With oral mucosal transudate and serum samples from 101 human immunodeficiency virus type 1 (HIV-1)-infected subjects and 100 HIV-1-negative volunteers, the OraQuick HIV-1 test demonstrated 100% specificity and 96% sensitivity. Four false-negative subjects, who were characterized by early initiation of effective antiretroviral therapy, demonstrated waning serum anti-gp41 titers and Western blot band intensities.
Background Clostridium difficile-associated diarrhea (CDAD) is an important cause of nosocomial diarrhea with increasing morbidity, mortality, and healthcare costs. There is growing recognition that critically ill trauma patients comprise a unique at risk population. This study describes the clinical epidemiology of CDAD in military trauma patients.MethodsThrough the Trauma Infectious Disease Outcomes Study (TIDOS), patients with a diagnosis of confirmed (laboratory supported) or presumptive (diarrhea with treatment for CDAD in absence of lab confirmation) CDAD (September 2009–February 2014) were analyzed. Patient demographic, injury, and infection data were evaluated. CDAD severity was defined per 2017 IDSA guidelines.ResultsOf 2,660 patients, 19 and four patients with confirmed and presumptive CDAD, respectively, were identified with an incidence of 2.76/10,000 (95% CI: 1.75–4.15) occupied bed days. Sixteen (70%) had blast injuries, four had gunshot wounds, and threehad other injuries. Median age was 24 years (IQR 23, 31). Median injury severity score was 38 (IQR 26, 47). Severe and fulminant CDAD was diagnosed in 8 (35%) and six (26%), respectively. Patients had a median hospitalization of 12 days (IQR 9.5, 34) and threeOR visits (IQR 2, 6) prior to CDAD diagnosis. Nineteen (83%) patients were in the ICU and 17 (74%) were intubated prior to or upon diagnosis. Seventeen patients had ≥1 infection before CDAD diagnosis, largely pneumonia (47%) and skin and soft-tissue infections (47%). Most patients (96%) were on antibiotics pre-CDAD diagnosis: first generation cephalosporins (1GC; 96%), tetracyclines (87%), vancomycin (74%), carbapenems (70%), and fluoroquinolones (FQ; 57%). Five (22%) received clindamycin. Of the 2637 patients without CDAD, 91% received antimicrobials during hospitalization (86% a 1GC, 47% FQ, and 16% clindamycin). Median length of hospital stay after CDAD diagnosis was 34 days (IQR 16, 55). Treatment included only oral metronidazole in 15 patients, IV metronidazole in 2, and some combination of oral vancomycin, metronidazole, and IV metronidazole in 6. No patients died.ConclusionDespite high rates of antimicrobial usage in this severely injured population, CDAD was uncommon. Though CDAD was severe or fulminant in >50%, no patients died.Disclosures All authors: No reported disclosures.
BackgroundCombat-associated invasive fungal infections (IFI) of the deep skin and soft tissue are an infectious disease. Reliance on conventional techniques to diagnose IFIs has limitations as culture is insensitive and time-delayed and histopathology cannot provide a species-level or even a genus-level identification (ID). Molecular-based methods are rapid, provide species-level ID, and have been studied to a limited extent in the trauma setting although they may prove overly sensitive as soil (thereby fungal) contamination is common. In this study, we examined the performance characteristics of a panfungal PCR for the diagnosis of IFI among subjects injured in Afghanistan operations.MethodsFormalin-fixed paraffin-embedded (FFPE) tissue samples obtained during debridement from IFI cases with angioinvasion (AI) and controls (combat-injured with negative histopathology) were evaluated with a panfungal PCR targeting the internal transcribed spacer (ITS 1 and ITS 2) of the fungal genome.ResultsWe assessed 41 injury sites where culture, histopathology, and FFPE specimens were available contemporaneously. Fungus was cultured from 32 sites (78%) with the order Mucorales represented in 18 sites (44%, five sites with Saksenaea spp.), and Aspergillus spp. in six (15%) sites. Using PCR, a fungus was identified from 33 sites (81%) with order Mucorales identified from 28 sites (68%, 20 with Saksenaea spp.) and Aspergillus spp. from five (12%) sites. When compared with the gold standard (histopathology), the sensitivity, negative, and positive predictive value were 83, 94, and 98%, respectively. Specificity was calculated to be 99.2% based upon the identification of one false-positive among 118 controls.ConclusionConcerns about PCR being overly sensitive for the diagnosis of trauma-related IFI are not upheld. The PCR-based method was sensitive, specific, and had a high negative predictive value for the diagnosis of AI IFI. Re-demonstrated is the inability of culture to identify fungi of the order Mucorales and the need for antifungal coverage targeting fungi of the order Mucorales and Aspergillus in AI IFI. As Saksenaea is the dominant fungus identified in this setting, study of the virulence characteristics and antifungal susceptibility is warranted.Disclosures All authors: No reported disclosures.
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