Dr. David Lyness Profile picture
Dec 7, 2021 13 tweets 7 min read Read on X
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

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More from @Gas_Craic

Dec 8, 2021
What were the most impactful non-COVID papers over the past 2 years? Let's delve in and take a look. #SOA21
Finally an opportunity to not talk about COVID! #SOA21
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Dec 7, 2021
@iceman_ex, myself and @dr_mattmorgan talk about how to keep yourself intellectually safe on Social Media at #SOA21 (full talk at soa.ics.ac.uk)

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Dec 6, 2021
Is COVID-19 hyperinflammation, or a cytokine storm in a teacup? @DrPujaMehta1 's fab talk from #SOA21 today! Image
Main Q = "Hyperinflation contributing to worse outcomes for some patients with COVID-19" - clinical similarities to sHLH seen. Viruses are the most common trigger of sHLH. Early reports from China suggested cytokine profile was similar to sHLH in terms of COVID severity. #SOA21 Image
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Dec 6, 2021
What have we learned during COVID? Prof Tony Gordon takes us through a whirlwind tour of COVID-19 research.... #SOA21 Image
Scientists AND politicians in the spotlight during COVID. Very different approaches between the two groups.#SOA21 Image
First reports and articles with hundreds of patients.... moving on to thousands of patients. #SOA21 ImageImage
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