BackgroundAn infectious diseases (ID) consultation is often, but not always, obtained to help guide treatment of patients with candidemia. We examined if ID consultation affected patient outcome in patients with culture positive candidemia.MethodsWe assembled a retrospective cohort of 1,873 cases of candidemia in patients hospitalized in our academic tertiary care hospital from 2002 to 2015. We collected data on comorbidities, predisposing factors; antifungal therapy, survival and ID consult. Patients who died within 24 hours of diagnosis were excluded, under the presumption that they did not have an opportunity to receive an ID consult. Survival analysis was performed via univariate and multivariate Cox Regression with censoring at 90 days, as subsequent mortality was less likely to be related to candidemia.Results913 (49%) of the candidemic patients received an ID consult; 960 (51%) did not. Underlying comorbidities were evenly distributed between patients with and without an ID consult, except that patients with an ID consult more frequently had a central line (39% vs. 26%, p < 0.001), were on mechanical ventilation (4% vs. 2%, P = 0.003) or were receiving extracorporeal membrane oxygenation (2.2% vs. 0.5%, p = 0.002). The ID consult group had lower 90-day mortality compared with patients without an ID consult (34% vs. 49%, P < 0.001), with an adjusted hazard ratio of mortality for those patients receiving an ID consult of 0.55 (95% CI: 0.48, 0.64, P < 0.001) (Fig 1). Patient management differed significantly: the ID consult group was more likely to receive an echinocandin (29% vs. 21%, P < 0.001) or amphotericin B (AmB) (3.4% vs. 1.4%, P = 0.006).ConclusionCandidemic patients who received an ID consult were significantly less likely to die, and were more likely to receive therapy with amphotericin or an echinocandin. These data suggest that an ID consult should be an integral part of clinical care of patients with candidemia.Figure 1.Survival curve of 1,873 patients with candidemia by receipt of ID consult adjusted for age above 50, receipt of chemotherapy, the presence of central line, previous use of corticosteroids, receipt of ECMO and recent `pleural procedure.Disclosures W. Powderly, Merck: Grant Investigator and Scientific Advisor, Consulting fee and Research grant; Gilead: Scientific Advisor, Consulting fee; Astellas: Grant Investigator, Research grant; A. Spec, Astellas Pharma US, Inc.: Grant Investigator, Research grant

Introducción: el glioblastoma (GBM) de pronóstico adverso y alta letalidad hasta la introducción del protocolo Stupp con adyuvancia de solo seis meses de temozolamide, es considerado el tratamiento estándar definido como el primer esquema para aumentar la sobrevida global.Objetivo: describir el comportamiento clínico, epidemiológico y de resultados terapéuticos del GBM con la aplicación del protocolo Stupp para luego hacer un análisis de diferentes variables en sobrevida y demostrar la necesidad actual de cambio de adyuvancia más prolongada, buscando definir el periodo mínimo que genere iguales o mejores resultados en sobrevida frente al estándar de seis meses de temozolamide en adyuvancia.

Introducción: se analiza el perfil epidemiológico de pacientes con cáncer de próstata en subetapa clínica T1c definido como el diagnóstico por biopsia en pacientes con enfermedad no palpable, solo con un nivel de PSA elevado, representando el tercer cáncer más común y la primera neoplasia en hombres en nuestra área.

Objective There are few multinational studies on gestational trophoblastic neoplasia (GTN) treatment outcomes in South America. The purpose of this study was to assess the clinical presentation, treatment outcomes, and factors associated with chemoresistance in low-risk postmolar GTN treated with first-line single-agent chemotherapy in three South American centers. Methods Multicentric, historical cohort study including women with International Federation of Gynecology and Obstetrics (FIGO)-staged low-risk postmolar GTN attending centers in Argentina, Brazil, and Colombia between 1990 and 2014. Data were obtained on patient characteristics, disease presentation, and treatment response. Logistic regression was used to assess the relationship between clinical factors and resistance to first-line single-agent treatment. A multivariate analysis of the clinical factors significant in univariate analysis was performed. Results A total of 163 women with low-risk GTN were included in the analysis. The overall rate of complete response to first-line chemotherapy was 80% (130/163). The rates of complete response to methotrexate or actinomycin-D as first-line treatment, and actinomycin-D as second-line treatment postmethotrexate failure were 79% (125/157), 83% (⅚), and 70% (23/33), respectively. Switching to second-line treatment due to chemoresistance occurred in 20.2% of cases (33/163). The multivariate analysis demonstrated that patients with a 5 to 6 FIGO risk score were 4.2-fold more likely to develop resistance to first-line single-agent treatment (p = 0.019). Conclusion 1) At presentation, most women showed clinical characteristics favorable to a good outcome, 2) the overall rate of sustained complete remission after first-line single-agent treatment was comparable to that observed in developed countries, 3) a FIGO risk score of 5 or 6 is associated with development of resistance to first-line single-agent chemotherapy.

BackgroundDifferentiating between localized and disseminated cryptococcal disease is key to the management of this infection, since induction therapy with amphotericin B and flucytosine is warranted in the latter. We compared mortality in disseminated Cryptococcus with non-central nervous system (CNS) involvement, with those with CNS involvement and localized pulmonary disease.MethodsDemographics, predisposing factors, presentation, laboratory values, treatment and outcome data were collected retrospectively on patients hospitalized at an academic tertiary-care hospital for cryptococcal infection from 2002 to 2017. Outcomes were compared between three patient groups based on extra-pulmonary and CNS involvement. Survival analysis was performed using univariate and multivariate Cox Regression with censoring at 90 days.ResultsOf 312 patients identified, 63 (20%) had pulmonary, 154 (49.2%) CNS and 95 (30.4%) had disseminated non-CNS disease. At day 90, 38 (40%) from the disseminated non-CNC group had died, compared with 37 (24%) in the CNS disease and 13 (20.6%) in the pulmonary groups. After adjusting for age ≥55 years, organ transplant, end-stage liver disease (ESLD) and AIDS, 90-day mortality risk was higher in the disseminated non-CNS group compared with the pulmonary (HR 2.97 [95% CI 1.55, 5.7]; P = 0.001) and the CNS disease group (1.84 [1.16, 2.93]; P = 0.009) (Figure 1). Median [IQR] time to diagnosis was 10 [4, 19] days and not significantly different between groups (P = 0.752). Induction therapy for ≥2 weeks was more common in the CNS disease (64.3%) that in the pulmonary (33.3%) or disseminated non-CNS disease group (38.7%) (P = 0.01). Median duration of azole therapy in days was longer (315 [61, 750]) in the CNS disease than in the disseminated non-CNS (184 [23.5, 403.5]) or the pulmonary group (214 [86, 415]) (P = 0.04).ConclusionPatients with disseminated cryptococcal disease without CNS involvement have higher risk for mortality than those with CNS disease. However, management of patient’s disseminated non-CNS cryptococcosis was similar to those with localized pulmonary infection.Figure 1.Survival curve of 312 patients with Cryptococcus infection by localization, adjusted for age ≥55, organ transplant, ESDL, and AIDS.Disclosures All authors: No reported disclosures.