Evaluation of venous thromboembolism prophylaxis protocol in hematopoietic cell transplant patients.

Hematopoietic cell transplant (HCT) recipients are at risk for thromboembolic and bleeding complications. There is limited evidence regarding the optimal approach to managing venous thromboembolism (VTE) prophylaxis in hospitalized patients undergoing HCT. In this retrospective cohort study, we evaluated the incidence of bleeding and VTE events in hospitalized HCT patients who received VTE prophylaxis per our institution's VTE Prophylaxis Protocol (VPP), with either enoxaparin 40 mg subcutaneously daily or heparin 5 000 units subcutaneously twice daily, compared to historical controls who did not receive VTE prophylaxis. The primary outcome was a composite of major bleeding events, clinically relevant non-major bleeding (CRNMB), and minor bleeding. The secondary outcome was a composite of VTE events. A total of 614 patients were evaluated, including 278 prior to and 336 after implementation of VPP. VTE prophylaxis resulted in no difference in bleeding events (15.1% in the pre-VPP group vs. 14.6% in the post-VPP group, p = 0.86) or composite of major and CRNMB events (0.72% vs. 0.30%, p = 0.59). There was a trend toward lower incidence of VTE events in the post-VPP group which did not reach statistical significance (8.6% vs. 6.0%, p = 0.20). We conclude that VTE prophylaxis does not pose additional bleeding risk in HCT patients.

Reductions in vancomycin and meropenem following the implementation of a febrile neutropenia management algorithm in hospitalized adults: An interrupted time series analysis.

OBJECTIVE: To evaluate broad-spectrum intravenous antibiotic use before and after the implementation of a revised febrile neutropenia management algorithm in a population of adults with hematologic malignancies. DESIGN: Quasi-experimental study. SETTING AND POPULATION: Patients admitted between 2014 and 2018 to the Adult Malignant Hematology service of an acute-care hospital in the United States. METHODS: Aggregate data for adult malignant hematology service were obtained for population-level antibiotic use: days of therapy (DOT), C. difficile infections, bacterial bloodstream infections, intensive care unit (ICU) length of stay, and in-hospital mortality. All rates are reported per 1,000 patient days before the implementation of an febrile neutropenia management algorithm (July 2014-May 2016) and after the intervention (June 2016-December 2018). These data were compared using interrupted time series analysis. RESULTS: In total, 2,014 patients comprised 6,788 encounters and 89,612 patient days during the study period. Broad-spectrum intravenous (IV) antibiotic use decreased by 5.7% with immediate reductions in meropenem and vancomycin use by 22 (P = .02) and 15 (P = .001) DOT per 1,000 patient days, respectively. Bacterial bloodstream infection rates significantly increased following algorithm implementation. No differences were observed in the use of other antibiotics or safety outcomes including C. difficile infection, ICU length of stay, and in-hospital mortality. CONCLUSIONS: Reductions in vancomycin and meropenem were observed following the implementation of a more stringent febrile neutropenia management algorithm, without evidence of adverse outcomes. Successful implementation occurred through a collaborative effort and continues to be a core reinforcement strategy at our institution. Future studies evaluating patient-level data may identify further stewardship opportunities in this population.

Identification of genes encoding atypical odorant-binding proteins in Aedes albopictus (Diptera: Culicidae).

Insect odorant-binding proteins (OBPs) are a diverse gene family that encode proteins thought to function as molecular chaperones by binding semiochemicals and transporting them through the aqueous lymph of insect sensilla. Between 66 and 68 genes have been classified as OBPs in both Anopheles gambiae (Giles) and Aedes aegypti L. based on bioninformatics criteria. We have cloned and sequenced from a subtracted cDNA library three OBPs in Aedes albopcitus (Skuse). BLASTP and phylogenetic analysis of deduced amino acid sequences identified a unique putative ortholog in Ae. aegypti for each Ae. albopictus OBP. Comparison of these putative Ae. aegypti orthologs with the results of previous bioinformatics analyses of OBP genes in Ae. aegypti highlight the potential variability of bioinformatics analyses and suggest that the OBP gene family of Culicids is even more diverse than previously described. Alignment of deduced amino acid sequences and phylogenetic analysis identified the N-terminal region of Culicid OBPs that is associated with aedine-specific diversification. Analysis of tissue-specific expression indicates that two of the Ae. albopictus OBPs are expressed both in preadult stages and in the hemolymph of adults, suggesting that the proteins encoded by these genes may be involved in the transport of hydrophobic ligands in the hemolymph. The other Ae. albopictus OBP is expressed exclusively in antennae and leg, suggesting a chemosensory function. These results are discussed within the context of the evolution and functional diversification of OBPs in mosquitoes.