Several indices are available to predict poor outcomes in older patients admitted to the emergency department (ED); however, there remains a need for more practical, sensitive, and easily applicable tools. This study aimed to develop a novel prognostic index to predict the risk of disability, hospitalization, and mortality in older patients presenting to the ED. This study included 356 patients aged 65 and older presenting to the ED. Exclusion criteria were: poor general condition preventing response to questions, low level of consciousness (GCS <15), inability to provide informed consent, and lack of prospective follow-up. The G8 scale, PRISMA-7 questionnaire, Katz Activities of Daily Living Questionnaire (ADL) scale, and Charlson Comorbidity Index were administered. Follow-up assessments were conducted via telephone on the 30th and 180th days post-application, using the Katz ADL scale. Patients or their relatives were also queried about repeated outpatient clinic visits, emergency admissions, hospitalizations, nursing home admissions, and survival status. Parameters significantly associated with adverse outcomes in univariate analysis were further analyzed using multivariate regression, resulting in the development of the GAZI Index. This new index includes six simple parameters independently associated with adverse outcomes. The predictive performance of the GAZI Index was compared to that of the PRISMA-7, a validated tool in the ED. The GAZI Index demonstrated significantly superior predictive ability for poor outcomes compared to the PRISMA-7 (p = 0.008). The GAZI Index is a novel, valid, and practical tool for predicting adverse outcomes in older patients presenting to the ED.

Charlson comorbidity index and palliative performance scale predict prognosis in dialysis patients: a retrospective cohort study.

This study examined whether different levels of cognitive impairment influence postural control (PC) in physically independent older women, using complementary time domain and time-frequency analyses. Understanding these associations may help identify early markers of cognitive vulnerability and guide preventive strategies aimed at reducing fall risk in aging. A cross-sectional sample of 129 women aged ≥ 60 years (mean age 69), physically independent and not engaged in structured exercise for at least three months, was categorized into three groups according to Montreal Cognitive Assessment (MoCA) scores: normal cognition (NC), mild cognitive impairment (MCI), and advanced cognitive impairment (ACI). PC was assessed through time domain variables, mean sway velocity (anteroposterior and mediolateral) and the area of the center of pressure (A-COP), and through time-frequency parameters categorized into low (0.05-0.5Hz; visual-vestibular contribution), medium (0.5-1.5Hz; cerebellar modulation), and high (1.5-10Hz; proprioceptive contribution) frequency bands. Confirmatory analyses for the primary conditions (BSEO and BIUS) were performed using ANCOVA adjusted for age, body mass index (BMI), Charlson Comorbidity Index (CCI), and Falls Efficacy Scale (FES) scores. Exploratory outcomes were analyzed with one-way ANOVA, followed by Sidak-adjusted post hoc tests. Effect sizes were estimated using partial eta squared. Time domain analyses showed that women with better cognitive performance demonstrated better postural control, reflected by lower sway velocity, particularly in the BSEO and BIUS conditions. Exploratory analyses also identified group differences in the BIVR condition. Although the time-frequency analyses did not reveal statistically significant differences between groups, the descriptive patterns suggested that lower-frequency components were more evident during less demanding tasks, whereas medium and high frequency components appeared more prominent in more challenging conditions. Effect-size estimates supported the clinical relevance of time domain differences between cognitive groups. Cognitive status influences postural control in physically independent older women. Time domain measures, particularly sway velocity, were sensitive to poorer balance among those with cognitive impairment, while time-frequency parameters did not differentiate cognitive groups. These findings highlight the importance of incorporating cognitive screening into balance assessment and fall-prevention strategies in aging populations.

Gallstone formation is a potential long-term complication of gastrectomies. However, data on symptomatic gallstone disease after gastrectomy for gastric cancer are limited. This nationwide population-based study aimed to determine the incidence and risk factors of symptomatic gallstone disease requiring invasive intervention. This nationwide cohort study was based on claims data from the Korean National Health Insurance Service Database. The study included 90456 patients who underwent gastrectomy for gastric cancer between 2007 and 2020 after excluding individuals with prior gallbladder disease, liver dysfunction, or ursodeoxycholic acid use. The primary outcome was symptomatic gallstone disease that required invasive intervention (cholecystectomy or endoscopic/percutaneous biliary procedures). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards analysis. During a mean follow-up of 7.5years, 6465 patients (7.1%) developed symptomatic gallstone disease requiring invasive intervention, with 5-year and 10-year cumulative incidences of 4.9% and 8.9%, respectively. Independent risk factors included age 60-79years (HR 1.49, 95% CI 1.25-1.78) and ≥ 80years (HR 2.10, 95% CI 1.69-2.61), body mass index ≥ 25 kg/m2 (HR 1.25, 95% CI 1.19-1.32), hypertension (HR 1.10, 95% CI 1.04-1.16), diabetes mellitus (HR 1.10, 95% CI 1.04-1.17), Charlson Comorbidity Index ≥ 6 (HR 1.32, 95% CI 1.23-1.43), total gastrectomy (HR 1.80, 95% CI 1.70-1.90), and adjuvant chemotherapy (HR 2.11, 95% CI 1.98-2.24). Female sex (HR 0.76, 95% CI 0.71-0.82), pylorus-preserving gastrectomy (HR 0.47, 95% CI 0.33-0.67), and laparoscopic surgery (HR 0.85, 95% CI 0.81-0.90) were protective. Symptomatic gallstone disease requiring invasive intervention occurred in 7.1% of the patients after gastrectomy for gastric cancer, representing a substantial increase compared to the general population. Pylorus-preserving gastrectomy and laparoscopic surgery were associated with a lower risk, suggesting that the surgical approach may influence the long-term gallstone risk.

BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty (pTHA). However, the literature demonstrates significant variability regarding the relative contributions of different factors. AIM To investigate the key determinants of aseptic loosening, we performed a systematic review and meta-analysis. METHODS A comprehensive search of PubMed, Web of Science, EMBASE, and the Cochrane Library was conducted, encompassing studies from database inception to January 1, 2025. Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA. Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility. Study quality was assessed using standardized categories. Pooled odds ratio (OR) with corresponding 95% confidence interval were calculated with random- or fixed-effects models to generate reliability estimates, and study heterogeneity was visualized using forest plots. Ten factors, categorized into patient-, surgeon-, and device-related domains, were reviewed and meta-analyzed. Funnel plot analysis demonstrated a relatively symmetrical distribution, suggesting minimal publication bias. RESULTS A meta-analysis of 20 studies (520789 participants) found a pooled prevalence of 1.96%. Significant risk factors for aseptic loosening after pTHA included elevated body mass index (OR = 1.116, P &lt; 0.001), higher Charlson comorbidity index (OR = 1.378, P &lt; 0.001), prosthesis-related factors (OR = 1.497, P &lt; 0.001), and adverse lifestyles (OR = 2.198, P = 0.037). Protective factors were non-white race (OR = 0.445, P &lt; 0.001) and favorable genetics (OR = 0.723, P &lt; 0.001). Male sex increased risk (OR = 1.232, P = 0.016), while age and anatomy were not significant. Surgical expertise showed a slight protective effect (OR = 1.048, P &lt; 0.001). A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors, surgical expertise, and prosthesis characteristics. CONCLUSION The identification of these factors is critical for risk mitigation. High-risk patients should receive targeted counseling regarding individualized profiles. Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.

Background and Objectives: This study aimed to comparatively evaluate the association of commonly used comorbidity scores with survival, mortality, and recurrence in ovarian cancer patients aged 50 years and above. Materials and Methods: In this single-center, retrospective study, 130 female patients diagnosed between 2017 and 2024 who had received systemic therapy and had complete medical records were included. Comorbidity scores—including the Charlson Comorbidity Index (CCI), Cumulative Illness Rating Scale-Geriatric (CIRS-G), Adult Comorbidity Evaluation-27 (ACE-27), Elixhauser Comorbidity Index, Index of Coexistent Disease (ICED), and Functional Comorbidity Index (FCI)—were calculated for each patient. Survival analyses were conducted using the Kaplan–Meier method and Cox regression modeling. The prognostic accuracy of comorbidity scores was assessed via receiver operating characteristic (ROC) curve analysis. Results: Patients with higher CCI scores had significantly shorter survival, and CCI was identified as an independent prognostic factor in multivariate analysis. While other comorbidity scores were associated with overall survival in univariate analyses, they lost statistical significance in multivariate models. Patients with a higher comorbidity burden experienced more frequent disease recurrence and shorter time to recurrence. Conclusions: Comorbidity burden is a key clinical determinant of survival and disease trajectory in older patients with ovarian cancer. The CCI demonstrated the highest prognostic accuracy in this population and may serve as a valuable tool in individualized treatment planning. Integration of comorbidity-based assessments into standard decision-making processes is recommended in geriatric oncology practice.

BackgroundOutcomes of patients with acute pyelonephritis (AP) treated in a hospital-at-home setting have not been comprehensively evaluated in the United States.MethodsWe performed a multicenter, retrospective cohort study of adults diagnosed with and managed for AP in Mayo Clinic's Advanced Care at Home (ACH) program between July 2020 and January 2025. Collected data included demographics, Charlson Comorbidity Index (CCI), genitourinary comorbidities, severity of illness (SOI), and risk of mortality (ROM) scores, as well as pyelonephritis-related complications. Outcomes included length of stay (LOS), escalation of care, and 30-day postdischarge emergency department (ED) visits, readmissions, and mortality.ResultsA total of 165 patients met inclusion criteria. Median age was 67 years; SOI scores were moderate in 33.3%, major in 52.1%, and extreme in 8.5%. ROM scores were moderate in 30.3%, major in 38.2%, and extreme in 6.7%. Median CCI score was 5, and all patients had preexisting genitourinary conditions. On admission, 30.9% met sepsis criteria, acute kidney injury was present in 47.3%, and bacteremia developed in 33.3%. Median LOS in the ACH program was 3.1 days. Only 4.8% required escalation to a brick-and-mortar hospital. Readmission occurred in 17.0%, and 4.8% had ED visits. No in-program deaths occurred.ConclusionsThis multicenter retrospective study shows that AP, including cases with high illness severity and complex comorbidities, can be managed safely and effectively in a hospital-at-home setting with careful patient selection and robust infrastructure to support timely escalation when needed.

Suicide attempts and associated factors in patients with dementia: A 7-year population-based cohort study in Taiwan.

Previous studies suggest that critically injured patients are at increased risk of suicide following discharge, but these have mainly been single-center studies or had limited data on comorbidities and socioeconomic factors. To examine the risk of suicide after hospitalization for traumatic injuries. This nationwide register-based cohort study used data from 5 Norwegian nationwide health registries and Statistics Norway between 2014 and 2020. Patients registered in the Norwegian Trauma Registry (NTR) for whom trauma team activation at hospital arrival was mandated by national guidelines between 2015 and 2018 were matched to general-population controls on gender and birth year in a 1:10 ratio according to a matched cohort design. Patients discharged alive were followed-up for a minimum of 2 years. All Norwegian hospitals treating patients with traumatic injuries provide data to the NTR. The final analysis was conducted in April 2025. Traumatic injury, admitted to hospital, and registered in the NTR. The outcome of interest was suicide, as registered in the Norwegian Cause of Death Registry. Cumulative incidence ratios (CIR) of suicide with 95% CIs, taking nonsuicidal death as a competing event into account, were estimated. Adjustments for Charlson Comorbidity Index, previous psychiatric illness, and socioeconomic position (SEP) were conducted using inverse probability of treatment weights. A total of 25 536 patients with traumatic injuries (165 897 [67%] male; mean [SD] age, 41 [23] years) were matched to 247 095 controls, with a mean (SD) age of 41 (23) years and 68% male. The cumulative incidences of suicide were 0.18% at 2 years and 0.34% and 5 years for patients with traumatic injuries and 0.02% at 2 years and 0.05% at 5 years for controls (2-year CIR, 9.3 [95% CI, 5.4-13.0]; 5-year CIR, 6.9 [95% CI, 4.4-9.1]). Patients with traumatic injury were older at the age of suicide compared with controls (mean [SD] age, 43 [19] years vs 36 [17] years; P = .03) and female patients with traumatic injury had higher incidence of suicide compared with female controls (36% vs 17%; P = .005). In this cohort study of patients in Norway discharged alive after critical injury, a 9-fold increased risk of suicide after 2 years was observed. These findings suggest that follow-up is warranted for possible psychological distress in this patient group.

Trends in prevalence, associated comorbid burden, and subsequent mortality of social isolation: A gender perspective.

We know little of the impact that pre-critical illness physical function plays in the recovery from critical illness. The agreement between patients and surrogates on physical function questionnaires is unclear. Prospective observational cohort conducted at a tertiary medical center. We enrolled patient-participants who were treated for respiratory failure, shock, and/or sepsis and their well-chosen surrogates. None. We assessed patient-participant physical function anchored on the 4 weeks before admission using the virtual Short Physical Performance Battery (vSPPB); Strength, Assistance in Walking, Rising from a Chair, Climbing Stairs, Falls (SARC-F) questionnaire; and Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) questionnaire completed by both patient and surrogate participants. The primary outcome was agreement between patient and surrogate responses on composite scores from each questionnaire. Secondary outcomes included correlations between patient and surrogate responses, and the relationship between surrogate and patient responses. We enrolled 75 patient-surrogate dyads. Patient-participants had a median (interquartile range) age of 61 (52-69), a Charlson Comorbidity Index of 2 (1-2), and a baseline activities of daily living disability score of 3 (1-7). Most surrogates were spouses (68%), who spent an average of 20 hours per day (12-24 hr/d) with patients. We found fair agreement between patient and surrogate scores on the vSPPB (intraclass correlation coefficient [ICC], 0.52; 95% CI, 0.31-0.69), SARC-F (ICC, 0.43; 95% CI, 0.22-0.60), and FRAIL (ICC, 0.45; 95% CI, 0.24-0.63). We found moderate correlation between patient and surrogate scores on the vSPPB, SARC-F, and FRAIL (Spearman r 0.60, 0.46, and 0.53, respectively [p < 0.001]). We found fair agreement and moderate correlation on previously validated self-report questionnaires of physical function. Patients reported better function than their surrogates particularly at lower levels of function. Our findings highlight the need for further development of tools to assess pre-critical illness physical function.

Background Length of postoperative stay (LOPS) is an important indicator for resource allocation and clinical management in elderly patients with hip fractures. However, previous studies have mostly dichotomized this continuous variable to determine whether it is prolonged, a practice that inherently reduces information and introduces limitations. This study aimed to develop and validate a machine learning (ML) model to accurately predict the specific LOPS in elderly patients with hip fractures. Methods This retrospective cohort study included electronic health records (EHRs) of elderly patients with hip fractures admitted to Yichang Central People’s Hospital from January 2016 to December 2022, with a total of 734 patients. Variables commonly measured preoperatively were extracted based on a review of previous studies, and features were selected using Pearson correlation coefficients combined with LASSO regression to construct a backpropagation neural network (BP-NN) model. For comparative evaluation, support vector machine (SVM) and random forest (RF) regression models were developed under the same dataset split (8:2), feature set, and hyperparameter optimization strategy. Model performance was assessed by comparing predicted values versus actual LOPS and calculating root mean square error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE), and error thresholds (20%, 30%). The feature importance of the BP-NN model was analyzed via SHapley Additive exPlanations (SHAP) values. Results Among 734 elderly patients with hip fractures, 503 (68.53%) were female, with an average LOPS of 17.42 ± 3.77 days. Femoral neck fracture (59.26%) and hemiarthroplasty (41.96%) were the most common fracture type and surgical type, respectively. Pearson correlation analysis and LASSO regression showed that age, age-adjusted Charlson comorbidity index (ACCI), and surgical type were the predictors of LOPS. Further sensitivity analysis adjusting for confounding factors revealed that the very old elderly group (aged or above 90 years) had the longest LOPS (15.84 ± 0.15 days vs. 17.85 ± 0.14 days vs. 21.99 ± 0.66 days), with no statistically significant difference in LOPS between different surgical type subgroup ( P &amp;gt; 0.05). The predicted values of the BP-NN were consistent with the trend of actual LOPS ( R 2 = 0.83), with the vast majority of prediction results falling within 30% clinically acceptable error threshold. Its RMSE, MAE and MAPE of 1.23 days, 1.57 days and 7.69% respectively. SHAP analysis revealed that ACCI and age were the main factors influencing LOPS. Conclusion The BP-NN model, enhanced by multimethod feature selection, rigorous parameter tuning, and SHAP based interpretability, provides early and accurate LOPS prediction for elderly hip fracture patients. It can be used as a tool to assist in clinical decision-making, resource planning, and discharge preparation, without increasing the clinical burden. Future external validation across multiple centers is needed to confirm generalizability.

Refractory status epilepticus (RSE) is a medical emergency defined as "status epilepticus persisting despite administration of at least 2 appropriately selected and dosed parenteral medications including a benzodiazepine." Control of RSE is critical to avoid irreversible neuronal damage, with midazolam and propofol as the most commonly used agents. This study evaluates the effectiveness of midazolam versus propofol in preventing mortality and complications of RSE. Patients from the TriNetX Research Network who received either midazolam or propofol monotherapy on the day of RSE onset were included. Outcomes were assessed at 30 days and maximal follow-up (≤20 years) using Cox proportional hazard models. Propensity score matching (1:1) controlled for demographics and 93 comorbidities from the Charlson Comorbidity Index. Among 117 736 patients with RSE, 5310 received midazolam and 2136 received propofol. Midazolam was associated with significantly decreased hazards of mortality at 30 days (HR = 0.509 [95% CI: 0.397, 0.653]) but not at maximal follow-up (HR = 0.922 [0.797, 1.067]). Midazolam was also associated with significantly reduced hazards of lactic acidosis (HR = 0.537 [0.427, 0.674]), rhabdomyolysis (HR = 0.295 [0.150, 0.578]), hypertriglyceridemia (HR = 0.316 [0.135, 0.740]), tracheostomy (HR = 0.633 [0.438, 0.916]), PEG placement (HR = 0.519 [0.371, 0.725]), and mechanical ventilation (HR = 0.313 [0.265, 0.370]). Among patients with a traumatic brain injury in the week prior to RSE, midazolam was associated with a significantly lower hazard of 30-day mortality (HR = 0.381 [0.136, 0.993]), while the hazards were not significantly changed in patients with CNS infections (HR = 1.150 [0.351, 3.768]) or cerebrovascular disease (HR = 0.656 [0.421, 1.025]) in the week prior to RSE onset. Midazolam monotherapy for RSE was associated with decreased mortality and adverse effects compared to propofol monotherapy in the short term, but relatively equivalent in the long term. Prospective comparative trials are needed to ascertain superiority of either intervention in reducing morbidity and mortality in patients with RSE.

Acute limb ischaemia (ALI) is a vascular emergency that often involves life-or-limb-threatening consequences. For patients with irreversible limb ischaemia or those who are high-risk surgical candidates, palliative care may be underutilised. This study examined the role and use of palliative care for ALI patients at our institution. A retrospective observational study was conducted for ALI patients referred to the vascular service from January 2019 to December 2023. Data collected included demographics, comorbidities using the Charlson comorbidity index (CCI), the primary intervention offered and their Australia-modified Karnofsky Performance Status (AKPS). Outcomes included 30-day mortality, major limb amputation and referral to palliative care. A total of 114 patients, with median age of 75, and 65 male patients were included. On presentation, 2 patients (1.8%) underwent major limb amputation and 15 patients (13.2%) received palliative care. Patients who received palliative care on presentation were, on average, older by 11.4 years, had a higher CCI score by 2.7 and a lower AKPS by 19.1 (p < 0.01) compared to patients who did not receive palliative care. Within 30 days, 12 (80%) of the primary palliation group died, compared to 8 (8.1%) in the non-palliation group. None of the patients who underwent amputation received palliative care or died within 30 days. ALI is associated with high mortality. In selected patients, particularly those with non-viable limbs, advanced age, high comorbidity burden and low functional status, early palliative care may be more appropriate than surgery. Avoiding 'palliative amputation' through timely palliative care involvement offers a more holistic, patient-centred approach to care at the end of life.

This retrospective database study evaluates postoperative complications following total shoulder arthroplasty (TSA) in patients with non-alcoholic cirrhosis (NAC) versus non-alcoholic fatty liver disease (NAFLD) using a large matched national cohort. Among 266,263 patients who underwent TSA, 171,059 had continuous enrollment and were undergoing TSA for the first time. Out of this group, 1986 patients had NAC and 4240 had NAFLD. Propensity-score matching was conducted controlling for age, sex, Charlson Comorbidity Index, and key clinical covariates, resulting in a final cohort of 2170 total patients (1085 per group). Multivariable logistic regression was used to compare 90-day and one-year postoperative complication rates. Within 90 days postoperatively, patients with NAC had higher rates of acute kidney injury, blood transfusion, and any complication compared to patients with NAFLD. At one year, NAC patients continued to show higher odds of blood transfusion and overall complications, while NAFLD patients had significantly higher deep vein thrombosis incidence. Patients with NAC undergoing TSA are at increased risk for postoperative complications compared to those with NAFLD. Although NAFLD patients had fewer adverse outcomes, they exhibited elevated thromboembolic risk at one year. Tailored perioperative strategies to liver disease subtype patients are needed to help mitigate postoperative complications in this vulnerable population.

The MALDI-TOF MS Bruker Biotyper MBT subtyping IVD module enables the early detection of cfiA-positive Bacteroides fragilis (cfiA+ BF) during bacterial identification. However, the relationship between genetic positivity, phenotypic resistance, and clinical outcomes has not been fully elucidated. This retrospective study analyzed B. fragilis isolates from three Hong Kong hospitals between 2021 and 2025 to examine their prevalence and the clinical utility of MALDI-TOF MS in rapid cfiA detection. Antibiotic susceptibility testing, cfiA gene detection using MALDI-TOF MS, and Oxford Nanopore sequencing were performed. Medical records were reviewed, and univariate analyses and multivariate logistic regression were used to identify factors associated with cfiA positivity and 30-day all-cause mortality. Overall, B. fragilis exhibited a high rate of antibiotic resistance. Concomitant resistance to carbapenems and metronidazole was identified in three isolates. Among the 166 isolates, 40 (24.1%) were cfiA-positive. cfiA detection by MALDI-TOF MS showed 100% concordance with the gene sequencing results and correlated strongly with phenotypic carbapenem resistance (Φ = 0.82, p &lt; 0.001 for meropenem; Φ = 0.70, p &lt; 0.001 for ertapenem; Φ = 0.63, p &lt; 0.001 for imipenem). Phylogenetic analysis revealed two distinct clusters corresponding to cfiA status, each exhibiting genetic diversity based on multi-locus sequence typing (MLST). The cfiA+ BF isolates demonstrated high-level phenotypic carbapenem resistance in the presence of upstream insertion sequences. The predominant sequence type (ST) among cfiA+ BF isolates was ST157, and 70% of ST157 isolates harbored IS1187 in the upstream region of cfiA. Gene sequencing also identified other emerging beta-lactamase genes blaOXA-347 and blaMUN. The 30-day all-cause mortality following B. fragilis infection was 13.3%, with independent predictors including a high Charlson Comorbidity Index (OR = 1.30; p = 0.02) and the absence of early source control (OR = 4.84; p = 0.03). This study highlights the widespread occurrence of cfiA+ BF in Hong Kong and the clinical significance of rapid cfiA detection. Continuous surveillance is essential to monitor the ongoing threat of antibiotic resistance in B. fragilis.

BackgroundGram-negative bacteremia (GNB) in pediatric patients presents a serious clinical challenge, yet comprehensive data on its epidemiology, management, and outcomes in this population are limited. This study aimed to characterize the clinical features, microbiologic profile, and factors associated with mortality in pediatric patients with monomicrobial GNB at a large academic medical center.MethodsA retrospective cohort study was conducted among 970 patients with GNB identified from institutional microbiology records; 62 pediatric patients (< 18 yrs) with monomicrobial GNB were included. Demographics, clinical characteristics, microbiology, time to diagnostics and interventions, and outcomes were analyzed.ResultsOf the 62 pediatric patients, 64.5% of infections were community-acquired. The cohort was predominantly White (75.8%) followed by 9.7% Black, 9.7% Hispanic, and 4.8% other. The most common pathogens were E. coli (51.6%) and Klebsiella spp. (12.9%). Overall mortality was 11.3%, with a 90-day readmission rate of 25.8%. ICU admission occurred in 19.4% of cases. ID consultation was obtained in 58.1% of cases, with a median (IQR) time to consult of 22.2 hrs (6, 43.9). Median hospital LOS was 15.5 days (10, 72); ICU LOS was 10.4 days (6.4, 18.1). Time to ePlex® result and susceptibility data were 15.6 hrs (13.1, 23.5) and 3.6 days (2.6, 5.7), respectively. Median duration of antimicrobial therapy was 10 days (6.9, 13.5). The Charlson Comorbidity Index (CCI) was low in 79%, moderate in 12.9%, and high in 8.1%, with higher CCI significantly associated with mortality (p=0.003). Mortality was highest among patients with P. aeruginosa (100%, N=3) and E. coli (9.4%, N=3) bacteremia. No deaths occurred among patients with Klebsiella spp. or S. marcescens infections.ConclusionAt our institution, pediatric Gram-negative bacteremia was predominantly community-acquired and most frequently caused by E. coli. Although overall mortality was low, it was notably higher in patients with P. aeruginosa infections and elevated CCI scores. Ongoing efforts are needed to enhance risk stratification and optimize management strategies in this high-risk population.DisclosuresAll Authors: No reported disclosures

BackgroundMRSA bloodstream infections have a higher inpatient mortality rate compared to other bloodstream infections, constituting a significant burden to patient outcomes. Vancomycin remains the backbone treatment for MRSA bacteremia despite some studies having shown superiority or non-inferiority of other anti-MRSA agents such as daptomycin. There remains uncertainty in treating MRSA bacteremia patients as to whether vancomycin portents better outcomes compared to non-Vancomycin agents.MethodsA retrospective cohort of patients with MRSA bacteremia admitted from March 2024 to April 2025 were extracted from our institution medical records. We compared various metrics associated with care and clinical outcomes for patients with a diagnosis of MRSA bacteremia who were either treated with Vancomycin (VP) vs treated with Non-Vancomycin Agents (NVP). Primary endpoint was all cause inpatient mortality. A multivariate logistic regression was conducted. Secondary end points included: requirement of ICU admission, vasopressor use, development of acute kidney injury that required hemodialysis (AKI-HD), hospitalization days since the first MRSA positive blood culture (MRSA-LoS) and time to clearance of blood cultures (TTC). To compare MRSA-LoS and TTC, a multivariate linear regression was conducted.ResultsA total of 88 hospitalizations during which a patient had MRSA bacteremia met the eligibility criteria. No statistically significant difference in inpatient mortality was noted (VP: 12% vs. NVP: 5.3%; p = 0.277), but Charlson Comorbidity Index (CCI) (aOR 1.46, p=0.041) and Pitt Bacteremia Score (PBS) (aOR 2.45; p=0.007) were predictors of inpatient mortality. Treatment with Vancomycin (aOR 3.75, p=0.043) and PBS (aOR 3.12, p< 0.001) were statistically significant predictors of ICU admission (Table 1). There was no statistically significant difference in vasopressor use (p=0.607), development of AKI-HD (p=0.401), MRSA-LoS (p=0.318) or TTC (p=0.906) between VP vs NVP.ConclusionAntibiotic choice vancomycin vs non-vancomycin as definitive therapy was not associated with a clear difference in inpatient mortality for the treatment of MRSA bacteremia in this retrospective analysis. Conversely, receiving Vancomycin as definitive therapy was associated with ICU admission.DisclosuresAll Authors: No reported disclosures

BackgroundImplementing a formal program for the review of oral antibiotic discharge prescriptions (AbxRx) is often limited by staffing constraints. At our institution, primary teams can choose to reach out to an antimicrobial stewardship pharmacist (ASP) for guidance on AbxRx at discharge via curbside consultation (DCC). We described DCC and compared clinical outcomes between ASP vs. team-based (TB) groups.MethodsThis was a retrospective study of adult inpatients who received an AbxRx between 1/2024 to 6/2024 with or without ASP intervention. TB group consisted of a medicine (MD/DO) attending and an advanced practice provider (APP) without ASP intervention. The primary composite outcome was the appropriateness of AbxRx, defined as use of narrow spectrum of activity, dosing and duration consistent with local ASP guidelines. Secondary outcomes include length of stay (LOS), readmission, and incidence of Clostridiodies difficile infection (CDI).ResultsOf 359 reviewed, 299 patients prescribed an AbxRx were included (ASP n=150, TB n=149). Age and Charlson comorbidity index were similar between groups. The most common infection was pneumonia (38%), urinary tract (27.8%), and skin soft tissue infections (16.7%). APPs were more likely to initiate DCC (64.4% vs 19.5% attending). DCC were triggered by bacteremia (13.7% vs 0%, P=< 0.001), intravenous abxRx with Pseudomonal coverage (69.1% vs 40.7%, P< 0.001) and presence of positive cultures (54.4% vs 30.7%, P< 0.001). Median time from admission to ASP intervention was 3 days (IQR 2-4), from ASP intervention to discharge was 4.7h (IQR 1.7-25.1h). More patients in the ASP group were discharged on cefuroxime (20.1% vs. 4%, P< 0.001) while more patients in TB group were discharged on cefpodoxime (10.7% vs. 29.3%, P< 0.001). Patients in the ASP group were more likely to have appropriate AbxRx (96% vs. 60%, P< 0.001) and higher adherence to AS guidelines (97.1% vs. 75%, P< 0.001). LOS (3 vs. 3 days, P=0.34), readmission (4.7% vs. 2%, P=0.22) and CDI (0%) were similar between groups.ConclusionDCC were more commonly triggered by APPs, likely for the need of higher-level infectious disease training and comfortability in interpreting cultures. ASP improved the appropriateness of AbxRx with increased narrow spectrum antibiotic use and adherence to AS guidelines.DisclosuresAll Authors: No reported disclosures

BackgroundThe global prevalence of cancer has increased in recent decades. Cancer patients are particularly susceptible to invasive infections such as bacteremia. In Peru, the rising incidence of bloodstream infections caused by resistant pathogens represents a significant public health concern. However, limited information is available on this complication in the Peruvian oncologic population. No previous studies in the country have assessed mortality or examined the impact of antimicrobial resistance on patient outcomes in this population.MethodsThis study aimed to evaluate 28-day all-cause mortality and its associated factors among cancer patients with bacteremia at a referral cancer center in Lima. We retrospectively analyzed data from first episodes of bacteremia in hospitalized adult patients between July 2020 and June 2024.ResultsA total of 293 patients were included. The mean age was 65.42 ± 15.31 years, and 53.92% were female. Most patients had solid tumors (84.30%) and active disease (91.81%), with digestive cancers being the most common (34.13%). The 28-day all-cause mortality rate was 32.08%. Empirical antimicrobial therapy was appropriate in 80.70% of cases, Table 1. Gram-negative bacteria predominated (82.80%), with Escherichia coli being the most frequently isolated pathogen (45.70%). Among enterobacteria, 43.60% were ESBL producers, and 3.27% of gram-negative isolates were carbapenem-resistant, Figure 1 and Table 2. Multivariate Poisson regression identified the Charlson Comorbidity Index (IRR 1.11; 95% CI 1.02–1.21), sepsis (IRR 2.26; 95% CI 1.19–4.29), septic shock (IRR 2.74; 95% CI 1.58–4.76), and respiratory failure (IRR 1.66; 95% CI 1.05–2.62) as independent factors associated with increased 28-day mortality. A urinary source of infection was found to be protective (IRR 0.38; 95% CI 0.19–0.77), Table 3.ConclusionIn this cancer referral center, one-third of patients with bacteremia died within 28 days. Mortality was primarily driven by infection severity and specific comorbidities rather than antimicrobial resistance.DisclosuresAll Authors: No reported disclosures