bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2065. Profile and Risk Factors of Breakthrough COVID-19 Infections Among Healthcare Workers Post-Vaccination
Authors: Panaligan Mario M 
Published: January 2025

Abstract

Background
This study aimed to assess breakthrough COVID-19 infections in vaccinated healthcare workers, characterize their demographic and clinical profiles and identify associated risk factors.

Methods
A cross-sectional study was conducted in four hospitals using a stratified sampling approach. Data were collected via standardized questionnaires and analyzed using descriptive statistics for demographic and clinical features, with Chi-square or Fisher’s exact test to examine for significant associations and T-tests or Mann-Whitney U Tests for significant differences.

Results
Among 378 vaccinated healthcare workers, all experienced breakthrough infections, the majority during the surge of the omicron variant. Overall, 60% were females, and 91.5% were below 44. There were 172 (45.5%) nurses, 66 (17.5%) physicians, and the remaining were paramedical personnel. Breakthrough infections were shorter in vaccinated individuals (mean 11 days, SD = 5.58) compared to unvaccinated (mean 14 days, SD = 8.11). For those who developed their first breakthrough infection, the need for hospitalization and abnormal clinical and laboratory findings were significantly lower compared to unvaccinated. Among the vaccinated, higher rates of first breakthrough infection were significantly associated with being healthcare-associated and part of an outbreak. During the surge of infections due to the omicron variant, community-associated exposure and hospitalization were significantly higher among unvaccinated patients. Healthcare-associated contact was significantly associated with vaccinated people. By regression analysis, breakthrough infections due to omicron were significantly associated with a higher number of vaccine doses (OR 4.465 95% CI 1.978, 10.083) and hospitalization (OR 11.2 95% CI 2.386, 52.728). The probability of contracting the omicron variant with unknown exposure in patient care units within the past 14 days is lower (OR 0.389, 95% CI 0.174-0.866).

Conclusion
Breakthrough COVID-19 infections occurred in all vaccinated healthcare personnel, with new variants and healthcare-related duties playing significant roles.

Disclosures
All Authors: No reported disclosures
P-2068. Assessing New York City’s COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution
Authors: Schwalbe Nina , Nunes Marta C , Cutland Clare , Wahl Brian , Reidpath Daniel 
Published: January 2025

Abstract

Background
This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City (NYC).

Methods
A retrospective ecological study was conducted assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and NYC Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in NYC. Population data were obtained from Census Bureau and NYC Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors.

Results
Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45–64 years in the wealthiest quintile).

Conclusion
A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower.

Disclosures
All Authors: No reported disclosures
P-2072. COVID-19 and RSV Prevention Products in Pregnancy – Overcoming COVID-19 Network, United States, October 2023–March 2024
Authors: Simeone Regina , Newhams Margaret M , Zambrano Laura D , Orzel Amber , Lindley Megan , Payne Amanda B , Calixte Jemima , Lindsey Katherine N , Wu Michael J , Randolph Adrienne G , Campbell Angela P 
Published: January 2025

Abstract

Background
Maternal vaccines for COVID-19 and respiratory syncytial virus (RSV) are tools to prevent severe infant respiratory disease. Among recently pregnant people with hospitalized infants &lt; 6 months with COVID-19 or COVID-like illness, we evaluated receipt of these products and association with provider recommendations, other vaccine receipt, and acceptability of future vaccines in pregnancy.

Methods
Mothers of infants &lt; 6 months hospitalized either for COVID-19 or COVID-like illness were interviewed for the Overcoming COVID-19 Network. Outcomes were 1) verified receipt of COVID-19 and maternal report of RSV vaccines during pregnancy by provider recommendation (among those eligible for updated/new vaccine based on date of vaccine approval and infant date of birth), 2) influenza and Tdap vaccine receipt during pregnancy, and 3) willingness to receive vaccines in future pregnancies.

Results
Caregivers of 514 (68%) of 760 hospitalized infants &lt; 6 months were interviewed; 216 (42%) of 514 interviews were among mothers. Seven (5%) of 147 eligible mothers received COVID-19 vaccine during pregnancy, 8 (5%) were vaccinated 1 to 180 days before pregnancy, and 132 (90%) were vaccinated &gt;180 days before pregnancy or not at all. Ten (9%) of 113 eligible mothers received the RSV vaccine during pregnancy; 20 (19%) mothers who did not receive RSV vaccine reported their infant receiving an infant monoclonal antibody against RSV. Provider recommendation was associated with maternal receipt of both COVID-19 and RSV vaccines during pregnancy (Figure 1A, 1B). Tdap was the most received vaccine during pregnancy (n=117 [61%]) (Figure 2). Willingness to receive vaccines in a future pregnancy was common for Tdap (n=93, 58%), influenza (n=88, 55%), and RSV (n=87, 54%). Only 22% (n=35) of mothers stated they would be willing to receive a COVID-19 vaccine in a future pregnancy.

Conclusion
Among mothers of infants hospitalized with COVID-19 or COVID-19-like illness, few had received a COVID-19 vaccine during or within 180 days before pregnancy. Tdap and influenza vaccines were more commonly received during pregnancy and were more acceptable in future pregnancies. Provider recommendation was associated with receipt of COVID-19 and RSV vaccines during pregnancy.

Disclosures
Regina Simeone, PhD, Pfizer: Stocks/Bonds (Private Company) Adrienne G. Randolph, MD, MSc, Illumina, Inc.: Reagents|Inotrem: Advisor/Consultant|Thermo Fisher, Inc.: Advisor/Consultant
P-2111. Automated Bacterial Growth Detection, Bacterial Species Estimation and Antimicrobial Susceptibility Testing on Agar Plates Using a Light Transmission-based Monitoring System
Authors: Ariizumi Reiichi , Umebayashi Kyohei , Maeta Shogo , Ozaki Hiroaki , Fujisawa Akihiko , Tezen Tomoya , Tsunashima Takanori , Ito Kaoru , Abe Daichi , Yamaguchi Kazunori , Ohnuma Kenichiro , Ishida Nami , Ebisawa Kei Furui , Ohji Goh , Nakajima Masakazu , Taketani Makoto 
Published: January 2025

Abstract

Background
Culturing bacteria on agar plates is essential for diagnosing bacterial infections, but it usually takes overnight and is labor-intensive. We have developed a novel device using a thin-film transistor image sensor to measure light transmission through agar plates every five minutes during incubation (Nakada et al. ASM 2023 and IDweek 2023). Here we present a proof of concept study for using this device for automated early detection and disk-diffusion susceptibility testing and compare the results to those obtained by experienced microbiology technicians.

Methods
Chromogenic agar plates were used for early detection and subsequent species estimation based on colony color changes, i.e. Enterobacteriaceae on CHROMagar mSuper CARBA plates and Staphylococci on MDRS-K plates. Statistical background subtraction was used for early detection of bacterial growth and histogram comparison of pseudo-color images created by correcting the intensity of red, blue, and green lights for species estimation.
For disk diffusion tests susceptible and resistant E. coli and S. aureus were inoculated on Mueller-Hinton plates against the known agents and incubated for 18 hours with monitoring. Transmitted light images after 18 hours were first binarized and the distance of the shortest bacterial growth pixel from the center of the corresponding antibiotic disk was measured as the inhibition zone diameter.

Results
The device detected Enterobacteriaceae and MRSA as early as 6 and 8 hours after incubation, respectively, when the suspensions were densely streaked (Figure 1).
The device also estimated the bacterial species with sensitivity and specificity over 90% for Enterobacteriaceae, however, the specificity for MRSA against MRCNS was approximately 70% (Table 1).
An example of the automated inhibition zone measurement is shown in Figure 2.
All automated measurements agreed well with the manual measurements (Table 2).

Conclusion
The performance in the bacterial detection, species estimation and the zone diameter measurement indicated that the device can be useful in accelerating, automating, and standardizing routine testing in microbiology laboratories.

Disclosures
Goh Ohji, MD, Ph.D, CarbGem Inc.: Advisor/Consultant Masakazu Nakajima, B. Engineering, CarbGeM Inc.: Board Member|CarbGeM Inc.: Ownership Interest
P-2113. Development of a Local Multidrug-Resistant Gram-Negative Antibiogram
Authors: Crawford Robert , Bunner Courtney , Chin Jacinta , Gould Alyssa P 
Published: January 2025

Abstract

Background
As gram-negative (GN) resistance continues to rise, it is imperative to understand the best empiric treatment options on a local or regional level. Traditional antibiograms including all isolates may be diluted by sensitive organisms that do not have broad spectrum agents automated for susceptibility testing. The purpose of this review was to develop a health system antibiogram and assess susceptibility rates specific to multidrug-resistant (MDR) GN organisms, including newer broad-spectrum agents that are not routinely reported on traditional antibiograms.
Multidrug-Resistant Gram-Negative Antibiogram 2017-2023

Methods
Data was collected from acute care facilities within a large community hospital system. MDR GN isolates including extended spectrum β-lactamase-producing (ESBL) Enterobacterales, carbapenem-resistant (CR) Enterobacterales, difficult-to-treat (DTR) Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and Burkholderia cepacia complex from January 2017 to December 2023 were included. Susceptibility testing was completed using VITEK 2 system (bioMérieux), E-test or Kirby-Bauer disk diffusion. Interpretation of susceptibility data was based on CLSI M100 guidance.

Results
The MDR GN antibiogram is shown in Table 1. The most common isolates encountered were ESBL Escherichia coli (n=8797) and ESBL Klebsiella pneumoniae (n=1779). DTR P. aeruginosa had the lowest susceptibility across all agents; in comparison to CR P. aeruginosa isolates, ceftazidime/avibactam susceptibility was similar however ceftolozane/tazobactam susceptibility was lower. Notably, ceftazidime/avibactam (100%) retained activity for CR K. pneumoniae while CR E. coli had a lower than expected isolate count and susceptibility. S. maltophilia had lower reported susceptibility to trimethoprim/sulfamethoxazole and levofloxacin (84% and 86% respectively) than minocycline (95%) which is performed upon request via manual E-test.

Conclusion
Most MDR GN pathogens within a large community hospital system had reported activity to newer antimicrobial agents. Overall, our antibiogram aligns with treatment recommendations advised by IDSA 2023 Antimicrobial Resistance guidance. Next steps include additional data review for annual susceptibility trends.

Disclosures
All Authors: No reported disclosures
P-2115. Clinical Presentation and Outcome of Tuberculosis in Chronic Kidney Disease Stage 4 and 5 from a high TB burden Country
Authors: Samar Rohama , Dodani Sunil , Nasim Asma , Udin Zaheer 
Published: January 2025

Abstract

Background
Diagnosis and management of Tuberculosis (TB) in chronic kidney disease (CKD) is challenging. Our aim is to study clinical presentation and outcome in patients with stage 4 and 5 CKD from a high TB burden country.

Methods
All patients registered from May 2016 to June 2020 were included. Rifampicin resistance on GeneXpert test was excluded. Patients with CKD stage 4 and 5 were studied for demographics, TB history, clinical features, diagnoses, treatment success and mortality. CKD stage 4 and 5 were compared with other patients registered at the TB treatment center.

Results
Out of 828, 259 (31%) had CKD stage 4 and 5. Out of 259, 156 (60%) had extra-pulmonary TB (EPTB). Microbiological diagnosis done in 118 (45.51%), 25% in EPTB and 72.9% in pulmonary TB (PTB). TB culture was positive in 46 (17.8%), Isoniazid resistance [10] 21.7%. Treatment success was 80.7%. PTB was significantly associated with mortality (p=0.031). In CKD stage 4 and 5 treatment success was significantly lower with high mortality (p=0.033).

Conclusion
In CKD stage 4 and 5, EPTB is the most common presentation. Microbiological diagnosis could be achieved in one -fourth of EPTB. There is high INH resistance. The treatment success is low with high mortality and PTB is a significant risk factor for mortality.

Disclosures
All Authors: No reported disclosures
P-21. Comparison of Three RSV Vaccine Lower Respiratory Tract Disease Primary Endpoint Definitions for Adult Vaccine
Authors: Williams Sarah E , Begier Elizabeth , Ilangovan Kumar , Hall-Murray Cassandra , Gessner Bradford D 
Published: January 2025

Abstract

Background
Despite their public health importance, a consensus definition for lower respiratory tract disease (LRTD), or illness (LRTI) is lacking. Clinical trials of three respiratory syncytial virus (RSV) vaccines for older adults used different LRTI/LRTD definitions for vaccine efficacy (VE). We hypothesize differences between definitions could bias product comparisons.Table 1.Variation of signs or symptoms included in criteria to meet case definition of LRTI or LRTD in three RSV vaccine clinical trials

Methods
We reviewed case definitions for LRTI/LRTD in RSV vaccine clinical trials conducted in older adults.Table 2.Specified values for symptoms/signs included in LRTI/LRTD criteria definitions for three RSV vaccine clinical trials

Results
Two of three published RSV vaccine clinical trials from Pfizer and Moderna used two outcomes (LRTI/LRTD with ≥2 signs/symptoms or ≥3 signs/symptoms) to measure VE, while the third trial from GlaxoSmithKline (GSK) used one (combining ≥2 and ≥3 signs/symptoms) (Table 1). The Pfizer trial included 5 signs/symptoms as components of LRTI; three of these (tachypnea, wheezing, shortness of breath) suggest lower airway involvement and two (cough and self-reported sputum production) could also result from upper airway infection. At interim analysis, 29 of 45 cases had only 2 symptoms (64.4%). Of these 29, 25 had only cough and sputum production (86.2%). The GSK trial, by contrast, required all LRTD cases to include at least one sign, all of which indicated lower airway involvement (Table 2). The Moderna trial included 10 signs/symptoms, including the potential for subjects to have only cough and sputum production. Even within signs/symptoms, definitions differed (e.g., tachypnea cutoff ranged from 20 to 25 breaths per minute; Table 2). When using comparable definitions, full season 1 VEs for Pfizer and GSK products were similar while the point estimate for the Pfizer product was higher during season 2 (Table 3).Table 3.Vaccine efficacy for three RSV vaccine clinical trials using study LRTI/LRTD definitions

Conclusion
Lack of standard case definitions limit ability to compare results across trials. Some ≥2 LRTI events for Pfizer and Moderna may not have involved the lower respiratory tract but rather the upper respiratory tract only. The most comparable case definitions likely are ≥3 signs/symptoms LRTI in the Pfizer and Moderna trials, and LRTD in the GSK trial.

Disclosures
Sarah E. Williams, MD, MPH, Pfizer, Inc: Salary|Pfizer, Inc: Stocks/Bonds (Private Company) Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company) Kumar Ilangovan, MD, MSPH, MMCi, Pfizer, Inc.: salary|Pfizer, Inc.: Stocks/Bonds (Public Company) Cassandra Hall-Murray, PharmD, Pfizer, Inc.: employee|Pfizer, Inc.: Stocks/Bonds (Public Company) Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)
P-2141. Factors Associated With Death in a Population-based Invasive Mold Surveillance Program, Atlanta, GA
Authors: Oliver Nora T , Mackey Carolyn , Goodenough Dana , Thomas Stepy , Witt Lucy S 
Published: January 2025

Abstract

Background
Invasive mold infections (IMI) can lead to severe illness and are associated with high mortality. Using data from a population-based surveillance program, we describe risk factors associated with death in patients with IMI.
Demographic information, total cohort of patients with IMI, N = 236

Methods
The Georgia Emerging Infections Program conducted a CDC-funded active IMI surveillance program at 3 academic hospitals in the Atlanta metropolitan area from 2020-2022. Cases were determined based on EORTC/MSG criteria using supportive culture and Aspergillus galactomannan (serum or BAL) data. Cases were also ascertained if the treating physician provided a diagnosis of IMI and the patient received mold-active antifungal therapy. Variables listed are for 30 days from incident mold specimen identified and 90 days for COVID-19 diagnosis. Descriptive and univariate analyses evaluated risk factors for 90-day mortality after incident mold specimen identified
Risk Factors for Death from Invasive Mold Infection, Univariate Analysis, N = 236

Results
Of 236 patients identified with IMI, average age was 59 years, 134 were White race (56.8%), and 148 (62.7%) were men (Table 1). 109 patients (46.2%) died. Lymphopenia and neutropenia were present in 138 (58%) and 33 patients (13.9%), respectively. SARS-CoV-2 virus infection was found in 43 patients (18.2%). Ventilatory support was used in 89 patients (37.7%), and 133 (56.3%) patients had pulmonary source of IMI (Table 1). The most common identified fungal pathogen was Aspergillus fumigatus (18.6%) followed by other unidentified Aspergillus spp (6.4%), Fusarium (5%), and Scedosporium spp (5%); GM was positive in 92 patients (39%).
Univariate analysis revealed significant association with death in patients with lymphopenia (p = &lt; 0.0001), neutropenia (p = 0.001), ventilator use (p &lt; .0001), and COVID-19 illness (p &lt; .006). Factors not significant for death included age &gt;65 years, race, sex, presence of chronic lung disease, pulmonary source of IMI, and receipt of anti-mold therapy (Table 2).

Conclusion
Among patients with IMI in these 3 Atlanta hospitals from 2020-2022 , death was associated with underlying host factors such as lymphopenia and neutropenia status. Similarly, ventilatory support and COVID-19 illness were also associated with mortality. Further studies will examine these associations and differences between mold infections.

Disclosures
All Authors: No reported disclosures
P-2145. Candida blankii: An Emerging Threat among Hospitalized Neonates of Bangladesh
Authors: Shuvo Tanzir Ahmed , Shaly Nusrat Jahan , Pammi Farhat Jaby , Islam Md Kamrul , Tasnim Adiba , Tabriz Bhuiyan Shams E , Farzana Fahmida Dil , Aleem Md Abdul , Chowdhury Fahmida , Huq Sayeeda 
Published: January 2025

Abstract

Background
Invasive fungal infections (IFIs) cause serious complications and fatality. Despite the severity of such magnitude, the true burden of these infections remains unclear. In LMICs like Bangladesh, there is a lack of surveillance mechanisms to understand the burden of IFIs. Candida blankii (C. blankii) is an emerging clinical pathogen with first reported human infection in 2014 and limited global reports of clinical infection since then. This study aims to investigate the burden on C. blankii along with other IFIs among hospitalized neonates in Bangladesh.

Methods
Since July 2022, a hospital-based IFI surveillance has been ongoing in the neonatal ICU of a tertiary level hospital in Bangladesh. From then until April 2024, 224 patients were enrolled, who were suspected of have IFIs based on predefined inclusion and exclusion criteria. Blood and endotracheal aspirate samples were collected and sent to the laboratory for microscopy, culture and identification using Vitek 2 and Vitek MS automated system. Additionally, antifungal susceptibility testing (AFST) was performed using the Vitek2 system.

Results
Median age of the enrolled neonates were 17 days (IQR:12-21); 67% of them were male. Notably, 76% of these neonates had positive blood cultures for at least one fungal organism. Kodamaea ohmeri was the most frequently identified fungus (52 cases), followed by Candida cifferi (45) and the emerging fungus C. blankii (36). There were only two cases of Cryptococcus laurentii along with other candida species. Mortality rates were highest among neonates infected with Candida cifferi (67%), followed by C. blankii (45%) and Kodamaea ohmeri (36%). Worryingly, C. blankii exhibited high resistance to Amphotericin B (97%) and Voriconazole (69%), potentially limiting effective treatment options.
High Antifungal Resistance

Conclusion
This ongoing surveillance identified a high prevalence of IFIs, particularly caused by the emerging fungus C. blankii. Further research is necessary to elucidate the potential sources and transmission pathways of C. blankii to design targeted interventions to effectively control this emerging threat in this vulnerable population. The surveillance team is actively working with the hospital authorities to identify potential sources and implement strategies to minimize such infections.

Disclosures
All Authors: No reported disclosures