A Single Site, Retrospective Chart Review of Renal Transplant Graft Failure and Mortality Rates Pre and Post COVID-19 Pandemic.

INTRODUCTION: Immunosuppressed patients are at an increased risk of complications from COVID-19. Despite the morbidity and mortality associated with COVID-19, there is little information regarding its effect on post-renal transplant patients. This study investigated the impact of a COVID-19 diagnosis on renal transplant recipients in terms of graft failure and mortality. METHODS: Renal transplant recipients were included if they had a functioning graft between March 2020 and March 2022. COVID-19 test results, duration from COVID-19 to graft failure and mortality, vaccination status, and COVID-19 treatment regimen were recorded and analyzed. RESULTS: There were 175 renal transplant recipients who met study criteria. Of these, 82 patients had documented COVID-19 cases, and 93 patients did not have a documented case. Of the patients who had a COVID-19 positive test, 3 experienced renal graft failure, and 15 experienced mortality. When comparing graft failure rate between the two groups, there was no significant difference. The mortality risk was significantly increased in COVID-19 positive patients (p=0.021). The COVID-19 immunization rate (at least one dose) was 82.5% for renal transplant recipients compared to 77.2% for all of South Dakota. CONCLUSIONS: There was no significant difference in renal graft failure rate between the two groups, but there was a significantly increased mortality risk in patients with COVID-19 positivity.

The Spontaneous Uterine Rupture in Labor: When to Expect the Unexpected.

Uterine rupture is a potentially life-threatening complication that is typically seen in pregnant females who have undergone prior uterine surgeries such as cesarean sections. This usually occurs when the uterine myometrium is weakened and thus is more prone to stress during labor. In an unscarred uterus, the incidence of uterine rupture is lower. Risk factors in the unscarred uterus include trauma, obstructed labor, high parity, placental abnormalities, operative deliveries, and imprudent use of uterotonic medications. This case report describes a situation in which uterine rupture occurred in the absence of the common risk factors. With prompt recognition of clinical signs, quick assembly of a team, and emergent interventions, this patient and her infant survived. The goal of this report is to educate clinicians on the occurrence of uterine rupture in an unscarred uterus and how to recognize and manage this complication.

Antibiotic Prescribing Practices in Group B Streptococcus Positive Obstetric Patients with Penicillin Allergy.

INTRODUCTION: Group B Streptococcus (GBS) positive patients with penicillin allergies receive intrapartum antibiotics for neonatal sepsis prophylaxis based on recommendations from the American College of Obstetricians and Gynecologists (ACOG). The objective of this study was to determine which antibiotics are used in GBS positive patients with documented penicillin allergies and evaluate for antibiotic stewardship improvements at a tertiary hospital in the Midwestern U.S. METHODS: Retrospective chart review identified GBS positive patients with and without penicillin allergies admitted to the labor and delivery floor. EMR-documented penicillin allergy severity, results of antibiotic susceptibility testing, and all antibiotics administered from admission to delivery were recorded. The study population was divided based on penicillin allergy status with antibiotic choice analyzed using Fisher's exact test. RESULTS: 406 GBS positive patients underwent labor between May 1, 2019, and April 30, 2020. Penicillin allergy was documented in 62 (15.3 percent) patients. Of these patients, cefazolin and vancomycin were prescribed most frequently for intrapartum neonatal sepsis prophylaxis. Antibiotic susceptibility testing was performed on the GBS isolate in 74.2 percent of the penicillin allergic patients. Between penicillin allergy and no penicillin allergy groups, the frequency of ampicillin, cefazolin, clindamycin, gentamicin, and vancomycin use showed statistical differences. CONCLUSION: The study results suggest that antibiotic choice for neonatal sepsis prophylaxis in GBS positive patients with penicillin allergy at a tertiary Midwestern hospital follows current ACOG guidelines. Cefazolin was used most frequently in this population followed by vancomycin and clindamycin. Our results identify room for improvement regarding regular antibiotic susceptibility testing in GBS positive patients with penicillin allergy.