bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2282. Infectious Complications Following Lung Transplant for COVID-19 Related Respiratory Failure
Authors: Kapur Nandita , Birk Navina K , Jayaprakash Rachna , Khalil Basmah , Singh Rajan , Hanna Zachary W , Ramesh Mayur , Alangaden George J 
Published: January 2025

Abstract

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

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

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

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

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

Abstract

Background
Multi-drug resistance in gram-negative bacilli is major cause of concern in managing patients with febrile neutropenia particularly among hematology-oncology patients. Reversing AMR has never been demonstrated previously in this setting.
Table of various parameters comparing Cohort A and B

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

Background
Bacterial infections such as Pseudomonas aeruginosa (PsA) and S. aureus lead to increased morbidity post-lung transplant. Less is known about the impact of enteric gram-negative (GNR) infections. This study’s aim was to assess risk factors for developing GNR infections within 6-months of transplant and associated 1-year outcomes compared to lung transplant recipients (LTR) with other bacterial infections or uninfected LTR.
Table 1
Characteristics and Outcomes of LTR with post-transplant GNR infections, other bacterial infections, and no infection

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

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

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

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

Abstract

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

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

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

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

Disclosures
All Authors: No reported disclosures
P-2330. Herpes Zoster in Mexican Patients With Cancer. Clinical Features, Complications and Economic Burden
Authors: Fernandez Pamela Alatorre , Osorio López Erick Antonio , Guerrero Maura González , Zúñiga Antonio Camiro , Islas-Muñoz Beda , Volkow-Fernández Patricia , Juarez Patricia Cornejo 
Published: January 2025

Abstract

Background
Herpes zoster (HZ) typically causes a painful, unilateral, vesicular rash that affects one dermatome. In immunocompromised, it can disseminate and cause postherpetic neuralgia. The incidence of HZ has increased in recent years, especially in elderly and immunocompromised people, cancer patients included. Mexico has a low vaccination rate with no policy for patients at high risk for HZ.

Methods
Between 2021 and 2023, all patients with HZ identified at our Tertiary Cancer Institute were included. Demographics, clinical manifestations, therapeutics, and complications were registered. To determine the economic burden of the disease, an economic analysis was done.

Results
280 cases of HZ were identified. 164 (59%) women; median age 57 years (IQR 45-67.5). 200 solid tumors (71%) mainly breast cancer (n=72, 26%). Eighty hematological malignancies (HM) (29%), lymphoma the most frequent (n=51, 18%). 77 disseminated HZ, 62 (22%) cutaneous and 11 (4%) in CNS. 77 cases (27.5%) were treated outside of our institution. In 154 cases (55%), ambulatory therapy was prescribed, and 49 (17.5%) were treated in-hospital [median hospital stay: 8 days (IQR 5-13)]. In 45 (16%) patients, HZ delayed oncological treatment. One patient died.
Bivariate analysis comparing outpatients vs. hospitalized was significant for PLHIV (p=0.001), HM (p=0.002), chemotherapy in the previous month (p=0.022), chronic steroid (p=0.009), infection that precedes HZ (p=0.003), and disseminated zoster (p=0.001). Older age, high blood pressure, and disseminated HZ were related to the development of postherpetic neuralgia [OR 1.036 (1.006-1.066), 3.637 (1.541-8.580) and 2.961 (1.306-6.717)].
The estimated cost of care during the three years was USD 208,304.05. The average cost of care was USD 743.94. The bivariate analysis is presented in Table 1. Healthcare cost of attention is presented in Table 2.

Conclusion
HZ in this oncologic center is a growing concern. The projection of the potential increase in cases for 2024 estimates 173 new cases, which will represent USD 128,419.45.
The most affected groups were patients with breast cancer, hematological malignancies, chronic steroid use, PLHIV, and those over 50 years of age. Our study's data will help enforce HZ vaccination in oncological patients and PLHIV.

Disclosures
All Authors: No reported disclosures
P-2332. Pre to Post COVID-19 pandemic: Analyzing Recovery of Respiratory Viral Circulation Patterns
Authors: El Haddad Kim , Liu Wei , Burke Patrick , Esper Frank 
Published: January 2025

Abstract

Background
The COVID-19 pandemic and resulting worldwide countermeasures immediately impacted the circulation of endemic respiratory viruses. Yet the dynamics of recovery have varied between species. We hypothesize the level of disruption in virus circulation and the time to return to pre-pandemic norms is dependent on circulation overlap with the pandemic strain.

Methods
Interrupted time series (ITS) analysis and continuous wavelet analysis of univariate times series (Morlet) was conducted on Cleveland Clinic respiratory virus results from 2015 through 2023. Data was analyzed on individual virus species grouped in 3 seasonality patterns: wintertime (FLUA, FLUB, RSV), springtime (HMPV, PIV3) and year-round (ADENO, RHINO/ENTERO). Pre and post pandemic trends in positivity, peak shift analysis and periodic cycle were assessed.

Results
FLUA positivity dropped by 11% (95% CI 7.4-14%) in first effective quarter post-pandemic and gradually increased (+1.9% per year, p=.046) afterwards. The dominant cycle shifted from annual pre-pandemic to semiannual, with virus incidence peaks (median week) at 21-W50, 22-W17, and 22-W51, respectively, departing from the pre-pandemic baseline (W7, p &lt; 0.001). RSV positivity decreased by 2.6% per year after the pandemic (95% CI 1.2-4.0%). The annual cycle remained dominant, but peak incidence of RSV shifted earlier then gradually normalized (baseline-W1 vs. 21-W39 vs. 23-W45, p&lt; .0001). FLUB positivity significantly decreased postpandemic (0.18% vs 6.1%, p&lt; .0001). No significant impact on PIV3 and HMPV positivity occurred. Both viruses showed an annual cycle dominance throughout, with a semiannual cycle only observed post-pandemic. ADENO showed decreasing trends before the pandemic and increasing trends after the pandemic (-0.63% vs +0.94%, p=.001). Both ADENO and RHINO/ENTERO did not show changes in circulation with no distinct peaks observed.

Conclusion
Pandemic circulation disproportionately affects co-circulating viruses. Wintertime dominant viruses experienced prolonged displacement and have yet to return to pre-pandemic norms. Conversely, spring and year-round viruses were only modestly displaced and are now near pre-pandemic baseline. This study holds important implications for public health preparedness for future pandemics.

Disclosures
All Authors: No reported disclosures
P-2336. Efficacy of Treatment Regimens in Achieving Virological Response in Patients with Hepatitis D Virus Infection: A Network Meta-analysis
Authors: Ouranos Konstantinos , Mylona Evangelia K , Dellis Charilaos , Bakaloudi Dimitra Rafailia , Shehadeh Fadi , Kalligeros Markos , Mylonakis Eleftherios 
Published: January 2025

Abstract

Background
Despite the availability of treatment options for hepatitis D virus (HDV) management, choosing the most appropriate drug scheme for achieving virological response (VR) has not been adequately studied.

Methods
We conducted a systematic review and network meta-analysis of randomized trials in PubMed, EMBASE, and Web of Science databases reporting rates of VR (defined as undetectable HDV RNA or decrease by ≥ 2 log10 IU/ml at the end of treatment compared with baseline measurements). Available treatment regimens included interferon-alpha (IFN-alpha), pegylated IFN-alpha (PEG-IFN-alpha), nucleoside analogs (NA), bulevirtide (BLV), lonafarnib (LNF), combination therapy or placebo. We used random effects model and estimated odds ratio (OR) with 95% confidence interval (CI) to compare treatments based on VR. To identify the best treatment, we estimated the surface under the cumulative ranking (SUCRA) curve. Analyses were performed using the meta and netmeta packages in R (version 4.3.3).
*Denotes statistically significant associations

Results
A total of 1322 patients from 21 studies were included in the analysis and were randomized in one of 11 treatment interventions, as described in Figure 1. Treatment duration ranged from 24 to 96 weeks. BLV + PEG-IFN-alpha was ∼6 times more likely to result in VR compared with BLV alone (OR, 5.55 [95%CI: 1.60, 19.25]). Treatment with BLV + PEG-IFN-alpha was ∼17 times more likely to result in VR compared with PEG-IFN-alpha monotherapy (OR, 16.7 [95%CI: 5.6, 49.5]) (Table 1), the main agent recommended by official guidelines for HDV management. Based on probability ranking, the most effective drug schemes for achieving VR at the end of treatment were BLV + PEG-IFN-alpha (99.7%), BLV + NA (84.4%), BLV (78%), and PEG-IFN-alpha (61.3%).

Conclusion
BLV + PEG-IFN-alpha is superior in achieving VR at the end of HDV treatment compared with all other available drug schemes. Further research to determine whether BLV + PEG-IFN-alpha can maintain long-term VR after end of treatment is needed. Studies should also evaluate the impact of different BLV dosages on VR.

Disclosures
Eleftherios Mylonakis, MD, PhD, BARDA: Grant/Research Support|Basilea: Advisor/Consultant|Chemic Labs/KODA Therapeutics: Grant/Research Support|Cidara: Grant/Research Support|Leidos Biomedical Research Inc./NCI: Grant/Research Support|NIH SciClone Pharmaceuticals: Grant/Research Support|NIH/NIAID: Grant/Research Support|NIH/NIGMS: Grant/Research Support|Pfizer: Grant/Research Support|Regeneron Pharmaceuticals, Inc.: Grant/Research Support