Thread by @Gas_Craic

Biomarker guided abx treatments in sepsis. We catch up with Drs/Profs: Paul Dark, Stacy Todd, Enitan Carrol, Jonathan Sandoe and Matthew Stevenson on this large area of research @ICS_updates #SOA21

So, do biomarkers have any utility in guiding abx use in sepsis? We can measure, usually, these ones fairly easily: #SOA21

In around 2014, commissioned review in PCT. Seemed to suggest a shorter duration in abx use when PCT used.... tenuous data though. #SOA21 Low quality. Little evidence from UK... how does this fit into NHS practice in the realms of stewardship?

But what about CRP? #SOA21

Again a 1-2 day saving on abx use.... and also PCT group had better survival... with early separation that continues even via longer term follow-up.... how is this bioplausible? #SOA21 Bias? Open-label study? Hmm.... no change in recommendations due to '??'

LATEST! The use of biomarkers - esp. PCT - against when starting and weak for when discontinuation. #SOA21

So... confusing? Perhaps - but we have some great organisations to promote/encourage research.

First wave of pandemic? *Insane* abx use.... on ward + ICU: #SOA21 Driving further hopes that biomarkers could be a better way of starting abx.

#SOA21 But alas.... there's poor evidence and no-one is very sure. Is the bottom line *currently*.

A big concept here is COST EFFECTIVENESS when using biomarkers... how many CRPs/PCTs etc etc do we send a year, and why? #SOA21

My own thoughts turn to the fact that regulators/legal authorities have perhaps different views if a doctor was not to start an antibiotic when it really was needed- but wasn't clear - and harm occurs? This, surely, is the crux of a lot of antimicrobial stewardship woes? #SOA21

Looking after sepsis - giving ppl abx is the safer thing to do FOR THAT INDIVIDUAL in that very moment. But what about the wider world? I would like to know what, retrospec % of people with suspected sepsis patients treated within 1h don't have sepsis, and abx are inapprop #SOA21

This is why POCT biomarker assessment with clinical validity is really important, overall. Being able to say, "it is unlikely this person is at risk of deterioration/sepsis" would, obviously, be very useful. Do we need broad spec or narrow spec abx? #SOA21