f Vancomycin-resistant enterococci (VRE) are a growing health problem, and uncertainties exist regarding the optimal therapy for bloodstream infection due to VRE. We conducted systematic comparative evaluations of the impact of different antimicrobial therapies on the outcomes of patients with bloodstream infections due to VRE. A retrospective study from January 2008 to October 2010 was conducted at Detroit Medical Center. Unique patients with blood cultures due to VRE were included and reviewed. Three major therapeutic classes were analyzed: daptomycin, linezolid, and ␤-lactams. Three multivariate models were conducted for each outcome, matching for a propensity score predicting the likelihood of receipt of one of the therapeutic classes. A total of 225 cases of bacteremia due to VRE were included, including 86 (38.2%) cases of VR Enterococcus faecalis and 139 (61.8%) of VR Enterococcus faecium. Bacteremia due to VR E. faecalis was more frequent among subjects treated with ␤-lactams than among those treated with daptomycin or linezolid. The median dose of daptomycin was 6 mg/kg of body weight (range, 6 to 12 mg/kg). After controlling for propensity score and bacteremia due to VR E. faecalis, differences in mortality were nonsignificant among the treatment groups. Therapy with daptomycin was associated with higher median variable direct cost per day than that for linezolid. This large study revealed the three therapeutic classes (daptomycin, linezolid, and ␤-lactams) are similarly efficacious in the treatment of bacteremia due to susceptible strains of VRE.

By this time, multiple vaccines have been approved to limit the spread of SARS-CoV-2 worldwide. These include new-generation vaccines that contain mRNA of the target organism. Some common side effects were identified and reported during phase 3 clinical trials of vaccination, but more rare adverse events were reported in the literature. One such concern is autoimmune conditions that SARS-CoV-2 viral antigens could have possibly incited. We are presenting here a case of a young female with no known autoimmune diseases, diagnosed with autoimmune hemolytic anemia about a week after receiving her first dose of the COVID-19 mRNA vaccine. We discuss the possible culprit for precipitation of autoimmune hemolytic anemia after the SARS-CoV-2 mRNA vaccine, which encodes virus spike protein. This case highlights the importance of being vigilant for identifying rare adverse events that could appear during mass vaccination.

Objective: To gain insights on the impact of fecal occult blood tests, we evaluated inpatients on whom these tests were performed.Patients and Methods: This single center, retrospective study was conducted at a large, academic, tertiary care center. Between Jan 1, 2016-Dec 31, 2017, inpatients who developed a drop in hemoglobin ≥2 grams/dL and had an FOBT were identified. Further data was extracted on a random selection of half of these patients. Patients were categorized as having an overt GI bleed (symptoms of melena, hematochezia, or hematemesis) or not.Results: Over the study period 6,310 patients developed a hemoglobin drop of ≥2 grams/dL. Of these 817 (12.9%) had an FOBT and we reviewed 407 (49.8%) randomly selected patients from this group. Those with missing FOBT results (n=13) were excluded, leaving 394 included in the final analysis. The mean age was 62.7 years with 211 females (53.7%). FOBTs were performed in 34.6% of patients despite the presence of overt GI bleeding. In patients without overt GI bleeding, the proportion of patients who underwent endoscopic procedures was higher in those with a positive FOBT than those with negative FOBT (40.4% vs 13.2%, p < .00001). There were no differences in rates of endoscopic evaluation in patients with overt GI bleeding based on FOBT results.Conclusions: FOBTs continue to be utilized in inpatient settings including in those presenting with overt GI bleeding. In the absence of overt GI bleeding, positive results may drive endoscopic evaluation.