A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated. The participants (N = 90) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago, Chile. The program was carried out by volunteer community health monitors and evaluated through an experimental, randomized, controlled clinical trial. Cost-effectiveness was examined in comparison with standard health care. Results show higher scores for the intervention group on the mothers' mental health and nutritional state, as well as on the children's levels of linguistic development.

Guidance regarding indications for initial or follow-up blood cultures is limited. We conducted a scoping review of articles published between January 2004 and June 2019 that reported the yield of blood cultures and/or their impact in the clinical management of fever and common infectious syndromes in nonneutropenic adult inpatients. A total of 2893 articles were screened; 50 were included. Based on the reported incidence of bacteremia, syndromes were categorized into low, moderate, and high pretest probability of bacteremia. Routine blood cultures are recommended in syndromes with a high likelihood of bacteremia (eg, endovascular infections) and those with moderate likelihood when cultures from the primary source of infection are unavailable or when prompt initiation of antibiotics is needed prior to obtaining primary source cultures. In syndromes where blood cultures are low-yield, blood cultures can be considered for patients at risk of adverse events if a bacteremia is missed (eg, patient with pacemaker and severe purulent cellulitis). If a patient has adequate source control and risk factors or concern for endovascular infection are not present, most streptococci or Enterobacterales bacteremias do not require routine follow-up blood cultures.

Background: Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. Methods: Before-after study evaluating the impact of a diagnostic stewardship program to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCx ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx and positive BCx. Balancing metrics included compliance with Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. Results: After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PD) in the MICU (P=0.001) and from 10.9 to 7.7BCx/100 PD for the 5 medicine units combined (P<0.001). BCx rates in the control units did not decrease significantly (surgical ICU, P=0.06, surgical units, P=0.15). The proportion of inappropriate BCx did not significantly change with the intervention (30% in the MICU and 50% in medicine units, respectively). BCx positivity increased in the MICU (from 8% to 11%, P<0.001). Solitary BCx decreased by 21% on the medicine units (P<0.001). Balancing metrics were similar before and after the intervention. Conclusions: BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.