bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1875. A Quality Initiative to Understand Risk Factors for Pneumonia Readmissions at a Regional Medical Center
Authors: Morgan Chloe A , Jaronko Jaime , Schembri Frank , Manzoor Kamran 
Published: January 2025

Abstract

Background
Pneumonia is a significant cause of hospitalizations in the United States, with 1 million pneumonia-related hospital admissions in 2014. Additionally, patients discharged after pneumonia treatment have a high all-cause 30-day readmission rate between 17%-25%. In order to create a quality improvement initiative to decrease pneumonia readmissions, we sought to identify risk factors, rates, and causes of readmission in patients with index admissions due to pneumonia.

Most Common Readmission Comorbidities

Methods
We performed a manual review of deidentified electronic medical record (EMR) data to select adult patients hospitalized for pneumonia for four consecutive months over two years (August to November 2022 and 2023) at a regional medical center. We assessed the primary cause of readmission for patients readmitted within 30 days of discharge to understand the risk factors, associated comorbidities, and care received.

Results
EMR review identified 161 hospitalizations due to pneumonia in 8 months. Of these, 24 patients (15%) were readmitted within 30 days of hospital discharge, and most (15) of these readmissions were within 15 days. Notably, only 2 readmissions (8.3%) were due to pneumonia-related causes. The two most common causes for readmission were infections other than pneumonia (25%) and renal failure (21%). Most readmissions (14 readmissions [58%]) were classified as at risk for aspiration, and 4 (17%) were associated with opioid use. The most frequently seen comorbidities in readmission were aspiration risk/dysphagia, chronic kidney disease, chronic obstructive pulmonary disease, and atrial fibrillation (Figure 1). 15 out of 24 patients (63%) did not have a 30-day follow-up with their primary care provider.

Conclusion
Our data suggest that most readmissions were not directly related to pneumonia, further suggesting that patient comorbidities and risk factors play a more significant role. Quality improvement programs should focus on a broad, multidisciplinary approach to identify the most vulnerable patient populations and associated risk factors and prioritize prompt outpatient follow-up with a primary care physician.

Disclosures
All Authors: No reported disclosures
P-1895. Outpatient Parenteral Antimicrobial Therapy Multidisciplinary Partnership Reduces Readmissions and Emergency Center Visits in a Comprehensive Cancer Center
Authors: Dailey Garnes Natalie J , Rowan Meagan , Pena Jaime , Kamath Meghan , Florack Ashlyn Anastasia , Finder Janice , Baulis Jessica E , Amistad Wesley , Jiang Ying , Adachi Javier 
Published: January 2025

Abstract

Background
Outpatient parenteral antimicrobial therapy (OPAT) programs have reduced readmissions without impacting emergency center (EC) visits. Our initial pilot OPAT program improved laboratory monitoring without decreasing readmissions or EC visits. We expanded the program and made additive quality improvement interventions.
Outcomes Associated with Outpatient Parenteral Antimicrobial Therapy Interventions in Patients Receiving Care at a Comprehensive Cancer Center
*Previously published initial pilot program. **Compared with baseline among patients with &gt;/= 1 EC visit.
OPAT, Outpatient parenteral antimicrobial therapy; APP, advanced practice provider; EMS, electronic medical system; EC, emergency center; ID, infectious diseases

Methods
We obtained demographic data and baseline frequencies of 30-day unplanned readmissions and EC visits from our electronic medical system (EMS) for 48 patients over 6 weeks prior to pilot implementation. Using the Model for Improvement, we made iterative additions, including pharmacist regimen review, monitoring within the EMS, online commercial laboratory result access, weekly nursing phone calls after discharge, and expansion to infectious disease outpatient starts. After interventions, we compared categorical variables to baseline by using Chi-square or Fisher’s exact test, as appropriate, and compared continuous variables by using nonparametric Wilcoxon rank sum test. We performed multivariable logistic regression to identify risk factors independently associated with readmission.

Results
During June 2018–November 2023, our OPAT program provided care for 1,274 patients. Readmissions decreased from 30% to 15% (p = 0.02) (Figure). Mean number of EC visits per patient decreased (1.3 vs. 1.0, p = 0.002). In multivariable analysis, EMS monitoring and online access to laboratory results were independently associated with decreased readmission risk (aOR 0.22 [95% CI: 0.09-0.56]). Nursing calls after discharge independently protected against readmission (aOR 0.18 [95% CI: 0.07-0.47]). Patients with Eastern Cooperative Oncology Group-Performance Status ≥2 were readmitted more often than those with &lt; 2 (aOR 1.63 [95% CI: 1.05-2.52]).

Conclusion
Improving efficiency and access to laboratory data and weekly nursing phone follow up were associated with fewer readmissions among OPAT patients with cancer. This study is the first, to our knowledge, to show an impact of OPAT on EC visits in any population. OPAT patients with poor functional status have an increased risk for readmission and may benefit from closer monitoring. OPAT programs can improve safety for adult patients with cancer despite competing risks inherent to this population.

Disclosures
Natalie J Dailey Garnes, MD, MPH, MS, AlloVir: Grant/Research Support
641. Real-Time Whole Genome Sequencing Surveillance of Healthcare Associated SARS-CoV-2, Respiratory Syncytial Virus (RSV) and Influenza
Authors: Rangachar Srinivasa Vatsala , Griffifth Marrisa P , Patrick Rose , Waggle Kady D , Okonkwo Dumebi , Van Tyne Daria , Snyder Graham M , Sundermann Alexander , Pless Lora , Harrison Lee 
Published: January 2025

Abstract

Background
Seasonal respiratory viruses contribute to substantial healthcare burden, marked by elevated rates of hospitalizations, morbidity and mortality. The transmission dynamics of respiratory viruses in adult acute care hospitals are not well described. To address this, we performed whole genome sequencing (WGS) surveillance to investigate transmission of SARS-CoV-2, RSV, and influenza among hospitalized patients in a single health system.

Methods
From August 30, 2023 to March 31, 2024, nasal swab specimens positive for SARS-CoV-2, influenza, or RSV were collected weekly from inpatients hospitalized for ≥ 3 days from two hospitals. Additional specimens collected from the same patient within a 14-day period were excluded. Specimens with qPCR cycle threshold (Ct) values ≥ 34, ≥ 39, and ≥ 31 for SARS-CoV-2, RSV and influenza, respectively, were excluded from WGS. WGS was performed using tiled PCR amplicons or Twist Bioscience hybridization method, followed by bioinformatic analyses to assess genetic relatedness [≤ 2 single nucleotide polymorphisms (SNPs) except for influenza (≤ 3 SNPs)]. Clusters were further investigated for epidemiological connections (shared locations or staff).

Results
We collected 179 SARS-CoV-2, 37 influenza and 16 RSV specimens, of which 93 specimens did not meet the inclusion and the qPCR QC criteria. We sequenced 84% (87/104) of SARS-CoV-2, 86% (19/22) of influenza, and 92% (12/13) of RSV specimens. Of these, 45% (39/87) of SARS-CoV-2 and 32% (6/19) of influenza genomes formed genetically related clusters, each with 2-4 patients. We identified an epidemiological link for 73% (11/15) of SARS-CoV-2 and 100% (2/2) of influenza clusters (Fig. 1 & Fig. 2). For RSV genomes, we identified one cluster with two epidemiologically linked patients (Table1). On average, the transmission clusters spanned a duration of 15 days (range: 1−35 days, Table1).

Conclusion
Respiratory viral transmission is frequent in hospitals, with around 40% of sequenced specimens genetically related to each other. While this study serves as an initial step towards possible implementation of real-time WGS surveillance, further investigation is needed to address broader implications, including implementation of infection prevention strategies to address transmission clusters.

Disclosures
Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant Alexander Sundermann, DrPH, CIC, FAPIC, OpGen: Honoraria Lee Harrison, MD, GSK: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant
P-1917. Hospital-Acquired Infections and Their Impact on Length of Stay for Veterans with COVID-19: A Nationwide Cohort Study
Authors: Li Haojia , Khader Karim , Jones Barbara E , Rubin Michael , Zhang Yue 
Published: January 2025

Abstract

Background
The COVID-19 pandemic has intensified concerns about hospital-acquired infections (HAI) due to multidrug-resistant organisms (MDRO) in hospitalized patients. This study assesses the excess length of stay (LOS) attributed to MDRO HAI across all acute Veterans Affairs (VA) hospitals.

Methods
A retrospective cohort study was conducted within the VA healthcare system, including 115,000 hospital admissions from March 1, 2020, to August 31, 2022. We included 71,432 COVID-19 patients admitted within 14 days of a lab-confirmed diagnosis, excluding cases with community-acquired infections, non-MDRO HAIs, and readmissions. We utilized balanced risk-set matching (RSM) and mixed integer programming (MIP) to optimize covariate balance via Mahalanobis distance among key variables including demographic data, comorbidities, and both time-independent and -dependent treatments. Standardized mean differences (SMD) were used to ensure covariate balance, with an absolute value of less than 0.1 considered balanced.

Results
We matched 1,088 patients who experienced HAI with MDRO. Covariate balance was achieved, with only minor deviations (SMD slightly over 0.1). The mixed-effect Poisson regression model adjusted for temporal and facility-level factors revealed that HAIs associated with MDRO resulted in a 32% longer LOS compared to the non-HAI group (95% CI: 30% - 35%; mean LOS: 26.8 days vs. 20.5 days; median LOS: 22 days vs. 16 days).

Conclusion
This study highlights the significant impact of HAIs due to MDROs on the length of hospital stays among veterans with COVID-19. The findings underscore the need for enhanced infection control practices and targeted strategies to mitigate the burden of HAIs in this vulnerable population. Further research should explore the specific mechanisms by which HAIs extend hospitalization and the potential for intervention at various levels of healthcare delivery.

Disclosures
All Authors: No reported disclosures
P-1923. Outcomes of COVID-19 in Patients with Liver Cirrhosis
Authors: Monteiro Menezes Luanna Silva , Sales da Cunha Pedro Ferrari , Pires Magda Carvalho , Valle Lucas Rocha , Rodrigues Carvalho Rafael Lima , Marcolino Milena S 
Published: January 2025

Abstract

Background
There is scarce data related to chronic liver disease in some developing countries, including prognosis and behavior in face of SARS-Cov-2 infection. In this context, robust studies from Latin America investigating the clinical outcomes of COVID-19 in patients with cirrhosis are lacking. Therefore, this study aimed to compare the clinical features and outcomes between COVID-infected inpatients with and without cirrhosis in Brazil.

Methods
This study is a substudy of a multicenter retrospective cohort of patients from 41 Brazilian hospitals diagnosed with COVID-19 from March to September 2020 and from March 2021 to August 2022. Demographic data, clinical characteristics and outcomes were collected from the medical records. To adjust for potential confounding variables, patients with cirrhosis were matched with patients who did not have cirrhosis (controls) based on propensity score. The propensity score model was estimated by logistic regression and included sex, age, number of comorbidities and hospital of admission. Chi-square and Fisher’s exact tests were used to compare categorical variables and the Wilcoxon–Mann–Whitney test for continuous variables. Results were considered statistically significant if p-value was &lt; 0.05.

Results
This study included 749 patients (median 61 years old [interquartile range: 50-70], 63,4% were men). Among those, 117 were patients with cirrhosis and 632 matched controls. There were no significant differences in the self-reported symptoms between cases and matched controls. Compared to matched controls, cirrhotic patients presented higher in-hospital mortality (51.3% vs. 21.7%, p &lt; 0.001), frequency of admission in intensive care unit (ICU) (51.3% vs. 38.0%, p = 0.007), invasive mechanical ventilation (IMV) (26.6% vs. 43.9%, p &lt; 0.001), dialysis (17.9% vs. 11.1%, p = 0.038), septic shock (23.9% vs. 14.9%; p = 0.015) and institution of palliative care (19.7% vs. 7.4%; p &lt; 0.001).

Conclusion
COVID-19 inpatients with cirrhosis had significantly worse clinical outcomes when compared to matched controls. Our findings reinforce that those patients require particular attention from the healthcare team and resources.

Disclosures
All Authors: No reported disclosures
P-1999. Predictors of Mortality in Myelodysplastic Syndrome with COVID-19: A 2020-2021 National Study
Authors: Jagannathan Madhumithaa , Sivasubramanian Barath Prashanth , Babu Sonia , Sripathi Shanthi Reddy , Javvaji Avinash , Jain Priyanshu , Joshi Shashvat , Shanmugam Dinesh Kumar , Swami Kannan Bharath Duraisamy , Dalal Rutul , Tirupathi Raghavendra 
Published: January 2025

Abstract

Background
We aimed to evaluate mortality predictors in Myelodysplastic Syndrome who were admitted for COVID-19 (MDSCov) using the Healthcare Cost and Utilization Project.
Sociodemographics in MDSCoV Patients

Methods
A cross-sectional study using the NIS on adults (≥ 18 years) hospitalized in the United States for MDSCov (n=769). We identified 151 nonsurvivors among MDSCov. Analysis was done using t-tests and chi-square tests, and multivariate regression models were constructed with p≤ 0.05 significance.
Factors Associated with Higher Mortality in MDSCoV Patients

Results
The average age of MDSCov was higher than those without COVID-19 (77.3 vs 53.5 years, p=0.0000). MDSCov had a longer average length of stay (7.9 vs 5.1 days, p=0.0000) and higher total hospital charges ($85,059.6 vs $66887.8, p=0.0001) compared to MDS patients without COVID-19. We found that HSCT (allogenic and autogenic) was not associated with increased MDSCov hospitalization (2.2% vs 2.5%, p=0.8286). Males experienced a higher mortality rate (64.9% vs 53.9%, p=0.015; aOR 1.51, p=0.076) as they have higher expression of ACE2 receptors than females, correlating to disease severity. Race did not contribute to mortality (White 72.8% vs 77.3%, p=0.5267). The Non Survivors of MDSCov showed a high association with stroke (2% vs 0.3%, p=0.0227; aOR 4.7, p=0.026), severe sepsis (17.9% vs 0.6%, 0.0000; 9.1, 0.000), acute respiratory failure (66.9% vs 49.5%, 0.0001; 3.93, 0.000), and acute kidney injury (45.7% vs 29.1%, 0.0001; 1.27, 0.326). Due to COVID-19, T-cell exhaustion and secondary infections that contribute to sepsis can occur. Increased microthrombus formation and endothelial dysfunction can lead to thromboembolic episodes. Increased proinflammatory cytokines (IL-1β, IL-6, IL-12, IFN-γ, IP-10, and MCP-1) caused by the virus contribute to pulmonary inflammation and lung injury. The use of vasopressors to maintain MAP (9.3% vs 0.2%, p=0.0000; aOR 6.65, p=0.081) was markedly higher but not significant among nonsurvivors.
Sociodemographic Profile of Patients with MDS

Conclusion
Our study identified several predictors of mortality in MDSCov. However, due to the need for more information on disease severity and laboratory evidence, future studies are needed to develop timely treatment plans. Appropriate chemotherapeutic regimens for MDS and antivirals/biologics for COVID-19 are needed.
Predictors of In-hospital Mortality in Patients with MDS and COVID-19

Disclosures
All Authors: No reported disclosures
P-2000. A Case-Control Study of the Risk of COVID-19 Infection in Underserved Persons with HIV (PWH) in Middle Tennessee
Authors: Rao Mallika , Wilus Derek , Berthaud Vladimir 
Published: January 2025

Abstract

Background
The COVID-19 pandemic had disproportionately affected racial and ethnic minorities. We undertook this study to examine the risk factors for COVID-19 infection and death in African Americans with HIV.

Methods
We conducted a prospective case-control study to assess the risk for COVID-19 infection in a clinic serving predominantly underserved African Americans in Middle Tennessee. Matched cases and controls were tested for COVID-19 by PCR around the same time. COVID-19 information, demographics, clinical and social determinants of health (SDoH) data were collected from electronic health records. Chi-square and Fisher’s exact tests were applied to evaluate the associations between outcome and predictor variables. Binary logistic regression was used to examine the effects of 18 predictors on COVID-19 infection. R/RStudio version 4.3.2 was used. The local IRB approved the study protocol.

Results
From 4/2020 to 11/2023, 91 PWH tested COVID-19-positive and 181 negative. We excluded 11 cases and 29 controls due to missing SDoH data; 81.0% of the patients were African American, 26.3% were female, and 46.1% fell into the 45-64-year-old age group. Among 73 symptomatic cases, the most common symptoms were cough, fever, and chills. 28/91 were admitted to the hospital, 11/28 went to ICU, and 8/28 died. All the deceased had &gt;1 cardiovascular risk factor. 12/91 cases had a CD4 cell count &lt; 200/mm3 and 73/91 had an HIV-1 RNA level &lt; 200 copies/mL. In the bivariate analysis, incarceration (p &lt; 0.001), renal failure (p &lt; 0.001), smoking (p &lt; 0.001), alcoholism (p = 0.003), drug use (p = 0.023), and cardiovascular risk (p = 0.023) were highly associated with COVID-19 infection. In the multivariable model, the most strongly associated risks were incarceration [OR = 18.68; 95% CI: (4.66, 74.87); p &lt; 0.001], renal failure [OR = 40.62; 95% CI: (3.96, 416.83); p = 0.002], hyperlipidemia [OR = 3.94; 95% CI: (1.54, 10.06); p = 0.004], 25-44 years of age [OR = 2.48; 95% CI: (1.10, 5.58); p = 0.028], no insurance [OR = 0.36; 95% CI: (0.14, 0.92); p = 0.033], and smoking [OR = 2.20; 95% CI: (1.01, 4.82); p = 0.048].

Conclusion
Incarceration, renal failure, and cardiovascular disease were very strong risk factors for COVID-19 infection in this population of PWH in Middle Tennessee.

Disclosures
Vladimir Berthaud, MD MPH, GILEAD SCIENCES: Grant/Research Support|GSKVIIV: Grant/Research Support|MODERNA: Grant/Research Support|NOVAVAX: Grant/Research Support
P-2003. Clinical Outcomes of COVID-19 among Immunocompromised Patients at Siriraj Hospital
Authors: Phoompoung Pakpoom , Dilokruangchai Jirapa 
Published: January 2025

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic has caused significant mortality for patients worldwide. The clinical outcomes of COVID-19 among immunosuppressed patients, who are at presumably risk of more severe disease have not been well characterized.
Clinical outcome between immunocompetent and immunocompromised patients hospitalized with COVID-19

Methods
We performed a retrospective cohort study including all adult patients hospitalized with COVID-19 during July to December 2021. Primary outcome was a 3-month death among immunocompetent and immunocompromised patients. Secondary outcomes included superimposed infections and intensive care unit (ICU) admission within a 6-month period, and factors associated with death in immunocompromised patients.
Comparison between immunocompromised patients hospitalized with COVID-19 who were dead and survived during 3 months after COVID-19

Results
303 patients were enrolled (239 immunocompetent and 64 immunocompromised patients, with mean age of 71 (±14) and 63 (±16) years, respectively). Immunocompromised patients showed more superimposed herpes simplex virus infection (3.1% vs. 0%, P 0.006). There was a trend towards higher ICU admission rate (20.3% vs. 11.%, P 0.058) in the immunocompromised group. However, the 3-month death between both groups did not differ significantly (24.7% immunocompromised vs 20.5% immunocompetent, P 0.437). Interestingly, there was a higher death among immunocompromised patients who had co-infections (61.5% vs. 32.4%, P 0.019) and superimposed infections (56.5% vs. 17.9%, P 0.002). On the other hand, there was a lower death rate in immunocompromised patients receiving immunosuppressive drugs prior to COVID-19 diagnosis (12.9% vs. 59.2%, P &lt; 0.001).

Conclusion
Three-month mortality rate did not differ between immunocompromised and immunocompetent patients. Superimposed and co-infections increased mortality in immunocompromised COVID-19 patients. Prior use of immunosuppressive agents was associated with less mortality, which may be explained by less detrimental inflammatory response.

Disclosures
All Authors: No reported disclosures
P-2005. Long-term complications of COVID-19 in pediatric population in Lima, Peru
Authors: Navarro Rafaella , Ochoa Theresa , Carrasco Gabriel , Peña Brian 
Published: January 2025

Abstract

Background
Peru is the eighth country in South America with most COVID-19 cases (134 684 cases per million population) and the first country in the world with most COVID-19 deaths (6 595 deaths per million population). However, is lacking data on the long term complications of COVID-19 in children and adolescents. Peru does not have guidelines for the diagnosis and management of long-term complications of COVID-19. Thus, studies are needed to develop evidence-based management and to propose the necessary infrastructure to provide comprehensive care.

Methods
A multicenter study was carried out in 16 hospitals from Lima to describe the long-term complications of COVID-19 in subjects under 18 years and to compare with subjects without a history of COVID-19 (controls). A history of COVID-19 episode was defined by a positive laboratory test or presence of symptoms with a confirmed household case. The comparison group included subjects with no history of COVID-19 symptoms, no history of COVID-19 epidemiological contact and/or negative laboratory tests. Enrolled patients were screened using a survey from the Long-COVID Clinic of Miami. If the screening was positive the Yorkshire Test was applied during a medical evaluation.

Results
2,954 cases and 1,500 controls were enrolled, from which 2,558 cases and 1,452 controls completed the screening survey. A higher positive screening for long-term symptoms was found in subjects with COVID-19 history (1,389/2,558, 54.3%) in comparison with subjects without COVID-19 history (251/1452, 17.3%). Among subjects with a positive screening, 439 (31.6%) cases and 53 (21.1%) controls completed a medical evaluation; 381 (86.8%) cases had at least one new symptom posterior to COVID-19 that lasted at least 3 months (positive Yorkshire Rehabilitation Scale) and 32 (60.4%) among controls. (Tab 1) The most common symptoms were cough (53% vs 26%), pain (48% vs 21%), gastrointestinal symptoms (48% vs 16%), and anxiety (44% vs 30) among cases and controls, respectively. (Tab 2)

Conclusion
More than half of pediatric patients with COVID-19 have long-term symptoms. Study limitations are: recall bias, not all subjects with a positive screening were evaluated by a physician, and we could be overestimating the frequency of symptoms since we enrolled subjects in hospitals.

Disclosures
Rafaella Navarro, n/a, Pfizer: Grant/Research Support Theresa Ochoa, PhD, Pfizer: Grant/Research Support Gabriel Carrasco, n/a, Pfizer: Grant/Research Support Brian Peña, n/a, Pfizer: Grant/Research Support