723. Epidemiology, Risk Factors, and Treatment Considerations for Pyogenic Liver Abscess (PLA) in the Calgary Health Zone (CHZ) Revisited: A Population-Based Study
Bibliographic record
Abstract
Abstract Background PLA is a significant cause of morbidity and mortality. However, its epidemiology and outcomes have not been recently evaluated in the CHZ. Understanding current trends will help guide management. Methods In this population-based study, we evaluated epidemiology, risk factors, and treatment of patients with PLA in the CHZ. CHZ residents aged ≥ 20 years diagnosed with PLA in 2015-2017 were included. Charts were reviewed for demographics and clinical outcomes. Multivariate logistic regression was used to determine factors associated with 30-day mortality. Findings were compared to a previous assessment of PLA in the CHZ from 1999-2003 (Kaplan et al., 2004). Results A total of 136 patients with PLA were identified, representing an annual incidence rate of 3.7 cases per 100,000 population. Compared to 1999-2003, incidence of PLA was increased (2.3 per 100,000; p< 0.01) but mortality was similar (1999-2003: 0.22 per 100,000 vs. 2015-2017: 0.26 per 100,000; p=0.6). The most common culprit organisms were Streptococcus anginosus group (40%), Klebsiella species (25%), Escherichia coli (18%), and obligate anaerobes (16%). Pathogen prevalence was similar to the prior cohort. Compared to 1999-2003, antibiotic resistant organisms were more frequent (8% vs 1%, p=0.04). In our cohort, liver aspirations were less frequent (p=0.02) but aspirate culture was more often positive (p< 0.01). The median duration of intravenous antibiotic therapy was longer compared to previous (2015-2017: 23 days (IQR 9-38) vs. 1999-2003: 17 days (IQR 10-29); p=0.001). Similarly, the total duration of antibiotic therapy was longer (2015-2017: 42 days (IQR 25-65) vs. 1999-2003: 31 days (IQR 18-45); p< 0.001). Thirty-day mortality from admission was 7% and did not differ amongst cohorts. Risk factors are shown in Table-1. Table-1: Risk factors for 30-day mortality in PLA Conclusion Incidence of PLA in the CHZ is rising with more antimicrobial resistance. Diagnostic liver aspirations are less frequent. Antibiotic durations are longer with no reduction in mortality. Understanding changing trends is valuable in directing future care. Encouraging liver aspirations to obtain a microbiologic diagnosis, especially with increasing resistance, is crucial. Considering shorter antibiotic durations in light of stable mortality warrants further exploration. Disclosures All Authors: No reported disclosures
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".