Following the performance of a superovulation protocol, multiple nodules were observed bilaterally in the uterine horns of 31 of 276 (11.2%) C57BL/6 J female mice aged 8.5 ± 0.6 (mean and standard error of mean) weeks. These lesions prevented embryo collection, and the uterine decidual reaction was suspected. Samples of pathological uteri (n = 20) and the normal genital tracts of donors treated with a similar superovulation protocol (control group, n = 10) were collected. Immunohistochemistry was performed to evaluate pancytokeratin, desmin, vimentin, progesterone receptor (PR), estrogen receptor α (ERα), Ki-67, cyclin D3 and c-Myc expression, as well as quantitative polymerase chain reaction to assess cyclin D3, Hoxa-10 and heparin-binding epidermal growth factor-like growth factor (HB-EGF) mRNA expression. The uterine decidual reaction presented a high degree of structural organization and specifically affected the antimesometrial region of the endometrium. The abnormal decidual cells were large polygonal cells that were frequently polyploid or binucleated and strongly positive for desmin. Immunohistochemistry showed higher Ki-67 proliferation index and higher expression of PR and cyclin D3 in decidual cells in the antimesometrial aspect of the endometrium, compared to nondecidualized endometrial stromal cells in the mesometrial aspect of affected uteri, and compared to endometrial stromal cells in healthy uteri. High expression of cyclin D3 and Hoxa-10 mRNA was also observed in uteri affected by the decidual reaction. These results suggest that PR overexpression in endometrial stromal cells, likely due to high progesterone levels, triggers cyclin D3 and Hoxa-10 overexpression, which may be involved in the pathological mechanisms of the mouse uterine decidual reaction.

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Background Facility treatment guidelines for antibiotic choice and duration are a priority in the CDC Core Elements of hospital antimicrobial stewardship (AMS). Urinary tract infection (UTI) and community acquired pneumonia (CAP) are common pediatric diagnoses with potential for AMS impact in both inpatient and outpatient settings. We describe a project at a free-standing children’s hospital that was implemented through a collaboration of multidisciplinary providers who participated in the national Value in Inpatient Pediatrics (VIP) program. One aim of this project is to evaluate baseline and improve antibiotic duration for CAP and UTI. Methods This is a retrospective/prospective chart review study that compares baseline and post-intervention duration of antibiotic prescribing for UTI and CAP cases from July 2019-December 2021 based on data collected through the VIP program. Figure 1 describes the timeline of events and results. Patients included were identified by diagnosis code for CAP and UTI. Each case was randomized for inclusion and manually reviewed to ensure it met the diagnosis clinical definition. Cases with underlying chronic medical conditions were excluded from this analysis. Duration of antibiotics prescribed was compared for each group using Wilcoxon rank-sum testing. Figure 1.Timeline of guideline implementation and evaluation Results Among the 351 patients included, 163 had a diagnosis of CAP (98 pre-, 65 post- implementation); 188 with UTI (121 pre-, 67 post- implementation). Post Implementation, there was a significant decrease in median duration of antibiotic prescribing from 10 to 7 days in both groups (p< 0.001). Figure 2.Median duration of antibiotics pre and post program implementation (p<0.001) Conclusion Institutional implementation of guidelines is an important step in local AMS. Guideline implementation alone is not enough to ensure practice change and going beyond the CDC core elements has become important. In our case, participation in a national project with local multidisciplinary involvement was successful in improving duration of therapy for CAP and UTI not previously achieved by the local guidelines. Changes were made to the electronic medical record in the ED to ensure sustainability of this change. Disclosures All Authors: No reported disclosures.