UF Health Shands Hospital

Introduction: Mobile Stroke Treatment Units (MSTUs) are redefining the framework of acute stroke care by bringing the hospital to the patient and reducing time to treatment. Patients treated with tenecteplase (TNK) in the MSTU may bypass the Emergency Department (ED) and be admitted directly to the Neuro ICU. Previous research has demonstrated the benefit of quicker treatment onboard an MSTU for stroke patients, but no studies have been published about the benefits of direct admission to an ICU from an MSTU. Therefore, we aim to evaluate the ‘direct to’ process for improved patient care and outcomes as compared to patients being taken to the hospital by the standard emergency medical services (EMS) to ED pathway. Methods: We conducted a retrospective study of stroke patients at a large academic hospital between July 2023 and July 2025. We included patients with a final diagnosis of ischemic stroke who received IV TNK. Non-ischemic diagnoses (e.g., intracerebral hemorrhage and stroke mimics) were excluded. Patients were categorized into MSTU Direct-to-Neuro ICU or the standard EMS-to-ED groups. We evaluated total hospital length of stay (LOS) and functional outcomes measured by modified Rankin Score (mRS) at discharge. An mRS of 0-2 was defined as a good outcome. Chi-square test was used for categorical variables and Mann-Whitney U test for continuous variables. Results: Our cohort consisted of 87 patients; 22 (25.3%) arrived by MSTU and 65 (74.7%) arrived by EMS. Median age was 79 [IQR: 63-86] in MSTU and 70 [IQR: 59-78] in EMS (p=0.078) groups. Patients were 66.7% female in the MSTU and 47.7% in the EMS groups (p=0.207), and race distributions were similar (p=0.168). Total hospital LOS was shorter for patients directly admitted through the MSTU when compared to those from the ED (3.41 [IQR: 1.89-4.44] vs 5.62 [IQR: 3.18-8.74] days, p=0.032). There was no statistically significant difference in good functional outcomes at discharge between groups (MSTU 52.4% vs EMS 55.9%, p=0.980). Conclusion: Our results show that the Direct-to-Neuro ICU approach for MSTU patients was associated with shorter hospital LOS, suggesting potential for optimizing resource use. This approach also appeared safe in our cohort, with similar functional outcomes at discharge. Larger studies are needed to validate our results.

Gastrointestinal bleeding (GIB) and acute myocardial infarction (AMI) are major emergencies with rising evidence of a bidirectional relationship. Post-AMI antithrombotics increase GIB risk, while GIB may worsen cardiac outcomes. While short-term effects are recognized, long-term mortality trends for co-occurring GIB and AMI remain understudied. We examined temporal and demographic mortality patterns in the U.S. from 1999 to 2020. We used CDC WONDER mortality data for adults aged ≥25years. Deaths listing both GIB and AMI as underlying or contributing causes were included. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated, and Joinpoint regression was used to estimate annual percent change (APC) and average APC (AAPC), stratified by sex, age, race/ethnicity, and urban-rural status. A total of 51,113 deaths were attributed to GIB and AMI. AAMR declined from 1.72 in 1999 to 0.81 in 2020 (AAPC -3.9%), with the steepest decline from 2002 to 2010 (APC -7.5%). Males had higher mortality than females (1.43 vs. 0.81). Non-Hispanic Black individuals had the highest AAMR (1.26) but also a steep decline (AAPC -4.43%). AAMRs were higher in rural (1.01) than urban areas (0.94). The 85+ age group had the highest mortality but greatest decline (AAPC -4.15%). The Northeast had the highest regional AAMR (1.15). From 1999 to 2020, U.S. mortality from GIB and AMI declined significantly, likely due to improved cardiovascular and bleeding risk management. However, persistent disparities by sex, race, age, and geography remain, underscoring the need for more targeted and equitable strategies.

Abstract Background Candida species are common nosocomial or donor-derived fungal pathogens in lung transplant recipients, but their impact on outcomes, including species-specific variation, remain unclear. Given evolving fungal epidemiology, we evaluated the association between early Candida isolation with post-transplant survival, and clinical predictors of infection. Methods We conducted a retrospective cohort study of incident lung transplant recipients at a tertiary-care center between 2010 to 2024. Eligible recipients were identified by procedural codes and associated hospitalization. Post-transplant Candida isolation was defined as any culture-positive isolation using microbiology and susceptibility testing reports. Follow-up began on the date of lung transplant, and the primary outcome was 10-year overall survival. Cox proportional hazards models, adjusted for demographics and transplant-specific factors, were applied to assess differences in pathogen isolation and survival. Logistic regression identified pre-transplant predictors of Candida isolation. Results Among 463 lung transplant recipients, adjusted mortality rates were 7.3% (n=34) at 1 year and 58.0% (n=160) at 10 years post-transplant, with a median follow-up of 5.3 years. Candida was documented in 45 (9.7%) and 66 (14.3%) recipients within 30 days and 1 year after transplant, respectively. Most common Candida species were C. glabrata (n=31, 6.7%), C. parapsilosis (n=15, 3.2%), and C. albicans/dubliniensis (n=14, 3.0%). No C. auris was identified. Those with Candida isolation within 1 year after transplant had a significantly poorer survival (adjusted hazard ratio: 1.6, 95%CI: 1.0–2.5, p = 0.041). C. glabrata isolated within 30 days was associated with 2.1-fold increased risk of mortality (95%CI:1.1-4.0, p=0.026). Pre-transplant predictors of C. glabrata isolation within 30 days include history of myocardial infarction (adjusted odds ratio [aOR]: 7.7, p=0.012) and moderate/severe liver disease (aOR: 5.9, p=0.016). Conclusion Candida isolation, particularly early C. glabrata, may be associated with reduced post-transplant survival. Specific baseline comorbidities predicted risk of infection. Future research will evaluate the impact of antifungal prophylaxis strategies on clinical outcomes. Disclosures Kathryn DeSear, PharmD, Abbvie: Advisor/Consultant|Biomerieux: Advisor/Consultant|Cormedix: Speaking|GSK: Advisor/Consultant|Shionogi: Speaking

Abstract Background Hospital outbreak identification often lacks standardization and uses time-intensive surveillance, potentially delaying intervention against hospital-acquired pathogens. We combined space-time permutation analysis with machine learning to statistically identify hospital-onset Pseudomonas aeruginosa outbreaks and contributing etiologies. Methods We retrospectively analyzed hospital-onset P. aeruginosa isolates (2016-2024) using electronic health records (EHR) at a single tertiary care center. Hospital-onset infections were defined as cultures collected more than two days after admission. Susceptibility profiles were standardized by imputing intrinsic resistance and classifying extensive (XDR) or multidrug-resistance (MDR). Space-time permutation analysis (modified WHONET-SatScan) identified resistance-based clusters, validated by whole-genome sequencing (WGS). For each cluster, we conducted case-control studies comparing identified cases with non-case P. aeruginosa during the same period. Feature selection for temporally scaled risk factors was performed using elastic net regularization. Results Among 19,055 hospitalizations (11,112 patients) with P. aeruginosa, 6,557 (34.4%) were hospital-onset. Hospital-onset isolates were 1.9 (95% CI: 1.8–2.1) times more likely to be MDR and 2.2 (95% CI: 1.9–2.6) times more likely to be XDR compared to community-onset. Of 615 unique resistance profiles identified, 53% were susceptible to all antipseudomonal classes. Resistance to antipseudomonal cephalosporins was most common (30.2%). Space-time permutation analysis detected 12 unique clusters, none matching WGS-identified clusters. One cluster defined by cephalosporin resistance (n=17) was further examined. Final elastic net model identified 32 features associated with cluster membership compared to controls (n=213), including open excision 5–9 days prior (OR: 28.1, p< 0.001) and skin graft 2 days prior (OR: 45.2, p< 0.001). Conclusion We demonstrate the use of EHRs to statistically detect related hospital-onset P. aeruginosa and suggest biologically plausible etiologies. Resistance-based models did not align with clusters confirmed by WGS. Future research will establish causal links and extend to other hospital-acquired pathogens. Disclosures Kathryn DeSear, PharmD, Abbvie: Advisor/Consultant|Biomerieux: Advisor/Consultant|Cormedix: Speaking|GSK: Advisor/Consultant|Shionogi: Speaking

Staphylococcus aureus infection is one of the most common and serious infections that arises in children and is associated with high morbidity. S. aureus is the leading cause of acute hematogenous osteomyelitis in children. In the absence of concerns regarding resistance to methicillin, an anti-staphylococcal isoxazolyl penicillin, such as oxacillin or nafcillin, is the drug of choice for treatment of S. aureus osteomyelitis. However, first-generation cephalosporins, such as cefazolin, can also be used. There are limited antimicrobial options available for osteomyelitis and persistent or intermittent bacteremia when surgical intervention for source control is not indicated or feasible. Hence, there is a need to improve our knowledge of synergistic antimicrobial combinations to guide clinical practice and improve outcomes, particularly among children. We present the case of an 11-year-old child with persistence of acute hematogenous vertebral osteomyelitis with discitis and bacteremia, despite appropriate treatment with an anti-staphylococcal beta-lactam. Blood cultures were sterilized, and symptoms resolved after the addition of ertapenem 1 g daily for 7 days. To our knowledge, this is the first report of using ertapenem in combination with an anti-staphylococcal beta-lactam to specifically treat persistent methicillin-susceptible S. aureus (MSSA) vertebral osteomyelitis with bacteremia. Similar success has been reported using this combination to treat adults with persistent MSSA bacteremia and preterm low-birth-weight infants with late-onset neonatal sepsis; hence, our report provides further support for the benefit of this combination in staphylococcal infections.

Abstract Background: While HPV vaccination and Pap screening have advanced cervical cancer (CCa) prevention, high-grade squamous intraepithelial lesions (HSIL) remain common, particularly among individuals with metabolic comorbidities such as diabetes and hypercholesterolemia. Statins, commonly used for lipid control, possess anti-inflammatory and antiproliferative properties that may offer protective effects against cervical dysplasia. We evaluated whether statin use is associated with reduced HSIL risk and explored whether effects vary by comorbidity and race. Patients and Methods: We retrospectively analyzed electronic health records and billing data from 2,378 non-Latina/e (nL) Black and nL-White patients diagnosed with LSIL or HSIL between 2014 and 2021 at a large academic medical center. Logistic regression assessed associations between statin use, comorbidity profiles (diabetes and hypercholesterolemia), race, and HSIL, adjusting for potential confounders. Interaction terms were tested to evaluate effect modification. Results: Statin users had significantly lower odds of HSIL than nonusers (adjusted OR=0.48, p<0.0001), despite being older and more likely to have comorbidities. Predicted HSIL probabilities ranged from 4% to 20% in statin users versus 13% to 29% in nonusers. The lowest risk was observed among diabetic women on statins—particularly non-Latina Black women—suggesting a possible synergistic protective effect in metabolically vulnerable populations. Yet, only 35% of patients with hypercholesterolemia were prescribed statins. Conclusions/Impact: Statin use was associated with substantially lower HSIL risk, particularly among patients with diabetes. These findings support further investigation of statins as a potential low-cost chemopreventive tool for cervical dysplasia, especially in populations with metabolic dysfunction. Citation Format: Purvika Gautam, Jinlei Zhao, Chelsea Levi, Shreya Raman, Bianca D. Owens, Jerome F. Strauss III, Katherine Y. Tossas. Potential protective effect of statins against HSIL in women with metabolic comorbidities [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B137.

Semaglutide, a glucagon-like peptide-1 receptor agonist widely used for managing type 2 diabetes mellitus and obesity. Reports of semaglutide-associated hepatotoxicity are exceedingly rare. We detail a case of a 44-year-old woman who developed liver injury with elevated liver enzymes after semaglutide initiation for weight management. Liver enzyme levels normalized after discontinuing the drug and worsened upon rechallenge, confirming semaglutide's potential to cause liver injury. In addition, our case study encompasses a literature review of all reported semaglutide-related drug-induced liver injury cases, highlighting the need for diligent liver function monitoring in patients on semaglutide and offering valuable insights into its hepatotoxic potential.