Detroit Medical Center

Introduction: Stenotrophomonas maltophilia has a high mortality risk, with rates estimated to be between 23-77%. Trimethoprim/sulfamethoxazole (TMP/SMX) or minocycline (MIN) are the mainstay treatment of S. maltophilia. However, there is a lack of comparative clinical data comparing the two antibiotics. The objective of this study was to assess clinical outcomes between patients treated with TMP/SMX or MIN for pneumonia due to S. maltophilia. Methods: This was a retrospective cohort study of patients admitted to an ICU at the Detroit Medical Center from August 20th, 2019 to February 19th, 2024. Adult patients with clinical signs of pneumonia; a culture growing S. maltophilia; and who received TMP/SMX or MIN ≥ 48 hours were included. Patients were excluded if they received combination therapy; had a non-susceptible S. maltophilia isolate; or died or were transferred to hospice within 48 hours of treatment. The primary outcome was 28-day all-cause mortality. Secondary outcomes included 28-day ventilator free days, ICU length of stay, in-hospital mortality, clinical response at EOT, and rates of adverse effects including hyperkalemia and hepatotoxicity. Results: A total of 71 patients were included (TMP/SMX, n=37; MIN, n=34). A majority of patients were male (62%) and African American (66%). Baseline characteristics were similar, though more patients in the MIN group had recent surgery (26.4% vs. 8.1%, p=0.01) and a higher Charlson Comorbidity Index (4.3 vs. 3.1, p=0.03); more patients in the TMP/SMX group had COPD (14.7% vs. 32.4%, p=0.04). Baseline SOFA scores (MIN=4.9 vs. TMP/SMX=5.7, p=0.15) were similar between the two groups. A majority of cultures were polymicrobial (82.5%). The primary outcome of 28-day all-cause mortality occurred in 29% of MIN patients and 32% of TMP/SMX patients (p=0.39). Mean 28-day ventilator free days (10.5 vs. 10.1, p=0.46), ICU length of stay (24 vs. 20, p=0.39), in-hospital mortality (41% vs. 40%, p=0.47), and clinical response at EOT (55% vs. 56%, p=0.47) were similar for TMP/SMX and MIN, respectively. Rates of adverse effects were similar between groups. Conclusions: TMP/SMX had similar rates of mortality and clinical outcomes when compared to MIN for the treatment of S. maltophilia. Future prospective trials should be conducted to confirm the results of this study.

Cocaine use disorder prevalence is around 2.2% for individuals age 12 and older, with higher rates reaching 6.2% in young adults ages 18-25. In 2021 around 23% of all US overdose deaths were related to cocaine. Cannabis use disorder is more prevalent than cocaine use disorder with prevalence reaching 14.7%. This study aims to evaluate the impact of cocaine and cannabis on clinical cardiovascular outcomes. Specifically, it investigates the incidence of new-onset cardiac arrhythmia between the cocaine and cannabis users, as well as the incidence of cardiac arrest events, major adverse cardiovascular events including myocardial infarction (MI) and stroke, and all-cause mortality. We did a retrospective cohort analysis using the TriNetX database of cocaine and cannabis users patients and created two cohorts: cocaine and cannabis. Propensity score matching was employed to reduce baseline disparities.The primary outcome was the incidence of new-onset cardiac arrhythmia. Secondary outcomes included cardiac arrest events, all cause mortality, and occurrence of major adverse cardiovascular events (MI and stroke). After matching, 248,769 patients were included in each cohort (cocaine and cannabis users). New-onset cardiac arrhythmia occurred more frequently in the cocaine group (0.2%) compared to the cannabis group (0.15%) (HR: 1.067; 95% CI: 1.022-1.115, P < 0.035). Cocaine use was also associated with higher rates of the secondary outcomes: cardiac arrest (HR: 1.442; 95% CI: 1.346-1.545, P < 0.001), all-cause mortality (HR: 1.215; 95% CI: 1.187-1.243, P < 0.013), and major adverse cardiovascular events (HR: 1.147; 95% CI: 1.116-1.178, P < 0.001). Cocaine users experience significantly higher rates of new-onset cardiac arrhythmias, cardiac arrest, and major adverse cardiovascular events (MI and stroke) compared to cannabis users. These findings highlight the differing outcomes associated with substance use. Future research should aim to validate our findings through prospective, multicenter studies with standardized diagnostic methods as well as longer-term follow-up to more accurately define the outcomes.

Amyloid deposition is an increasingly recognized contributor to chronic kidney disease and end-stage renal disease. It can result from various underlying conditions, including monoclonal gammopathies and chronic inflammatory states. Diagnosis is typically established by kidney biopsy demonstrating characteristic amyloid deposits. ALECT2 (leukocyte chemotactic factor 2) amyloidosis can present as nephrotic-range proteinuria. ALECT2 amyloidosis is an uncommon and under-recognized.

Interventional Radiology (IR) has emerged as one of the fastest-growing medical specialties in the United States. Despite its rapid expansion and distinction as a specialty separate from Diagnostic Radiology (DR), IR continues to struggle with issues of public recognition and professional identity. These challenges include turf battles with other specialties, a lack of awareness among the public and other medical professionals, and limited referrals from non-radiology disciplines. Addressing these challenges requires concerted efforts to market the full breadth of IR’s capabilities to both the public and other medical professionals. Increasing awareness and collaboration with other specialties, such as gynecology, orthopedics, and vascular surgery, is essential for enhancing referrals and ensuring the continued growth of IR. Ultimately, the future success and autonomy of IR depend on reshaping its public image, fostering inter-specialty collaboration, and delivering high-quality care to broaden its impact and recognition within the medical community.

BackgroundFecal microbiota, live-jslm (RBL) is FDA-approved for prevention of recurrent Clostridioides difficile infection (rCDI) in adults following completion of antibiotic treatment. The safety and efficacy of RBL have been demonstrated in trials, but few studies have evaluated outcomes in real-world populations. The primary objective of ROAR (NCT05835219) is to assess RBL effectiveness in reducing rCDI through 8 weeks in clinical practice.Table 1.Treatment success rates by subgroupMethodsROAR is an ongoing, prospective, multicenter, open-label, non-interventional registry of patients receiving RBL for rCDI prevention in the United States. Adults who completed antibiotics for rCDI and are not in an interventional trial are eligible. The primary endpoint assesses the proportion of patients who experience treatment success (no CDI recurrence through 8 weeks). Other objectives describe rCDI management in real-world clinical practice and adverse events (AEs) after RBL administration. This analysis includes patients who received RBL within 30 days of completing antibiotics for rCDI.ResultsAs of September 18, 2024, 76 patients received RBL within 30 days of completing antibiotics and completed 8 weeks of follow-up. Patients were mostly White (93.4%) and female (76.3%), with a median age of 69 years (range, 19-96 years) and a median body mass index of 24.4 (range, 16.5-49.4). Through 8 weeks, 82.9% of patients (63/76; 95% CI, 72.5%-90.6%) experienced treatment success. Similarly, the rate of treatment success was 87.8% (36/41) in the subgroup of patients who received RBL after an antibiotic washout period > 72 hours. Treatment success rates ranged from 77-100% across patient subgroups, including those stratified by age and number of previous CDI episodes within the past 3 years (Table). Overall, 18 (23.7%) patients experienced an AE, 6 (7.9%) experienced a serious AE, and 1 (1.3%) experienced an AE of special interest (large bowel obstruction). AEs assessed as related to RBL occurred in 3 patients (3.9%). There was 1 fatal AE during the study, considered unrelated to RBL.ConclusionInitial results from ROAR are consistent with previous RBL trial results, indicating that RBL is effective and safe for preventing rCDI through 8 weeks after administration in real-world practice.DisclosuresNicholas W. Van Hise, PharmD, Ferring: Advisor/Consultant|Ferring: Grant/Research Support|Innoviva: Advisor/Consultant Teena Chopra, MD, MPH, Cepheid: Advisor/Consultant|Ferring Pharmaceuticals, Inc: Advisor/Consultant|Melinta: Speaker|Pfizer: Advisor/Consultant|Pfizer: Speaker|Shinogi: Speaker Kelly R. Reveles, PharmD, PhD, AstraZeneca: Advisor/Consultant|Ferring Pharmaceuticals: Advisor/Consultant Sahil Khanna, MBBS, MS, Ferring Pharmaceuticals, Inc: Grant/Research Support|ProbioTech Inc: Advisor/Consultant|Rise: Advisor/Consultant|Takeda: Advisor/Consultant|Vedanta: Grant/Research Support Lasse Nielsen, MS, Ferring: Employee Lorien E. Urban, PhD, Ferring Pharmaceuticals Inc: Employee