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Many countries have observed an increase in the incidence of invasive fungal infections (IFIs) over the past two decades with emergence of new risk factors and isolation of new fungal pathogens. Early diagnosis and appropriate antifungal treatment remain the cornerstones of successful outcomes. However, due to non-specific clinical presentations and limited availability of rapid diagnostic tests, in more than half of cases antifungal treatment is inappropriate. As a result, the emergence of antifungal resistance both in yeasts and mycelial fungi is becoming increasingly common. The Delhi Chapter of the Indian Association of Medical Microbiologists (IAMM-DC) organized a 1 day workshop in collaboration with BSAC on 10 December 2015 in New Delhi to design a road map towards the development of a robust antifungal stewardship programme in the context of conditions in India. The workshop aimed at developing a road map for optimizing better outcomes in patients with IFIs while minimizing unintended consequences of antifungal use, ultimately leading to reduced healthcare costs and prevention development of resistance to antifungals. The workshop was a conclave of all stakeholders, eminent experts from India and the UK, including clinical microbiologists, critical care specialists and infectious disease physicians. Various issues in managing IFIs were discussed, including epidemiology, diagnostic and therapeutic algorithms in different healthcare settings. At the end of the deliberations, a consensus opinion and key messages were formulated, outlining a step-by-step approach to tackling the growing incidence of IFIs and antifungal resistance, particularly in the Indian scenario. [ABSTRACT FROM AUTHOR]

Background Infections with carbapenem-resistant organisms (CRO) are increasing worldwide and are associated with high mortality. Patients transferred from outside hospitals have been reported to be at increased risk of CRO colonization and infection. The rate of subsequent CRO infection in patients colonized with CRO is unclear in a high CRO burden setting Methods Medanta Hospital in Gurgaon, India instituted CRO colonization screening for patients transferred from outside hospitals for infection control purposes. From April 2018 to May 2018, patients transferred from other hospitals to the intensive care unit at Medanta were subjected to CRO colonization screening using Xpert Carba R (Cepheid) performed on the day of transfer. Subsequent recovery of CRO in cultures of blood, bronchoalveolar lavage fluid, urine in specimens with pyuria obtained from patients without urinary catheters, pus, and tissue were considered to be indicative of CRO infection. The association of CRO colonization with subsequent CRO infection was assessed with a Fisher exact test Results Among 457 patients screened, 205 patients (45%) were found to be colonized with CRO at admission. Genes for New Delhi Metallo-β-lactamase (NDM) were detected in 184 (40%) patients, OXA-48 in 97 (21%) patients, VIM in 18 (4%) patients, KPC in 5 (1%) patients, and IMP1 in 5 (1%) patients; >1 carbapenemase gene was detected in 95 (21%) patients. CRO infections were observed in 25 (5%) patients including 12 with bacteremia, 7 with pneumonia, 4 with urinary tract infection, and 2 with soft-tissue infection. Among patients with CRO colonization, 17 (8%) patients developed CRO infection during the course of hospitalization; among patients without admission CRO colonization, subsequent CRO infection was found in 8 (3%) patients. CRO admission colonization was associated with subsequent clinical infection with CRO (odds ratio = 2.8, P = 0.02) Conclusion CRO colonization was found in almost half of patients transferred from outside hospitals to a large tertiary care hospital in India and was associated with subsequent CRO infection. Further work is necessary to understand the role of CRO colonization screening in infection control and antimicrobial stewardship in a setting with high CRO burden Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]