Background There was evidence that antibiotic usage increased in hospitalized COVID-19 patients during the early days of the pandemic. Objective We assessed the impact of stewardship interventions on antibiotic usage in these patients. Methods We designed a quasi-experimental study using an interrupted time series. Patients were stratified according to the severity category of the illness – mild and moderate-to-severe (O2 saturation ≥94% and <93% respectively). Baseline antibiotic usage data was collected in the pre-intervention phase. Intervention was given in the form of focus group discussion (FGD) and followed up with feedback-audit during the post-intervention phase. Primary outcome was the change in days of therapy (DOT) per 1000 patient-days. Results 361 adult patients were recruited in both phases during July to December, 2020. In the post-intervention phase, DOT per 1000 patient-days reduced from 589 to 523 (P=0.013) and from 843 to 585 (P <0.0001) in mild and moderate-to-severe categories, respectively. De-escalations at 48 hours increased significantly from 21% to 41% (P=0.0079) and from 31% to 62% (P=0.0006), respectively. No difference in mortality was observed. Conclusion We found high usage of empirical antibiotics in adult patients hospitalized with COVID-19. FGD and feedback audits can successfully reduce antibiotic overuse in these patients.

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Background: An association between increased incidence of acute myocardial infarction (AMI) and elevated levels of stored iron concentration was recently reported. The data in India regarding association between AMI and levels of serum ferritin are lacking. Objectives: To study the association between serum ferritin level and risk of AMI. Materials and Methods: The present case-control study was conducted from May 2016 to October 2017 on 64 patients aged ≥30 years of either sex who were diagnosed with AMI (group I) and 60 controls (group II). Patients who attended outpatient department of hospital for minor illnesses, routine health checkups, and persons accompanying patients were selected randomly as controls. The controls had no signs of AMI or coronary heart disease (CHD) on clinical examination and had normal electrocardiogram (ECG). Quantitative measurement of serum ferritin was done in all subjects. The Chi-square or Fisher’s exact test and unpaired t-test were used to compare the categorical and quantitative variables, respectively. The independent association of serum ferritin with AMI was tested using multivariate logistic regression analysis. Results: The mean serum ferritin level was significantly higher in group I (203.5 µg/L) as compared to group II (111.8 µg/L). In group I, 82.9% patients had serum ferritin ≥150 µg/L as compared to group II (15.0%) with p-value = 0.001. Multivariate analysis showed history of smoking, body mass index (BMI) >25 kg/m2 , serum ferritin levels >200 µg/L, and high-density lipoprotein (HDL) cholesterol level <35mg/dL were independent and significant determinants of AMI. Conclusions: There was an association between elevated serum ferritin levels with AMI.

Background The World Health Organization (WHO) recommends routine cryptococcal antigen (CrAg) screening in patients with advanced HIV disease initiating antiretroviral treatment (ART). India has yet to adopt this strategy as the burden of cryptococcal disease is unknown.Methods This was a prospective cohort study conducted between March 1, 2010 and March 1, 2017 at three private hospitals in Pune, India. All HIV-positive patients (symptomatic and asymptomatic) with CD4 counts ≤ 200 cells/µL were screened for serum cryptococcal antigen. Serum CrAg was measured using latex agglutination (LA) test. Both, ART naïve and ART experienced patients were included in the study. All HIV infected patients who were CrAg-positive were offered lumbar puncture (LP) and worked up for disseminated cryptococcal disease.ResultsA total of 785 HIV-positive patients (24.2% females) were included. Median age of cohort was 42 years (IQR, 35–49) and median CD4 count was 79 cells/mm3 (IQR, 37–82). 182/785(23.2%) patients were ART experienced. A total of 6.75% (53/785) of patients were CrAg positive in serum. Thirty-nine of 53 (73.6%) patients with positive serum cryptococcal antigen test had CD4 count ≤100 cells/mm3 while 14/53 (26.4%) had CD4 between 100 and 200 cells/mm3. Cerebrospinal fluid (CSF) CrAg was positive in 44/53(83%) patients. Two of 53(3.78%) had non-CNS, diffuse pulmonary cryptococcal disease and 7/53(13.2%) patients had isolated cryptococcal antigenemia. Patients with cryptococcal meningitis and crptococcal pulmonary disease were treated with Amphotericin-B plus oral Fluconazole. Patients with isolated cryptococcal antigenemia were treated with oral Fluconazole. Mortality at 6 months for patients with positive CrAg test was 22.6% (12/53).Conclusion We found 6.75% prevalence of cryptococcaemia amongst HIV patients with CD4 <200 cells/mm3. Given the high fatality rates observed, routine CrAg screening should be considered for all Indians with advanced HIV disease.Disclosures All authors: No reported disclosures.