Febrile neutropenia (FN) is a common serious complication in patients undergoing hematopoietic stem cell transplantation (HSCT) requiring urgent evaluation and initiation of empiric broad spectrum antibiotics (BSA). The appropriate duration of BSA for FN in patients with negative cultures and no identifiable infection remains undefined. We retrospectively analyzed allogenic and autologous HSCT patients with FN and negative infectious work-up at our facility from 2012 to 2018. The early deescalation group (EDG) included those who had BSA de-escalation to fluoroquinolone prophylaxis at least 24 h prior to absolute neutrophil count (ANC) recovery after the patient was fever-free for at least 48 h. Among 297 patients undergoing their first HSCT who experienced FN with negative infectious work-up, 83 patients were de-escalated early with the remaining 214 in the standard of care group (SCG) whose BSA were continued until ANC was > 500. Duration of broad-spectrum antibiotics was shorter in EDG compared to SCG (3.86 days vs. 4.62 days, p = 0.03). Rates of mortality, new infections, and clinical decompensation requiring intensive care unit transfer and/or pressor use within 30 days were all similar between the two groups (0% vs. 0.4% p = 1.00, 0% vs. 1.4% p = 0.56, 13.2% vs. 8.4% p = 0.27). This indicates that it is safe to de-escalate antibiotics prior to ANC recovery, leading to less BSA exposure.

External urinary collection devices (EUCDs) may reduce indwelling catheter usage and catheter-associated urinary tract infections (CAUTIs). In this retrospective quasi-experimental study, we demonstrated that EUCD implementation in women was associated with significantly decreased indwelling catheter usage and a trend (P = .10) toward decreased CAUTI per 1,000 patient days.

Background Measles outbreaks have become increasingly common due to deteriorating vaccination rates, fluctuating herd immunity, and varying antibody decline. Limited knowledge exists regarding prevalence and risk factors associated with measles seronegativity among persons with HIV (PWH). Materials/methods This was a cross-sectional study conducted at an academic HIV clinic in Omaha, Nebraska. Participants were screened for the presence of measles IgG antibody. Demographic and clinical information was obtained through electronic medical record review. Simple and multivariable logistic regressions were performed to identify risk factors for measles seronegativity. Results 351 participants were enrolled with a measles seroprevalence rate of 70.3%. Mean age was 48 years (range 20 to 74), 77% were male and 53% Caucasian. Mean CD4 nadir was 334 cells/mm3 (range 1 to 1675). At the time of testing, 86% and 87% of the seronegative and seropositive participants had an HIV RNA &50 copies/mL, respectively. Younger age was significantly associated with measles seronegativity (p=0.003) as was birth year after 1957 (p=0.021). Prior history of measles infection was associated with seropositivity (p=0.011). All other risk factors evaluated, including written documentation of adequate vaccination, were not associated with seronegativity. Conclusions Our study demonstrates a measles seroprevalence rate that is remarkably lower than previously reported in PWH (92%), and, more importantly, is considerably lower than the rate needed to maintain herd immunity (95%). With higher than expected seronegativity and absence of notable risk factors aside from age, our findings support expanded measles immunity screening for PWH who are at risk of measles exposure.

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As the Coronavirus disease 2019 continues to circulate, testing strategies are of the utmost importance. Given national shortages of testing supplies, personal protective equipment, and other hospital resources, diagnostic stewardship is necessary to aid in resource management. We report the low utility of serial testing in a low prevalence setting.