bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2034. Inappropriate Outpatient Antibiotic Prescribing for COVID-19 in New York City, 2020—2022
Authors: Foote Mary K , Kochar Nisha , Thu Kyaw Nang Thu 
Published: January 2025

Abstract

Background
Antibiotic misuse is a key driver of antimicrobial resistance. Early in the COVID-19 pandemic, several unproven therapies were used, including antibiotics. In November 2020 and December 2021, monoclonal antibodies and oral antivirals were authorized for the outpatient treatment for COVID-19 respectively, which may have influenced inappropriate antibiotic prescribing (IAP). Here we describe prescribing trends and proportion of inappropriate antibiotic prescriptions for COVID-19 by patient and provider characteristics during 2020—2022 in New York City (NYC).

Methods
We performed a retrospective descriptive analysis of medical visits for COVID-19 during 2020—2022 identified by ICD-10 codes and associated antibiotic prescription fills using IQVIA medical data, which captures office-based physician and specialists visit claims, and prescription data, which captures 94% of retail pharmacy prescription claims. Medical visits with a concomitant diagnosis for conditions which may or do require antibiotics were excluded. Inappropriate antibiotic prescription (IAP) was defined as an antibiotic prescription claim linked to a COVID-19 medical visit within ≤7 days.

Results
Of 1,284,623 medical visits for COVID-19, 81,885 (6.4%) resulted in an antibiotic prescription fill, a majority were macrolides (62%). Most patients were seen in a clinic (32.4%) or urgent care (28.7%) and by a physician (85.2%), most frequently Internal Medicine (34.7%). Rates of IAPs were 5.5% in 2020, 6.7% in 2021 and 6.5% in 2022. Patients aged 50-64 years (8.7%), who were female (6.9%) or had a telehealth encounter (9.9%) received more IAPs than other groups. Antibiotics were more likely to be inappropriately prescribed by providers who were male (8.6%), aged ≥50 years (7.6%) or internal medicine physicians (9.0%).

Conclusion
Availability of COVID-19 treatments did not appear to decrease antibiotic prescribing. IAP was lower overall compared to national estimates but varied significantly by patient and provider characteristics. Limitations include lack of data on unfilled prescriptions, race, ethnicity, disease severity or underlying conditions. These findings can help target interventions to improve quality of treatment for COVID-19.

Disclosures
All Authors: No reported disclosures
P-2038. A Pharmacist-Run Treatment Decision Program for High-Risk Outpatients with Mild-Moderate COVID-19 at an Urban Veteran's Affairs Medical Center
Authors: Kuhn Ryan , Weslosky Lauren , Natesan Suganthini Krishnan , Dhar Sorabh 
Published: January 2025

Abstract

Background
Antiviral treatment is recommended for high-risk outpatients with mild-moderate COVID-19 to prevent progression to severe disease. Antiviral treatment decisions remain challenging due to the need for early initiation of treatment and the potential for drug-drug interactions with first-line therapy.

Methods
This single center, retrospective review evaluated the impact of a Pharmacist-run treatment decision program for high-risk outpatients with mild-moderate COVID-19 from 1/1/2022 through 12/28/2023. All outpatient treatment candidates were reviewed by a Clinical Pharmacist prior to initiation of oral antiviral treatment. A 5-day course of oral ritonavir-boosted nirmatrelvir (RNM) was considered first-line. A 5-day course of oral molnupiravir (MNP) was used as an alternative in situations where oral RNM was not clinically appropriate. The Clinical Pharmacist determined the optimal antiviral treatment, the appropriate medication dose, reviewed for drug-drug interactions, helped implement any necessary medication adjustments and/or monitoring plans, and assisted with patient education. Patient characteristics and the number of pharmacist interventions related to RNM drug-drug interactions were summarized.

Results
From 1/1/2022 to 12/28/2023, 455 high-risk outpatients were treated with oral antivirals for mild-moderate COVID-19 through the Pharmacist-run treatment decision program. Four-hundred and two patients (88.35%) were treated with RNM and 53 patients (11.65%) were treated with MNP. Patient ages ranged from 23 to 97 years (mean 66.4, SD 12.1). The mean duration of COVID-19 symptoms for patients who received oral antiviral treatment was 3 days (SD 1.12). The Clinical Pharmacist intervened on a total of 624 drug-drug interactions related RNM. The most common reason for use of MNP was the presence of major drug-drug interactions related to RNM (47/53; 88.7%), followed by severe renal impairment (6/53; 11.3%).

Conclusion
A Pharmacist-run treatment decision program for high-risk outpatients with mild-moderate COVID-19 was effective at initiating appropriate oral antiviral treatment in a timely fashion and ensuring patient safety by managing drug-drug interactions related to RNM.

Disclosures
All Authors: No reported disclosures
P-2045. Humoral Response induced by Three-Dose Vaccination Schemes Against SARS-CoV-2 in Pediatric Hematopoietic Stem Cell Transplant Recipients: Experience from a Middle-Income Country
Authors: Soffia Andrés , Le Corre M Nicole , Torres Juan Pablo , Cecilia Vizcaya M , Martinez-Valdebenito Constanza , González Natalia , Catalán Paula , Donoso Paulina , Barrera Aldo 
Published: January 2025

Abstract

Background
Hematopoietic Stem Cell Transplant (HSCT) recipients are at high risk for severe COVID-19, requiring effective vaccination strategies. SARS-CoV-2 inactivated vaccines elicit lower levels of neutralizing antibodies (NAbs) compared to mRNA vaccines and have been little studied in immunocompromised children. However, low- and middle-income countries predominantly use inactivated vaccines. Aim: to explore the immunogenicity of different COVID-19 vaccination strategies in pediatric HSCT recipients from Chile, where both vaccine types are used.

Methods
Multicenter cross-sectional study of pediatric HSCT recipients, previously immunized with 3-dose regimens based on CoronaVac/Sinovac (CV) and BNT162b2/Pfizer-BioNTech (BNT) vaccines &gt;=3 months post-transplant. NAbs against the original Wuhan strain and the Omicron XBB1.5 variant were evaluated 8-12 weeks after the 3rd dose using a pseudovirus-based assay. A positive Nab titer was defined as a neutralizing activity of at least 50% (ID50) at a 1:160 dilution. Safety/reactogenicity outcomes were recorded.

Results
27 pediatric HSCT recipients were included (median age 11.9 y), of whom 21 were vaccinated with 2 doses of CV followed by a BNT booster, 1 with 2 doses of BNT followed by a CV booster and 5 with 3 BNT doses. At 11.1 weeks (IQR 9.2-13.6) after the 3rd dose, 84% reached NAb positivity for the Wuhan strain, while only 40% reached it for the XBB1.5 variant (P&lt; 0.005). Neutralizing capacity was higher against Wuhan compared to XBB1.5, with a median ID50 of 2127 vs 75.9 (P&lt; 0.0001). NAb-positive patients for the Wuhan strain had higher IgG levels (median 693 mg/dL vs 371.5 mg/dL in non-responders, P&lt; 0.05). No significant differences were found in neutralizing capacity based on the scheme administered. In a multivariate linear regression, the CD19 count predicted neutralization capacity. No serious adverse events were reported.

Conclusion
No differences were observed in neutralizing capacity based on the vaccines administered, supporting the use of heterologous schemes including both inactivated and mRNA vaccines in HSCT pediatric recipients. Neutralizing capacity was higher against Wuhan than XBB1.5, emphasizing the importance of booster doses of bivalent vaccines that target this variant.

Disclosures
All Authors: No reported disclosures
P-2048. COVID-19 XBB.1.5 Vaccine Uptake Based on State Vaccine Registries Compared to National Survey Data
Authors: Cook Angela , Andersen Kathleen M , Brouillette Matthew A , McGrath Leah , McLaughlin John M 
Published: January 2025

Abstract

Background
Prior to May 11, 2023, all COVID-19 vaccinations were required to be reported by states to the Centers for Disease Control and Prevention. In the post-pandemic era, national vaccination uptake is now estimated using the National Immunization Survey (NIS). While survey methodology attempts to achieve random sampling of the population and accurate assessment of vaccine use through self-report, it is unknown how these estimates compare to state vaccine registries. We aimed to compare estimated COVID-19 vaccine uptake during the 2023-2024 season from state vaccine registries with estimates from the NIS.Figure 1.Uptake of XBB.1.5 COVID-19 vaccine in state vaccine registries versus national survey estimates, September 2023 - February 2024

Methods
We utilized two COVID-19 state vaccination registries where COVID-19 vaccine reporting was required: CAIR2 in California and LINKS in Louisiana. We identified COVID-19 XBB.1.5-adapted vaccines administered between September 11, 2023, and February 10, 2024, using CVX vaccine codes 308 - 313. California and Louisiana 2023 population estimates were obtained from the U.S. Census Bureau and used as the denominator to calculate population-level uptake. For the same time period, state-specific COVID-19 vaccine uptake estimates were also obtained from state-specific NIS data for California and Louisiana as a comparison.

Results
At the end of the study period, 14.4% of adults and 5.6% of children in California were documented as vaccinated in the CAIR2 registry compared to NIS estimates that 23.8% (1.6x) of adults and 17.3% (3.1x) of children in California had been XBB.1.5 vaccinated (Figure). For Louisiana, 5.4% of adults and 0.6% of children were found in LINKS registry data compared to NIS estimates that 12.3% (2.3x) of adults and 3.9% (6.5x) of children were XBB.1.5 vaccinated.

Conclusion
XBB vaccination coverage was low overall but was substantially lower when measured using state vaccine registry data compared with national survey data, especially for children. Efforts to improve COVID-19 vaccination are warranted, as are future studies to determine why COVID-19 uptake appears higher in national survey data compared to what is captured in state registries.

Disclosures
Angela Cook, MS, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Kathleen M. Andersen, PhD MSc, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Matthew A. Brouillette, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Leah McGrath, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) John M. McLaughlin, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)
P-2075. Immunogenicity of co-administration of influenza vaccine and COVID-19 vaccine in healthy volunteers
Authors: Tongsengkee Nonthanat , Pinpathomrat Nawamin , Siripaitoon Pisud , Kositpantawong Narongdet , Kanchanasuwan Siripen , Chittrakarn Sorawit , Chusri Sarunyou 
Published: January 2025

Abstract

Background
The emergence of coronavirus disease 2019 (COVID-19) and seasonal influenza results in a substantial disease burden worldwide. The immunogenicity of co-administering the COVID-19 and influenza vaccines was not well established, as co-administration may reduce the antibody response. The aim of the study is to evaluate the humoral immune response (HIR) and cell-mediated immune response (CMIR) of co-administration among healthy volunteers.

Methods
A pilot randomized controlled trial was conducted in Southern Thailand from March to April 2024. Healthy adults who had received at least one dose of any COVID-19 vaccine more than 6 months prior were enrolled and randomly assigned (1:1:1) to receive the influenza vaccine (VaxigripTetra™) alone, the COVID-19 vaccine (bivalent mRNA BNT162b2) alone, or co-administration of both vaccines. T-cell response against SARS-CoV-2 by Interferon gamma enzyme-linked immunosorbent spot (IFN-γ ELISpot) assay and anti-receptor-binding domain immunoglobulin G (anti-RBD IgG) level were measured before and 4 weeks after vaccination. The primary outcomes were the geometric mean ratio (GMR) of ELISpot and anti-RBD IgG level, with a lower bound 95% confidence interval (CI) &gt; 0.67 for the non-inferiority margin (within 1.5-fold). The sample size was 12 per arm, according to the pilot study.

Results
Thirty-six participants were recruited. The enrollment and study flow are shown in Figure 1. Demographic data of participants are demonstrated in Table 1. Geometric means (GMs) for IFN-γ ELISpot and anti-RBD IgG are shown in Figure 2. GMRs between the co-administration and COVID-19 group were 1.03 (95% CI 0.43-2.44) for IFN-γ ELISpot and 0.82 (95% CI 0.52-1.29) for anti-RBD IgG, both failed to meet the non-inferiority margin due to the lower bound 95% CI &lt; 0.67 (Figure 3). Mild solicited systemic adverse reactions in the influenza, COVID-19, and Co-administration groups were 8.3%, 75%, and 83%, respectively.

Conclusion
Co-administration of COVID-19 and influenza vaccines tended to show comparable both HIR and CMIR, as well as adverse reactions, with COVID-19 vaccination alone. This finding may support co-administration policy. According to pilot study, larger sample size study and effectiveness of vaccine co-administration need to be investigated.

Disclosures
All Authors: No reported disclosures
P-2109. Culture-Free Identification of Microbes in Seconds Directly from Clinical Samples using the MasSpec Pen Technology
Authors: Downey Rachel , Kumar Manoj , Kirkpatrick Lindsey M , Hauger Sarmistha Bhaduri , Johnson Coreen , Dunn James , Jackobs Faith , Keating Michael , Eberlin Livia 
Published: January 2025

Abstract

Background
Broad spectrum antibiotics are often used empirically in cases of suspected invasive infection requiring surgical intervention while awaiting results of conventional testing (cultures and molecular tests). Rapid and accurate diagnosis of the etiologic pathogens is critical to allow for selection of targeted antibiotics and improve outcomes for patients.
We present current results of a large, multi-center clinical study using the MasSpec Pen (MSPen) technology to characterize the metabolic profiles of clinically relevant microbes in culture isolates and apply the technology to culture-independent identification of infectious agents directly in clinical samples.Figure 1.Schematics showing the key operating steps and results when using the MasSpec Pen to perform analysis and identification of bacteria.

Methods
The MSPen allows direct sample analysis using a solvent droplet followed by immediate mass spectrometry analysis, with total acquisition time of ∼15 seconds (fig 1). In this study 785 samples (635 isolates and 150 clinical specimens) were analyzed using this technology to create distinct metabolic profiles to differentiate bacterial pathogens. 80% of data were used as a training set to develop such profiles; 20 percent of data were used as a test set to identify bacterial infection.Fig 2.Species identification in pure isolates

Results
We identified over 400 bacterial metabolites and lipids in 10 different microbial species and compiled a unique metabolic profile for each that was used to directly identify specific microbes in cultures and clinical specimens.
Among culture isolates, our statistical classifiers were able to achieve 99% accuracy for Gram-typing, and 99% accuracy among 10 bacteria in the test set (fig 2).
Using species-specific metabolites and lipids, we were able to identify Pseudomonas aeruginosa directly from 3 infected specimens and Staphylococcus epidermidis directly from infected bone.

Conclusion
Our results show the incredible promise that direct MSPen analysis has for rapid, culture-independent identification of bacteria from patient tissues. We are working to build classifiers to differentiate bacteria by specific m/z values to improve identification in tissue samples.

Disclosures
Manoj Kumar, PhD, LSE is an inventor in patents related to the MSPen technology owned by University of Texas Austin and Baylor College of Medicine. LSE is a co-founder,: LSE is an inventor in patents related to the MSPen technology owned by University of Texas Austin and Baylor College of Medicine. LSE is a co-founder, Lindsey M. Kirkpatrick, DO, PhD, Thermo Fisher Scientific: Honoraria Michael Keating, PhD, MS Pen Technologies: Advisor/Consultant Livia Eberlin, PhD, Merck: Honoraria
P-2116. Analysis of No-Growth Wells in Escherichia coli (EC) During Fosfomycin Broth Microdilution (BMD) and Agar Dilution (AD) Testing
Authors: Salay Jenna , Malik Khadijah , Collins Lindsey , Chang Tiffany , Bixby Morgan L , Bixby Morgan L , Hirsch Elizabeth B 
Published: January 2025

Abstract

Background
Although AD is the reference method for CLSI and EUCAST, it is not clinically efficient. Neither CLSI nor EUCAST approve the use of BMD due to less precision, trailing endpoints, and presence of no-growth wells before the minimal inhibitory concentration (MIC). However, available data describing these phenomena are very limited. We sought to evaluate rates of scientific error—no-growth wells and growth at concentrations above the MIC in BMD and AD—among a collection of EC isolates, to determine if BMD is truly less precise than AD.

Methods
A convenience collection of EC clinical urine isolates (n = 106) collected in 2022 was included. BMD and AD were performed in technical triplicate and in biological duplicate on separate days to determine a final MIC. A measured MIC was defined as the MIC obtained from a single biological replicate whereas the final MIC was the shared MIC (± 1 dilution) between two biological replicates of the same isolate. For AD, MIC were determined from the first concentration with no growth or only a single colony formed; for BMD: lowest concentration with no visible growth in all three technical replicates. For BMD, a no-growth well was defined as lack of growth at any concentration below the MIC. Growth above the measured MIC was defined as a single well with any visible growth at a concentration greater than the MIC. For AD, error was recorded as any single colonies at the MIC or any countable colony growth at concentrations above the MIC.

Results
The collection had a range of final MIC from 0.5 to &gt; 64 µg/mL for AD and BMD (Table 1). For BMD final MIC including data for &gt; 2 isolates, no-growth wells occurred up to 38.1% of the time (Figure 1A). Additional growth beyond the MIC occurred up to 16.7% of the time (Figure 1B). Single colonies at or beyond the MIC occurred up to 50% of the time (Figure 1C).

Conclusion
Rates of no-growth wells and growth at concentrations higher than the measured MIC for fosfomycin BMD and AD testing was high among a collection of EC isolates, which resulted in frequent scientific error. BMD had increased rates of scientific error while reading results. Additional analysis using a larger isolate set is needed to further validate these results; however, the frequency of error demonstrated for both testing methods should prompt re-evaluation of fosfomycin BMD and AD testing.

Disclosures
Elizabeth B. Hirsch, PharmD, FCCP, FIDSA, GSK: Advisor/Consultant|GSK: Honoraria
P-2121. A prospective observational study of usefulness of interferon-gamma release assay for latent tuberculosis infection in pediatric hematopoietic stem cell transplant recipients
Authors: So Hyejin , Lee Jina 
Published: January 2025

Abstract

Background
Pediatric hematopoietic stem cell transplantation (HSCT) recipients are one of the high-risk groups concerning tuberculosis and screening for latent tuberculosis infection (LTBI) prior to HSCT is important and accurate diagnostic tests for predicting LTBI in these high-risk children are on demand. However, there are concerns for Interferon-gamma release assay(IGRA) being less sensitive in the children group for screening LTBI. This study was aimed to evaluate the predictive value of Quantiferon-TB Gold test (QFT-G) using the enzyme-linked immunosorbent spot assay (T-SPOT.TB) in immunocompromised Korean children.

Methods
In this prospective observational study, children under age 20 who were scheduled for allogeneic HSCT at Asan Medical Center Children`s Hospital were enrolled during March 2017 and May 2018. QFT-G test and T-SPOT.TB were done prior to HSCT. Concordance rates were calculated among each group. Electronic Medical Records was reviewed for clinical and demographic data of the enrolled patients.

Results
Among the 62 patients who were planned to receive allogenic HSCT during March 2017 and May 2018, 11 patients were excluded and a total of 51 patients were enrolled. Median age was 10 years and the underlying disease leading to HSCT was mostly aplastic anemia (31.4%). Others were acute myeloid leukemia (23.5%), acute lymphoblastic leukemia (15.7%), myelodysplastic syndrome (7.8%), and other benign disease (17.6%). About 52% of the patients were applied immunosuppressive drugs in the recent 3-month period prior to testing. 4 patients were considered LTBI based on screening test results. At 2 year follow up period, 1 patient was confirmed pulmonary TB. Overall concordance rate was 82.4% (42/51). The age-based concordance rate was 93.8% (14/15) for children younger than 5-years old and 77.8% (28/36) for 5 or above. Concordance rate between negative test results and not TB diagnosis was further checked; QFT-GIT 97.8% (44/45), T-SPOT. TB 97.9% (46/47), and TST 100% (10/10).

Conclusion
This study shows that the GFT-GIT well matched with the T-SPOT.TB for screening LTBI and children under age 5 showed to have higher concordance rates compared to the older age group. This could provide evidence to testing younger children with IGRA assays.

Disclosures
All Authors: No reported disclosures
P-2122. Spectrum of Infection and Outcomes in Individuals with Candida auris Infection in Qatar
Authors: Al Ajmi Jameela A , Malik Aimon , Nafady-Hego Hanaa , Hanana Fathima , Abraham Joji , Garcell Humberto G , Hudaib Ghada , Al-Wali Walid , Eltayeb Faiha , Shams Sherin , Thomas Anil G , Saleem Samah , Abou-Samra Abdul-Badi , Butt Adeel A 
Published: January 2025

Abstract

Background
We investigated the spectrum of infection and risk factors for invasive fungal disease due to Candida auris (CA) in Qatar.

Methods
We performed structured chart reviews on individuals with any positive CA culture between May 2019 and December 2022 at three tertiary care hospitals in Qatar. Invasive CA disease (ICAD) was defined as a positive sterile site culture, or any positive culture for CA with appropriate antifungal prescription. Main outcomes included proportion of individuals who developed ICAD among those with positive cultures, and 30-day/in-hospital mortality.

Results
Among 331 eligible individuals, median age was 56 years, 83.1% were male, 70.7% were non-Qataris, and 37.5% had &gt; 3 comorbidities at baseline. Overall, 86.4% were deemed to have colonization and 13.6% developed ICAD. Those with ICAD were more likely to have invasive central venous or urinary catheterization and mechanical ventilation. Individuals with ICAD had longer prior ICU stay (16 vs 26 days, P=0.002), and longer hospital length of stay (63 vs. 43 days; P=0.003), and higher 30-day mortality (38% vs. 14%; P&lt; 0.001). In multivariable regression analysis, only mechanical ventilation was associated with a higher risk of ICAD (OR 3.33, 95% CI 1.09-10.17).

Conclusion
Invasive Candida auris Disease is associated with longer hospital stay and higher mortality. Severely ill persons on mechanical ventilation with any positive C. auris cultures should be especially monitored for development of invasive fungal disease.

Disclosures
Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support