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Background Bacterial co-infections in COVID-19 patients represent a significant challenge for clinicians and can impact outcomes. Rapid identification of bacterial co-pathogens improves management, and is crucial to avoid inappropriately administered antimicrobials. We evaluated the use of a multiplex PCR assay in the early detection of respiratory co-infections in COVID-19 hospitalized patients. Methods The study included non-ICU patients with high clinical suspicion of respiratory co-infection. Lower respiratory tract samples (sputum/bronchial secretions), were analyzed using BIOFIRE® FILMARRAY® pneumonia panel plus [(bioMerieux, USA), FA]. Specimens were considered as acceptable based on Gram stain. Conventional cultures were also performed. Results A total of 28 samples from 27 patients (20 males, median age 60 years, IQR 49-71) were analyzed. 8/27 patients were intubated, 5 were treated with high flow nasal canula oxygenation and 11 with high or low oxygen mask. 18 patients received dexamethasone. Co-infection was detected in 17/27 patients (62.9%). 11 specimens were collected in less than 48 hours from admission and no target was identified in 6/11. Detected pathogens and AMR genes, per sample tested, are presented in the table. Bacterial pathogens and any AMR genes were detected in 15 and 4 samples, respectively, leading to modifications of antimicrobial treatment. The semi-quantitative results along with patients’ clinical presentation assisted with differentiation of bacterial colonization versus infection, especially in cases where multiple targets were identified. De-escalation was implemented for 12 patients, for whom no co-infection or a viral co-pathogen (n=2) was detected. One patient was co-infected with another Coronavirus; further analysis, using the FA respiratory panel, detected Human coronavirus HKU-1 along with SARS-CoV-2. Median time until discharge or death was 13.5 days (IQR 9-24). Overall mortality was 33.3%. Detected pathogens, microbial load and AMR genes, per sample tested. Conclusion Implementation of FA assay proved effective for the rapid detection of respiratory co-infections in COVID-19 non-ICU patients. Molecular panel-based assays can contribute to timely adaptation of antimicrobial treatment, benefiting patient management and antibiotic stewardship strategies. Disclosures All Authors: No reported disclosures.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Fusariosis in humans comprises a vast array of rare but serious and difficult-to-treat infections, ranging from keratitis and onychomycosis in immunocompetent hosts to life-threatening systemic infections in immunocompromised patients such as those with hematologic malignancies. We aimed to assess the disease burden and baseline epidemiology of fusariosis in Greece. Methods From 2004 through 2020 a prospective, nationwide, multicenter survey took place. Demographic and clinical data of fusariosis cases were recorded. Fusarium strains isolated were identified to species level with molecular methods and/or MALDI-TOF MS, and tested for antifungal susceptibility in vitro with the EUCAST methodology. Results A total of 54 cases were registered. The most frequent infection was keratitis (n = 21, 39%), followed by bloodstream infections in patients with hematologic malignancy (n = 12, 22.2%). Other infections involved the respiratory tract (n = 3, 5.5%), and sinuses (n = 3, 5.5%) in immunocompromised patients, soft tissues after trauma (n = 5, 9.3%), or diabetic foot (n = 2, 3.7%), and onychomycosis (n = 8, 14.8%). The estimated incidence of invasive Fusarium infections was 2.9 cases/year (0.027 cases/100 000 population). The most frequently isolated species were: F. solani species complex (SC) (n = 13, 24%), F. oxysporum SC (13, 24%), F. fujikuroi SC (n = 12, 22.2%, of which 6 F. verticillioides and 6 F. proliferatum). Other SCs included F. brachygibbosum, F. chlamydosporum, and F. dimerum. In keratitis cases, F. solani was associated with infection secondary to injury with plant material, whereas F. fujikuroi with soft contact lens wear. Fusarium oxysporum was more frequently isolated from nails or soft tissue infections (53.8%). Antifungal MICs were high, with no clear interspecies differences (geometric mean 1.6, 2.5, 3.2 mg/l for amphotericin B, voriconazole, and posaconazole, respectively, median values 2, 4, 8 mg/L, respectively). Fluconazole and the echinocandins showed no activity (MIC >32 mg/l). The most frequently used antifungals were amphotericin B and voriconazole, usually in combination. Treatment failure in keratitis was 38.5%. In patients with hematologic malignancy the crude mortality rate was 71.4%, usually related to the underlying disease. Soft tissue infections complicating diabetic foot or trauma were treated surgically, with favorable outcomes. Conclusion Fusarium infections in Greece remain rare, but with considerable morbidity and mortality in the immunocompromised. Early diagnosis and initiation of the appropriate treatment were critical for a successful outcome in keratitis cases, despite moderately high MICs of the antifungals used.

Background Antimicrobial resistance (AMR) is an increasing threat to public health and antimicrobial consumption is a primary driver of resistance. Many studies have shown that the implementation of an antibiotic stewardship program (ASP) improves prescribing of antibiotics and can reduce AMR. Purpose of the study was to assess the impact of a successful ASP, implemented for four years, on AMR in our 427-bed tertiary general hospital. Methods We monitored pharmacy data for the years 2015 (pre-intervention) and 2016-2019 (post-intervention) for antibiotic consumption (DDD/100 bed-days) and resistance rates. AMR data were obtained from the clinical microbiology laboratory’s electronic database. To achieve the goals of ASP we used a range of interventions as pre-authorization strategy for the protected antibiotics (tigecycline, carbapenems, quinolones, glycopeptides, daptomycin, colistin, linezolid), prospective audit and feedback with direct intervention, de-escalation or switch from iv to oral administration and appropriate selection and duration of chemoprophylaxis in surgery. Results Significant reductions were observed for: total antibiotics, colistin, carbapenems, quinolones and tigecycline consumption during study period. Significantly lower resistance rates were documented in 2019 compared to 2015 for Pseudomonas aeruginosa and for Klebsiella pneumoniae. As for Acinetobacter baumannii isolates, which in our hospital are highly-resistant exhibiting >90% resistance to carbapenems, no significant changes were noted during the study period. Infections caused by Gram-positive pathogens are less prevalent in our hospital. Lower rates of vancomycin-resistant enterococci were noted after the implementation of our ASP (30.4% in 2019 vs. 50.0% in 2015 for E. faecium and 0.6% vs. 6% for E. faecalis, respectively), whereas methicillin-resistant S. aureus isolates increased (40% in 2019 vs. 31.1% in 2015), possibly because most of these infections were not hospital-acquired. Resistance rates of Pseudomonas and Klebsiella Conclusion Our ASP was successful in reducing antibiotic consumption and AMR for important pathogens. Disclosures All Authors: No reported disclosures

This study aimed to investigate the effects of a 4-year antibiotic stewardship program (ASP) in a tertiary hospital. We monitored data for 2015 (pre-intervention) and 2016-2019 (post-intervention) about antibiotic consumption (DDD/100 bed days), Clostridioides difficile infections (CDIs), resistance rates, length of stay (LOS), and annual antibiotic costs. Significant reductions were observed for total antibiotics/colistin/carbapenems/quinolones/tigecycline consumption and resistance rates of Pseudomonas aeruginosa, Klebsiella pneumoniae, and vancomycin-resistant enterococci. Considerable reductions occurred for LOS (4.18 [2015]/3.0 [2019] days), CDIs (1.47 [2015]/0.86 [2019] per 1000 patients), antibiotic cost/patient (39.45€ [2015]/23.69€ [2019]). The ASP was successful in reducing antibiotic consumption, antibiotic costs, length of hospital stay, and CDIs.