The authors report a case of Kawasaki disease that manifested in a newborn and presented at the age of 6 weeks of age with coronary artery aneurysms.

Corrective cardiac surgery for selected critically ill infants with large ventricular septal defects, severe malnutrition, and pneumonia requiring mechanical ventilation is feasible and should be considered a viable management strategy.

Blastomycosis is a mycotic infection that typically affects the lung, but that can have dermatologic, orthopedic, genitourinary, and central nervous system manifestations. Blastomyces dermatitidis is a true human pathogen, which can produce disease in immunocompetent hosts. Risk factors for infection include residence in or travel to endemic areas and outdoor occupation, particularly those activities near open bodies of water and that disrupt soil. Immunosuppressed patients are also at increased risk for severe and disseminated disease. We present a case of a 79-year-old male who presented with a 2-week history of progressive right upper extremity weakness and severe odontogenic disease. He was found to have multiple brain abscesses with positive cultures from a cerebral abscess incision and drainage for B dermatitidis. He underwent an incision and drainage of the largest cerebral abscess and was treated with intravenous liposomal amphotericin B, which he tolerated poorly. He was subsequently switched to voriconazole, which was well tolerated, and his neurological deficits improved throughout his hospitalization.

BackgroundAt University of Kentucky (UK) HealthCare, the transition from latex agglutination testing (Remel, Lenexa, KS) to IMMY Cryptococcal Antigen Lateral Flow Assay (CrAg LFA) occurred in September 2016. A few months later, it was noticed that several cryptococcal cases were diagnosed with weak positive test results where the diagnosis could not be confirmed by additional testing. The purpose of this study was to analyze the characteristics of these patients, and to assess the interventions they received based on positive results.MethodsThis was a retrospective study of the patients with positive CrAg LFA treated at UK HealthCare from November to December 2016. Low antigen titers (≤ 1:20) were considered to be false positive if repeat testing with the Remel Cryptococcal Latex assay, IMMY latex and IMMY microwell EIA were negative, cultures and histopathology were negative and there was no clear clinical evidence of infection.ResultsDuring this 2-month period, CrAg LFA was positive in 12 patients. The diagnosis of cryptococcosis could not be confirmed by additional testing in 9 (75%) individuals. Cirrhosis/liver disease was present in 3 (33.3%) patients, 5 (55.6%) underwent lumber puncture and antifungal therapy was administered in 8 (88.9%) patients (Table 1). CrAg LFA was false positive in 1/2 (50%) HIV, 3/3 (100%) transplant, and 5/7 (71.4%) non-HIV/non-transplant patients (Figure 1). Among the false positives, 4 (44.4%) patients had titer of 1:5, two (22.2%) had 1:20, and the original positive screen was not detected upon titration in 3 (33.3%) other patients. One HIV patient received a complete treatment course for unconfirmed cryptococcal meningitis because an LP could not be performed.ConclusionFalse-positive low CrAg LFA titers led to unnecessary tests, antifungal treatments and prolonged hospitalization in some patients. One-third of these individuals had cirrhosis/liver disease. Other institutions also reported false-positive low CrAg LFA titers. As a result, the company staged a recall of the specific lot and corrected the problem in reagent manufacturing. Low-positive titers using CrAg LFA should be interpreted carefully and further testing should be considered as determined by the clinical situation. Disclosures All authors: No reported disclosures.

BackgroundThe selection of intravenous (IV) antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia can be influenced by the vancomycin minimum inhibitory concentration (MIC). This study explores the changes in antibiotic use and inpatient mortality for patients with MRSA bacteremia after switching the MIC testing methods.MethodsAt University of Kentucky Medical Center, Etest™ was implemented in November 2013 for all Staphylococcus aureus blood isolates. In April 2016, this was changed to Phoenix™ automated system. Data regarding antibiotic usage for patients with MRSA bacteremia were collected from July 2014 to December 2015 (Etest™) and September 2016 to March 2017 (Phoenix™). Only patients started on IV vancomycin were included. Daptomycin and ceftaroline use was monitored by the antimicrobial stewardship team with focus on guideline adherence.ResultsA total of 119 and 62 patients were identified before and after switching to Phoenix™. MICs of 2 μg/mL were significantly decreased (P < 0.001) after changing to Phoenix™ (Table 1). Daptomycin use (alone or in combination) decreased from 37% (44/119) to 21% (13/62) (P = 0.013). Ceftaroline use (alone or in combination) decreased from 32% (38/119) to 19% (12/62) (P = 0.036). The reason for escalation in 13 of 44 (30%) patients with daptomycin and 6 of 38 (16%) patients with ceftaroline was an MIC of 2 μg/mL. Overall, IV vancomycin use (alone or in combination) increased from 50% (60/119) to 69% (43/62) (P = 0.007). All-cause inpatient mortality was 16% (19/119) before and 10% (6/62) (P = 0.24) after switching to Phoenix.Table 1:Difference in MIC Data and Antibiotic UtilizationParametersEtest™ (n = 119) n (%)Phoenix™ (n = 62) n (%) P-ValueMIC = 2 μg/mL56 (47)2 (3)<0.001MIC = 1.5 μg/mL37 (31)N/AN/AMIC ≤1 μg/mL26 (22)60 (97)<0.001IV vancomycin60 (50)43 (69)0.007Daptomycin44 (37)13 (21)0.013Ceftaroline38 (32)12 (19)0.036Other antibioticsa4 (3)4 (6)0.27All-cause inpatient mortality19 (16)6 (10)0.24 aInclude linezolid and trimethoprim/sulfamethoxazole.ConclusionA switch in vancomycin susceptibility testing from Etest™ to Phoenix™ automated system was associated with a significant decrease in daptomycin and ceftaroline use and an increase in IV vancomycin use without any change in all-cause inpatient mortality.Disclosures All authors: No reported disclosures.