Clinical characteristics and outcomes of HIV positive patients with lymphoma in an oncological reference center in Mexico City

The epidemiology of lymphomas has changed since the use of antiretroviral therapy. The incidence of Non-Hodgkin Lymphomas (NHL) has significantly decreased in high income countries but not in low and middle-income countries where AIDS-related events remain high. This observational study describes the characteristics, infectious complications and main outcomes of patients diagnosed with HIV and lymphoma at the Instituto Nacional de Cancerología.All adults >18 years diagnosed with HIV and lymphoma from January 2010 to December 2017 were included. Information on HIV and lymphoma was collected, as well as the occurrence of co-infections at diagnosis and during therapy. Multiple regression was done with NHL patients to evaluate independent variables associated to death.One hundred fifty three patients were included: 127 patients with NHL (83%) and 26 (17%) with Hodgkin lymphoma (HL). Of the NHL, 49 (38%) were diffuse large B cell Lymphomas (DLBCL), 35 (27%) plasmablastic, 28 (23%) Burkitt, 10 (8%) primary DLBCL of Central Nervous system, 3 (2%) T-cell lymphomas, and 2 (2%) pleural effusion lymphoma. Most patients were diagnosed in an advanced stage: 70% of NHL had a high International Prognostic Index (IPI); 68% of patients had <200 cells/mm. Almost 25% of NHL patients had an opportunistic infection at lymphoma diagnosis. During chemotherapy, 60% of all patients presented with at least 1 serious non-opportunistic infectious complication, and 50% presented 2 or more infectious complications, mostly bacterial infections. Thirty six percent of NHL and 23% of HL died. After adjusting for confounders, the variables associated with death were IPI and lymphoma type.HIV positive patients with lymphoma in our institution are diagnosed with an advanced stage and a high burden of infections complications. Death remains high and the variables strongly associated with death are those related to lymphoma prognosis such as lymphoma type and IPI.

1783. Implementation of New Strategy for Real-time Antimicrobial Stewardship (ASP) in a Secondary Healthcare Hospital, in Mexico City

Background

Real-time antimicrobial stewardship programs are associated with improved time to optimal an effective therapies and decreased unnecessary antimicrobial use. However, these programs are often expensive and need special hardware or software for their implementation. Real-time communication technologies based on smartphones and texting media applications have not been used previously as a tool that emulates these clinical decision support programs (CDSP). We evaluated the clinical impact of implementing this technologies as fundamental part of an ASP in a Secondary Healthcare Hospital. Preauthorization, prospective audit, and feedback interventions were combined into a texting media group alert, composed by infectious diseases physicians, pharmacists, microbiologist and epidemiology department, which evaluated and decided the best treatment option in a real-time period consisting of 2 hours for each patient. Preauthorization rules included carbapenems, glycopeptides, quinolones, clindamycin, Linezolid, and amphotericin.

Methods

We conducted an observational and descriptive study for the total number of interventions in a 3-year period. Data collection included hospital service for application, authorization or restriction, consumption in terms of defined daily dose, economic outcomes, nosocomial bacteria’s resistance patterns, and overall mortality rates.

Results

A total of 8,004 interventions were carried out; only 7.7% (636) were unanswered within the 2 hour period. Emergency department (34.35%) and Internal Medicine (24.6%) were the most monitored services. The most restricted ones were Surgery and Intensive Care Unit with at least 25% of prescriptions. The most restricted antibiotics were piperacillin/tazobactam, clindamycin and quinolones, restraining up to 80%. Saving cost represents US$130,000.00 for colisitin and US$64,800.00 for carbapenems. The isolates of P. aeruginosa and A. baumanii resistant decreased by 75% and the overall mortality rate for nosocomial infections, were not increased.

Conclusion

This is the first report in Mexico of an ASP that incorporates mobile phone technology as a part of real-time surveillance program that emulates CDSP and allows to know in detail the correct use of antibiotics, saving costs and decreasing bacterial resistances

Disclosures

All authors: No reported disclosures.

Hepatotoxicity induced by a single ip injection of ruthenium red

Ruthenium red (RR) has been used as a marker in morphological observations of the glycocalix because it interacts with polyanionic mucopolysaccharides. This fact may explain its agglutinating effect on rat blood red cells following a single 20 mg/kg intraperitoneal injection, which increases with time post-injection. This study was performed to determine whether such an effect was due to a direct effect of the RR on the blood cells, to interference with coagulation, or to the non-specific general toxicity of this dye. Male rats were injected with 20 mg/kg RR ip and the enzymatic and coagulation parameters, plus the liver morphology were examined. Alanine aminotransferase (ALAT) activity was increased at 30, 60 and 120 min, and aspartic aminotransferase (ASAT) activity was increased 60, 120 and 480 min after RR injection. The prothrombin time (PT) and partially activated thromboplastin time (PTT) were significantly decreased, particularly after 60-120 min. The liver had an external granular appearance with clear signs of congestion and oedema, and showed degenerative changes very soon after RR injection. A single administration of RR induces serious functional and structural changes in the liver. Such a toxicity, and these changes must be taken into consideration, particularly with regard to neurological studies.