Phoebe Putney Memorial Hospital

Abstract Background: Patients with residual triple negative breast cancer (TNBC) after neoadjuvant chemotherapy (NAC) have a higher risk of recurrence and worse survival outcomes. Prior studies have shown that higher stromal tumor-infiltrating lymphocytes (sTILs) post-NAC in patients with residual TNBC is associated with improved survival outcomes. In this secondary analysis of EA1131, we evaluated the association between sTILs, intrinsic subtype, and invasive disease-free survival (iDFS), stratified by race in patients with residual TNBC after completion of NAC. Patients and methods: EA1131 enrolled patients with clinical stage II or III TNBC with ≥1.0 cm residual disease (RD) in the breast post-NAC were randomly assigned to receive platinum (carboplatin or cisplatin) once every 3 weeks for four cycles or capecitabine on days 1-14 of a 21-day cycle for six cycles. Stromal TIL density was assessed on full-face hematoxylin and eosin (H&E)-stained tumor sections. Patients were categorized into four groups based on sTILs level (<30% vs. ≥30%) and tumor intrinsic subtype (basal vs. non-basal): (1) low sTILs/basal, (2) low sTILs/non-basal, (3) high sTILs/basal, and (4) high sTILs/non-basal. Cox proportional hazard models were used to examine the association between sTILs and intrinsic subtype group and iDFS, adjusting for available baseline factors. The association between sTILs category and race and intrinsic subtype were examined using Fisher exact test. Results: Among 410 participants with TNBC and RD, H&E slides were available for all 342 who had intrinsic subtype (264 basal, 78 non-basal). Most patients (93%, n=319) had low sTILs (<30%); only 23 (7%) had high sTILs (30-50%: n=17; 51-70%: n=3; >70%: n=3). There was no difference in sTILs by intrinsic subtype (p=0.31) or race (p=0.5). Compared to all groups, patients with low TILs and basal subtype (n=244) had the worst iDFS (p=0.005) and had numerically worse OS (p=0.084). Other significant risk factors for iDFS in this group included high histologic grade (vs intermediate and low), positive lymph node (vs negative), higher pathologic T stage (as a continuous variable). Differences according to race could not be analyzed due to small sample size. Conclusion: In the EA1131 clinical trial, patients with residual basal-like TNBC and low sTILs had the worse iDFS, delineating a particularly high-risk subgroup. These findings underscore the prognostic relevance of post-treatment immune microenvironment characteristics and suggest that patients with basal-like, TIL-low residual TNBC may derive limited benefit from current standard adjuvant therapies. Further investigation is warranted to identify and develop tailored therapeutic approaches for this biologically aggressive subgroup to improve long-term outcomes. Citation Format: S. S. Badve, F. Zhao, S. Reid, Y. Gokmen-Polar, I. Mayer, C. L. Arteaga, W. F. Symmans, B. H. Park, B. L. Burnette, D. F. Makower, M. Block, M. A. Kimberly, C. R. Jani, C. Mescher, S. J. Dewani, B. Tawfik, B. Tawfik, L. E. Flaum, E. L. Mayer, W. M. Sikov, E. T. Rodler, A. M. DeMichele, J. A. Sparano, A. C. Wolff, K. D. Miller, ECOG-ACRIN. Tumor infiltrating lymphocytes in post-NACT residual tumors in ECOG-ACRIN EA1131 - impact of intrinsic subtypes [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr RF3-06.

Background:While isavuconazole (ISA) has demonstrated non-inferiority to voriconazole (VCZ) for invasive aspergillosis (IA) in clinical trials, real-world comparisons are limited.Objectives:To compare treatment completion, adverse events, hospitalizations, and healthcare costs in patients treated with VCZ versus ISA for IA.Design:Retrospective cohort study using Merative MarketScan claims data (2017–2020).Methods:Adults (⩾18 years) diagnosed with IA (International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes) who received VCZ or ISA monotherapy were included. Treatment completion was defined as ⩾42 days of therapy. Descriptive statistics and logistic regression were used to assess outcomes and predictors of antifungal selection, adverse events, hospitalizations, and treatment completion.Results:Among 335 patients, 84% (n = 282) received VCZ and 16% (n = 53) received ISA. Baseline characteristics were comparable, although the VCZ group had higher Medicaid enrollment, and the ISA group had more patients with malignancy. Treatment completion rates were comparable (92% each, p = 1), as were median treatment durations (VCZ: 120 days, ISA: 112 days, p = 0.95). Adverse event rates were not significantly different (VCZ: 49%, ISA: 60%, p = 0.18), but CNS-related events occurred more frequently with ISA (16% vs 9%, p = 0.32). VCZ was associated with lower outpatient pharmacy costs (median $1,596.68 vs $11,000.66, p < 0.001) and total hospitalization costs (median $40,681.89 vs $121,545.89, p = 0.01). Malignancy was associated with lower odds of receiving VCZ (OR 0.30, p = 0.001), and younger age predicted higher odds of treatment incompletion (OR 0.97, p = 0.035). Female sex was associated with increased adverse event risk. Notably, VCZ use was not associated with increased adverse events or treatment incompletion.Conclusion:VCZ was prescribed five times more frequently than ISA for IA, despite similar treatment durations and completion rates. VCZ was associated with lower costs and did not increase the risk of adverse events or treatment discontinuation. These findings suggest that VCZ remains commonly used and potentially more cost-effective treatment option for IA.

Introduction: Fluid stewardship is a pillar in the management of ARDS. Previous studies evaluating conservative fluid management had difficulty achieving daily fluid targets and evaluations of adjunctive albumin have found conflicting results. Methods: This was a retrospective study conducted at a large community hospital. Patients were included if >17 years old, admitted to an ICU from January 2016 to September 2021, had a diagnosis of ARDS, and received loop diuretic and albumin within one hour of each other. Exclusion criteria included liver failure, ESRD, and positive test for SARS-COV-2. Patients were divided into two groups by baseline serum albumin, where low albumin was defined as ≤ 3.5g/dL. The primary outcome was the percentage of patients with a positive response to combination therapy, defined as UOP ≥ 600mL within 6 hours of administration. Secondary outcomes included UOP at 6 hours, and change in PF ratio and serum albumin at 24 hours. Nominal data are presented as percentage, whereas continuous variables are presented as median and were analyzed using Chi-square and Mann Whitney U tests, respectively. Alpha of < 0.05 was deemed statistically significant. Results: 108 patients were in the low-albumin (LA) group and 67 in the normal-albumin (NA) group. The NA group were statistically heavier (99 vs. 88kg), had higher total protein (7.2 vs. 5.1 g/dL), had diagnosis of sepsis (59 vs. 6%) and had less prior diuretic use (48 vs. 74%). Key baseline similarities included PF ratio (158 vs. 160, p=0.7), creatinine (1.22 vs. 1.20 mg/dL), and presence of shock (27 vs. 33%). Statistically, more patients in the NA group received 5% albumin, (63 vs. 34%), received less albumin (12.5 vs. 25 grams), and similar loop diuretic dose expressed as furosemide equivalents (40 vs. 40 mg). 43 (64%) were positive responders in the NA group compared to 61 (57%) in the LA group (p=0.48). UOP at 6 hours (670 vs. 653mL) and change in PF ratio at 24 hours (+23 vs. +13) were statistically similar. The change in albumin was different between the Normal and Low groups (-0.6 vs. +0.2 g/dL, p< 0.05). Conclusions: Low albumin did not affect the urinary response in patients with ARDS receiving albumin and loop diuretics. These findings are limited by heterogeneity in baseline characteristics and components of the intervention.

Acinetobacter baumannii is an opportunistic bacterial pathogen that causes severe infections in immunocompromised patients. The emergence of multi- and pan-drug resistant strains of A. baumannii from clinical sources has confounded treatment and enhanced morbidity and mortality associated with these infections. One way that A. baumannii circumnavigates environmental and antimicrobial challenge is by forming tertiary architectural structures of cells known as biofilms. Biofilm-inhibiting molecules could be deployed as a potential chemotherapeutic strategy to inhibit or disrupt A. baumannii biofilms and mitigate adverse outcomes due to infection. Lactoferrin is an innate immune glycoprotein produced in high concentrations in both human and bovine milk which has previously been shown to have antibacterial and antibiofilm activities. We sought to test lactoferrin against a bank of clinical isolates of A. baumannii to determine changes in bacterial growth or biofilm formation. Our results indicate that human lactoferrin has slightly more potent antibacterial activities than bovine lactoferrin against certain strains of A. baumannii and that these effects are associated with anatomical site of isolation. Additionally, we have shown that both bovine and human lactoferrin can inhibit A. baumannii biofilm formation and that these effects are associated with anatomical site of isolation and whether the strain forms robust or weak biofilms.

1 Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, GA 2 Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA 3 Department of Critical Care Medicine, Phoebe Putney Memorial Hospital, Albany, GA The authors have disclosed that they do not have any potential conflicts of interest.

There is limited data regarding outcomes after in-hospital cardiac arrest among coronavirus disease 2019 patients. None of the studies have reported the outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in the United States. We describe the characteristics and outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in rural Southwest Georgia. Retrospective cohort study. Single-center, multihospital. Consecutive coronavirus disease 2019 patients who experienced in-hospital cardiac arrest with attempted resuscitation. Attempted resuscitation with advanced cardiac life support. Out of 1,094 patients hospitalized for coronavirus disease 2019 during the study period, 63 patients suffered from in-hospital cardiac arrest with attempted resuscitation and were included in this study. The median age was 66 years, and 49.2% were males. The majority of patients were African Americans (90.5%). The most common comorbidities were hypertension (88.9%), obesity (69.8%), diabetes (60.3%), and chronic kidney disease (33.3%). Eighteen patients (28.9%) had a Charlson Comorbidity Index of 0-2. The most common presenting symptoms were shortness of breath (63.5%), fever (52.4%), and cough (46%). The median duration of symptoms prior to admission was 14 days. During hospital course, 66.7% patients developed septic shock, and 84.1% had acute respiratory distress syndrome. Prior to in-hospital cardiac arrest, 81% were on ventilator, 60.3% were on vasopressors, and 39.7% were on dialysis. The majority of in-hospital cardiac arrest (84.1%) occurred in the ICU. Time to initiation of advanced cardiac life support protocol was less than 1 minute for all in-hospital cardiac arrest in the ICU and less than 2 minutes for the remaining patients. The most common initial rhythms were pulseless electrical activity (58.7%) and asystole (33.3%). Although return of spontaneous circulation was achieved in 29% patients, it was brief in all of them. The in-hospital mortality was 100%. In our study, coronavirus disease 2019 patients suffering from in-hospital cardiac arrest had 100% in-hospital mortality regardless of the baseline comorbidities, presenting illness severity, and location of arrest.