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The incidence of candidemia showed an increase over the years. It was higher in the elderly adults, being the group with worse outcomes.

The Objective Structured Clinical Examination (OSCE) appears to be an effective alternative for assessing not only medical knowledge, but also clinical skills, including effective communication and physical examination skills. The purpose of the current study was to implement an OSCE model in a geriatrics fellowship program and to compare the instrument with traditional essay examination. Seventy first- and second-year geriatric fellows were initially submitted to a traditional essay examination and scored from 0 to 10 by a faculty member. The same fellows subsequently underwent an OSCE with eight 10-minute stations covering a wide range of essential aspects of geriatric knowledge. Each OSCE station had an examiner responsible for its evaluation according to a predefined checklist. Checklist items were classified for analysis purposes as clinical knowledge items (CKI) and communication skills items (CSI); fellow responses were scored from 0 to 10.Although essay examinations took from 30 to 45 minutes to complete, 180-200 minutes were required to evaluate fellows using the proposed OSCE method. Fellows scored an average of 6.2 ± 1.2 on the traditional essay examination and 6.6 ± 1.0 on the OSCE (P < .001). Subanalyses of OSCE scores indicated that average performance on CKI was lower than the average on CSI (6.4 ± 1.1 vs. 8.4 ± 1.1; P < .001). Fellow performance on the essay examination was similar to their performance on CKI (P = .13). Second-year fellows performed better than first-year fellows on the essay examination (P < .001) and CKI (P = .05), but not on CSI (P = .25).The OSCE was successfully implemented as an educational strategy during a geriatrics fellowship program. Combining different testing modalities may provide the best assessment of competence for various domains of knowledge, skills, and behavior.

COVID-19 associated pulmonary aspergillosis (CAPA) incidence varies depending on the country. Serum galactomannan quantification is a promising diagnostic tool since samples are easy to obtain with low biosafety issues. A multicenter prospective study was performed to evaluate the CAPA incidence in Argentina and to assess the performance of the lateral flow assay with digital readout (Sōna Aspergillus LFA) as a CAPA diagnostic and screening tool. The correlation between the values obtained with Sōna Aspergillus LFA and Platelia® EIA was evaluated. In total, 578 serum samples were obtained from 185 critically ill COVID patients. CAPA screening was done weekly starting from the first week of ICU stay. Probable CAPA incidence in critically ill patients was 10.27% (19/185 patients when LFA was used as mycological criteria) and 9% (9/100 patients when EIA was used as mycological criteria). We found a very good correlation between the two evaluated galactomannan quantification methods (overall agreement of 92.16% with a Kappa statistic value of 0.721). CAPA diagnosis (&gt;0.5 readouts in LFA) were done during the first week of ICU stay in 94.7% of the probable CAPA patients. The overall mortality was 36.21%. CAPA patients' mortality and length of ICU stay were not statistically different from for COVID (non-CAPA) patients (42.11% vs 33.13% and 29 vs 24 days, respectively). These indicators were lower than in other reports. LFA-IMMY with digital readout is a reliable tool for early diagnosis of CAPA using serum samples in critically ill COVID patients. It has a good agreement with Platelia® EIA.

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Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Fusarium is a serious fungal disease that mainly affects high-risk hematological patients. Early recognition of cutaneous entry of Fusarium in severely immunocompromised patients is critical to initiate early treatment. The aim of this presentation is to present two cases of disseminated fusariosis in severe oncohematological patients with favorable outcomes. Case 1: A 65-year-old man was admitted to the hospital for allogeneic hematopoietic cell transplantation. He had chronic myelomonocytic leukemia treated with cytosine analog antineoplastic and received pre-transplant prophylaxis with voriconazole 400 mg/day. On day 8 after transplantation, he presented pain and erythema on the fifth toe. Scarification of the digital intertrigo showed fine septate hyaline filaments. Antifungal treatment with voriconazole 400 mg/day plus liposomal amphotericin B 5 mg/k/d was administered. The patient remained severely neutropenic and the digital lesion progressed to painful necrosis for the following 12 days. BACTEC blood culture developed F. keratoplasticum and MIC (mg/L) amphotericin B 1, voriconazole 8 (CLSI M38-3rd Ed). On day 24 post-transplant, the patient presented an erythematous lesion on the right leg. A toilette of the digital lesion and a skin biopsy of the lesion on the right leg was performed, both of which showed fine hyaline filaments on direct examination with negative culture. On day 55, the patient was stable and amphotericin B was discontinued. He was treated with voriconazole 400 mg/d and had a good clinical evolution. The patient was discharged 65 days after transplantation. Case 2: An 18-year-old man was admitted to the hospital for chemotherapy treatment for acute lymphocytic leukemia (ALL). The patient received prophylaxis with fluconazole. On day 15 after chemotherapy, he developed Candida parapsilosis candidemia; C.parapsilosis MIC (mg/L) amphotericin B 1, fluconazole 0.5, voriconazole 0.015; anidulafungin 0.4 (E Def 7.32.EUCAST). The patient was treated with anidulafungin. He remained febrile and neutropenic. On the 19th day, he presented a digital intertrigo on the foot. Direct examination of the scarification of the interdigital lesion showed fine hyaline filaments and the colony was identified as F. solani complex, MIC (mg/L) amphotericin B 2, voriconazole 8 (M 38 3rd Ed CLSI). The antifungal treatment was changed to voriconazole 400 mg/d and lipid complex amphotericin B 5 mg/kg/d. On day 22, he was still neutropenic and febrile. Chest and sinus CT scans showed no abnormalities. Blood cultures and BAL culture were negative. The patient developed multiple ecthyma gangrenosum skin lesions on the torso and legs. On day 35, he received a granulocyte transfusion. On days 42 and 44, the serum GM Aspergillus was 0.2 and 0.4 respectively. On day 45, he presented a nasal lesion. The nasal biopsy showed a positive direct examination and development of the F. solani complex. On day 47, a surgical toilette of the foot lesion was performed. The patient had a favorable outcome with voriconazole 400 mg/day until hematopoietic cell transplantation. Conclusion Evaluation of skin lesions in severely immunocompromised patients allows prompt diagnosis for antifungal treatment and appropriate debridement in patients with a proven mycological diagnosis of disseminated fusariosis.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM It is known that the incidence and epidemiology of candidemia vary according to different geographic regions and/or hosts. Between 1998 and 2019, the incidence in a university hospital in the city of Buenos Aires Argentina, ‘HCJSM’, was 2.19/1000 discharges. The coronavirus disease 2019 (COVID-19) pandemic altered the previously recognized course of severe infections, including candidemia. Objective The aim of this report is to determine the incidence of candidemia in critically ill COVID-19 patients, and the clinical and microbiological aspects of these episodes hospitalized at HCJSM. Methods The source documents of this retrospective study are medical records from patients with Sars-Cov-2 and candidemia who were diagnosed between March 1, 2020 and June 30, 2021. At the onset of the pandemic, the HCJSM began admitting patients with COVID-19, and elective procedures were canceled. Demographic, clinical, and laboratory data were reviewed. All data were analyzed using RStudio, a statistical computing platform (version 4.0.2). Results During the period under review, 61 episodes of candidemia were identified: 23 episodes (39.7%) in COVID-19 patients, and 38 episodes (60,3%) in no COVID-19 patients. Incidence (x 1000 admission) in no COVID-19 patients was 2.5 (38/14 903): in COVID-19 patients 14.4 (23/1595) and in COVID-19–ICU was 42.3 (20/472). The average age of patients is of 65 years (32-84 range years). The time from admission to ICU to the development of candidemia had a median of 18 days (RIC 9-23). A total of 87.5% of the patients had been on mechanical ventilation and 100% of the patients received broad-spectrum antibiotics and had catheters. Episodes were caused by C. parapsilosis (39.7%), C. albicans (35%), C. glabrata (14%), and other species of Candida (11%). A total of 62% of COVID-19 patients who developed episodes of candidemia died during the period under examination. The survival likelihood at 30 days of COVID-19 patients who developed candidemia was higher for C. parapsilosis episodes and lower for C. glabrata episodes. Conclusion The incidence of candidemia showed an increase in COVID-19 hospitalized severe patients. The use of broad-spectrum antibiotics, the presence of catheters, and the use of ventilatory support in COVID-19 patients were the risk factors most associated with the development of candidemia. Although the number of episodes of candidemia is low, without the strength of statistical analysis, it is important to consider that the likelihood of survival of patients with episodes of candidemia varies according to the species recovered.