Background Clostridioides difficile (C. difficile) infection is the main cause of nosocomial diarrhea in the world. In our hospital, there was no standardized protocol for diagnosis and treatment of this infection. The aim of this study was to measure the impact of implementing a multimodal strategy of active surveillance, diagnosis and treatment in the clinical outcome of patients with C. difficile infection.MethodsObservational, retrospective, and analytical study that compared a multimodal strategy for the treatment of C. difficile infection against a traditional strategy, which consisted of treatment with either metronidazole or vancomycin with variable duration of therapy depending on the physician’s choice. The multimodal strategy consisted of active surveillance of cases of nosocomial diarrhea, timely diagnosis (<12 hours), and standard treatment with oral vancomycin for a minimum of 10 days (125 mg po qid in mild and moderate illness, and 250 mg qid in severe disease). Patients with a confirmed diagnosis of C. difficile infection (PCR- Gene Xpert Cepheid) and inflammatory diarrhea were included. The study was carried out in a third-level hospital, in the period between September 2017 and December 2018.ResultsIn 15 month study period, 92 cases of C. difficile infection were documented. All cases were caused by strain NAP1 / B1 / 027. Twenty-three patients (25%) had mild disease, 28 (30.4%) moderate illness and 41 (44.56%) complicated illness. Thirty-four patients were evaluated with multimodal strategy and 58 according to the traditional treatment. Only 24 patients (41%) in the traditional treatment group received treatment with oral vancomycin. The clinical outcomes of patients in the multimodal strategy against patients with the tradional strategy were: clinical cure 85.3% vs 37.9% (P = 0.02), recurrence 2.9% vs 17.2% (p = < 0.05) and death 11.8% vs 44.8%(p = < 0.05), respectively.ConclusionUnfortunately, in our country, there are no guidelines for the management of C. difficile infection, and in many hospitals, metronidazole is the most prescribed treatment. In this study, we documented that implementing a standardized strategy of surveillance, diagnosis and adequate treatment, reduced mortality related to C. difficile infection, recurrence, and achieved greater clinical cure. Disclosures All authors: No reported disclosures.

Background The surge of resistant Gram-negative organisms has been worrying infectious disease physicians and physicians in general because of the lack of a large number of antibiotics to which these organisms remain susceptible. Ceftazidime-Avibactam (CAZ-AVI) is a drug approved by the FDA to treat complicated urinary tract infections (cUTI), complicated intra-abdominal infections (cIAIs) in combination with metronidazole, and recently for the treatment of nosocomial pneumonia. Worldwide resistance rates of Enterobacteriaceae to CAZ-AVI have been reported below 2.6%, and 4-8% for Pseudomonas aeruginosa. The FDA, CLSI, and EUCAST assigned the clinical breakpoints of susceptibility: MIC &lt; /=8 mg/liter susceptible, and &gt;/=8mg/liter, resistant. In Mexico, CAZ-AVI was approved in 2018, and its cost is very high compared to other antimicrobials, so its use is limited in very specific cases. The resistance rates to this antibiotic in the Mexican population remain largely unknown. Methods We tested 106 specimens for susceptibility to ceftazidime-avibactam using the disk Kirby-Bauer method. The inhibition zone diameter was determined in all cases and we considered the organism susceptible when the inhibition zone diameter was &gt;=21 mm, and resistant with an inhibition zone diameter &lt; = 20 mm. Results We found 5 specimens (4.71%) resistant to ceftazidime-avibactam, corresponding to E. coli (3) and P. aeruginosa (2). Two of these were also resistant to colistin, and 4 to meropenem. All carbapenem-resistant isolates harbored Metallo-beta-lactamases genes, for E. coli was NDM gen, and for P. aeruginosa the VIM gene(GeneXpert® Cepheid). Conclusion The ceftazidime-avibactam resistance among Gram-negative bacteria in our study is similar to the one reported in other international studies. We need more studies in our population to know the nationwide resistance to this antibiotic. Disclosures All Authors: No reported disclosures

Background Mexico is one of the top five countries with a higher mortality rate of hospitalized patients of 30.1%. Since COVID-19 has been associated with immune dysregulation and hyper inflammation, JAK-12 inhibitors have been tested to reduce IL6 production. Studies have shown improvements when using ruxolitinib (rxb) in severely hospitalized patients with COVID-19. These have included patients in combination with corticosteroids such as dexamethasone (dxm). This work aims to test the response of hospitalized patients with severe or critical COVID-19 treated with rxb with or without dxm. Methods An experimental, open, prospective study in a single third-level hospital in Mexico was performed. The primary outcome was favorable clinical response defined as withdrawal or decline of supplementary oxygen. Secondary outcomes such as mean hospital stay, improvement in systemic inflammatory response parameters, and mortality were also evaluated. Statistical differences for baseline and final measure and the use and not use of dxm were estimated. The study included adults with SARS-CoV-2 infection confirmed with polymerase chain reaction, radiological pneumonia, and oxygen saturation less than 90%. Rxb was administered 5mg/12hrs/15days, IV dxm 6mg/day/10days. Results The final sample was 108 adults with complete information and informed consent. Sixty-two patients (57%) received only rxb. There were no differences between groups for any parameter at the beginning of treatment, and all patients were receiving supplemental oxygen. After 28-day follow-up, 70% reduce supplemental oxygen requirement (74% rxb and 71% rxb+dxm; p=0.628), 18% remained, and 2% increases support (1% with rxb, and 5% rxb+dxm; p&lt; 0.001); 87% of patients were discharged (89% rxb and 85% rxb+dxm; p=0.603). In both groups, there was a significant reduction of CRP, LDH, and Ferritin on day 15. The mortality rate was 9% (no difference in groups; p=0.453), and a higher proportion died for Pseudomonas aeruginosa superinfection in the rxb+dxm group (p&lt; 0.001). Differences for support oxygen at baseline and discharge Final health outcomes of patients with severe or critical COVID-19 in a third-level hospital in Mexico Conclusion The use of rxb could be considered as a treatment helping clinical improvement in hospitalized patients with severe COVID-19. Combination with dxm apparently did not add clinical benefits. It should be further evaluated. Disclosures All Authors: No reported disclosures