nine (21%) had a prior or current history of incarceration. Fifteen (36%) patients had a history of coccidioidomycosis including pulmonary (n=9), skin/musculoskeletal (n=5), and CNS infection (n=1) prior to diagnosis of CVO. Known comorbidities included long-term corticosteroid use (n=2), HIV infection (n=2), and pregnancy at time of CVO diagnosis (n=3 of 8 females). Of the 37 patients with complement fixation titers available at time of presentation, 25 patients had a titer &gt;=1:128. The most frequent imaging findings identified via CT or MRI were paraspinal/epidural abscesses (n=32) or bone lytic lesions/erosions (n=32). All patients received triazole therapy, 32 (76%) received amphotericin B (median 15.5 days) at some point during their treatment course, and 4 (10%) received an investigational drug. Sixteen (38%) patients underwent surgical debridement and spinal fixation hardware was placed in 13 (31%). Thirteen (31%) patients experienced disease progression warranting re-admission. Four (10%) died within 3.5 years of diagnosis and all deaths were secondary to complications associated with CVO.

Conclusion
There is a high morbidity and mortality due to CVO. Most patients with CVO are African American males and few have predisposing comorbidities. A remarkably high proportion (21%) have a history of incarceration suggesting it may be a risk factor for CVO. A better understanding of the factors that predispose individuals to CVO and better therapies are urgently needed to improve outcomes in this frequently devastating illness.

Disclosures
Fariba Donovan, MD, PhD, F2G: Advisor/Consultant|F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support|F2G Ltd: Honoraria