bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2309. Assessment of Risk Factors Associated with Subtherapeutic Posaconazole Levels
Authors: Garzia Christopher , Nelson Brian , Loo Angela , Demenagas Nicholas , Kubin Christine J 
Published: January 2025

Abstract

Background
There is significant variability in patient serum posaconazole levels, and it is unclear what characteristics increase the risk for subtherapeutic levels. Higher levels have been associated with improved outcomes. The purpose of this study is to identify risk factors associated with subtherapeutic posaconazole serum levels.

Methods
Retrospective study of adult patients admitted to NewYork-Presbyterian Hospital who received posaconazole with at least one level obtained at steady-state. Levels were obtained after at least five consecutive days of therapy with no interruptions &gt; 24 hours or dosage changes prior to initial level. Patients were grouped based on if the initial level was therapeutic, defined as a serum level &gt; 1 mcg/mL. Risk factor assessment was performed using a logistic regression model. Baseline characteristics between therapeutic and subtherapeutic groups were compared via chi-squared test for categorical variables and independent t-test for continuous variables.

Results
383 patients were included: 280 initial levels were therapeutic and 103 were subtherapeutic. Patients primarily consisted of those with solid organ transplant (48.8%) and hematologic malignancy (38.6%). Significant differences between therapeutic and subtherapeutic groups included median weight (73 vs 78 kg, p=0.017) and initial weight-based doses (4.4 vs 4.2 mg/kg, p=0.044), respectively. This prompted an exploratory analysis finding significant association with BMI &gt; 35 (4.1% therapeutic vs 12.1% subtherapeutic, p=0.006). Initial dose thresholds of at least 3 mg/kg and 4 mg/kg showed nonsignificant increases in therapeutic levels (p=0.056 and p=0.107 respectively). On multivariable analysis, subtherapeutic levels were more likely in patients who are black or African American (OR 1.869, 95% CI 1.009, 3.465), had diarrhea (OR 1.978, 95% CI 1.149, 3.408), and had a BMI &gt; 35 (OR 3.538, 95% CI 1.300, 9.628).

Conclusion
Patients who are Black or African American, have diarrhea, and have a BMI &gt; 35 were identified as having increased risk for subtherapeutic levels at 300 mg daily dosing. Patients at risk may benefit from initial weight-based dosing of at least 4mg/kg, however this requires additional confirmatory studies.

Disclosures
All Authors: No reported disclosures
P-2310. Gammaproteobacteria Load Responses in the Intestinal Microbiota of Patients Undergoing Hematopoietic Cell Transplantation Predicts Resistant Gram-Negative Rod Colonization
Authors: Mortimer Leanne , Sénéchal Jaxon , Janusz Nicole , Carroll Amanda C , Yan Austin , Leite Tamara , Purssell Andrew , Kekre Natasha , Kennah Michael , Buchan C Arianne , MacFadden Derek 
Published: January 2025

Abstract

Background
Hematopoietic cell transplant (HCT) patients are at high risk of Gram-negative rod (GNR) blood stream infections (BSIs) particularly before pre-engraftment. Globally, breakthrough infections with resistant GNRs (rGNRs) are increasing in HCT while rGNR epidemiology has become increasingly complex to predict. It’s recognized that individualized antimicrobial HCT therapy is needed but it is unclear what screening strategies are optimal to detect rGNR colonization. Single taxon dominance of certain Gammaproteobacteria (ɣ-bacteria) species in HCT intestinal microbiomes is a BSI risk factor where colonizing strains present prior to transplant are predominant aetiologies of GNR BSIs. In this study we sought to understand how ɣ-bacteria loads respond to HCT antimicrobial therapy.

Methods
We performed a prospective study of 60 adult patients undergoing HCT at The Ottawa Hospital from 2021-2022. A baseline fecal sample collected &lt; 1 week before conditioning was screened by culture for colonization with rGNR to fluoroquinolones (FQ), 3rd generation cephalosporins (3GC) and carbapenems. Total- and ɣ-bacteria loads were measured by qPCR in baseline and serial specimens until engraftment, expressed as the Log10 (ɣ-bacteria 16S copies / total 16S copies) per ng fecal DNA. Ceftriaxone (CTX) and piperacillin-tazobactam (TZP) are used for prophylaxis and empiric FN therapy, respectively at our institution.

Results
High ɣ-bacteria loads were associated with baseline rGNR colonization compared to no rGNR colonization (Log10 (-1.85) vs Log10 (-2.39), p &lt; 0.0095) (Fig. 1). Highest loads occurred when resistant Escherichia coli or Klebsiella pneumoniae colonized the intestinal microbiota (Log10 (-1.34), p &lt; 0.001). ɣ-bacteria loads were refractory to CTX and TZP therapy when colonizing E. coli or K. pneumoniae carried 3GC resistance (Fig. 2a). In contrast, ɣ-bacteria loads decreased &gt; 2 Log10 in response to CTX and TZP if at baseline rGNRs were FQ resistant, expressed chromosomal AmpC, or if no rGNRs were detected (Fig. 2b, c, d).

Conclusion
ɣ-bacteria load measurement during HCT may be useful for predicting colonization with rGNR strains and identifying patients at risk of GNR BSI.

Disclosures
All Authors: No reported disclosures
P-2324. Detections of Endemic Coronaviruses in Medically Attended Respiratory Illness: Clinical Characteristics and Seasonal Trends from Two Public Health Surveillance Studies in Minnesota
Authors: Bastug Kristen , Martin Karen , Como-Sabetti Kathryn , Friedlander Hannah , Sanders Jeffrey , Brandstetter-Figueroa Izzy , Bistodeau Sarah , Strain Anna K , Vetter Sara , Lynfield Ruth , Thielen Beth K 
Published: January 2025

Abstract

Background
Human coronavirus (hCoV) strains OC43, NL63, HKU1, and 229E exist worldwide and have the potential to cause severe disease. Understanding hCoV seasonality, clinical symptoms, and risk factors for severe disease may help predict the impact of emerging respiratory viral pathogens.

Methods
Eighteen outpatient clinics submitted clinical data and respiratory specimens from patients with influenza-like illness between 2010-2023. Inpatient surveillance data was submitted from 3 hospitals (including one freestanding children’s hospital) between 2013-2018 from patients with acute respiratory illness. Respiratory specimens were tested using a multi-target real-time RT-PCR for 23 bacterial and viral respiratory pathogens.

Results
We tested 24,765 specimens (51.2% hospitalized, 48.8% outpatients) and identified 1,207 non-SARS-CoV-2 coronavirus-positive cases (42% hospitalized, 58% outpatient). 74% of inpatient cases were submitted by a standalone children’s hospital. For hCoV+ cases the median outpatient age in years was 36.5 and inpatient age was 0.6. All hCoV strains were detected at higher frequency during the winter months (Figure 1) and sequential winter seasons demonstrated different dominant strains of hCoV (Figure 2). hCoV was co-detected with other viral pathogens in 29% of cases but strains were not co-detected with each other (Figure 3). The median age for cough, diarrhea, fever, URI symptoms, seizure, vomiting and wheeze was ≤1.0 years, while headache, myalgia, and sore throat was 27-31 years (Figure 4). Among hospitalized children with only hCoV detected, comorbidities included neurologic disorder(22%), developmental delay(14%), seizure disorder(14%), cardiovascular disease(13%), prematurity(12%), and asthma(10%). 16% required mechanical ventilation, 27% required ICU admission, and 41% received antiviral therapy. Patients with hCoV+1 other pathogen compared to those with singular hCoV+ infection did not have an increased risk for ICU admission or mechanical ventilation.

Conclusion
hCoV circulation in Minnesota demonstrates temporal variation in dominant hCoV strain. hCoV infection may present with different symptoms according to the patient’s age. hCoV may contribute to severe respiratory disease in the absence of other pathogenic viruses.

Disclosures
Beth K. Thielen, MD, PhD, GSK: Honoraria|Merck: Grant/Research Support|Sanofi: Honoraria|Seegene: Honoraria
P-2338. Global surveillance of human Metapneumovirus (hMPV) and Respiratory Syncytial Virus (RSV) epidemiology since 2022
Authors: Billard Marie-Noelle , Wildenbeest Joanne G , Braas Olivier , Schneijdenberg Rob , Rodgers-Gray Barry , Fullarton John , Bont Louis J 
Published: January 2025

Abstract

Background
Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are common respiratory pathogens. Whilst the seasonality of RSV is well-documented, less is known about the epidemiology of hMPV and the global impact of the SARS-CoV-2 pandemic on both viruses. The objective of this study was to monitor the real-time temporal and geographic distribution patterns of hMPV and RSV over two seasons.

Methods
A global surveillance dashboard using publicly available outputs of (sub-)national clinical or laboratory-based surveillance data was developed in 2022. Twenty-six countries from both hemispheres were included, based on the availability and consistency of surveillance data for both viruses. For each country, data were extracted on the weekly number of hMPV- or RSV-positive cases and the weekly positivity rate (cases/total tested).

Results
From Jan-22­, hMPV and RSV circulated globally with seasonal patterns in most geographic regions. The hMPV season was typically observed in winter and spring, following the RSV season in autumn and winter. There was some overlap between the hMPV and RSV seasonal epidemic curves in most countries. The number of cases and the peak positivity rate were generally lower for hMPV than RSV. However, not all countries fit these patterns: hMPV can circulate year-round in tropical countries, and RSV peaked particularly early in East Asia, with a second peak in the spring and summer. While these data suggest a trend for both hMPV and RSV to return to pre-pandemic seasonality, there was residual displacement of the timing of the peaks in multiple countries.

Conclusion
hMPV and RSV displayed seasonal patterns in most countries with an evolving return to pre-pandemic seasonality. Continued surveillance is required to confirm this trend during the coming season to better understand the dynamics of hMPV seasonality.
Source of funding: Funded by Icosavax, a member of the AstraZeneca Group. All authors contributed to the development of the publication and maintained control over the final content.

Disclosures
Barry Rodgers-Gray, n/a, AstraZeneca: Employer has received payment from AstraZeneca for work on various projects outside the scope of this study|Sanofi: Employer has received payment from Sanofi for work on various projects outside the scope of this study John Fullarton, n/a, AstraZeneca: Employer has received payment from AstraZeneca for work on various projects outside the scope of this study|Sanofi: Employer has received payment from Sanofi for work on various projects outside the scope of this study
P-2354. Neonatal Enterovirus and Parechovirus Infections—National Enterovirus Surveillance System, United States, 2004–2022
Authors: Delahoy Miranda , Getachew Halle , English Randall , Kidd Sarah 
Published: January 2025

Abstract

Background
Enteroviruses (EV)—a group of viruses including echoviruses (E) and coxsackieviruses (CV)—and parechoviruses (PeV) can cause a range of symptoms, including respiratory illness; hand, foot, and mouth disease; acute flaccid myelitis; meningitis; and sepsis. Neonates (persons &lt; 1 month old) are at higher risk of severe EV or PeV disease. We analyzed data from the National Enterovirus Surveillance System (NESS) to assess types and outcomes of neonatal EV and PeV infections reported during 2004–2022.

Methods
NESS is a passive, laboratory-based surveillance system that collects reports of positive EV and PeV virus type results in the United States. We analyzed data on EV and PeV specimens collected during January 1, 2004–December 31, 2022. Outcome data (defined as whether the patient died) were reported to NESS during 2014–2022. Chi-squared tests were used to compare virus type frequencies by age, with differences considered significant if p &lt; 0.05.

Results
Overall, 10,833 EV and PeV infections were reported during 2004–2022: 9,197 (85%) had reported age, of which 753 (8%) were among neonates. Among 631 neonatal EV or PeV infections with identified virus type (84%), Coxsackievirus type B5 (CVB5) (76; 12%), CVB3 (64; 10%), PeVA3 (61; 10%), E11 (54; 9%), and CVB4 (52; 8%) were detected most frequently. Compared with persons ≥ 1 month old, CVB types 1–5, PeVA3, and E11 were significantly more likely to be detected among neonates, whereas EV-D68 and E30 infections were less common. Among 483 neonates with EV or PeV infections during 2014–2022, 68 (14%) had known outcome, of whom 16 (24%) died.

Conclusion
EV and PeV infections can cause severe disease among neonates. The frequencies of EV and PeV virus types detected among neonates differ from those among persons ≥1 month old, although this may partially reflect testing differences by age. Assessing mortality among neonates with EV and PeV illness is limited by incomplete outcome data and lack of systematic EV and PeV testing and reporting, which may be biased toward including patients with more severe illness. Strengthening capacity for EV and PeV testing, typing, and surveillance would be beneficial for understanding the disease burden among neonates and informing treatment options and prevention measures.

Disclosures
All Authors: No reported disclosures
P-2357. Respiratory Syncytial Virus (RSV) Disease Burden among Adults in Primary Care Settings in High-income Countries: a Systematic Review and Modelling Study
Authors: Li You , Kenmoe Sebastien , Begier Elizabeth , Wahi-Singh Pia , Wahi-Singh Bhanu , Liang Caihua , Sato Reiko , Gessner Bradford D , Nair Harish 
Published: January 2025

Abstract

Background
Data on RSV disease burden in adults remain scarce and mostly focus on hospitalisation. We aimed to estimate RSV disease burden in primary-care settings among adults in high-income countries.Figure 1.PRISMA flowchart

Methods
We conducted a systematic review to include studies that reported RSV disease burden in primary-care settings; studies of emergency department (ED) visits were also included but analysed separately. We searched MEDLINE, Embase, Global Health, CINAHL, Web of Science, and Global Index Medicus for eligible studies published between 1 Jan 1996 and 30 Nov 2022 and conducted citation searching of identified studies. Using a random-effects meta-analysis, we synthesised RSV incidence rate, positive proportion, and incidence-to-hospitalisation ratio. When estimating RSV incidence rate and positive proportion, we adjusted for RSV under-ascertainment related to clinical specimens and diagnostic tests used in individual studies by a previously published two-stage statistical framework. We used the Joanna Briggs Institute critical appraisal checklist for assessing study quality.

Results
We included 14 studies (Figure 1), with 13 studies rated as high-quality. RSV incidence rate increased with increasing age in primary-care settings and in ED; the adjusted annual incidence rate in primary-care settings ranged from 2,350 (95% CI: 1,254–4,405) per 100,000 in 18–49 year-olds to 4,339 (3,267–5,763) in adults ≥65 years (Table 1). The RSV positive proportion in acute respiratory infection episodes in primary-care settings was higher among those aged ≥65 years than 18–49 years (Table 2). In adults ≥65 years, 6.2% (1.4–23.8) of RSV episodes in primary-care settings led to hospitalisation, equivalent to one patient progressing to hospitalisation for every 16 outpatient visits. According to five studies (total N=413; age: &gt;60 or &gt;65 years), no RSV-associated deaths occurred in primary-care settings.

Conclusion
RSV disease burden in primary-care settings is substantial among adults in high-income countries, particularly for older adults. Further larger studies are needed to assess mortality risk following RSV-related outpatient visits. This study’s estimates have important implications for evaluating RSV prevention programmes’ impact.

Disclosures
You Li, Pfizer: Advisor/Consultant Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company) Caihua Liang, MD, PhD, Pfizer: Stocks/Bonds (Private Company) Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds (Private Company) Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Harish Nair, n/a, Pfizer: Advisor/Consultant
P-49. Sexual and Gender Minority Veterans With HIV More Likely Vaccinated Against HPV Than Those Without HIV in a Nationwide Cohort
Authors: Van Epps Puja , Meriwether Wyatt E , Matza Alexis (Lexi) , Mcconnell Alex , Shipherd Jillian , Kauth Michael R 
Published: January 2025

Abstract

Background
Certain sexual and gender minority (SGM) adults, particularly those with HIV, experience a disproportionate impact of Human Papillomavirus (HPV) and its related diseases. Vaccination against HPV, which is recommended in all adults up to age 26 and in some up to age 45, is an important tool in addressing this disparity. In non-Veteran cohorts, young SGM adults, particularly of non-White race are less likely to be vaccinated against HPV. We examined HPV vaccination rates in the Veterans Health Administration (VHA) among a nationwide cohort of age eligible SGM Veterans and report on disparities across racial groups and HIV status

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) as of April 2024. Birth sex male LGBQ+ and TGW 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 HPV vaccine doses in the VHA starting 2022 and compared rates of vaccine initiation or completion across groups.

Results
Among the 1802 LGBQ+ males age 26 and under, 561 (31%) had received at least one dose of the HPV vaccine in the VHA; of these, 50% had completed the series (Figure 1). In the 27-45 age group, 2082/14863 (14%) had initiated and of these, 60% had completed the series. Non-Whites in both age groups had higher rates of series initiation compared with Whites (19-26: 34% vs. 30%; 27-45: 17% vs. 11%) (Figure 2). Those with HIV had higher rates of series initiation in both age groups compared to those without (19-26: 52% vs. 30%; 27-45: 26% vs. 16%) (Figure 3). Among TGW: 26 and under (n=154), 21% had received at least one dose and 38% of these have completed the series; 27-45 (n=932) 9% had initiated the series, but rates were much higher in those with HIV in this group (series initiation: 33%; completion rate: 63%).

Conclusion
Less than a third of eligible SGM Veterans have received HPV vaccination in the VHA. Unlike non-Veteran cohorts, younger age and non-White race were associated with increased vaccination rates, with rates among those with HIV being the highest and those among TGW the lowest. More efforts are needed to increase HPV vaccination in these high need populations.

Disclosures
All Authors: No reported disclosures
P-55. Knowledge of Respiratory Syncytial Virus (RSV) Vaccine in Pregnant Women: A survey among Healthcare Professionals
Authors: Santoyo Leticia , López Karina , Martínez-Reséndez Michel F , Aguirre-García Gloria Mayela , Garza Erick 
Published: January 2025

Abstract

Background
Respiratory Syncytial Virus (RSV) is a leading cause of acute lower respiratory tract infection (RTI), playing a significant role in infant mortality under six months of age, especially in low and middle-income countries. In August 2023, the U. S. Food & Drug Administration approved active immunization of pregnant women between 32 to 36 weeks gestational age for the prevention of lower RTI and severe lower RTI caused by RSV in infants up to 6 months of age.
Figure 1.
Distribution of responses according to medical specialt

Methods
An electronic survey comprised of 18 questions was administered to primary care physicians, internists, gynecologists, and pediatricians. The survey included 4 items to gather participant characteristics, 1 addressing general vaccination recommendations during pregnancy, 5 covering general aspects of the RSV vaccine, 7 focusing on knowledge of the RSV vaccine during pregnancy and 1 item to ascertain whether they recommend this vaccine. If participants lacked prior knowledge of the vaccine or its use in pregnant patients, the survey was concluded
Figure 2.
Previous Knowledge of RSV Vaccine by Medical Speciality

Results
168 responses were received, the distribution by specialties is shown in Figure 1. A total of 76/168 doctors (45.2%) were aware of the existence of a vaccine against RSV (Figure 2), 52/76 (68.4%) had knowledge of the vaccine targeted to pregnant women (Figure 3). Among the doctors familiar with this vaccine, 29/52 (55.8%) knew that it is a single-dose vaccine. Additionally, 28/52 (53.8%) were aware of when it should be administered, 31/52 (59.6%) knew it is a seasonal vaccine and 27/52 (51.9%) were previously aware of its efficacy in providing protection to infants up to 6 months old. Furthermore, 100% of the surveyed expressed that they would recommend the vaccine once it is approved in Mexico
Figure 3.
Previous knowledge of the vaccine targeted to pregnant women

Conclusion
Only 27/168 (16%) of the surveyed demonstrated a satisfactory knowledge about the RSV vaccination in pregnant women, including details such as dosage, indication, timing of administration and efficacy.
These surveys serve to assess physicians knowledge on the topic under study, and are valuable educational tools for the respondents by provifing information and reliable sources for further reading of the topic. Nevertheless our findings highlight the need for additional comprehensive educational campaigns targeting healthcare providers

Disclosures
All Authors: No reported disclosures