Introduction: The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) limits effective treatment options. The aim of this study was to evaluate the susceptibility patterns of CR-Kp strains isolated from urine cultures to oral treatment options recommended by the Infectious Diseases Society of America guidelines, and ceftazidime-avibactam. Additionally, clinical data and outcomes of patients diagnosed with CR-Kp urinary tract infections (UTI) who were treated with fosfomycin sodium-including therapy regimens (FSITR) were analyzed. Methodology: This retrospective cohort study included adult patients with urine culture-proven CR-Kp between March 2016 and October 2022. Demographic and clinical data, antibiotic susceptibility, treatment outcomes, and one-month mortality (OMM) were evaluated. Results: A total of 179 patients were included. The susceptibility to fosfomycin tromethamol, nitrofurantoin, and co-trimoxazole (TMP-SMX) were (33.7%; 55/163), (7.7%; 13/167), and (11.1%; 20/179), respectively. All strains were resistant to ciprofloxacin. The susceptibility data compared until 2020 (pre-COVID-19) and afterwards, revealed TMP-SMX susceptibility (4.9% vs 24.1%, p = 0.0001) increased significantly. Susceptibility data for ceftazidime-avibactam were available for 22 isolates and 59% of the isolates were sensitive. OMM of the 179 patients with CR-Kp in urine cultures was 37.4% (67/179). There were 9 FSITR cases. Among those, microbiological eradication was achieved in 87.5% (7/8) and OMM was 44.4% (4/9). Conclusions: Clinical experience may be feasible and needed to assess the efficacy of nitrofurantoin and TMP-SMX. Fosfomycin-including regimens may serve as a salvage treatment option for CR-Kp UTI in selected patients. However, the retrospective and single-center design of the study should be considered as a limitation.

Background/Aim: To compare the effectiveness ceftaroline-rifampicin (CR) and vancomycin-rifampicin (VR), against methicillin-resistant Staphylococcus aureus (MRSA) in a rabbit meningitis model, to compare the effects on brain tissues in terms of inflammation and apoptosis and to test the antibiotics via in vitro time-kill and synergy tests. Method: Meningitis was induced using MRSA strain ATCC 43300. After 28 hours, the rabbits were split into three groups: control, VR, and CR. A CSF culture was taken at the start (T0) and end of treatment (EOT)-the 24th hour of treatment. At EOT, the animals' brain tissues were examined for inflammation and apoptosis. The study strain was tested for a 24-hour time kill assay. Results: At the EOT, statistically significant differences were observed between the treatment groups in terms of reducing the cerebrospinal fluid (CSF) bacterial count, achieving partial or complete treatment response, and exhibiting lower levels of neuronal apoptosis compared with the control group. However, there was no significant difference in all three parameters and in survival between the two treatment groups. The CR group exhibited a noticeable decrease in inflammation than the control group, but no significant difference was found between the control group versus VR and VR versus CR group. Rifampicin did not improve antibacterial efficacy in the in vitro time-kill assay. Conclusion: The CR arm showed better complete response and inflammation, but both treatments were similar in other parameters. CR combination was found as effective as VR combination for treating MRSA meningitis.

This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir ( p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode ( p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation ( p < 0.001, OR 62.042, 95% CI 9.528–404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia ( p < 0.001, OR 17.869, 95% CI 3.592–88.907), receiving tocilizumab therapy ( p = 0.028, OR 32.227, 95% CI 1.469–707.053), septic shock ( p = 0.001, OR 15.4 96% CI 3.164–75.897), and the need for ICU ( p < 0.001, OR 91.818, 95% CI 15.360–548.873), (iv) OMM: [mechanical ventilation ( p = 0.001, OR 19.041, 95% CI 3.229–112.286) and septic shock ( p = 0.010, OR 5.589,95% CI 1.509–20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.

Background: In this study it was aimed to evaluate the efficacy and timing with technique of the source control for the subgroup of septic shock (SS) patients with intraabdominal infections (IAI) in a tertiary-care educational hospital. Methods: Patients who had SS with IAI and consulted by Infectious Diseases consultants between December 2013 and October 2022 in our centre were analyzed retrospectively. Results: A total number of 390 patients were included. Overall day-30 mortality (OMM) was 42.5% on day 3 while day 14 and 30 mortality rates were 63.3% and 71.3%, respectively. Source control by surgical or percutaneous operation was performed in 123 of 390 cases (31.5%) and mortality rate was significantly lower in cases that were performed source control at anytime during SS (65/123-52.8% vs 213/267-79.8%, p<0.001). In 44 of 123 cases (35.7%) source control was performed during the first 12 hours and mortality was significantly lower in this group versus others (24/44-54.5% vs 254/346-73.4%, p=0.009). On the other hand, female gender (p<0.001, odds ratio(OR)=1.714-5.054, 95%CI=1.714-5.054), diabetes mellitus (p= 0.014, OR=2.284, 95%CI=1.179-4.424), carbapenem-resistant Gram-negative etiology (p=0.011, OR=4.386, 95%CI=1.398-13.759), SOFA≥10 (p<0.001, OR=3.036, 95%CI=1.802-5.114), lactate >3 mg/dl (p<0.001, OR=2.764, 95%CI=1.562-4.891) and lack of source control (p=0.001, OR=2.796, 95%CI=1.523-5.133) were significantly associated with OMM in logistic regression analysis. Conclusions: Source control has a vital importance in terms of mortality rates for IAI related septic shock patients. Our study underscores the need for additional research, as the present analysis indicates that early source control does not manifest as a protective factor in logistic regression.

AIM In this study it was aimed to analyse the clinical characteristics and outcomes of IE cases in our hospital. BACKGROUND Despite developments in antibiotics and medicine, infective endocarditis (IE) is associated with significant morbidity and mortality. METHODS Patients that were followed up for definite IE (diagnosed according to modified Duke criteria) in ourhospital between March 2007 and September 2023 were analyzed retrospectively. Patients were evaluated in terms of demographic features,underlying diseases, risk factors, clinical and laboratory findings, therapy responses, complications, and mortality. RESULTS There were 230 patients diagnosed with IE [79-52.6% femaie, aged 53.3±16.9 years, ranging 18-92 years] fulfilling the study inclusion criteria. Risk factors, complaints, laboratory findings and complications of patients was shown in Table 1. Blood culture was positive in 175 patients (75,5%). The most common etiologic agents were; S. viridans (26.08%), S. aureus (18.6%) and E. feacalis (10.8%). The antibiotherapy of 40 patients with native valve endocarditis comprised ampicillin/sulbactam and gentamicin (other therapy combinations were vancomycin and gentamicin [n=11], penicillin and gentamicin[n=38]). Nine of 49 patients with prosthetic valve endocarditis were treated with vancomycin, rifampicin and gentamicin while other nine were treated with daptomycin including therapy. In hospital mortality was (20%-46/230). Mortality rates between blood culture positive and negative cases were similar (Chi-square test p=1) while mortality in S. viridans was less than S. aureus or enterococci (Chi-square test p=0.0085, Table 2). CONCLUSIONS IE is still associated with significant mortality. More interventions are needed to further decrease the complication and mortality rates.

Aim: To evaluate the effect of timing of antimicrobial therapy on clinical progress of patients with septic shock.Materials and Method: We included 204 adult patients diagnosed with septic shock according to Sepsis-3 criteria between March 2016 and April 2021. One-month survival was evaluated using univariate and logistic regression analysis.Results: Antibiotic treatment was initiated within 1 h of the vasopressors in 26.4 % of patients. One-month mortality did not differ significantly between patients with and without empirical therapy coverage on etiological agents. Univariate factors that significantly affected one-month survival were starting antibiotics at the first hour, the unit where the case was diagnosed with septic shock, SOFA scores, qSOFA scores, and lactate level. In multivariate analysis, diagnosis of septic shock in the Emergency Service, SOFA score >= 11, qSOFA score of three and lactate level >= 4 were significantly associated with one-month mortality.Conclusion: Training programs should be designed to increase the awareness of septic shock diagnosis and treatment in the Emergency Service and other hospital units. Additionally, electronic patient files should have warning systems for earlier diagnosis and consultation.

Herein, we aimed to describe the outcomes of patients with blood stream infections due to carbapenem-resistant Klebsiella pneumoniae (CR-Kp) who received ertapenem plus meropenem combination treatment (EMCT). A total of 53 patients with culture proven CR-Kp bacteremia treated with ertapenem + meropenem were included. The patients with secondary bacteremia due to urinary tract infection exhibited a significantly lower 1-month mortality (OMM), particularly in those with microbiological eradication and those with end-of-treatment success. Salvage EMCT resulted in 49% 1-month survival.

BACKGROUND:Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). MATERIALS/METHODS:This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. RESULTS:Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). CONCLUSIONS:Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.

Background: Pseudomonas aeruginosa (PSA) is one of the most important pathogens causing nosocomial bacteremia in most parts of the world. Objectives: In this study it was aimed to evaluate the resistance patterns and incidence of microbiologically confirmed nosocomial bacteremia (MCNB) related PSA strains between 2001-2019. Methods: Any patient in whom PSA was isolated in at least one set of blood cultures (sent to the bacteriology laboratory 72h after hospital admission) was considered to have microbiologically confirmed NB. Blood cultures were performed on Back/Alert (bioMerieux, Durham, NC). Bacterial identifications were performed by automated API (bioMerieux, Durham, NC). Antibacterial susceptibility tests were evaluated according to Clinical Laboratory Standards Institute (CLSI) criteria until 2014 and EUCAST between 2015 and 2019. Incidence density of PSA MCNB was calculated by using hospital electronic database. Results: A total of 1705 strains of P.aeruginosa fulfilling study inclusion criteria, were isolated during the 19-year study period in the hospital from intensive care units and clinics and included in the study. When the 2001-2002 and 2018-2019 periods were compared, there was a decrease in resistance to meropenem and amikacin (31.1%-20.4% p: 0.025 and 34.3%-22.8% p:0.029). However, the analysis of the resistance patterns of carbapenem-resistant P. aeruginosa strains as a subgroup (2001-2002) vs (2018 vs 2019), ciprofloxacin and cefepime resistance rates increased significantly (58%-79% p:0.0096 and 46%-72% p: 0.026). P. aeruginosa bacteremia rates incidence density rates ranged between 0.11 and 0.30 episodes per thousand hospital day during the study period. Conclusion: During the 19 years there was a significant decrease in amikacin and meropenem resistance while there was a significant increase in the subgroup of carbapenem-resistant strains. More infection control and antimicrobial stewardship efforts are needed to decrease the antibacterial resistance rates and incidence.

Introduction: Ventilator-associated pneumonia (VAP) is one of the major hospital-acquired infections in the intensive care unit (ICU). The Centers for Disease Control and Prevention (CDC) made changes in the definitions of VAP. In this study, we aimed to prospectively evaluate patients in the tertiary-level chest diseases ICU between December 2016 and May 2017 in terms of ventilator-related events using the new surveillance criteria for patients requiring invasive mechanical ventilation. Materials and Methods: Patients in the chest diseases ICU were prospectively evaluated in terms of VAP development, and the incidence was calculated according to the old and new CDC criteria. Results: A total of 82 patients (31 women, 51 men) were followed up in the chest diseases ICU. Twenty-four patients who met the new surveillance criteria (survived >4 days) with 1632 patient-days and 601 ventilator days were included in the study. The incidences of VAP according to the old and new criteria were 31.6 and 1.6 per 1000 ventilator days, respectively. Conclusion: Our data suggest that new CDC definitions underdiagnose pneumonia in the daily practice. We may conclude that it does not seem rational to switch to the newer VAP definitions in the daily practice from the elder CDC definitions.

This study aimed to evaluate the influencing variables for outcomes in patients with septic shock having culture-proven carbapenem-resistant Gram-negative pathogens. It included 120 patients (mean age 64.29 +/- 1.35 years and 58.3% female). The mean Sequential Organ Failure Assessment score during septic shock diagnosis was found to be 11.22 +/- 0.43 and 9 +/- 0.79 among the patients with mortality and among the survivors, respectively (P = 0.017). The logistic regression analysis showed that empirical treatment as mono Gram-negative bacteria-oriented antibiotic therapy (P = 0.016, odds ratio (OR) = 17.730, 95% confidence interval (CI): 1.728-182.691), Charlson Comorbidity Index >2 (P = 0.032, OR = 7.312, 95% CI: 5.7-18.3), and systemic inflammatory response syndrome score 3 or 4 during septic shock diagnosis (P = 0.014, OR = 5.675, 95% CI: 1.424-22.619) were found as independent risk factors for day 30 mortality. Despite early diagnosis and effective management of patients with septic shock, the mortality rates are quite high in CRGNP-infected patients.

Abstract Background Herein, we aimed to analyze the outcomes of the methicillin sensitive (MS) versus methicillin resistant (MR) culture-proven Staphylococcus spp. nosocomial meningitis (S-NM) in our setting. Methods We extracted data and outcomes for all adult patients (age >18 years) consulted by the Infectious Diseases Consultants and diagnosed NM (developed at a compatible time according to CDC nosocomial meningitis definitions) between January 2006 and 2021 and fulfilled the following study inclusion criteria: (a) Age ≥18-year-old; (b) CSF culture is positive for Staphylococcus spp. (c) Presence of at least two of three clinical/laboratory criteria as meningitis findings: (i) Body temperature >38oC; (ii) CSF finding; >250 leucocytes/mm3; (iii) at least one of the following clinical findings, ie. impairment of consciousness, neck stiffness, nausea/vomiting. Identification of the infecting bacteria and determination of antimicrobial susceptibility were performed using the VITEK 2 automated system (BioMerieux Inc, Mercy L’etoil, France) and conventional methods. Resistance to methicillin was tested by E-test (bioMérieux). Antibacterial susceptibility tests were evaluated according to Clinical Laboratory Standards Institute (CLSI) criteria until 2014 and EUCAST between 2015 and 2021. Chi-square and Student T tests were used for statistical comparison. Results A total of 9 patients in MSS-NM, 41 patients in MRS-NM group fulfilled the study inclusion criteria. Age, gender, and CSF findings (except CSF glucose was significantly lower in MSS-NM) were similar in both groups (Table 1). Besides, EOT clinical success and overall success (EOT success followed by one-month survival without relapse or reinfection) rates were similar (Table 1). Relapse and reinfection rates during post-treatment one month period were 0%-0% and 0%-6.6% in MSS/MRS-NM, respectively. In MRS-NM group reinfection pathogens were Acinetobacter baumannii and Pseudomonas aeruginosa after 12 and 30 days end of treatment. Characteristics of NM Conclusion Overall success in MSS-NM was acceptable while it was non-significantly lower in MRS-NM. The medical community should seek better infection control measures from NM. Disclosures All Authors: No reported disclosures

Abstract Background In this retrospective cohort study, it was aimed to compare the clinical characteristics and outcomes of IE cases without and with an indication for cardiac surgery in terms of whether they have been operated or not, in a tertiary-care educational hospital. Methods Patients that were followed up for definite IE (diagnosed according to modified Duke criteria between March 2007 and November 2020) with an indication for cardiac surgery according to European Society of Cardiology Guidelines, comprised the study group. Subjects were evaluated in terms of whether these cases have been operated or not, demographic features, underlying diseases, risk factors, clinical and laboratory findings, therapy responses, complications, and mortality. The timing of surgery is defined as emergency; surgery performed within 24 hours, urgent; within a few days, elective; after at least one-two weeks of antibiotic therapy. Statistical analysis was performed via Chi square and Student T tests and a p value < 0.05 was considered significant. Results A total of 90 patients with an indication for surgery, 33.3% patients in underwent surgery, 66.6% patients in not underwent surgery group fulfilled the study criteria. The most frequently seen complaints in patients were fever (91.1%), cold-shiver (56.6%), weight-loss (27.7%), dyspnea (25.5%), and tachycardia (20%). Heart murmur was detected during cardiac auscultation of 44 patients. Mean blood leukocyte count, C-reactive protein and erythrocyte sedimentation rate were 12324 ± 6558/mm3 (1408-30330), 11.46 ± 8.38 mg/dl (0.18-34.6) and 61.43 ± 33.4 mm/h (2-130), respectively. There was no significant difference between two groups in terms of cardiac/non-cardiac risk factors, age, gender, etiologic agents, laboratory findings, septic embolisms and complaints (Table 1). In total IE with an indication for surgery mortality was 27.7%. Mortality rate was significantly less and heart murmur was significantly higher in cases who underwent surgery than those did not undergo surgery (p: 0.0447). Table 1. Comparison of basic characteristics of patients in the two operated / unoperated cohorts. Conclusion These data support the importance of the guidelines’ criteria for cardiac surgery in the management of IE. Assuming that only 1/3 of the surgery needing cases received surgery, more interventions are needed to decrease the barriers against surgery. Disclosures All Authors: No reported disclosures

Abstract Background Herein we aimed to evaluate osteomyelitis cases in our setting. Methods We evaluated the hospital records of patients with osteomyelitis between January 2013 and December 2020 retrospectively. Osteomyelitis was confirmed by direct radiography or magnetic resonance imaging or pathology. Demographic features, risk factors, clinical/laboratory findings, treatment response and mortality rates were evaluated. Clinical response was defined as (resolution of clinical signs including fever and purulent discharge and other symptoms) and/or negative culture at the end of antimicrobial therapy. Results Patients were 33 female, aged 29–85 years (mean 59±12.6). Fourty nine of the patients were diabetic foot infection, 30 were spondylodiscitis, eight were primary, seven were post-traumatic, and five were post-surgical osteomyelitis. Overall 62 patients had diabetes mellitus and 16 patients had chronic renal failure. Peripheral arterial disease, neuropathy, diabetic retinopathy and venous insufficiency rate in the DM subgroup is shown in table. Fever was present in 24.2% of the cohort. İncreasing of CRP was in 95,9%, erythrocyte sedimentation rate in 83,9%, and leukocytosis in 37.3%. The radiological findings of osteomyelitis were detected via magnetic resonance imaging in 73 patients. Etiology in biopsy cultures were elucidated in 59.5% and the most common pathogen was S. aureus (30%) Table1. The most common empirical treatment regimens were tigecycline in 27 patients, ampicillin/sulbactam in 19 patients and ceftriaxone+teicoplanin in 12 cases. Duration of treatment was 36,2±17.3 days (range 6-104 days). Overall, clinical response was obtained in 91.9%. Fifty patients were performed surgical procedure + antibacterial treatment, clinical response was 96% (p:0.091). Surgical debridement could be performed in 22 patients, clinical response was obtained in all (p:0.193). Thirteen patients developed recurrence within one year. Sixty-seven patients received oral consecutive treatment after discharge. In hospital mortality rate was 2/99 (2,02%). Conclusion Despite surgical debridement and/or developed antimicrobial treatment, approximately 1/5 of osteomyelitis cases required further treatment Further interventions seem to be needed to reach better outcomes. Disclosures All Authors: No reported disclosures

ABSTRACT In this study, we aimed to compare the antibacterial activities of daptomycin and vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis (induced by MRSA strain ATCC 43300) in an experimental rabbit meningitis model. After an 8-h period of treatment, bacterial counts decreased significantly in both treatment groups compared to the control group ( P < 0.05). However, there was no statistically significant difference between treatment groups. Our results suggest that the antibacterial activity of daptomycin is similar to vancomycin for treatment in the experimental MRSA meningitis model in rabbits.

Amaç: Bu çalışmanın amacı, 2014 ve 2018 yılları arasında yoğun bakım ünitelerinde (YBÜ) sağlık çalışanlarının el hijyeni uyum oranını saptamaktır. Gereç ve Yöntem: Bu araştırma yedi YBÜ’de (Çocuk Sağlığı ve Hastalıkları, Yenidoğan, İç Hastalıkları, Anestezi ve Reanimasyon, Göğüs Hastalıkları, Nöroloji ve Kalp Damar Cerrahisi) çalışan doktor, hemşire ve yardımcı sağlık personelinin el hijyeni uyumunu değerlendiren prospektif, gözlemsel bir çalışmadır. El hijyeni uyumu enfeksiyon kontrol hemşireleri tarafından Dünya Sağlık Örgütü (DSÖ) beş endikasyonuna göre Ocak 2014 ile Aralık 2018 arasında haberli gözlem şeklinde yapılmıştır. Ayrıca, yüksek ve düşük el hijyeni uyumluluğuna sahip bireylere kişisel geri bildirimler verilmiştir. Bulgular: Toplam 24153 el hijyeni fırsat gözlemi (2014: 5695, 2015: 5307, 2016: 4563, 2017: 4821, 2018: 3767) yapıldı. Çalışmamızda 2014'ün ilk döneminde el hijyeni uyum oranı %25,6 idi. Tüm çalışanların el hijyeni uyum oranı sırasıyla; 2014: %32,0, 2015: %55,7, 2016: %61,0, 2017: %55,6 ve 2018: %68,1 olmuştur. Mesleklere göre; el hijyeni uyum oranları hemşirelerde %37 ile %70, yardımcı sağlık personelinde %20 ile %51, doktorlarda %28 ile %49 arasındaydı. Sonuç: Hastanemizde el hijyeni kurallarına uyum, sürekli çabalarla nispeten zayıf seviyelerden ortalama seviyelere yükselmiştir. El hijyeni uyum oranlarını %70'lerin üstüne çıkarmak için daha fazla destekleyici çalışmaya ihtiyaç vardır.

In this study, we aimed to investigate retrospectively the patients with carbapenem-resistant Enterobacteriaceae urinary tract infections (UTIs) in the terms of demographic findings, antibiotic sensitivity patterns and clinical features along with the treatment options. This study was performed at a tertiary-care educational university hospital. Adult (>18 years old) patients diagnosed with culture proven UTI due to carbapenem-resistant Klebsiella pneumoniae (between December 2016 to December 2017) were included in the study. Antimicrobial susceptibility testing of the isolates was performed with the VITEK 2 system (bioMerieux). Resistance to imipenem, ertapenem, and meropenem was tested by E-test (bioMerieux). The results were interpreted according to the EUCAST criteria. A total number of 100 patients (34% female, mean age 61.69 +/- 1.65 years) were included in this study. One month all-cause mortality rate was 19%. Microbiologic eradication rate was 88.7% while it was significantly higher in combination therapy (65/70 vs. 14/19, p = 0.019) and carbapenem long-lasting (4 h) infusion subgroups (54/56 vs. 2/56, p = 0.005). Relapse and reinfection rates were 61.7 and 29.7%, respectively. Logistic regression analysis for mortality risk factors resulted as history of ertapenem usage (OR: 4.74, 95% CI: 0.678-33.201, p = 0.117), lack of microbiologic eradication (OR: 21.7, 95% CI: 1.906-247.375, p = 0.013) and ICU stay (OR: 54.8, 95% CI: 4.145-726.324, p = 0.002). Combination, carbapenem long-lasting infusion and double carbapenem therapies seem to result in higher microbiologic eradication rates and thus may effect the mortality rates of these group of patients. Randomized-controlled studies should be performed in this critical patient group to confirm these results.

Abstract Background CRE are globally important pathogens associated with significant morbidity and mortality. The problem of carrying CRE may continue to create a problem in discharged cases in the community. Saccharomyces boulardii sachet therapy (SBST) is reported to cause decolonization in several MDR bacteria carriers. Herein, it is aimed to present the decolonizing rates of rectal CRE colonized cases after SBST treatment. Methods The study period was August 2018–March 2019. Inclusion criteria were: (i) age >18, (ii) receiving Saccharomyces boulardii 250 mg sachets q12h for 7 days, (iii) being proven CRE carrier on rectal swab culture (RSC) up to 5 days period before SBST. The first repeated RSC was performed 3–5 days after the end of SBST. Data were retrieved from the hospital electronic database. Cases with three consecutive weekly performed negative RSC were considered to be decolonized. RSC were processed according to CDC protocol; briefly, the swab was inoculated into 10 mL of trypticase soy broth (bioMérieux Inc., Marcy-l’Étoile, France) with the addition of one 10-μg ertapenem disk (Oxoid, Altrincham, UK) and incubated at 35°C for 18–20 h. The next day, after vortexing, 100 μL of the inoculum was subcultured (8) onto chromID CARBA agar plates (bioMérieux) and incubated at 35°C for 18–20 h. Suspected CRE colonies on chromID CARBA (blue/green to blue/gray in color) were identified by the VITEK MS system (bioMérieux). Susceptibility testing of the isolates was performed with the VITEK 2 system (bioMérieux). Isolates were tested for their resistance phenotypes to imipenem, ertapenem, and meropenem by E-test (bioMérieux). The results were interpreted according to the EUCAST criteria. Results Fifteen cases [2 women, mean age 60.6 ± 18.3 (min. 18–max. 83)] fulfilled the inclusion criteria. All had a history of carbapenem usage. Five cases (33%) had three consequent negative RSC after SBST and were considered to be decolonized. Twelve cases were receiving concomitant antibiotic during SBST (10 carbapenem based regimens). Three cases who received no concomitant antibiotic were decolonized. Conclusion SBST may be a promising tool for decolonizing CRE carriers. These data need to be validated in larger cohorts preferably via randomized-controlled trials. Disclosures All authors: No reported disclosures.

Introduction: Hand hygiene is one of the most cost-effective infection control measures. In this multicenter Study we analysed the hand hygiene compliance observation results of 15 hospitals in Turkey. Materials and Methods: This study was performed in intensive care units (ICUs) of 15 hospitals (Eight terriary-care educational hospitals, six state hospitals and one private hospital) from 11 cities from six regions of Turkey The observations were made by infection control practitioners according to the World Health Organization - Five Moments for Hand Hygiene (WHO-5) indications rule for hand hygiene and overall compliance rates were calculated. Observations were unblinded (healthcare professionals knew that they were observed). The study period included 2015 and 2016 calendar years. Results: There was a statistically significant increase in hand hygiene compliance rates in 2016 versus 2015. The overall number of hand hygiene indications and compliance in 2015 and 2016 were 60071/78116-76,9% and 66551/83607-79,6% (p=0.0001), respectively. Nurses were the most compliant group in both years. The highest compliance was in after body fluid exposure indication (88.2%-2015 and 91.4%-2016) while the lowest compliance was in before patient contact indication (61.3%-2015 and 65%-2016). Conclusion: The presented data suggest that under unblinded observations, hand hygiene compliance seems to be in relatively acceptable rates in Turkey. Centers with compliance rates below 50 percentile rates in any of the 5 moments should increase efforts to enhance compliance in that indication.