Exophiala dermatitidis is a dematiaceous fungus with yeast-like and hyphal growth states that may cause cutaneous and visceral infections. Recently, E. dermatitidis has been linked to central line associated blood stream infection (CLABSI), probably due to its ability to produce extracellular polysaccharides and grow as biofilm. We describe an E. dermatitidis CLASBI. The strain was identified by morphological and molecular methods. E. dermatitidis CLASBI is highly uncommon, but seems to be increasing.

Transcatheter aortic valve implantation (TAVI) is an alternative treatment for severe aortic valve stenosis (AS) in patients with prohibitive risk for surgical aortic valve replacement (SAVR). Prosthetic valve endocarditis (PVE) is a rare complication of this relatively novel procedure and current guidelines do not include specific recommendations for its treatment. We report a case of PVE due to Pseudomonas aeruginosa after TAVI that required SAVR, with successful outcome. PVE usually occurs during the first year after TAVI and entails a high mortality risk because patients eligible for this min-imally invasive procedure are fragile (i.e. advanced age and/or severe comorbidities). Additionally, clinical presentation may be atypical or subtle and transesophageal echocardiogram (TEE) may not be conclusive, which delays diagnosis and treatment worsening the prognosis. This case highlights that open SAVR might be ultimately indicated as part of treatment for TAVI-PVE despite a high-risk surgery score.

therapy that includes a beta-lactam plus a macrolide; however, the evidence from controlled trials does not confirm this observation.To assess the impact of monotherapy with a beta-lactam versus beta-lactam plus a macrolide on 14-day mortality in patients hospitalized with CAP.Methods & Materials: NACREG1 is a prospective populationbased study conducted in three cities of South America designed to estimate incidence rate of CAP in adults. Patients ≥18 years of age with radiographically confirmed diagnosis of CAP were enrolled. This substudy analyzes 14-day mortality according to the initial antibiotic regimen in hospitalized patients. The antibiotic regimen was chosen by the attending physician, the choice of which was not part of the NACREG1 study. Initial antibiotic regimens were grouped as monotherapy with beta-lactam antibiotics (MB), combined therapy with beta-lactams plus macrolide (BM), and other regimens.Results: From January 2012 to December 2016, 2700 were enrolled in the study, of which 1897 were hospitalized, 1444 in the general ward (76.3%) and 448 in the ICU (23.7%). 956 received MB, 771 BM and 163 other regimens. In the whole population of hospitalized patients 14-day mortality was 16.6% for those on MB and 18% for those on BM (p = 0.52). For patients hospitalized in ICU 14-day mortality was 34,8% for those who received MB and 33% for those treated with BM (p = 0.75). For patients hospitalized in general ward, 14-day mortality in those treated with MB was 13,2% and 11,2% for those treated with BM (p = 0.30). Conclusion:The present study shows that in a real world study, without adjustment for severity or other variables, patients hospitalized with CAP in general ward or in the ICU, 14-day mortality was similar for those who received monotherapy with beta-lactams or combination therapy with beta-lactam plus macrolide.

Background: Brucellosis is one of the most important diseases among humans and animals. Clinical management of brucellosis due to an increased rate of treatment failure and recurrence is extremely worrying. The aim of this study was to determine the antimicrobial susceptibility pattern of the brucella isolates.Methods & Materials: From April to September 2014 a total of 30 brucella isolates that were cultured on brucella agar has been studied. The species identification was carried out and to determine the effect of antibiotics on bacteria antibiogram testing was performed by disk diffusion.From April to September 2014 a total of 30 brucella isolates that were cultured on brucella agar has been studied. The species identification was carried out and to determine the effect of antibiotics on bacteria antibiogram testing was performed by disk diffusion.Results: In this study, 30 brucella strains were isolated from cultured specimens and antibiogram testing was performed. All microbial positive specimens were sequenced by PCR. All isolates were Brucella melitensis. According to the tests, suceptibility to tetracycline, minocycline, gentamicin, tigecyclin was 100%, to doxycycline 93.3%, co-amoxiclave 66.7%, rifampin 44.7%, streptomycin 86.7%, ciprofloxacin 80%, cotrimoxazole 76.7% and ceftriaxone 73.3%. Conclusion:This study shows that the predominant strain in our patients was Brucella melitensis. Also, due to high levels of resistance to rifampin to use the other effective drugs like gentamicin, streptomycin, ciprofloxacin or cotrimoxazole in combination with doxycycline or tetracycline. This study shows that the predominant strain in our patients was Brucella melitensis. Also, due to high levels of resistance to rifampin to use the other effective drugs like gentamicin, streptomycin, ciprofloxacin or cotrimoxazole in combination with doxycycline or tetracycline.

BackgroundSurgical site infections following spinal surgery affect 0. 3 to 20% of patients. The longer the infection, the greater the chance of antibiotic treatment failure due to the establishment of mature microbial biofilm on the hardware, requiring its removal for infection eradication.MethodsRetrospective cohort of patients with microbiologically confirmed SII following spinal surgery treated with debridement and retention. SII was defined as the presence of clinical signs of deep surgical site infection with 2 or more positive culture results of tissue surrounding the implant taken during surgical debridement; or from CT guided biopsy. Inclusion criteria: adults with a 1º episode of microbiological confirmed SII diagnosed from 2008 to 2017 with >2 years of follow-up, treated with implant retention. Definitions Early-onset infection (EOI): infection < 1 month following implant placement. Late onset infection (LOI): between 30 days and 1 year after implant placement. Delayed onset infection (DOI): >1 year of implant placement. Statistical analysis made in Graph Pad Prism 5. 0.ResultsWe analyzed 19 patients with SII treated with hardware retention. Mean age was 54 (21–70) years, 63% were female. Comorbidities, clinical manifestations and motive for surgery are in Table 1 and Figure 1. Hardware material used was titanium 15(79%) and steel 4(21%). In addition to the hardware,11 patients (57. 9%) underwent bone grafting, 4 experienced treatment failure (4/11 = 36. 4%); 2 patients had nonmetallic material inserted (carbon polymer), the 2 patients experienced failure. 16 patients (84. 2%) had EOI, 2 (10. 5%) LOI, 1 (5. 3%) DOI. Failure requiring implant removal was observed in 26. 3% (n = 5), 2 of the cases were EOI, 2 LOI and 1 DOI. Bacterial characteristics of patients are shown in Table 2. 47,4% of patients required more than one debridement (Figure 2). In the lineal regression model, treatment failure was associated with bone grafting (P = 0. 04) and the use of carbon polymer materials (P = 0. 007).ConclusionTreatment of SII with debridement plus antimicrobials treatment is acceptable, with a rate failure of 26%. In LOI and DOI spinal implant retention is more prone to fail. Bone grafting and the presence of polymers seem to be associated with treatment failure of conservative strategies. Disclosures All authors: No reported disclosures.