Medical Mycology, 2022, Vol. 60, No. S1 237 P398 COVID-19-associated pulmonary aspergillosis: Species distribution and susceptibility profles Hamed Fakhim 1 , Afsane vaezi 2 , Elahe nasri 1 , Somayeh Sadeghi 3 , Mahsa Shelerangkon 1 , Mahnaz Hosseini Rizi 4 , Safyeh Ghafel 4 , Hamid Badali 5 , Hossein Mirhendi 4 1 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Isfahan, Iran 2 Department of Medical Laboratory Science, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran, Tehran, Iran 3 Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, Isfahan, Iran 4 Research Core Facility Lab, Isfahan University of Medical Sciences, Isfahan, Iran, Isfahan, Isfahan 5 Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA, San Antonio, Texas, USA Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objectives: This study aimed to investigate the species distribution and susceptibility profles of Aspergillus species isolated from patients admitted to the intensive care unit with severe COVID-19 in Isfahan, Iran, between April 2021 and March 2022. Methods: This retrospective study included intubated patients with COVID-19 in three referral COVID-19 hospitals. Tracheal aspirate (TA) samples were taken from 267 patients to investigate pulmonary co-infections. COVID-19-associated aspergillosis (CAPA) was defned according to the 2020 European Confederation of Medical Mycology/International Society of Human and Animal Mycosis consensus criteria. Aspergillus species obtained from samples were characterized based on conventional and molecular assays. In vitro antifungal susceptibility testing was performed on the obtained isolates according to the guidelines from the Clinical and Laboratory Standards Institute. Results: The mean age of the patients was 61.73 ± 12.69 years. The mean length of hospitalization and admission in ICU were 18.77 ± 12.94 and 13.51 ± 9.83 days, respectively. A total of 61 (22.9%) patients presented with a single cavity lesion. Pulmonary artery pseudoaneurysm was seen in seven patients and post-COVID-19 changes were seen in all patients. Based on the conventional and molecular techniques, 72 isolates of Aspergillus species (26.9%), including A. favus (10.1%%), A. fumigatus (8.6%%), A. niger (3.3%), A. tubingensis (2.9%), A. terreus (1.1%), A. luchuensis (0.37%) A. quadrillineatus, and (0.37%), were obtained from 267 patients. MIC results showed that all Aspergillus species were susceptible to all tested antifungal drugs. Conclusion: Access to priority clinical groups, improving the care of patients with simultaneous pulmonary aspergillosis with COVID-19, and identifying Aspergillus species are essential steps in the care cascade to manage those affected by them. P399 Diagnostic value of Candida coloni zation index and serum Candida mannan antigen for candidemia in febrile episodes of pediatric lymphoreticular malignancies Suchita Gautam 1 , Shukla Das 1 , Rumpa Saha 1 , N. P. Singh 1 , Sunil Gomber 3 , Gargi Rai 2 , Praveen Singh 1 1 Department of Microbiology, University College of Medical Sciences (University of Delhi), & Guru Teg Bahadur Hospital, Delhi, India 2 Multi-Disciplinary Research Unit, University College of Medical Sciences (University of Delhi), & Guru Teg Bahadur Hospital, Delhi, India 3 Department of Pediatrics, Delhi, India Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objective: To evaluate the diagnostic performance of Candida colonization index and serum Candida mannan antigen predicting candidemia in febrile episodes of pediatric lymphoreticular malignancies Methods: It was a prospective observational study done for 18 months, from November 2018 to April 2020 at the pediatric oncology unit of a multispecialty tertiary care center. Based on our patient load, duration of the proposed study, and available resources, a sample size of 49 (n = 49) was decided and 100 febrile episodes in children with lymphoreticular malignancy were studied. Children below 12 years, receiving chemotherapy for hematological malignancy having oral or axillary temperature ˃38.3 ° C for ˃1 h were included in this study. Children receiving the antifungal treatment in last 7 days were excluded from the study. Blood collected on day1 and day4 was cultured in BACTEC-9120. For colonization, swabs and samples were collected and cultured on SDA on day1, day4, and day8. All Candida isolates were subcultured on SDA and subjected to Gram’s stain, germ tube test followed by Microscan identifcation. DNA sequencing followed by phylogenetic analysis was done for all the isolates of Candida recovered from blood. Antifungal susceptibility of yeast stains was done. Serum collected on day1 was used for C. mannan antigen detection using ELISA system. Results: Prevalence of candidemia was 5%. Non-albicans Candida spp were isolated from blood cultures on day 4. Candida colonization decreased from day1 to day8. Colonization index (CI) day1 showed 80% sensitivity 98.9% specifcity, and 98.9% negative predictive value. Signifcant colonization (CI ≥0.5) was seen in a larger proportion of cases that developed candidemia. There was a signifcant association of Candida colonization (CI ≥0.5) with occurrence of candidemia on day1 and day4. A total of 4 (80%) of candidemia episodes were positive for serum mannan antigen while 1 (20%) was negative. Mannan antigen was detected earlier with 80% sensitivity, 92.6% specifcity, and 98.9% negative predictive value. All Candida isolates were sensitive to fuconazole, amphotericin-B, and caspofungin. Receiver operator characteristic curves for diagnostic performance of various parameters in predicting candidemia show the following trends: • Best parameter in terms of AUROC is the CI (Day 1). • Best parameters in terms of sensitivity are the CI (Day 1), CI (Day 4), and mannan antigen level. • Best parameter in terms of specifcity is the CI (Day 8). • Best parameter in terms of positive predictive value is the CI (Day 1). • Best parameters in terms of negative predictive value are the CI (Day 1), CI (Day 4), and mannan antigen level. • Best parameters in terms of diagnostic accuracy are the CI (Day 1), CI (Day 8). Conclusion: The CI can predict candidemia but the threshold value needs to be explored in pediatric patients with lym- phoreticular malignancies. Mannan antigen detection gives early results with a high negative predictive value. Downloaded from https://academic.oup.com/mmy/article/60/Supplement_1/myac072P399/6706157 by guest on 01 October 2022