Objective To assess the extent of antimicrobial stewardship programs (ASPs) at solid organ (SOT) and hematopoietic cell transplant (HCT) centers in the United States (US). Design An 18-item voluntary survey was developed by Memorial Sloan Kettering Cancer Center and University of Miami to gauge current antimicrobial stewardship practices in transplant patients, examine the availability and perceived usefulness of novel diagnostics and azole levels to guide therapy, and identify challenges for implementation of ASPs at these centers. Participants The survey was distributed electronically to Infectious Disease physicians and pharmacists at adult and pediatric SOT and HCT centers during May 1–22, 2015. Facilities were de-identified. Results After duplicate removal, 71 (56%) of 127 unique transplant centers in 32 states were analyzed. Forty-four sites (62%) performed ≥ 100 SOT annually, and forty (56%) performed ≥100 HCT annually. Top five stewardship activities encompassing transplant patients included formulary restriction, guideline development, prospective audit & feedback, education, and dose optimization. Respiratory viral panels (100%), azole levels (97%), and serum/BAL galactomannan (88%) were perceived as most useful to guide therapy. Apparent challenges to antimicrobial stewardship included: undefined duration for certain infections (90%), diagnostic uncertainty (80%), the perception that antibiotic-resistant infections required escalation (71%), prescriber opposition (69%), and costly drugs (63%). Conclusions ASP activities were performed at many adult and pediatric SOT and HCT centers in the US. Diagnostic and therapeutic uncertainty in transplant patients are challenging for ASPs. Collaborative research to examine the impact of antimicrobial stewardship practices in SOT and HCT should be explored.

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Objective To assess the outcome of cochlear implantation in children with Autism Spectrum Disorder Study Design Retrospective case review and survey Setting Tertiary referral center Patients Children who meet criteria for cochlear implantation and diagnosis of Autism Spectrum Disorder Main Outcome Measures Receptive and expressive language scores and parental survey data. Results 15 patients with history of ASD and cochlear implantation were analyzed and compared to 15 patients who received cochlear implant and have no other disability. Post-operatively, more than 67% of children with ASD significantly improved their speech perception skills and 60% significantly improved their speech expression skills while all patients in the control group showed significant improvement in both aspects. The top three reported improvements after cochlear implantation were name recognition, response to verbal requests, and enjoyment of music. Of all behavioral aspects, the use of eye contact was the least improved. Survey results in regards to improvements in patient interaction were more subtle when compared to those related to sound and speech perception. The most improved aspects in the ASD patients’ lives after cochlear implantation appeared to be attending to other people’s requests and conforming to family routines. Of note, awareness of the child’s environment is the most highly ranked improvement attributed to the cochlear implant. Conclusions Cochlear implants are effective and beneficial for hearing impaired members of the ASD population even though development of language may lag behind that of implanted children with no additional disabilities. Significant speech perception and overall behavior improvement are noted.