Objective To describe the clinical features, outcomes, and molecular epidemiology of an outbreak of multidrug resistant (MDR) A. baumannii. Methods We performed a retrospective analysis of all MDR A. baumannii isolates recovered during an outbreak from 2011 to 2015 in a tertiary care cancer hospital. Cases were classified as colonized or infected. We determined sequence types following the Bartual scheme and plasmid profiles. Results There were 106 strains of A. baumannii isolated during the study period. Sixty-six (62.3%) were considered as infection and 40 (37.7%) as colonization. The index case, identified by molecular epidemiology, was a patient with a drain transferred from a hospital outside Mexico City. Ninety-eight additional cases had the same MultiLocus Sequence Typing (MLST) 758, of which 94 also had the same plasmid profile, two had an extra plasmid, and two had a different plasmid. The remaining seven isolates belonged to different MLSTs. Fifty-three patients (50%) died within 30 days of A. baumanniii isolation: 28 (20%) in colonized and 45 (68.2%) in those classified as infection (p<0.001). In multivariate regression analysis, clinical infection and patients with hematologic neoplasm, predicted 30-day mortality. The molecular epidemiology of this outbreak showed the threat posed by the introduction of MDR strains from other institutions in a hospital of immunosuppressed patients and

BackgroundUrinary tract infections (UTIs) are among the most common causes for antibiotic prescription. The use of clinical scoring models in predicting infection with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) may help select an adequate empiric treatment.MethodsThis retrospective case–control study included all urine cultures with E. coli from symptomatic patients 18 years of age or more admitted to Medica Sur Hospital from December 2014 to 2016. Cases were ESBL producing cultures and controls non-ESBL. Demographic and clinical information was drawn from electronic file. Sensitivities and specificities were performed at various cutoffs and area under the receiver curve (ROC AUC) was determined for each of the two models studied.ResultsA total of 171 cases and 294 controls were included. Table 1 displays the statistically significant variables associated with ESBL in a multivariate regression model. ROC AUC in Figure 1 was 0.691 for Tumbarello and 0.670 for Duke. With a 2-point cutoff, sensitivity for Tumbarello was 71% and specificity 61%, for Duke 58% and 75%, increasing cutoff to 4 points increases specificity to 87 and 93%, decreasing sensibility to 35 and 20%, respectively. Table 2 classifies by type of UTI, shows the percentage of adequate initial antibiotic for ESBL, and the number of cases predicted by each model. Tumbarello’s model predicts all cases, while Duke’s model predicts most cases of cystitis and pyelonephritis and all cases of complicated UTI and urosepsis.Figure 1Table 1Variableβ-Coefficient P Confidence Interval 95%Recent antibiotic therapy0.23<0.0010.16–0.35Diabetes mellitus0.17<0.0010.11–0.32Previous hospitalization0.16<0.0010.10–0.32Connective tissue disease0.110.0140.06–0.48Complicated UTI0.110.0170.02–0.19Table 2Type of UTI/Initial AntibioticESBL E. coliNon-ESBL E. coliTumbarelloDukeCystitis621188760Nitrofurantoin o fosfomycin10%5%Pyelonephritis771408971Carbapenem58%31%Complicated UTI899312689Carbapenem56%42%Urosepsis40406445Carbapenem65%78%ConclusionClinical scoring models have a high specificity identifying best non-ESBL infections, this aids in the choice of a more adequate empirical antibiotic for community-acquired UTI.Disclosures All authors: No reported disclosures.

Background Disseminated Mycobacterium avium complex (MAC) infection occurs in 20-40% of patients with &lt; 50 CD4/mm3. Data describing central nervous MAC involvement (CNS-MAC) in disseminated infection is scarce. Methods We conducted a retrospective case series in the outpatient infectious diseases clinic in the hospital “Dr. Manuel Gea Gonzales” in Mexico City. We reviewed all records from October 2020 to May 2021 and identified all culture proven MAC infections. Results We found 7 cases of MAC, with disseminated infection (positive bone marrow cultures) with 3 out of those 7 meeting our definition for CNS-MAC (positive cerebrospinal fluid culture). All cases of CNS-MAC infection occurred in patients with &lt; 50 CD4/mm3 and recent HIV diagnosis (1-4 months) that were referred to our institution with consumptive syndrome and fevers. All patients were receiving antiretroviral treatment (ART) with BIC/FTC/TAF and initiated ART in less than 1 month since HIV diagnosis. Opportunistic infections were ruled-out at the moment of CNS-MAC diagnosis (criptococcal meningitis, cytomegalovirus retinitis, tuberculosis and histoplasmosis). All patients exhibited non-specific neurologic symptoms at arrival (headache and bradipsiquia) mixed with more severe symptoms (one case of ataxia, one case of vertigo, one case of III nerve palsy). All patients were treated with Clarithromycin/Levofloxacin/Ethambutol. Two patients achieved symptom remission and 1 patient was lost to follow-up. Of important note, all CSF analysis and CNS imaging studies carried-out were normal. No MAC bacilli were identified with direct Ziel-Neelsen staining of CSF. Conclusion We found a high proportion of CNS-MAC in patients with disseminated MAC infection (42.8%) during the study period. All patients presented CNS symptoms and normal CSF characteristics. In our setting, patients with suspected disseminated MAC infection CD4 counts &lt; 50 cells/mm3 might represent a specific population that could benefit from routine targeted diagnostic test at presentation in order to establish CNS involvement. Disclosures All Authors: No reported disclosures

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