Staten Island University Hospital

Prophylactic antibiotic use before endoscopic retrograde cholangiopancreatography (ERCP) remains controversial. Current guidelines recommend against routine prophylaxis. This meta-analysis evaluates the role of prophylactic antibiotics in reducing infectious complications in patients with suspected biliary obstruction undergoing ERCP. We included randomized controlled trials (RCTs) published in full and comparing antibiotics with placebo in patients undergoing ERCP for suspected biliary obstruction. Outcomes assessed were rates of cholangitis, bacteremia, and infectious complications. Data sources included CENTRAL, MEDLINE, and EMBASE from inception through January 2025. Studies published as abstract only were excluded. For subgroup analyses, studies were stratified by antibiotic class (cephalosporins vs penicillins), presence of radiologic evidence or clinical suspicion of obstruction, and sample size (n <150 vs n≥ 150). 5 RCTs involving 1,154 patients met inclusion criteria, with 570 individuals receiving antibiotics and 584 serving as controls. Prophylactic antibiotics significantly reduced the risk of cholangitis (RR 0.44, 95% CI 0.22-0.89, p = 0.24; I2 27%), bacteremia (RR 0.28, 95% CI 0.13-0.58, p = 0.57, I2 0%), and infectious complications (RR 0.35, 95% CI 0.17-0.73, p = 0.16, I2 40%). The significant decrease in the rates of cholangitis, bacteremia, and infectious complications remained significant in patients with radiologic evidence of obstruction. Prophylactic antibiotics significantly reduced post-ERCP infections in patients with biliary obstruction. These findings challenge existing guidelines that recommend antibiotics in high-risk scenarios only. Our study highlights the importance of pre-procedural antibiotics, especially in patients with radiologically confirmed biliary obstruction. While further RCTs are needed to refine recommendations, clinicians should consider prophylactic antibiotics to improve patient outcomes.

Abstract Background Temporary epicardial pacing wires are routinely placed during cardiac surgery and are typically removed before discharge. When resistance is encountered, wires are clipped and left in place. Although long considered benign, retained wires have increasingly been linked to delayed migration into vascular, thoracic, and abdominal structures. The patterns, timing, clinical consequences, and mechanisms of these events remain poorly defined. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta Analyses 2020 guidelines and was registered with the International Prospective Register of Systematic Reviews CRD420251103727. Main body Twenty-two studies describing 23 patients with migration of retained temporary epicardial pacing wires were included. Ages ranged from 14 months to 89 years. Migration occurred between 12 days and 17 years after surgery, with a median interval of approximately 1 year. Cardiovascular migration was reported in 15 patients and involved the aorta, aortic arch, carotid artery, coronary artery, pulmonary artery, or cardiac chambers. Extracardiac migration was reported in 8 patients and involved the lung, bronchial tree, transverse colon, neck, jaw, and subcutaneous tissues. Migration location corresponded to the reported origin of the pacing wire. Atrial wires were described in cases involving systemic arterial structures, whereas ventricular wires were described in cases involving the right heart or pulmonary circulation. Fourteen patients were symptomatic at diagnosis, presenting with chest pain, respiratory symptoms, hemoptysis, abdominal pain, neurologic deficits, or localized inflammation. Infectious complications were reported in 8 patients, including several cases in which more than 1 wire had been retained. Computed tomography identified migration in 13 patients and was the most frequently reported diagnostic modality. Echocardiography detected intracardiac migration in 6 patients. Percutaneous extraction was reported as successful in all attempted cases. Surgical extraction was performed in 3 patients, and 2 patients were managed conservatively. Conclusion Migration of retained temporary epicardial pacing wires has been reported months to years after cardiac surgery and has involved both cardiovascular and extracardiac structures. Reported cases describe migration across multiple anatomic pathways and a range of clinical presentations. Computed tomography was commonly used to identify migration, and percutaneous retrieval was reported as successful in several cases. These findings describe the reported spectrum of migration patterns, presentations, and management strategies among published cases of retained temporary epicardial pacing wire migration.

Objective: We report a unique case of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) possibly related to administering daptomycin and ceftaroline for persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. We describe treatment strategies and challenges of determining drug causality when multiple antimicrobials are administered. Case: A 78-year-old male developed SJS/TEN during week 6 of daptomycin and ceftaroline therapy. Other antimicrobials administered within the previous 8 weeks included vancomycin, meropenem, piperacillin/tazobactam, levofloxacin, and fluconazole. Causality was assessed using the Algorithm of Drug Causality for Epidermal Necrolysis, which indicated probable association with ceftaroline and possible association with daptomycin. Management included discontinuing both agents, transferring to a burn intensive care unit, wound care, and treatment with intravenous immunoglobulin. Discussion/Conclusion: Stevens-Johnson syndrome and toxic epidermal necrolysis associated with the use of daptomycin and ceftaroline is rare. Appropriate and timely diagnosis and management by a multidisciplinary team led to favorable clinical outcomes.

Abstract Background: Latin American (LA) women are more likely to be diagnosed with aggressive early-stage breast cancer (EBC) compared to Non-Hispanic White (NHW) women, yet population-specific tumor biology remains underexplored. Previously, we reported elevated immune gene expression in BluePrint® (BP) Luminal B tumors in LA patients (pts) with EBC and obesity compared to Black and NHW cohorts. Here, we present updated clinical comparisons between LA, NHW and Black pts with EBC and whole transcriptome analysis (WTA) between BP Luminal B and Basal BC in pts with obesity. Methods: Clinical and WT data were analyzed from 15,577 EBC pts self-identified as LA, Black, or NHW enrolled in FLEX (NCT03053193), a prospective observational study with MammaPrint® risk of recurrence and BP molecular subtyping assays, and WT profiles. ImPrint, 53-gene immune signature, results (+/-) were generated for pts with hormone receptor positive (HR+) EBC. Chi-square and t-tests were conducted on clinical groups using arsenal R package. For WT comparisons, 215 obese LA pts with BP Luminal B and 77 with BP Basal EBC were matched to corresponding NHW and Black pts by age, T and N status. Differentially expressed genes (DEGs) were evaluated using limma, and pathway enrichment was performed using gene set enrichment analysis with Hallmark gene sets. Significant results were reported with adjusted p &amp;lt; 0.05. Results: Compared to Black and NHW pts, LA pts were younger and more often premenopausal (Table). Both LA and Black pts had statistically significantly higher rates of obesity compared to NHW pts. Significantly higher rates of MP High Risk 2, BP Basal and ImPrint+ tumors were observed in LA and Black pts vs NHW. WT comparisons among the obese subpopulations revealed that metabolic pathways, including adipogenesis, angiogenesis, epithelial-mesenchymal transition, and oxidative phosphorylation were significantly downregulated in EBC in LA pts vs NHW and Black cohorts. Conversely, immune-related pathways such as allograft rejection and interferon gamma response were enriched among LA pts with Basal cancers compared to NHW and Black groups. These coordinated pathway alterations suggest unique metabolic and immune profiles in LA EBC subtypes with a median absolute fold change of 1.3 among DEGs. Conclusion: The data suggest that signals from metabolic pathway alterations from modest immune-related gene upregulation may contribute to more aggressive tumor behavior in obese LA pts with EBC. Clinical and transcriptomic analyses demonstrated differences in Luminal B and Basal EBC biology among self-identified LA pts compared to NHW and Black cohorts, consistent with prior research. With further research, these findings may offer treatment targets which may enhance outcomes and reflect the importance of including racially and ethnically diverse pts in clinical trials to characterize population-specific differences in EBC outcomes. Citation Format: M. Mazo Canola, A. Santillan, J. Alberty-Oller, E. Dias, V. Kaklamani, A. Elkhanany, K. Hoskins, M. Habibi, R. Hampton, J. L. Barone, N. M. Johnson, N. Gordon, N. Sookhan, T. Bah, P. John, E. Aponte, S. Diab, V. Klimberg, N. Stivers, C. Page, S. Uygun, W. Audeh, J. O'Shaughnessy. Distinct Immune and Metabolic profiles in Latin American breast cancer patients with obesity enrolled in FLEX [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 PS4-09-09.

Tumor lysis syndrome (TLS) is a serious medical condition in which the lysis of tumor cells results in a variety of abnormalities, including elevated uric acid, potassium, and phosphorus, decreased calcium, seizures, arrhythmias, and acute kidney injury (AKI). TLS most often occurs in hematologic cancers and after chemotherapy, whereas cases that arise without chemotherapy are termed spontaneous TLS (STLS). In our case, an 81-year-old female with a past medical history of hypertensionand chronic obstructive pulmonary disease (COPD) initially presented to the emergency department for left lower back pain that was later found to have been caused by a bony metastatic lesion secondary to a neuroendocrine tumor of the lung. Her hospital stay was complicated by a worsening AKI that was refractory to fluids and the discontinuation of nephrotoxic medications. A uric acid, urine studies, lactate dehydrogenase, and metabolic panel ruled out other causes of her kidney injury and ruled in a diagnosis of STLS. The patient's condition worsened until she required hemodialysis, which she rejected in favor of comfort care. The patient died 14 days after admission. In conclusion, despite the majority of TLS cases originating from hematologic malignancies and in response to chemotherapy, STLS should be considered in refractory AKI for cancer patients, even when secondary to solid tumors like neuroendocrine tumors of the lung.

This study aimed to evaluate the impact of MetS on inpatient outcomes, health care utilization, and discharge patterns in hospitalized IBD patients. Inflammatory bowel disease (IBD) is a chronic, immune-mediated condition associated with rising prevalence, high hospitalization rates, and substantial health care costs. In parallel, the growing burden of metabolic syndrome (MetS) may further worsen clinical outcomes and resource utilization in this population. We conducted a retrospective analysis of the 2016-2020 National Inpatient Sample, identifying 241,772 hospitalized IBD patients. Patients were stratified by the presence of MetS, and the 2 cohorts were compared regarding inpatient outcomes including mortality, intensive care interventions, length of stay (LOS), and discharge disposition. Multivariable logistic regression models were used to assess associations between MetS, its individual components (hypertension, diabetes, obesity, and dyslipidemia), and key inpatient outcomes. Of the cohort, 6382 (2.6%) had MetS. Compared with patients without MetS, those with MetS were older, had higher comorbidity burden, longer LOS (5.77 vs 5.30 d), and increased likelihood of central line placement, intubation, and vasopressor use. Discharge to home was less frequent (57.4% vs 73.7%), with higher rates of skilled nursing or home health needs. Multivariable analysis demonstrated that MetS and individual components independently increased odds of mortality, intensive care interventions, and resource utilization. MetS significantly worsens inpatient outcomes and increases health care utilization in hospitalized IBD patients. Early identification and targeted management of metabolic comorbidities may reduce complications, optimize resource use, and improve discharge outcomes, underscoring the importance of integrated metabolic care in this population.

Abstract Introduction Left atrial appendage occlusion (LAAO) has emerged as an important alternative to long-term oral anticoagulation for stroke prevention in patients with atrial fibrillation. While LAAO is typically performed as a minimally invasive procedure with short hospital stays, certain patients experience prolonged hospitalization, leading to increased healthcare costs and potential complications. Understanding the predictors of extended hospital stays is crucial for optimizing patient selection and perioperative care. Purpose To identify demographic, clinical, and institutional factors associated with prolonged hospitalization (≥2 days) following LAAO procedures using a large national database. Methods Using the National Inpatient Sample (NIS) 2020 dataset, we identified patients who underwent LAAO procedures through ICD-10 codes. Prolonged hospital stay was defined as ≥2 days post-procedure. Multivariable logistic regression analysis was performed to identify independent predictors of extended hospitalization. The analysis included demographic characteristics, comorbidities, and hospital-related factors. Results Of 5,582 patients who underwent LAAO, 644 (11.5%) experienced prolonged hospitalization. The analysis revealed several independent predictors of extended stay. Among demographic factors, female gender (OR 1.36, 95% CI 1.15-1.62, p&amp;lt;0.001) and Hispanic ethnicity (OR 1.54, 95% CI 1.04-2.24, p=0.032) were significant predictors. Clinical comorbidities showing strong associations included chronic kidney disease (OR 1.82, 95% CI 1.48-2.23, p&amp;lt;0.001), chronic obstructive pulmonary disease (OR 1.48, 95% CI 1.22-1.81, p&amp;lt;0.001), pulmonary hypertension (OR 1.44, 95% CI 1.07-1.94, p=0.017), and chronic heart failure (OR 1.56, 95% CI 1.24-1.95, p&amp;lt;0.001). Healthcare system factors also played a significant role, with Medicaid insurance (OR 1.92, 95% CI 1.09-3.39, p=0.025) and non-metropolitan hospital setting (OR 1.90, 95% CI 1.02-3.57, p=0.045) being associated with longer stays. Conclusion This comprehensive analysis identifies several patient-specific and healthcare system-related factors associated with prolonged hospitalization after LAAO. These findings can help clinicians better identify high-risk patients, optimize pre-procedure preparation, and develop targeted strategies to reduce length of stay. The impact of socioeconomic and healthcare access factors suggests opportunities for system-level interventions to improve care delivery and outcomes.Prolonged Stay Risk Factors