BACKGROUND:Treatment of asymptomatic bacteriuria (ASB) is common. Overtreatment of ASB leads to harm, including adverse effects from antibiotics, antibiotic resistance, and increased length of stay. METHODS:This quality improvement initiative targeted inappropriate urine cultures across 11 hospitals in a safety-net setting. A mandatory prompt for appropriate indications for urine culture orders and a best practice advisory (BPA) for urine culture on patients with urinary catheters were created. Urine culture ordering was compared pre-intervention (6/2020 to 10/2021) to post-intervention (12/2021 to 8/2022). Catheter associated urinary tract infections (CAUTI) was compared pre- and post-intervention. Variation in urine culture ordering and CAUTI rates in hospitals were assessed. RESULTS:Inpatient urine cultures decreased by 20.9% (p<0.001). Inpatient urine cultures on patients with urinary catheters decreased by 21.6% (p<0.001). CAUTI rates remained unchanged post-intervention. High variation in urine culture ordering and CAUTI rates was seen among hospitals. CONCLUSIONS:This initiative successfully decreased urine cultures in a large, safety-net system. Further study is needed in assessing variation among hospitals.

Key Points Question Does COVID-19 convalescent plasma (CCP), compared with placebo, improve the clinical status of hospitalized patients with COVID-19 requiring noninvasive supplemental oxygen? Findings In this randomized clinical trial including 941 patients, based on the World Health Organization 11-point Ordinal Scale for Clinical Improvement, CCP did not benefit 468 participants randomized to CCP compared with 473 randomized to placebo from April 2020 to March 2021. However, in exploratory analyses, CCP appeared to benefit those enrolled from April to June 2020, the period when most participants received high-titer CCP and were not receiving remdesivir and corticosteroids at randomization. Meaning In this trial, CCP did not meet prespecified outcomes for efficacy, but high-titer CCP may have benefited hospitalized patients with COVID-19 early in the pandemic when other treatments were not in use, suggesting a heterogenous treatment effect over time.

We report the case of a 46-year-old male abattoir worker who developed myalgias, shortness of breath, and irritability 2 weeks after sustaining a laceration to the hand with a knife at work. During his hospital evaluation for septic shock he was noted to be febrile, hypotensive, profoundly jaundiced with aseptic meningitis, and renal failure, and was diagnosed with Leptospirosis interrogans infection confirmed by serum and urine polymerase chain reaction. After standard antibiotic therapy and recovery from severe clinical illness, he developed unilateral orchitis with pyuria secondary to leptospirosis, a well-established complication in the veterinary literature, but of which we offer the first report in humans in the English literature. The case presented was also the index case that uncovered a cluster outbreak of leptospirosis in New York City during the winter of 2016-2017, involving a total of three patients who lived or worked within a block of the abattoir. Two patients survived whereas the third died of pulmonary hemorrhage shortly after seeking medical care.