Impact of Urine Culture Reflex Policy Implementation in a Large County Hospital Inpatient Rehabilitation Unit - A Pilot Study.

OBJECTIVE: To promote antimicrobial stewardship, many institutions have implemented a policy of reflexing to a urine culture based on a positive urinalysis result. The rehab patient population, including individuals with brain and spinal cord injuries, may have atypical presentations of UTIs. The study objective is to determine the effects of implementing a urine culture reflex policy in this specific patient population. DESIGN: In an inpatient rehabilitation unit, 348 urinalyses were analyzed from August 2019 to June 2021. Urinalysis with greater than or equal to ten white blood cells per high power field (WBC/HPF) was automatically reflexed to a urine culture in this prospective study. Primary outcome was return to acute care related to urinary tract infection. Secondary outcomes included adherence to reflex protocol, antibiotic utilization and appropriateness, adverse outcomes related to antibiotic use, and reduction in urine cultures processed and the associated reduction in healthcare costs. RESULTS: There was no statistically significant difference pre- and post-intervention related to the primary outcome. Urine cultures processed were reduced by 58% post-intervention. CONCLUSIONS: Urine culture reflex policy is likely an effective intervention to reduce the frequency of urine cultures without significantly affecting the need to transfer patients from inpatient rehab back to the acute care setting.

Anaphylaxis Due to Remdesivir.

In December 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first detected in Wuhan, China and found to cause acute respiratory symptoms and pneumonia.1….

Bartonella quintana Infection Manifesting as Leucocytoclastic Vasculitis Rash.

We present the first case described in the literature of leucocytoclastic vasculitis due to Bartonella quintana infection. A 73-year-old woman presented to the hospital with persistent fevers, retro-orbital headache, generalized weakness, and left lower thigh pain for 1 week. She was found to have truncal and proximal lower extremity papules and small plaques. Serology revealed Bartonella quintana immunoglobulin M (IgM) titer of 1:256 with undetectable Bartonella quintana immunoglobulin G (IgG) and undetectable Bartonella henselae IgG and IgM. Skin biopsy of an abdominal lesion revealed fibrinoid necrosis of vessel walls in the superficial and mid-dermis consistent with leucocytoclastic vasculitis. Doxycycline 100 mg orally twice daily was initiated, after which she had defervescence within 36 hours and rapid improvement of other presenting symptoms.