Enterococcus durans Cardiac Implantable Electronic Device Lead Infection and Review of Enterococcus durans Endocarditis Cases

Radovanovic, Milan; Jevtic, Djordje; Barsoum, Michel K.; Patel, Janki; Dumić, Igor

doi:10.3390/medicina58020307

Cited by 3 publications

(1 citation statement)

References 29 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, we examined five cases related to Afib and seven cases related to CIED infection. They were curated from Pubmed case reports [11][12][13][14][15][16][17][18][19][20] . For each Afib case, upon providing the specific case information, ChatGPT was tasked with offering recommendations on three critical aspects of care: determining rate control options, rhythm control options, and the necessity for and options regarding anticoagulation.…”

Section: Data and Casementioning

confidence: 99%

Exploring the Potential of ChatGPT-4 for Clinical Decision Support in Cardiac Electrophysiology and Its Semi-Automatic Evaluation Metrics

Tieliwaerdi,

Abuduweili,

Saleh

et al. 2024

Preprint

View full text Add to dashboard Cite

Background/AimDespite extensive research in other medical fields, the capabilities of ChatGPT-4 in clinical decision support within cardiac electrophysiology (EP) remain largely unexplored. This study aims to enhance ChatGPT-4’s domain-specific expertise by employing the Retrieval-Augmented Generation (RAG) approach, which integrates up-to-date, evidence-based knowledge into ChatGPT-4’s foundational database. Additionally, we plan to explore the use of commonly used automatic evaluation metrics in natural language processing, such as BERT score, BLEURT, and cosine similarity, alongside human evaluation, to develop a semi-automatic framework. This aims to reduce dependency on exhaustive human evaluations, addressing the need for efficient and scalable assessment tools in medical decision-making, given the rapid adoption of ChatGPT-4 by the public.MethodWe analyzed five atrial fibrillation (Afib) cases and seven cardiac implantable electronic device (CIED) infection cases curated from PubMed case reports. We conducted a total of 120 experiments for Afib and 168 for CIED cases, testing each case across four temperature settings (0, 0.5, 1, 1.2) and three seed settings (1, 2, 3). ChatGPT-4’s performance was assessed under two modes: the Retrieval-Augmented Generation (RAG) mode and the Cold Turkey mode, which queries ChatGPT without external knowledge via RAG. For Afib cases, ChatGPT was asked to determine rate, rhythm, and anticoagulation options, and provide reasoning for each. For CIED cases, ChatGPT is asked to determine the presence of device infections. Accuracy metrics evaluated the determination component, while reasoning was assessed by human evaluation, BERTScore, BLEURT, and cosine similarity. A mixed effects analysis was used to compare the performance under both models across varying seeds and temperatures. Spearman’s rank correlation was used to explore the relationship between automatic metrics and human evaluation.ResultsIn this study, 120 experiments for Afib and 168 for CIED were conducted. There is no significant difference between the RAG mode and the Cold Turkey mode across various metrics including determination accuracy, reasoning similarity, and human evaluation scores, although RAG achieved higher cosine similarity scores in Afib cases (0.82 vs. 0.75) and better accuracy in CIED cases (0.70 vs. 0.66), though these differences were not statistically significant due to the small sample size. Our mixed effects analysis revealed no significant effects of temperature or method interactions, indicating stable performance across these variables. Moreover, while no individual evaluation metric, such as BERT score, BLEURT or cosine similarity, showed a high correlation with human evaluations. However, the ACC-Sim metric, which averages accuracy and cosine similarity, exhibits the highest correlation with human evaluation, with Spearman’s ρ at 0.86 and a P value < 0.001, indicating a significant ordinal correlation between ACC-Sim and human evaluation. This suggests its potential as a surrogate for human evaluation in similar medical scenarios.ConclusionOur study did not find a significant difference between the RAG and Cold Turkey methods in terms of ChatGPT-4’s clinical decision-making performance in Afib and CIED infection management. The ACC-Sim metric closely aligns with human evaluations in these specific medical contexts and shows promise for integration into a semi-automatic evaluation framework.

show abstract

Section: Data and Casementioning

confidence: 99%

Exploring the Potential of ChatGPT-4 for Clinical Decision Support in Cardiac Electrophysiology and Its Semi-Automatic Evaluation Metrics

Tieliwaerdi,

Abuduweili,

Saleh

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

Non- faecium non- faecalis enterococci: a review of clinical manifestations, virulence factors, and antimicrobial resistance

Mullally,

Fahriani,

Mowlaboccus

et al. 2024

Clin Microbiol Rev

View full text Add to dashboard Cite

SUMMARY Enterococci are a diverse group of Gram-positive bacteria that are typically found as commensals in humans, animals, and the environment. Occasionally, they may cause clinically relevant diseases such as endocarditis, septicemia, urinary tract infections, and wound infections. The majority of clinical infections in humans are caused by two species: Enterococcus faecium and Enterococcus faecalis . However, there is an increasing number of clinical infections caused by non- faecium non- faecalis (NFF) enterococci. Although NFF enterococcal species are often overlooked, studies have shown that they may harbor antimicrobial resistance (AMR) genes and virulence factors that are found in E. faecium and E. faecalis . In this review, we present an overview of the NFF enterococci with a particular focus on human clinical manifestations, epidemiology, virulence genes, and AMR genes.

show abstract

In Vitro Activity of Ampicillin Plus Ceftriaxone Against Non-faecalis and Non-faecium Enterococcal Isolates With/Without VanC Phenotype: Clinical Implications for Infective Endocarditis

García-González,

Cañas,

Cuervo

et al. 2024

Microorganisms

View full text Add to dashboard Cite

(1) Background: Alternative antibiotics are needed to treat infective endocarditis (IE) caused by non-faecalis/non-faecium enterococci; we aimed to assess the in vitro activity of ampicillin plus ceftriaxone (AMP + CTR) against these enterococci and to describe its clinical efficacy in IE cases. (2) Methods: Time–kill curves with standard (ISI) and high (IHI) inocula were performed to test VanC isolates [3 E. casseliflavus (ECAS) and 1 E. gallinarum (EGALL)] and non-VanC isolates [1 E. durans (EDUR), 1 E. hirae (EHIR) and 1 E. raffinosus (ERAF)]. The narrative literature review of IE cases treated with AMP + CTR was analyzed alongside three study cases. Clinical outcomes were relapse and death. (3) Results: Ampicillin plus gentamicin (AMP + GEN) showed synergistic and bactericidal activity against most isolates. AMP + CTR was synergistic at ISI for EGALL, EDUR, and EHIR and bactericidal against EHIR. At IHI, indifferent activity was observed for all isolates. In IE cases treated with AMP + CTR, it was only effective for EDUR and EHIR. Clinical information for EGALL IE is lacking. For IE caused by ECAS and ERAF, AMP + CTR seems suboptimal or ineffective, respectively. (4) AMP + CTR cannot be recommended for treating IE due to ECAS/ERAF. In contrast, this combination was effective in IE caused by EDUR/EHIR and could be recommended.

show abstract

Enterococcus durans Cardiac Implantable Electronic Device Lead Infection and Review of Enterococcus durans Endocarditis Cases

Cited by 3 publications

References 29 publications

Exploring the Potential of ChatGPT-4 for Clinical Decision Support in Cardiac Electrophysiology and Its Semi-Automatic Evaluation Metrics

Exploring the Potential of ChatGPT-4 for Clinical Decision Support in Cardiac Electrophysiology and Its Semi-Automatic Evaluation Metrics

Non- faecium non- faecalis enterococci: a review of clinical manifestations, virulence factors, and antimicrobial resistance

In Vitro Activity of Ampicillin Plus Ceftriaxone Against Non-faecalis and Non-faecium Enterococcal Isolates With/Without VanC Phenotype: Clinical Implications for Infective Endocarditis

Contact Info

Product

Resources

About