bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-678. Comparison between the Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Three Waves of the Pandemic
Authors: Mares Porto Barbara , Pereira Daniella Nunes , Kopittke Luciane , Asevedo Alisson , Gomes Angélica Gomides dos Reis , Behring Angelinda , Lima Beatriz , Silva Carla , Barros Cláudia , Pereira Elayne , Conceição de Oliveira Evelim Thainara , Vigil Flavia , Crestani Gabriela , Santos Lais , Moreira Leila Beltrami , Reis Marco , Bicalho Maria , Muller Vanessa , Tupinambás Unaí , Marcolino Milena Soriano 
Published: January 2025

Abstract

Background
Throughout the COVID-19 pandemic, new SARS-CoV-2 variants emerged, each prevailing during a certain time period and defining the pandemic waves that were observed all over the world. Even in different countries, such waves presented many similarities, such as the period of occurrence, clinical characteristics of those who were infected by the SARS-CoV-2 virus, COVID-19 outcomes and governmental public policies to stop the spread of the disease. Their major differences are believed to be related to the SARS-CoV-2 variant circulating at the time, as well as the availability of vaccines, patient vulnerabilities, resource availability and knowledge in patient management.

Methods
This study is part of a multicentric retrospective cohort, entitled the Brazilian COVID-19 Registry, which included adult patients (≥18 years), with laboratory-confirmed COVID-19, admitted between March 2020 and August 2022 in 41 hospitals in six Brazilian states. The primary outcome was in-hospital mortality. Secondary outcomes included: intensive care unit (ICU) admission, need for mechanical ventilation, kidney replacement therapy (KRT) thromboembolic event, nosocomial infection, acute heart failure and septic shock.

Results
The median age decreased in the second wave and increased in the third compared to the first. The total number of comorbidities was higher during the third wave and lower in the second. When evaluating symptoms, in the third wave, anosmia, ageusia and fever were less common when compared to the other waves , while neurological manifestations were more frequent. The frequency of admission to the intensive care unit and in-hospital mortality reduced throughout the pandemic.

Conclusion
The study showed that clinical manifestations and outcomes changed between the three COVID-19 waves. In the second phase of the pandemic, patients hospitalized with Covid-19 were younger and had fewer comorbidities. The risk of severe disease has decreased substantially since the start of the pandemic. However, the new strains are under continued investigation, because of the unknown impacts in severity and vaccine effectiveness, the response to existing therapies and the accuracy of diagnostic tools.

Disclosures
All Authors: No reported disclosures
P-679. Risk Factors Shared Among Common Respiratory Viruses
Authors: Waxse Bennett , Tran Tam , Mo Huan , Denny Joshua 
Published: January 2025

Abstract

Background
Upper respiratory infections affect patients of all ages, with severity influenced by demographics, comorbidities, and immunosuppression. Studies often determine risk factors associated with severe disease, but rarely are multiple upper respiratory pathogens compared within the same cohort. Using electronic health record (EHR) phenotyping of 267,031 participants with relevant EHR data enrolled in the National Institute of Health’s All of Us Research Program (All of Us), we identified and validated cohorts of participants, and revealed shared risk factors for severity among upper respiratory viruses.

Methods
We developed EHR phenotype algorithms for eight respiratory viruses using pathogen-specific billing codes, test results, and treatment-dose antivirals. We identified episodes of infection over 90-day periods and validated these using CDC national detection rates over the same period. We then used multivariable logistic regression to compare demographics and identify predictors of hospital admission, adjusting for age, sex, self-identified race and ethnicity, BMI, smoking status, and EHR record length.

Results
Scaled episode and testing counts paralleled CDC data, with expected seasonal trends observed for influenza, parainfluenza, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus (hMPV), SARS-CoV-2, and human coronavirus (hCOV) (RSV, hCOV, influenza, and SARS-CoV-2 shown in Figure 1). Across viruses, hospital admission was associated with older age, male sex, underweight, severe obesity, self-identified Black race, and smoking (Table 1). Notably, significant predictors of admission included COPD, asthma, heart failure, ischemic heart disease, hypertension, diabetes, chronic kidney disease, and immunodeficiency, even after adjusting for confounding variables (Figure 2).

Conclusion
In this study we established and validated an EHR phenotyping algorithm, and demonstrated that clinical risk factors — particularly cardiopulmonary, metabolic, and immunological comorbidities — are associated with severe outcomes among multiple upper respiratory viruses. These results suggest that universal prevention interventions may mitigate the impact of respiratory viral infections in high-risk populations.

Disclosures
All Authors: No reported disclosures
P-704. Sustained decline in the incidence of hospital-acquired Influenza A/B, Parainfluenza, and Respiratory Syncytial Virus (RSV) infections at the NIH Clinical Center
Authors: Forrester LaToya A , Odom Robin T , Scaletta Joseph , Michelin Angela V , Han Alison , Henderson David K 
Published: January 2025

Abstract

Background
Respiratory viral infections can result in significant morbidity and mortality for immunocompromised patients. The role of universal masking in hospitals to reduce the spread of respiratory infections remains controversial. The NIH Clinical Center serves immunocompromised patients and continued masking policies into 2024 (masking throughout the hospital April 8, 2020-June 4, 2023 and masking only in patient care from June 5, 2023 onward). We conducted a retrospective review of hospital-acquired Influenza A/B, Parainfluenza, and RSV infections from January 2010 to March 2024 to determine if masking policies were associated with a reduction in hospital transmission of selected respiratory viruses.

Methods
Incubation periods for each respiratory virus was established. Infections occurring after the incubation periods were considered hospital-acquired. Medical chart reviews were conducted to ascertain date of symptom onset and history of respiratory viral infection. Quantitative data analysis was performed.

Results
Between January 2010 and March 2024, 127 hospital-acquired Influenza A/B, Parainfluenza, and RSV infections were identified. Forty-five Influenza A/B, 42 Parainfluenza and 37 RSV infections were identified in the pre-masking period (January 2010 to April 7, 2020) vs. 0 Influenza A/B, 2 Parainfluenza and 1 RSV infections identified in the masking period (April 8, 2020 to March 31, 2024). Interrupted time-series analysis was significant for all hospital-acquired respiratory viral infections (p &lt; 0.001).

Conclusion
Masking was temporally associated with a decrease in all hospital-acquired respiratory viral infections. Pandemic mitigation measures, including symptomatic screening of building entrants, physical distancing, and asymptomatic testing of staff, may have contributed to this decline; however, when these strategies were relaxed and masking continued, hospital-acquired respiratory viral infections remained low. Wearing masks in the hospital may provide benefit for hospitalized immunocompromised patients.

Disclosures
All Authors: No reported disclosures
P-708. Risk Factors Associated with Lower Respiratory Tract Infections in Adult Patients with Respiratory Syncytial Virus Infections
Authors: Sharma Mamta , Szpunar Susan M , Bhargava Ashish , Saravolatz Louis 
Published: January 2025

Abstract

Background
Respiratory Syncytial Virus (RSV) is known to cause severe disease in elderly individuals and patients with underlying cardiopulmonary or immunocompromised conditions. Little is known about the factors associated with the lower respiratory tract infections (LRTI).

Methods
A multicenter historical cohort study was conducted on adult patients hospitalized for laboratory-confirmed RSV-related diseases in Ascension hospitals in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using ICD 10 codes for RSV-related diseases. Medical records were reviewed after IRB approval. LRTI was defined as an acute respiratory disorder meeting at least three out of four criteria: respiratory signs/symptoms (cough/ dyspnea/ tachypnea), fever, oxygen saturation below 94%, and abnormal chest x-ray at the time of hospital admission. Data were analyzed using Student’s t-test, the chi-squared test, the Mann-Whitney U test and logistic regression using SPSS v. 29.0.

Results
Of 360 patients, 143 (39.7%) had LRTI. The mean (sd) age of patients with LRTI was 69.1 + 15.3 years, and 76 (53.1%) were female. The mean Charlson Weighted Index of Comorbidity score was 2.5 + 2.1. Factors associated with LRTI in univariable analysis were age, sex, asthma, time period (TP) (pre-COVID (2017-2019) and COVID (2020-2021), maximum temperature within 24 hours of admission (Tmax), lowest diastolic blood pressure, oxygen requirement and neutrophil count at admission, infectious disease (ID) consultation, and antibiotics given for &gt;1 day. Predictors for LRTI in multivariable logistic regression were COVID TP (odds ratios [OR], 2.0; 95% CI 1.2-3.4), Tmax ([OR], 1.2; 95% CI 1.0-1.5), oxygen requirement at presentation (OR, 2.1; 95% CI 1.2-3.4), ID consultation ([OR], 2.7; 95% CI 1.6-4.4), antibiotics given for &gt;1 day (OR, 3.7; 95% CI 2.2-6.2) while female sex was inversely related to LRTI episodes ([OR], 0.4; 95% CI 0.3-0.7) .

Conclusion
Our study finds that COVID time period, maximum temperature within 24 hours of admission, oxygen requirement at admission, ID consultation, and antibiotics given &gt;1 day were significantly associated with LRTI among adult patients with RSV infection. Female sex was less likely to have LRTI. Further studies needed to confirm these findings.

Disclosures
All Authors: No reported disclosures
P-720. Are we aware of the RSV problematic in the Dominican Republic?
Authors: Rojas-Fermin Rita A , Guzman-Marte Anel E , Sanchez-Marmolejos Ann S , Guzman-Ricardo Francisco , Reyes Yeison , Calcano Ruben 
Published: January 2025

Abstract

Background
Respiratory Syncytial Virus (RSV) is a common cause of respiratory illness that could have a severe presentation in infants and elderly patients. As in other LATAM countries, RSV diagnosis is limited due to a lack of testing or access, and there is scarce data on the epidemiology, clinical impact, and mortality. Our aim was to characterize the disease in patients admitted to a hospital setting.
Distribution of admitted patients by age
Source: Statistical registry of the authors

Methods
We performed a retrospective review of admitted patients in a tertiary 289-bed hospital with a respiratory molecular panel from January 2022 to December 2023 (n = 715). RSV-positive patients (n = 91) were selected, and their clinical and demographic information, co-morbidities, risk factors, and outcomes were reviewed on their electronic medical record.
Microbial frequency in RSV coinfected patients
Source: Statistical registry of the authors

Results
Out of 91 patients, 58.2% (53/91) were male, 75.8% were ≤2 years old, and 8.8% were ≥60 years old. The RSV positivity rate for all ages (0–84 years old) was 12.7% and 53.4% (69/129) for ≤2 years old. All cases were detected near the second semester of each year (May–December 2022 and July–December 2023).
Out of 50 patients with RSV as the only pathogen confirmed through testing, 32 developed respiratory complications (bronchiolitis and pneumonia), and 14% required critical care. Whereas 41 patients had the simultaneous presence of other pathogens, among them, 31 patients had ≥2 respiratory viruses detected.
The most frequent symptoms in RSV-only patients were cough (79.12%), dyspnea (67.3%), and wheezing (63.74%). Asthma was the most common respiratory comorbidity (16.48%), followed by low birth weight and preterm. The mortality rate was 4/91 (4.39%); among them were 2 patients &lt; 6 months old with congenital cardiopathy and 2 elderly (69/78y) with Klebsiella pneumoniae-bacteremia.
Distribution of viral isolates from admitted patient respiratory and pneumonia panel samples.
Source: Statistical registry of the authors

Conclusion
RSV should be considered an all-ages respiratory infection, and it was found alone or in association with other respiratory pathogens mainly near the second semester each year. Studies like these are necessary in low-middle income countries like the Dominican Republic to address the burden of RSV and the impact that the vaccine applied during pregnancy and the elderly can have on disease prevention and complications. We encourage early and affordable diagnostic tests to curb the spread of RSV and reduce admissions.

Disclosures
Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-738. A Microbiological Profile of Necrotizing Fasciitis at a Tertiary Referral Hospital in a Low/Middle Income Country
Authors: Challita Caren , Abdallah Tamara , Zeid Daou Christopher Abi , Sawaya Tania , Hallal Ali , Madi Naji , Rizk Nesrine 
Published: January 2025

Abstract

Background
: Necrotizing fasciitis (NF), an uncommon, fatal infection of the skin and soft tissues, carries a significant mortality risk, with rates reaching as high as 76% despite prompt surgical interventions. While polymicrobial infections were more likely to be encountered, few studies reported a monomicrobial predominance. Despite its relevance, there is a notable lack of data in the Eastern Mediterranean region. We aimed to investigate the microbiological profile among patients diagnosed with necrotizing fasciitis in a tertiary referral center in Lebanon, with a particular focus on Multidrug-resistant organisms (MDROs) and Antimicrobial Resistance (AMR), given their increasing prevalence and the challenges they pose in clinical management.Table 1:Distribution of Organisms

Methods
A retrospective chart review of hospitalized cases between 2011 and 2021. The study population included adult patients diagnosed with NF during this period. Data included microbiological characteristics, with focus on Multidrug-resistant organisms (MDROs).Figure 1:Yearly Trend of MDROs Among Isolated Organisms

Results
41 cases of NF were identified showing a mortality rate of 37%. 46 % of cases had polymicrobial infections versus 42% monomicrobial. The predominant gram negative pathogen was E.coli in both types of infections followed by the gram positive pathogen, Enterococcus species. No difference in the type of infection was noticed in the survival group compared to a predominance of polymicrobial infection in the non-survival group. Fungi were recovered represented in 5.4% of cases and were part of a polymicrobial infection. Out of all the isolated organisms, 21.2% showed patterns of resistance (Extended Spectrum Beta Lactamase, Multidrug resistant, Vancomycin Resistant Enterococcus, and Carbapenem Resistant Enterobacteriaceae) with a yearly incremental rise.

Conclusion
This 10-year study emphasizes the urgency of prompt surgical intervention and tailored antibiotic treatment for NF, particularly in the context of increasing AMR and the presence of MDROs, contributing crucial regional data on NF demographics, comorbidities, and microbiology

Disclosures
All Authors: No reported disclosures
P-739. Injection-Related Skin Ulcers: a Common and Poorly Addressed Risk Factor for Rehospitalization among People who Inject Drugs in the CHOICE+ Cohort
Authors: Traver Edward C , Vaish Ishan Kumar , Omari Habib , Flores Hannah E , Stevens Jasmine , Derenoncourt Meghan , Reece Becky , Steck Alaina , Kuo Irene , Fujita Ayako Wendy , Raman Sumitha , Catalanotti Jillian S , Carpenter Joseph E , Kattakuzhy Sarah , Rosenthal Elana S 
Published: January 2025

Abstract

Background
Injection-related skin ulcers (IRSU) are a cause of acute bacterial infection among people who inject drugs (PWID). We aimed to measure the prevalence, characteristics, and risk factors for IRSU, and the risk of readmission, among a cohort of PWID hospitalized for infections.
Table 1
SD, standard deviation.

Methods
CHOICE+ is a multisite retrospective cohort study of adults hospitalized at four healthcare systems with infections due to injection opioid use between 1/1/2018 and 3/31/2022. Data were collected by abstraction of the electronic medical record and were analyzed by chi-square, multivariable logistic regression, and unpaired t-test. Factors statistically significant for IRSU in bivariate analysis were examined by multivariate logistic regression. Detailed data on IRSU were recorded from the Baltimore site.
Table 2
GWU, George Washington University; MOUD, medication for opioid use disorder; UMB, University of Maryland Baltimore; WVU, West Virginia University.

Results
Of 1652 included patients, 221 (13%) had a documented IRSU. Key demographics were similar between those with and without IRSU (Table 1). The odds of IRSU were higher among those who were positive for fentanyl and older age (Table 2). Baseline IRSU was associated with increased odds of readmission (aOR 1.4, p = 0.02) and a greater number of readmissions within 1 year (1.2 v. 0.9, p = 0.01, Figure 1).
Among 116 patients from Baltimore with documented IRSU and detailed data, IRSU was the primary reason for admission in 66%. Xylazine use was not noted in any records. Most patients had &lt; 4 ulcers and ulcers &lt; 10 cm. 13% of patients received sharp debridement and 6% were treated with limb amputation. IRSU was more frequently addressed in the discharge note if IRSU was the primary reason for admission (71% v 50%, p &lt; 0.05). Only 16 (14%) patients were advised or scheduled to attend an outpatient wound care appointment; only 3 (3%) did so within 30 days of discharge (Figure 2).
Figure 1
**, p=0.01.

Conclusion
Among PWID hospitalized for infection, IRSU were common, especially among older patients and those testing positive for fentanyl. Xylazine exposure was likely under-assessed. Importantly, IRSU was associated with an increased risk of hospital readmission, but outpatient planning and follow up were rare. Clinicians caring for PWID must address IRSU alongside other infectious diseases, addiction, and harm reduction interventions.
Figure 2
Discharge planning and outpatient care within 30 days of discharge. DC, discharge; *, p=0.048)

Disclosures
Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support
P-745. Skin and Soft-tissue Infections among Military Recruits
Authors: Mende Katrin , Igo Matthew , Seibert-Parzyszek Ian , Carson M Leigh , Davies Julian , Stewart Laveta , Tribble David 
Published: January 2025

Abstract

Background
Skin and soft-tissue infections (SSTIs), commonly Staphylococcus aureus, are an important cause of morbidity in congregate military populations with high rates among military recruits. We characterized SSTI epidemiology over an ∼10-year period at a military training facility in GA (largest U.S. training facility; ∼30,000 recruits per year).

Methods
SSTI data were collected from US Army Infantry recruits during basic training, through four studies (2 observational and 2 interventional studies spanning 2010-2019) and pooled into a single resource for retrospective research. SSTI characteristics (syndromes and diagnosis timing) and microbiology are described.

Results
The study population includes 3288 recruits who developed SSTIs during the training period for a total of 3690 SSTIs. Median age was 19 years and median time for initial SSTI development was 7 (IQR 4 -11) weeks of training. Cellulitis (N=1600, 43%) and abscesses (N=1098, 30%) were most common and median time to diagnosis was 7 (IQR 4-11) and 8 (IQR 4-11) weeks of training, respectively. Cultures were collected from 1620 (44%) SSTIs, including 77% of abscesses. Methicillin-resistant and methicillin-susceptible S. aureus (MRSA and MSSA) were identified in 784 (48%) and 610 (38%) cultures, respectively (Table). Other findings include coagulase-negative staphylococci (4%), group A streptococci (0.2%), and group B streptococci (0.4%). A total of 373 recruits had ≥ 2 SSTIs and 55% of the subsequent 402 SSTIs were abscesses. Median time to 2nd and 3rd SSTIs was 10 (IQR 7.5-12) and 12 (IQR 10-13) weeks of training, respectively. There was a significant difference among the bacterial distribution for abscesses (p&lt; 0.001) with MRSA contributing the highest proportion (62%), followed by MSSA (28%). MRSA was also identified with 64% of the 166 subsequent SSTIs with cultures.

Conclusion
Cellulitis and abscesses are frequent infections affecting military recruits during high-intensity congregate training. The most common bacteria with purulent infections (i.e., abscesses), as well as subsequent infections, was MRSA. Pooling data from multiple studies allows for examination of syndromes and etiology to inform targeted interventions.

Disclosures
David Tribble, MD, DrPH, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response