Unexpected Presence of Blastocystis Subtype 1-3 DNA in Human Vaginal and Sperm Samples Coinfected with Trichomonas vaginalis

There have been few reports on extra-enteric infections by <i>Blastocystis</i> STs and none have been molecularly identified in samples from human reproductive organs. We report for the first time the identification of 3 different subtypes of <i>Blastocystis</i> (ST1-3) in vaginal and sperm samples, from patients infected with <i>Trichomonas vaginalis</i>. <i>Blastocystis</i> STs were identified by PCR-sequencing and by phylogenetic inferences using 28 vaginal swab samples and 7 sperm samples from patients trichomoniasis. <i>Blastocystis</i> STs were identified in 6 of 28 vaginal swabs (21.4%) and in 3 of 7 sperm samples (42.8%). In both biological samples, STs 1-3 were found; one vaginal sample showed subtype co-infection with ST1 and ST3. High genetic variation was observed in the sequences obtained and no specific clustering in the phylogenetic trees was detected. Most of the haplotypes identified were placed far from the main dispersal centers. Our finding suggested that incorrect cleaning of the genital area or a contamination by combination of anal and vaginal intercourse.

Association between cycle threshold (Ct ) values and clinical and laboratory data in inpatients with COVID-19 and asymptomatic health workers

In‐house assays for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) by quantitative reverse‐transcription polymerase chain reaction (qRT‐PCR), are feasible alternatives, particularly in developing countries. Cycle threshold (C_t) values obtained by qRT‐PCR were compared with clinical and laboratory data from saliva of inpatients with COVID‐19 and asymptomatic health workers (AHW) were studied. Saliva specimens from 58 inpatients confirmed by qRT‐PCR for SARS‐CoV‐2 using nasopharyngeal specimens, and 105 AHW were studied by qRT‐PCR using three sets of primers for the N (N1, N2, and N3) gene of SARS‐CoV‐2, according to the CDC Diagnostic Panel protocol, showing a positivity of 88% for inpatients and 8% for AHW. Bivariate analysis revealed an association between C_t < 38.0 values for N2 and mechanical ventilation assistance among patients (p = .013). In addition, values of aspartate‐transaminase, lactate dehydrogenase, and ferritin showed significant correlations with C_t values of N1 and N3 genes in inpatients. Therefore, our results show that C_t values correlate with some relevant clinical data for inpatients with COVID‐19.

An Unexpected Case of Lagochilascariasis: Interdisciplinary Management and Use of 12S and 18S rDNA Analysis

A Mexican 24-year-old male patient was referred to our hospital due to increased left retroauricular volume with skin fistulisation, resembling an infection by the uncommon worm Lagochilascaris minor. The patient was submitted to lateral skull base surgery. No adult worms or eggs were observed during light and scanning electron microscopy analysis, as well as by histopathologic examination of the small piece of removed tissue, only L3 stage larvae of Lagochilascaris spp. were identified. Polymerase chain reaction-sequencing assays were performed using primers for the mitochondrial 12S and the nuclear 18S rDNA gene. DNA of some L minor adults, previously identified, were used as control. The molecular analysis identified the worm as L minor. According to previous reports, lagochilascariasis is a complicated infection that requires an interdisciplinary management by different clinical specialists. This is the first time that 12S and 18S rDNA genes are reported as molecular markers for diagnosis of L minor.

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.