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Background Candidemia leads to high morbidity and mortality especially in premature neonates from developing countries. We studied the spectrum and risk factors of candidemia in neonates with early onset disease (EOD) or late onset disease (LOD) which has not been extensively investigated in Pakistan. We also determined whether vaginal delivery is associated with candidemia in neonates with EOD. Methods A case control study was conducted at the Aga Khan University, Karachi, Pakistan. Cases (neonates with EOD) and controls (neonates with LOD) were identified from laboratory database for year 2014-2018, and for 2019 data was collected prospectively from laboratory during routine reporting of cultures at which time clinical information was gathered from the patient’s physician/guardian. Study was conducted after obtaining exemption from the ethical review committee. Results A total of 669 neonates with IC were identified, out of these 162 neonates had EOD while 507 had LOD. Chart 1 shows the year wise distribution and frequency of different C. species. Mean age of neonates with EOD and LOD was 1.7 and 12.2 days respectively. LOD in neonates was more likely to occur in male patients (COR 2.5, 95% CI 0.6-9.9) was and associated with use of carbapenems (COR 5.1, 95% CI 1.4-17.8). However, LOD had no correlation with non-C. albicans Candida sepsis (COR 0.6, 95% CI 0.1-6.3) as causative agent. EOD was more likely in patients delivered via vaginal delivery (COR 11.3, 95% CI 2.6-48.5). Chart 1: Year wise distribution of Candida species in neonates with candidemia from 2014-2019 Conclusion The trends for isolation of C. species in neonates showed a trend with C. tropicalis being more common C. species during the recent years. With the infrequent isolation of C. glabrata and C. krusei among other Candida species in this study, fluconazole may be considered a good empiric choice for neonates with suspected fungal sepsis. Disclosures All Authors: No reported disclosures

1181. Spectrum and Risk Factors of Early Onset versus Late Onset Neonatal Candidemia from Pakistan