Objective To compare clinical characteristics and outcomes of bloodstream infections (BSI) caused by Candida auris and other Candida spp. Methods Multicenter, retrospective, case-control study at three hospitals in Brooklyn, New York between 2016 and 2020. Patients ≥18 years of age with a positive blood culture for any Candida spp. treated empirically with an echinocandin were included in the analysis. The primary outcome was 30-day mortality. Secondary outcomes were 14-day clinical failure, 90-day mortality, 60-day microbiologic recurrence, and in-hospital mortality. Results 196 patients were included in the final analysis including 83 cases of candidemia caused by C. auris. After inverse propensity adjustment, C. auris BSI was not associated with increased odds of 30-day mortality (aOR 1.014 (0.563-1.828), p = 0.963) or 90-day mortality (aOR 0.863 (0.478-1.558), p = 0.625). A higher risk for microbiologic recurrence within 60 days of completion of antifungal therapy was observed in C. auris patients (aOR 4.461 (1.033-19.263), p = 0.045). Conclusions Candida auris BSI is not associated with an increased risk of mortality compared to BSI caused by other Candida spp. A higher risk for microbiologic recurrence occurred in the C. auris group.
Background Lactobacillus are low virulence commensal organisms which are commonly found in the human oral cavity, gastrointestinal and genitourinary tracts. Although Lactobacillus bacteremia (LB) is rare, evidence aggregating from case reports has implicated LB in several medical conditions. As such, there is reason to suggest that the presence of these organisms in blood cultures may not be due to spurious contamination, but rather, indicative of clinically meaningful events capable of inducing serious illnesses. The purpose of this study is to characterize the risk factors, clinical significance and outcomes of patients with LB. Methods We retrospectively reviewed the medical records of patients presenting to a large urban teaching hospital between January 1, 2017 and December 31, 2018, who were found to have LB. Identified individuals were grouped into two mutually exclusive case categories: true LB cases or non-true cases (i.e., contamination). Individuals with ≥1 positive blood and were started on appropriate antibiotics were considered true cases. Those with positive cultures not started on appropriate antibiotics were considered contaminants. Results A total of 14 patients were identified during our study period, with majority considered true LB cases [71.4%; n = 10]. These 14 individuals were mostly males [64.2%; n = 9] and reported no use of Lactobacilli probiotics [78.6%; n = 11] or antacids [57.1%; n = 8]. On average, true LB cases were older (mean [SD]): 80.1 [±10.9]vs. 54.0 [±19.1] years) and required longer hospitalization (38.5 [(±27.6] vs. 8.0 [(±6.2] days) compared to non-LB cases, respectively. Among the 10 true LB cases, the suspected source of infection included gastrointestinal system [50%; n = 5], infective endocarditis [10%; n = 1], genitourinary system [10%; n = 1]; and could not be determined in 3 [30%] cases. Concurrent infection with candida and gastrointestinal microbes were noted in four (40%) of the true LB cases, respectively. Overall, five deaths were observed, with 4 [80%] occurring in true LB cases and one in a non-LB case. Conclusion LB should not be dismissed as contaminants particularly in at-risk patients for LB, such as the elderly or immunocompromised individuals. Disclosures All Authors: No reported disclosures
A perioperative guideline of amiodarone, β-blockers, and high-intensity statins reduced POAF, but better benefits may result from enhanced adherence.
BackgroundUrinary tract infections (UTIs) are among the most commonly treated infections in the Emergency Department (ED). Treatment is largely empiric and based on an institution-wide antibiogram comprised of isolates from all infection sites, which may overestimate antibiotic resistance of urinary pathogens of nonadmitted ED patients. The primary goal of this study was to determine the antibiotic susceptibilities of urinary pathogens isolated from adult patients with a UTI and discharged from the ED.MethodsThis was a single-center, retrospective chart review of adult patients discharged from the ED with a UTI from August to December 2017. Descriptive statistics were used to compare the antibiotic susceptibilities of pathogens isolated from urine cultures to the institutional and local Brooklyn antibiogram. Antibiotic susceptibilities were determined by MicroScan. Data on antibiotic prescribing patterns and previously described risk factors for multidrug-resistant organisms were collected.ResultsTwo hundred forty-six patients were included with 267 isolates identified. 61% (151) of patients were between ages 18 to 65 years old and 73% (180) were female. The most common organism isolated was Escherichia coli (164, 62%). E. coli urine isolates were most susceptible to nitrofurantoin (98%) followed by cefazolin (81%), ciprofloxacin (84%), and sulfamethoxazole/trimethoprim (64%). There was no difference in susceptibility rates of E. coli to cefazolin or sulfamethoxazole/trimethoprim, but isolates were more susceptible to ciprofloxacin in the ED compared with the institutional antibiogram (84% vs. 70%). Twenty-six (10.6%) patients grew an ESBL organism and of these, 42% (11/26) had no identifiable healthcare exposure within the last 90 days.ConclusionDespite limitations in sample size, this study supports using separate antibiograms and pathways for the treatment of UTI in the ED, especially in a community with high rates of local resistance to first-line agents.Disclosures All authors: No reported disclosures.
Background Carbapenem-resistant gram-negative organisms are a continuously mounting threat, underscoring the need for effective antimicrobial stewardship interventions to improve the use of carbapenems. We sought to implement several multidisciplinary antimicrobial stewardship interventions beginning in January 2019 in an effort to reduce unnecessary meropenem use and the incidence of carbapenem-resistant gram-negatives. Methods Prospective audit and feedback was utilized daily in combination with weekly stewardship rounds between an Infectious Diseases pharmacist and physician in the Intensive Care Units. A second Infectious Diseases physician attended weekly interdisciplinary rounds on meropenem high-use units. Meropenem Days of Therapy (DOT) per 1,000 patient days and the incidence of meropenem resistant Pseudomonas aeruginosa and Klebsiella pneumoniae were compared by the chi-square test of proportions. Results Between 2018 and 2019 the institution’s meropenem DOT per 1,000 patient days decreased 33%, from 57 to 38 days per 1,000 patient days (difference, 19 days per 1,000 patient days; p< 0.001). In the hospital antibiogram, the meropenem susceptibility of Pseudomonas aeruginosa over the same time period increased from 71% to 77% of isolates (difference, 6%; p = 0.009). A non-significant decrease in the susceptibility of meropenem to Klebsiella pneumoniae was also observed from 92 to 90% (difference, 2%: p = 0.1658). Conclusion These data support the need for antimicrobial stewardship efforts targeting broad-spectrum antimicrobials such as meropenem. In the setting of a sustained decrease in meropenem use over 12 months, we observed a significant improvement in the percent susceptibility rate of Pseudomonas aeruginosa to meropenem for the first time in five years. Disclosures All Authors: No reported disclosures
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