bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-567. Baseline Patient and Clinician Results for the Pilot Project I-CARE-4-PAH (

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Authors: Womack Julie A , Johnson Chloe , Danvers Karina , Hsieh Evelyn , Lauro Michael , Marottoli Richard , Murphy Anne , Payne Erika , Sheehan Lisa , Stewart Wynnett , Virata Michael D , Barakat Lydia A 
Published: January 2025

Abstract

Background
More than half of people living with HIV in the United States are 50 years of age or older. Understanding how best to assess and address conditions associated with aging in HIV primary care is important for this population.

Methods
We trained clinicians in an academic HIV clinic to assess and address the 4F’s (polypharmacy, Falls, and Fragility Fractures) in their patients aging with HIV (PAH). We share results of this screening as well as key knowledge, attitudes, and practices (KAP) from the pre-test assessment of our clinician champions.

Results
126 patients 50+ years of age were enrolled. The mean age is 63±6 years. 49% were assigned female at birth and 1% are transwomen. 48% identify as Black, 48% White, and 14% Hispanic. 30% smoke tobacco, and 30% report ongoing marijuana use. Patients take 10±5 medications; 25% have hyperpolypharmacy ( &gt;15 medications), and 66% are on potentially inappropriate medications (PIMs). At least a quarter of patients have peripheral neuropathy: 25% have decreased sensation on the plantar surface of either foot; 35% have decreased vibratory sense on the right great toe,37% on the left. 42% reported a fall/near-fall in the past year; 10% experienced a serious fall leading to a visit with a healthcare provider. Mean risk of a serious fall in the next year is moderate: 4.05%±4.13%. 34% reported a fracture as an adult. Mean FRAX scores indicate a low 10-year risk for fragility fracture (major osteoporotic fracture: 8.71%±6.95%; hip fracture 2.11%±3.58%).
Eleven HIV clinicians are engaged with this project. Most (73%) regularly perform medication reconciliation. 55% report asking about falls only if the patient brings it up. 18% have never assessed their patients for fracture risk, and 36% have done so once.

Conclusion
Polypharmacy, peripheral neuropathy, PIMs, falls, and fractures are important intersectional risk factors for adverse outcomes in PAH and are inconsistently assessed by clinicians. Medication reconciliation is an important first step in identifying polypharmacy. Deprescribing, identifying patients with peripheral neuropathy, and discussing fall prevention are key foci for future interventions. Providing training resources for HIV clinicians to assess and prevent the 4F’s is crucial and feasible.

Disclosures
Richard Marottoli, MD, MPH, The Hartford: Advisory Panel on Older Driver Safety Michael D. Virata, MD, FACP, Janssen: Advisor/Consultant|Janssen: Honoraria|ViiV Pharmaceuticals: Advisor/Consultant|ViiV Pharmaceuticals: Honoraria
P-612. Effectiveness of Live Attenuated and Inactivated Influenza Vaccines in Children: Data from the 2023/24 Influenza Season
Authors: Bandell Allyn R , Barker Chris , Dibben Oliver 
Published: January 2025

Abstract

Background
Annual vaccination with a live attenuated influenza vaccine (LAIV) or inactivated influenza vaccine (IIV) is the most effective way to protect children from the burden of influenza infection, and to reduce the potential for transmission to family members and the community. Here we report vaccine effectiveness (VE) from data reported globally for LAIV and IIV in children from the 2023/24 influenza season.

Methods
Quadrivalent LAIV and IIV effectiveness studies conducted in children in the 2023/24 influenza season were identified from published literature and public health websites. Studies from Canada, Finland, the UK, the US, and a European-wide study in 10 countries, reporting VE data for any influenza infection (all strains), by strain type (all influenza A, A/H3N2, and A/H1N1pdm09), and by vaccination setting (primary/outpatient care and hospital) were included.

Results
In five studies reporting on influenza infections (all strains) in children with ages ranging from 6 months to 19 years across studies, VE estimates for LAIV ranged from 36% (95% CI: 21–48) in Finland to 65% (95% CI: 41–79) in the UK, and for IIV ranged from 59% (95% CI: 48–67) to 67% (95% CI: 48–80) in the US. When analyzed by vaccination setting, VE against any influenza, influenza A, A/H3N2, and A/H1N1pdm09 in all the included countries ranged from 36–65% for LAIV and 46–85% for IIV in children in primary/outpatient care (Figure 1). For hospitalized children, VE against any influenza, influenza A, A/H3N2, and A/H1N1pdm09 in all the included countries ranged from 25–80% for LAIV and 46–61% for IIV (Figure 2). Where available, VE data against influenza A, A/H3N2, and A/H1N1pdm09 were comparable for both LAIV and IIV in children in primary/outpatient care and hospitalized children.

Conclusion
VE data for the 2023/24 season from global reports show LAIV and IIV demonstrated comparable moderate protection for children against influenza infection. These early VE data were similar across the included healthcare settings of outpatient/primary care and hospitals.

Disclosures
Allyn R. Bandell, PharmD, AstraZeneca: Stocks/Bonds (Public Company) Chris Barker, PhD, AstraZeneca: Stocks/Bonds (Public Company) Oliver Dibben, PhD, AstraZeneca: Stocks/Bonds (Public Company)
P-651. An Artiﬁcial Intelligence Model Outperformed Experienced Clinicians in Differentiating the Aetiology of Pneumonia on Chest Computed Tomography: A Retrospective Study
Authors: Jin Wenting , Shao Ying , Gao Yaozong , Hu Bijie 
Published: January 2025

Abstract

Background
Rapid and precise aetiological diagnosis is crucial for managing pneumonia. We aimed to develop and validate deep learning (DL) models for differentiating ten pneumonia aetiologies on chest computed tomography images.
The area under the receiver operating characteristic curve (ROC) and the area under the curve (AUC) for the two deep learning models, the performance of four different radiologists and four different pulmonologists (A-B); The ROC and AUC of two models in identifying 10 different classifications (C-F).
Abbreviation: BP, bacterial pneumonia; AP, atypical pneumonia; PN, pulmonary nocardiosis; PTB, pulmonary tuberculosis; PNTM, pulmonary nontuberculous mycobacterial infection; PC, pulmonary cryptococosis; PA, pulmonary aspergillosis; PJP, pneumocystis jirovecii pneumonia, LC, lung cancer; PM, pneumonia mimics; Ra, radiologists; Pu, pulmonologists.

Methods
We enrolled 1091 pneumonia patients with one of 10 definite aetiological diagnoses from Zhongshan Hospital between Oct. 1st, 2015, and Jun. 30th, 2022, in this retrospective observational study. We trained and validated two DL models: a classic 3D-DenseNet model and a novel large vision model (LVM). The models were tested on a data from 59 nonoverlapping patients for external dataset. Model performance was assessed using the area under the curve (AUC) of the Top1 diagnosis and the accuracy of the Top1, Top2, and Top3 diagnoses. Comparisons were also performed between the DL models and eight experienced radiologists and pulmonologists.
The accuracy of Top1, Top2 and Top3 diagnoses of two deep learning models, radiologists and pulmonologists with or without nonimaging data
Abbreviation: LVM, large vision model; Note: + means with nonimaging data

Results
The LVM+ had a greater average prediction performance than DenseNet+, radiologists+ and pulmonologists+, with Top1 AUCs of 0.872, 0.851, 0.643 and 0.644, respectively. The Top1, Top2, and Top3 accuracies of LVM+ were 0.527, 0.701 and 0.820, respectively, similarly outperforming DenseNet+, radiologists+ and pulmonologists+. The two models performed similarly in the external test sets, with AUCs of 0.775 for LVM and 0.743 for DenseNet. The classification-related confusion matrix of LVM/DenseNet showed a significant advantage in identifying PNTM and PJP.

Conclusion
This study represents the most complete classification that best matches the diagnosis of pneumonia in realistic clinical settings. We expect this method to be applied clinically to foster novel approaches to improve the accuracy in diagnosing pneumonia.

Disclosures
All Authors: No reported disclosures
P-664. Trends in Bacterial Pneumonia-Related Mortality Among Older Adults in the United States
Authors: Ali Shah M Danial , Aslam Sadaf , Casanas Beata 
Published: January 2025

Abstract

Background
Bacterial pneumonia is one of the leading causes of mortality in the US, particularly among those aged 65 and older. No study has been done on this population to understand mortality patterns based on demographic characteristics such as age, gender, race, and geographic regions, which helps to enhance evidence-based interventions for this vulnerable age group.
Trends in Bacterial Pneumonia-related AAMRs and APC stratified by race in older adults.

Methods
This study involves a two-decade CDC WONDER data on bacterial pneumonia-related deaths via ICD-10 codes A48.1 and J13-J16.0 in ≥ 65-year-olds from 1999-2019. Demographic disparities are analyzed based on age, gender, race, census region, and urban-rural classification using systematic database analysis. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) with a 95% Confidence Interval (CI) are calculated through joinpoint regression analysis.
Trends in Bacterial Pneumonia-related AAMRs in Black and White men and women.

Results
155,819 individuals aged ≥65 died from bacterial pneumonia in the US from 1999 to 2019. Initially, AAMR declined (1999-2005: APC -0.47; 95% CI -1.53 to 1.08), followed by a steep decline (2005-2010: APC -6.25; 95% CI -9.72 to -4.51), and concluded with a significant increase (2010-2019: APC 1.97; 95% CI 1.09 to 3.12). Males had higher AAMR (23.6) than females (14.2). Hispanics (19.6) were more affected than non-Hispanics (17.8) and Blacks more than Whites, except for White men (23), surpassing Black women (15.3). Pneumonia mortality varied by region, highest in Arizona and California (44.5 and 30.4) and lowest in New Jersey and Wisconsin (8 and 9.4). Nationwide, Black/White mortality is comparable except for the Northeast, where Black mortality doubles that of Whites.
Trends in Bacterial pneumonia-related AAMRs stratified by census regions. *=significant at p &lt; 0.05; confidence interval does not include zero.

Conclusion
While initial reductions in bacterial pneumonia-related mortality among older U.S. adults were observed, an upward trend from 2010 to 2019 negated this progress, resulting in a concerning resurgence. This upsurge disproportionately impacts specific demographics, including those aged 85 and older, males, non-Hispanic Blacks, those in the Western U.S., and urban populations. To further reduce mortality rates, this highlights the urgent need for effective interventions, improved access to care, and age-specific preventive programs. Further research is required to understand contributing factors.
Bacterial Pneumonia-related crude mortality percentage stratified by different variables between men and women.

Disclosures
All Authors: No reported disclosures
P-665. Etiology of Pneumonia and Antibiotic Resistance in Adults with Cancer in the ICU of a Tertiary Care Centre in Eastern India: a Prospective Cohort Study
Authors: Malik Simran , Bhattacharya Sanjay , Das Bhattacharya Sangeeta 
Published: January 2025

Abstract

Background
Cancer and its treatment cause immune-dysregulation which, along with frequent healthcare exposure, poses a higher risk of respiratory infections, frequently with unusual pathogens that can be highly drug-resistant. We assessed the etiology of pneumonia in adult cancer patients admitted to the ICU over one year and summarized the antibiotic resistance seen.

Methods
Pneumonia cases were identified from October 2022-September 2023. Sputum, endotracheal secretion, bronchoalveolar lavage (BAL), tracheal aspirate, nose and throat swab samples from -4 to +10 days of the date of event were considered. Microbiological diagnosis involved microscopy, culture, ELISA, PCRs, and CBNAATs. Antibiotic susceptibility was determined phenotypically by disc-diffusion and genotypically using PCR tests for MRSA, ESBL, carbapenemase, and polymyxin resistance genes.

Results
355 cases of pneumonia were identified. 258 (72.7%) cases of had a positive microbiology, 123 were polymicrobial (47.7%) and termed “co-infections/ superadded infections". Table 1 summarizes the etiology of microbiology positive cases.
Antibiotic susceptibility data was available for 191 isolates, 14 were Staphylococcus aureus (table 2) and 177 were Gram-negatives (table 3). S. aureus have fluoroquinolones. 30.4% were MRSA and 21.4% showed inducible clindamycin resistance.
Gram negatives were resistant to third-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, carbapenems, aminoglycosides, fluoroquinolones and cotrimoxazole, though variations exist across genera. 51% Gram negative isolates were positive for ESBL, 5.8% for AmpC, 9.7% were polymyxin resistant, and 49.5% were resistant to carbapenems. Carbapenem resistance genotypes are summarized in table 4.

Conclusion
Isolates from adult cancer patients with pneumonia showed high prevalence of resistance to all first-line antibiotics.

Disclosures
All Authors: No reported disclosures
P-666. Impact of Ceftriaxone Duration in Community-Acquired Pneumonia: A Retrospective Comparative Analysis
Authors: Ureta Lyle , Aprelian Kevin , Jung Hemi , Lin Theresa , Kawaguchi Keitaro , Hernandez Delia Duenas , Eskandarian Romic , Lee Su 
Published: January 2025

Abstract

Background
In accordance with the American Thoracic Society (ATS) guidelines for community-acquired pneumonia (CAP), ceftriaxone plus a macrolide is commonly used as first-line for inpatient treatment of non-severe CAP(Metlay, 2019). In a community hospital, a CAP protocol was implemented to grant pharmacists the capability to discontinue antibiotics, including ceftriaxone, after 5 days of treatment in hospitalized patients that have reached clinical stability. On the other hand, extended treatment duration of ceftriaxone can lead to increased resistance, Clostridium difficile infections, adverse effects and cost (Guo 2017, Thomas 2002). The objective of this study is to compare patient outcomes between patients using ≤5 days (recommended duration) and &gt;5 days (extended duration) of ceftriaxone.

Methods
This study is a retrospective chart review in a community hospital, from Nov 1, 2022 to April 30, 2023. Adult patients treated with ceftriaxone for ≥ 3 days for CAP were included. Patients treated for non-pulmonary infections and/or co-infections were excluded. The primary outcome of this study is 30-day mortality; secondary outcomes include length of stay, and Clostridium difficile infection within 90 days. Outcomes were analyzed with Chi-square/Fischer’s exact test, normality test, student t-test, and Mann-Whitney U test using Prism Version 10. IRB Number: 2024-167 AHGL

Results
The 30-day all-cause mortality was 7.1% for the ≤5 days group (N = 379) and 7.8% for the &gt;5 days group (N = 166) was not statistically significant (p = 0.77). Length of stay median with interquartile range (IQR) was 6 (IQR 4-9) for the ≤5 days group and 8 (IQR 6-11) for the &gt;5 days group (p &lt; 0.01). The Clostridium difficile infection prevalence of 0.5% in the ≤5 days group and 0% in the &gt;5 days group was too low to make any relevant analysis.

Conclusion
This study comparing patient outcomes between ≤5 days and &gt;5 days durations of ceftriaxone for community-acquired pneumonia (CAP) revealed no significant difference in 30-day all-cause mortality rates but a significantly shorter hospital stays in ≤5 days group, which suggests that shorter ceftriaxone durations as per protocol can potentially optimize patient care by reducing hospital stays without compromising mortality outcome.

Disclosures
All Authors: No reported disclosures
P-756. Primary Mycobacterium Infections presenting in patients of Rheumatic diseases - A Case Series
Authors: Shah Aalesh , Patel Yug , Shukla Dhaiwat 
Published: January 2025

Abstract

Background
We present a study about patients with rheumatic diseases who were diagnosed for mycobacterium infections in their follow-up visit. The role of side effects of immunosuppressants have been established. However, their association with mycobacteria in endemic countries like India is yet to be understood well.
ABDOMINAL CT - CASE 1 (TUBERCULAR PERITONITIS)
Moderate to gross ascites with thickened enhancing parietal peritoneum, significant with caking and abdominal lymphadenopathy hence pointing towards Tubercular Peritonitis.

Methods
Consent was obtained from the patients to use their data for a case series. Relevant data related to the cases was collected, and organised.
HRCT THORX - CASE 3 (PULMONARY TB)
HRCT THORAX shows multiple, discrete, randomly distributed nodules in both the lungs, multiple enlarged lymph nodes in left axilla and in left anterior chest wall, some of which are confluent in nature and two calcifications in one of the lymph node.

Results
First case is about a 54 yr-old male patient, known case of Ankylosing spondylitis treated with 9 doses of Anti-TNF alpha drug Adalimumab presented with severe abdominal pain, fever with chills, vomiting & diarrhea for which he underwent abdominal CT-scan which revealed thickened enhancing parietal peritoneum, significant with caking and abdominal lymphadenopathy hence pointing towards Tubercular Peritonitis. Second case is about Non-Tuberculous Mycobacteria(NTM) or atypical mycobacteria diagnosed in a patient with Ankylosing Spondylitis who had negative tests for primary TB. Third case about a 28 year-old female, known case of bilateral iridocyclitis and recurrent multiple medium-vessel vasculitic/throm2botic occlusions treated with mycophenolate-mofetil and cyclosporine-A, was started on adalimumab. Later she presented with fever for which pulmonary workup was done which revealed positive TB. Fourth case is of a patient having symptoms similar to Rheumatoid arthritis but not responsive to treatment which led to extensive workup and mycobacterium leprae was found as a culprit. Fifth case is of a 16 year-old male, known case of GPA who was refractory to cyclophosphamide was started on rituximab, after which he presented with complaints of fever with chills and rigors, and breathlessness on exertion which was followed by the diagnosis of miliary tuberculosis.
TB patients were given Anti-tubercular therapy(ATT) and Leprosy patient was given Multi-drug therapy(MDT) and all are now improving.
Leonine Facies - Case 4

Conclusion
• Our study shows that immunosuppressants can be considered to have even increased risk of primary mycobacterium infection.
• Leprosy can present with similar manifestations of RA (Rheumatoid Arthritis) so signs of suspicion need to be kept in mind and screening should be done in such cases.
Leprosy mimicking RA - Case 4

Disclosures
All Authors: No reported disclosures
P-761. Advancing TB Patient Care: Utilizing XPERT MTB/XDR for Additional Drug Resistance Detection in an Indian Tertiary Care Context
Authors: Reddy challa Haripriya , Ventrapragada Bhuvaneswari , Mittal Ankit , Harshith B 
Published: January 2025

Abstract

Background
The World Health Organization (WHO) underscores the importance of universal access to drug susceptibility testing (DST) as a part of its END TB strategy. Rapid molecular tests with shorter turnaround time (TAT) are indispensable in this endeavor. Xpert MTB/XDR is one such test which identifies Mycobacterium tuberculosis complex (MTBC) and resistance to isoniazid, fluoroquinolones, aminoglycosides, and ethionamide. In this study we looked at clinical utility of this test in real world

Methods
Data of patients on whom Xpert MTB/XDR was done from September 2022 to April 2024 was collected retrospectively and analysed to see additional drug resistance capture. For baseline drug resistance data, we collected data of patients before September 2022 on whom additional DST (other than Rifampicin resistance testing by GeneXpert), including Line Probe Assays (LPA) and phenotypic DST (pDST) on culture isolates was done.

Results
Baseline drug susceptibility data were available for 39 patients, comprising 19 patients with first-line LPA, 14 with both first and second-line LPA, and 15 with only pDST. Among them, 3/39(7.69) exhibited rifampicin resistance, 7/39 (17.9) isoniazid resistance, 3/39(7.69) quinolone resistance, and 4/39(10.2) aminoglycoside resistance. Xpert MTB/XDR was performed on 193 patients, with 161 testing positive for MTBC. The median age of the study population was 64.5 years (IQR 29.7-56), with 64.7% being male. Rifampicin resistance was detected in 18/161 (11.18%) cases, isoniazid resistance in 24/161 (14.9%), fluoroquinolone resistance in 23/161 (14.29%), and aminoglycoside resistance in 4/161 (2.4%).Among all Rifampicin resistance patients 94% (14/18) are quinolone resistance. Isoniazid monoresistance is only 3% (5/161).

Conclusion
In clinical practice, compliance to FL-LPA, SL-LPA and pDST is low because of higher cost and TAT effecting capture of additional drug resistance especially of quinolones, which is an integral part of the drug resistant TB regimen. This is also important in special population like chronic liver disease or drug induced liver injury where pyrazinamide is replaced by quinolones. Xpert MTB/XDR is an efficient and cost-effective alternative to traditional DST methods with a lower TAT and should be integrated in National TB program

Disclosures
All Authors: No reported disclosures