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Background Lactococcus garvieae is an unusual cause of infective endocarditis (IE). No current diagnostic and therapeutic guidelines are available to treat IE caused by these organisms. Based on a case report, we provide a review of the literature of IE caused by L. garvieae and highlight diagnostic and treatment challenges of these infections and implications for management. Case presentation A 50-year-old Asian male with mitral prosthetic valve presented to the hospital with intracranial haemorrhage, which was successfully treated. Three weeks later, he complained of generalized malaise. Further work up revealed blood cultures positive for Gram-positive cocci identified as L. garvieae by MALDI-TOF. An echocardiogram confirmed the diagnosis of IE. Susceptibility testing showed resistance only to clindamycin. Vancomycin plus gentamicin were started as empirical therapy and, subsequently, the combination of ceftriaxone plus gentamicin was used after susceptibility studies were available. After two weeks of combination therapy, ceftriaxone was continued as monotherapy for six additional weeks with good outcome. Conclusions Twenty-five cases of IE by Lactococcus garvieae have been reported in the literature. Compared to other Gram-positive cocci, L. garvieae affects more frequently patients with prosthetic valves. IE presents in a subacute manner and the case fatality rate can be as high as 16%, comparable to that of streptococcal IE (15.7%). Reliable methods for identification of L. garvieae include MALDI-TOF, 16S RNA PCR, API 32 strep kit and BD Automated Phoenix System. Recommended antimicrobials for L. garvieae IE are ampicillin, amoxicillin, ceftriaxone or vancomycin in monotherapy or in combination with gentamicin.

The sparse inflorescence1 (spi1), Barren inflorescence1 (Bif1), barren inflorescence2 (bif2), and barren stalk1 (ba1) mutants produce fewer branches and spikelets in the inflorescence due to defects in auxin biosynthesis, transport, or response. We report that spi1, bif1, and ba1, but not bif2, also function in promoting cell elongation in the inflorescence.

Histoplasmosis is a common pathogen but rarely reported in prosthetic joint infections. We present a case of Histoplasmosis capsulatum prosthetic joint infection along with a literature review revealing no guidelines or consensus on surgical and antifungal management. We chose the 2-stage management with an antifungal spacer and systemic oral itraconazole.

BackgroundCAUTIs are one of the most common causes of hospital-acquired infections. We report on a retrospective analysis performed on prospectively collected CAUTI surveillance data from 2014 to 2016 at a large tertiary care academic hospitalMethodsA total of 181 CAUTIs by NHSN definition were reviewed to describe contemporary demographics, risk factors, microbiology, and outcomes.ResultsThe 181 CAUTIs involved 178 patients. 61% were female. Events mostly occurred in an ICU setting (65%), specifically our neurosurgical unit (23%), followed by floors (24%) and intermediate units (11%). Most episodes occurred within a week after the initial catheter insertion (60%). 40% of CAUTIs occurred within an average of 5.5 days (SD ± 5.12) after a Foley re-insertion. Of the 221 cultured micro-organisms, Gram-negatives accounted for 74% (predominately K. pneumoniae and E. coli), followed by Gram-positives and yeast at 18% and 8%, respectively. 8% of organisms showed multi-drug resistance, 8% of patients developed C. difficile co-infections, 23% had concomitant bacteremia, and the length of stay averaged 28 days (SD ± 26.74). 55% of patients were discharged to another facility. 12% of patients expired and 4% were discharged to hospiceConclusionWe describe the contemporary demographics, microbiology and outcomes of CAUTIs in a large tertiary care center. We also found that 40% of our CAUTIS are associated with a Foley removal and re-insertion event. Reasons requiring catheter exchanges and reinsertions include leakage, bleeding, obstruction, failed voiding trial, and general malfunction. Although this observation needs to be confirmed case control studies and larger observational trials, this new insight may provide an opportunity to intervene and focus infection prevention interventions in this novel high-risk population.Disclosures All authors: No reported disclosures.

BackgroundAccording to professional societies, the endpoint to consider hepatitis c virus (HCV) infection cured is the achievement of a sustained virologic response 12 weeks after treatment completion (SVR12). Late recurrences (beyond SVR12) are rare. Herein, we report two cases of HCV-infected cancer patients with late relapses post direct-acting antivirals (DAAs).MethodsPatients with any type of chronic cancer and HCV treated with DAAs between January 2014 and March 2018 at MD Anderson Cancer Center were prospectively followed. All patients had HCV RNA levels at baseline; 2 and 4 weeks after initiation of DAAs; at end of treatment (EOT); and 12 weeks after completion of DAAs. No phylogenetic analyses were available for samples collected.ResultsAmong 196 HCV-infected cancer patients treated with DAAs, 20 developed viral relapse, 2 (10%) of them with late relapse (Figure 1). Both patients denied behaviors, exposures, and conditions associated with HCV reinfection. Case 1: Fifty-six-year-old male with hepatocellular carcinoma (HCC), HCV genotype 1a, interferon-experienced, with compensated cirrhosis received in 2017 ledipasvir/sofosbuvir for 12 weeks, followed by systemic chemotherapy with sorafenib. He achieved an SVR12 but developed HCV relapse 12 weeks later (24 weeks after EOT). Patient remained infected with HCV 1a. He did not receive retreatment due to HCC not amenable for curative treatment. Case 2: 57-year-old male with multiple myeloma, HCV genotype 1a, interferon-experienced without cirrhosis. He received sofosbuvir and simeprevir in 2015 for 12 weeks. Post DAAs, he received chemotherapy with carfilzomib, lenalidomide, dexamethasone, and ixazomib followed by autologous hematopoietic cell transplant pre-conditioned with melphalan. He achieved both an SVR12 and SVR 24 but had HCV relapse detected during the one year follow-up visit. Patient remained infected with HCV 1a. He has retreated with sofosbuvir, veltapasvir, voxilaprevir and ribavirin and currently with HCV RNA level at EOT.ConclusionLate HCV relapses can occur in HCV-infected cancer patients. Long-term monitoring of HCV-RNA and easy-to-use tests to differentiate relapses from reinfection in real-world practice are warranted in this population. Disclosures H. Torres, Gilead Sciences, Merck & Co., Inc.: Grant Investigator, Grant recipient. Vertex Pharmaceuticals: Grant Investigator, Grant recipient.

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