bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-50. Mpox Vaccine Uptake Among Sexual and Gender Minority Veterans With and Without HIV in a Nationwide US Veteran Cohort
Authors: Van Epps Puja , Meriwether Wyatt E , Mcconnell Alex , (Lexi) Matza Alexis , Shipherd Jillian , Kauth Michael R 
Published: January 2025

Abstract

Background
Sexual and gender minorities (SGM) and people with HIV have been disproportionately affected by the Mpox pandemic. Vaccination is recommended for those who may be at an increased risk. We examined the uptake of Mpox vaccine nationally in the Veterans Health Administration (VHA) among SGM Veterans and reported on disparities across groups.

Methods
We queried VHA’s national database to identify Veterans whose sexual orientation is recorded as lesbian, gay, bisexual or queer (LGBQ+) and gender identity as transgender woman (TGW)/man (TGM), non-binary or another gender (except cisgender) [transgender or gender diverse (TGD)] as of April 2024. Birth sex male LGBQ+ and TGD Veterans of both birth sexes were included in the cohort, stratified by age, race/ethnicity and HIV status. Within these cohorts we quantified receipt of JYNNEOS vaccine in the VHA starting 2022.

Results
Among the 42,434 males who identify as LGBQ+, 4759 (11.2%) had received at least one dose of the JYNNEOS vaccine; of these, 74% completed the series. There were large variabilities in vaccine uptake among LGBQ+ males by age: the 19-29 cohort had the lowest uptake at 5.2% and lowest series completion rate at 58.1% while the 50-59 age group had the highest uptake at 15.6% (Figure 1). Among racial groups, Asian LGBQ+ males had the highest uptake at 19.3%, and Whites had the lowest uptake at 9.4% (Figure 2). Black and Hispanic LGBQ+ males had better than average uptake at 14.7% and 15.6% respectively. Among 111,338 Veterans who identify as TGD, only 138 (1.2%) had received at least one dose by the end of observation period. Among these, TGW had the highest number of persons vaccinated (n=73) but non-binary Veterans had highest rate at 2.6% (Figure 3). Those with HIV were much more likely to have received at least one dose of the vaccine compared to those without (LGBQ+ males 25.5% vs. 7.6%; TGD 15.1% vs. 1%) (Figure 4).

Conclusion
TGD Veterans were much less likely to have received Mpox vaccination in the VHA compared to LGBQ+ males, with HIV status being the strongest predictor of vaccination in both groups. While the overall rates of Mpox vaccination appear lower in the VHA compared to general population, we did not see racial disparities that have been reported in Blacks but observed age related differences.

Disclosures
All Authors: No reported disclosures
P-77. Ceftaroline versus Daptomycin as Definitive Treatment for Methicillin-Resistant Staphylococcus aureus Bone and Joint Infections
Authors: Goodman Reid , Ney Katheryn , Liang Stephen Y , Marschall Jonas 
Published: January 2025

Abstract

Background
There are no comparative effectiveness studies of ceftaroline versus other antibiotics for MRSA bone and joint infections (BJI). We retrospectively compared the clinical outcomes of patients with MRSA BJI initially treated with vancomycin and then transitioned to either ceftaroline (VtoC) or daptomycin (VtoD).

Methods
This retrospective nested case-control study analyzed data from a large Midwest academic center collected from 2018-2022. Patients with MRSA BJI whose definitive treatment was ceftaroline were compared in a 1:2 ratio to patients whose definitive treatment was daptomycin. The primary outcome was clinical success after initial treatment course (i.e., at 6 weeks) defined by a composite endpoint which included resolution of signs and symptoms and no repeat surgery or re-admission for treatment of the index BJI.

Results
We identified 36 patients to be included in this case-control study, with 12 VtoC cases and 24 VtoD cases. The demographic make-up was similar, as was the frequency of comorbidities (including Charlson score). Of the VtoC patients, 42% had implant-related infection vs. 17% of the VtoD group (p=0.1). A larger proportion of VtoC patients had systemic MRSA infection as documented by positive blood cultures (58% vs 38%; p=0.2). More VtoC cases were direct ICU admits (50% vs 13%; p=0.04), required intubation (58% vs 17%; p=0.02), or were admitted to the ICU at any point during their stay (67% vs 29%; p=0.07). Transition away from vancomycin occurred at 14.3 vs 10.6 days (p=0.6). There was only a single clinical success in the 12 VtoC patients (8%) vs. 7/24 (29%) in the VtoD group (p=0.2), with the majority of cases being failures (30.5%), all-cause deaths (30.5%), or lost to follow-up (16.7%). Follow-up was 103 vs 123 days (p=0.8) in the two groups.

Conclusion
In this comparison of ceftaroline to daptomycin for MRSA BJI we found ceftaroline recipients to have more severe illness (as suggested by need for ICU care) and experience very little clinical success. We suspect that there is selection bias in that more severely ill cases anticipated to have poor outcomes were more likely to be transitioned to ceftaroline. Our next steps are to include more data and conduct a propensity score analysis to better understand what factors are associated with transition to ceftaroline.

Disclosures
All Authors: No reported disclosures
P-78. Observational Comparison of In-Person vs. Remote Care for Bone and Joint Infections
Authors: Gupta Nupur , Mehta Steinke Seema , Nanjappa Sowmya , D’Angelo Nicholas , Kowdley Devan , Wong Victoria R , Abdel-Massih Rima , Mellors John W , Shah Neel 
Published: January 2025

Abstract

Background
Telemedicine can overcome barriers to accessing subspecialty expertise including for infectious disease (ID). A common need for ID expertise is bone and joint infections (BJI), which are associated with substantial morbidity and mortality. Access to BJI expertise in underserved locations could be increased through ID telemedicine (Tele-ID). Here, we compare patients, and outcomes of Tele-ID vs in-person ID care of BJI.Table 1:Characteristics of the Study Population

Methods
We conducted a retrospective study of BJI patients who received Tele-ID (live audio-video) care at hospital #1 vs. in-person ID care at hospital #2 between 2015-2019. Both hospitals are affiliated with a larger academic institution and have care provided by the same ID physicians. Demographic data, comorbidities, diagnostic and microbiological data, treatment, and outcomes were assessed.Table 2:Primary Outcomes of the Study Population

Results
Of the first 100 patients, half received Tele-ID care at hospital #1 and the other half received in-person ID care at hospital #2. Both groups had similar patient characteristics (Table 1), except for higher frequency of same site infection at hospital #2 (68 vs 26%). Patients cared for via Tele-ID were more often transferred to an alternative tertiary-care facility (30% vs. 0%) for surgical specialty services not available at hospital #1 (Table 2). For Tele-ID patients transferred vs in-person care, LOS was longer and discharge to home occurred less often compared with those not transferred. Readmission for the same infection within 30 days and mortality were not different (Table 2). The most common BJI managed by Tele-ID was diabetic foot osteomyelitis without any hardware, whereas joint infections with hardware were most commonly seen by in-person ID (Figure 1). Amongst patients with OR procedures, most OR cultures were negative, with Staphylococcus aureus being isolated most frequently at both hospitals (Figure 2).Figure 1:Type of Infection by Hospital

Conclusion
This initial observational study suggests that clinical outcomes are similar for patients with BJI cared for by in-person vs. Tele-ID, although hospital transfer for surgical interventions was more common at the Tele-ID site. Further comparison in a larger number of patients at each hospital is ongoing. This preliminary experience suggests that Tele-ID could provide appropriate care for BJI where in-person ID expertise is not available.Figure 2:OR Culture Organism(s) by Hospital

Disclosures
Seema Mehta Steinke, MD, MS, Pearl Diagnostics: Advisor/Consultant Rima Abdel-Massih, MD, Infectious Disease Connect: CEO & co-founder|Infectious Disease Connect: Ownership Interest John W. Mellors, MD, Infectious Disease (ID) Connect, Inc.: Share Options
P-82. Doxycycline versus other oral antibiotics for the treatment of gram-positive bone and joint infections
Authors: Corbino Joseph , Martin Tyler , Patel Manish , Andruski Rebecca , Kandiah Sheena , Schechter Marcos , Aldred Bruce 
Published: January 2025

Abstract

Background
The OVIVA trial demonstrated oral agents with high bioavailability after one week of IV treatment is non-inferior in treatment of bone and joint infections (BJI) compared to continued IV therapy. Oral therapy significantly reduced rates of IV catheter complications and hospital length of stay. Certain highly bioavailable oral options with coverage for gram-positive organisms were well studied in this phase III trial, such as linezolid (LZD) and trimethoprim/sulfamethoxazole (TMP/SMX), with doxycycline representing a small proportion. LZD and TMP/SMX exceeded their respective Clinical and Laboratory Standards Institute (CLSI) breakpoints and MIC90 values in the bone. Doxycycline achieves concentrations of 3 mcg/mL in the bone but may not reach upper concentrations of susceptibility per the CLSI breakpoint (≤ 4 mcg/mL). LZD and TMP/SMX penetrate the bone well, but adverse effects may make prolonged therapy difficult to tolerate compared to doxycycline.

Methods
A retrospective chart review was conducted of individuals ≥ 18 years prescribed doxycycline or either LZD or TMP/SMX for the treatment of a presumed or confirmed gram-positive BJI within the Grady Health System between January 1, 2021, and June 30, 2022. Individuals were included if they were referred to an ID provider within our Transitions of Care clinic and received oral antibiotics for ≥1 week on discharge. The composite primary outcome was suggested or performed amputation, OR debridement, all-cause mortality, or re-initiation of antibiotics. Secondary outcomes include rate of primary therapy completion and incidence of adverse effects.

Results
77 patients met inclusion for the study, doxycycline (n=33) and LZD or TMP/SMX (n=44). There was no significant difference in the primary outcome at 9 months between either group (10 vs 12, p=0.77). Loss to follow-up drove incompletion rates of primary antibiotic therapy in both groups. Laboratory adverse effects were more common in the LZD or TMP/SMX group compared to doxycycline.

Conclusion
Doxycycline may be associated with a favorable adverse effect profile compared to LZD or TMP/SMX. The efficacy of doxycycline compared to LZD or TMP/SMX should be considered exploratory with larger studies conducted to highlight its potential place in practice.

Disclosures
All Authors: No reported disclosures
P-86. Utility of Metagenomic Next-Generation Sequencing in Detecting Pathogens Causing Orthopedic and ENT Infections
Authors: McConnell Alia , Hussain Anila , Edmonston Tina B , Ianosi-Irimie Monica , Nikolic Dejan 
Published: January 2025

Abstract

Background
Traditional methods such as gram stain and cultures are recommended to identify pathogens from patient specimens. Metagenomic Next-Generation Sequencing (mNGS) is a new attractive technology to detect occult infections, that does not provide susceptibilities, with not well-established utility. We compared results of mNGS tests performed at Microgen Reference lab to those of traditional culturing on patient outcomes.

Methods
This retrospective study includes all patients from Aug 2022 to Dec 2023 whose biopsy samples were submitted for both traditional culturing and mNGS diagnostic tests. Clinical and lab data were extracted from the electronic medical record. Patient outcomes when utilizing traditional versus mNGS diagnostic methods were compared.

Results
53 orthopedics and ENT cases were studied. 31/41 (75.6%) orthopedic cases (spine, hips, and synovial fluid) had concordant results, with 19 (46.3%) concordant negative cases and 12 (29.3%) concordant positive cases showing similar organism(s). Of the discordant cases, 12.2% (5/41) mNGS results were accurate, and 9.75% (4/41) culture results were accurate. One specimen (2.44%) showed contamination with both methods. Of 12 ENT cases, overall concordance of accurate results was only 50%, 1 negative case and 5 cases showing the same organism(s) with both methods. 16.7% (2/12) the culture results were accurate while mNGS results were incorrect, and 4/12 (33.3%) specimens showed contamination by both methods.

Conclusion
Utilizing mNGS versus traditional methods did not result in any changes in patient management like empirical and targeted antibiotic regimen or in hospitalization outcomes including duration of therapy or length of stay. The accuracy of the testing is equivalent, while mNGS is much more expensive and not readily available in clinical labs, resulting in longer TAT (6 days vs. cultures 3 days). The quality of results is mainly affected by the quality of the specimen (33% contamination for ENT specimens). These data ultimately guided the stewardship discussions about utilizing mNGS at CUHC to discourage mNGS testing for ENT sources unless the collection method is improved and reserve the utilization of mNGS for challenging orthopedic cases.

Disclosures
All Authors: No reported disclosures
P-106. Preliminary Results of the

C

omparing

O

ral versus

P

arenteral

A

ntimicrobial

T

herapy (COPAT) Clinical Trial
Authors: Juskowich Joy J , Thompson Jesse M , Guilfoose John A , Lastinger Allison , Stanley Jonathan E , Smith Connie L , Arcega Victor A , Bage Seyoum , Sarwari Arif R 
Published: January 2025

Abstract

Background
Early intravenous (IV) to oral (PO) antibiotic transition for serious infections such as bacteremia, endocarditis, and bone/joint infections is noninferior to continued IV antibiotics. Our experience shows that Complex Outpatient Antimicrobial Therapy with PO antimicrobials (COpAT) is not only clinically effective but much safer. However, COpAT programs are not yet widely incorporated into clinical practice. Comparing Oral vs. Parenteral Antimicrobial Therapy (COPAT) Trial was designed to demonstrate improved safety with equivalent effectiveness of early IV to PO antibiotic transition across almost all infectious diseases. We hypothesized that, without compromising clinical outcomes, adverse events (readmissions, antibiotic toxicities, and line issues) will be significantly lower in patients discharged with PO antibiotics.

Methods
COPAT Trial is an ongoing open-label, pragmatic, randomized controlled trial at five Infectious Disease faculty staffed hospitals in one health system. A total 135 hospitalized patients otherwise being discharged with two or more weeks of IV antibiotics are randomized 2:1 to early PO (Experimental) vs. continued IV (Control) antibiotics. Two primary outcomes, assessed at 12 weeks, are efficacy equivalence and Experimental group safety superiority. From Aug 4, 2023 through Apr 30, 2024, 73 (Experimental 48, Control 25) active patients were enrolled and 64 (Experimental 42, Control 22) completed the trial.

Results
Demographics and infection type were similarly distributed between both groups with a predominance of bone/joint followed by endovascular infections (Table 1). While total antibiotic durations were comparable, Experimental group received disproportionately more PO antibiotics (87 vs. 37%, p&lt; 0.05) (Figure 1). Both groups had a strong preference for PO antibiotics, and all patients felt their infection had been successfully treated (Table 2). Experimental group had a significantly lower total adverse event rate (2.8 vs. 7.2%, p&lt; 0.05) (Table 3). All patients achieved clinical cure at 12 weeks.

Conclusion
Early IV to PO transition significantly improves antimicrobial treatment safety without compromising effectiveness across many serious infectious diseases. Patients report a strong preference for PO antibiotics.

Disclosures
All Authors: No reported disclosures
P-115. Lessons from Establishing a Vaccine Trial Clinic: Insights from the University of Louisville's Center of Excellence for Research in Infectious Diseases
Authors: Shafique Nouman , Shahnawaz Waqas , Balcom Dawn 
Published: January 2025

Abstract

Background
The COVID-19 pandemic spurred an urgent need for swift vaccine development to combat the disease. This study focuses on outlining the implementation approach for the Phase 3 clinical trial of the Ad26.COV2.S vaccine. The University of Louisville's Division of Infectious Diseases, known as the Center of Excellence for Research in Infectious Diseases (CERID), was contacted by Janssen representatives in July 2020 to conduct the trial.Figure 1.The structure of the Center of Excellence for Research in Infectious Diseases (CERID).

Methods
The CERID site was fully activated in November 2020, and the enrollment period spanned 16 working days, from November 21 to December 11, 2020. The study employed a randomized, double-blind, placebo-controlled design. Various organizational units within CERID, including community outreach, implementation, quality assurance, and laboratory, collaborated to develop standard operating protocols for communication and execution. These steps included community outreach, trainings, and the development of case report forms.Figure 2.Data collected at Screening and Day 1 participant visits.

Results
During the enrollment period, 64 participants were seen, with 62 enrolled in the trial. The self-sufficient organizational infrastructure of CERID was pivotal in facilitating the successful implementation of the Phase 3 clinical trial. Quality metrics were developed to minimize systematic errors and ensure accurate reporting of results. The Division of Infectious Diseases Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory provided essential support for COVID-19 diagnosis, sample processing, and shipping.Figure 3.Workflow in laboratory. Gold top humoral blood collection tube, PAXgene RNA blood sequencing tube, NP specimen tube, and saliva samples were delivered to the laboratory. Specimens processed per laboratory manual and stored in the -80°C freezer until shipping to the central laboratory.

Conclusion
The seamless execution of the Phase 3 clinical trial at CERID highlights the effectiveness of a multidisciplinary research coordinating center. The collaborative efforts of various units within CERID, along with proactive measures such as pre-labeling specimen tubes and addressing participant concerns directly, contributed to the trial's success. The described methods and approach can be adapted for use in diverse clinical and laboratory research settings, showcasing resilience and adaptability in the face of pandemic challenges

Disclosures
All Authors: No reported disclosures
P-121. Brucellosis outbreak in northwestern Tajikistan in 2023: a matched case-control study
Authors: Qurbonov Emomali , Silemonshoeva Jamila , Tilloeva Zulfiya H , Sharifov Rajabali , Yusufi Salomudin , Nabirova Dilyara , Horth Roberta 
Published: January 2025

Abstract

Background
A sharp increase in brucellosis incidence was observed in northwestern Tajikistan (from 1.0/100,000 people in 2022 to 32,7/100,000 by May 2023). Most cases, 82% (84/103), were from the same village (population=10,712). We investigated to identify risk factors and mitigate disease.
Epidemic curve of monthly cases of brucellosis from January to September 2023, Farob village, Panjakant district, Sughd region (n=123).

Methods
Using a case-control design, we conducted face-to-face interviews and collected blood from May-July 2023. Cases were the first person in a household diagnosed with brucellosis in February-June 2023 with positive Huddleson reaction test and Wright antibody titers ≥1/160. Two controls were selected for each case (neighbors from different households matched by age and sex). Controls testing positive were excluded (13%). We conducted conditional multivariable logistic regression to assess odds of brucellosis expressed as adjusted odds ratio (AOR) and 95% confidence intervals (CI).
Multivariate analysis of human brucellosis risk factors, Farob village, Panjakent district , Tajikistan, 2023

Results
Of 84 cases, 57 (58%) met inclusion criteria. Of which, 68% were 15-44 years old and 44% were male. Cases peaked in May. Common symptoms were joint pain (95%), fever (84%), weakness (72%), and night sweats (65%). All cases and 94% of controls (n=114) had livestock (mostly cattle, sheep or goats); no animals had not been vaccinated &lt; 5 years. A greater proportion of cases than controls had consumed homemade kaymak (clotted cream from unpasteurized milk) (89% vs 36%), home-produced meat (98% vs 82%) or neighborhood-produced milk (81% vs 61%); or engaged in animal slaughter (42% vs 11%) or animal grooming (32% vs 10%). Brucellosis was associated with consumption of homemade kaymak (AOR=60.6 [CI=4.2-873.0], p=0.003), homemade meat (55.1 [1.2-2,549.0], p=0.040), neighborhood milk (8.6 [1.6-47.9], p=0.014), animal slaughter (50.9 [2.8-919.0], p=0.008) or animal grooming (15.6 [1.1-234.0], p=0.047).

Conclusion
Contact with unvaccinated livestock or consumption of their products was a key contributor to this outbreak. Cases were likely higher than reported. Following our investigation, an education and vaccination was carried out and no more brucellosis cases were reported after August 2023.

Disclosures
All Authors: No reported disclosures