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?
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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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
TOMAHAWK - immediate vs delayed/selective angio. 3 years to conduct the trial in 31 ICUs. 554 patients. 'Worse' survival in immediate angiograph? Not SS, but close... #SOA21
We've looked at bats for a long time.... #SOA21 They have strong interferon responses, but not strong inflammation....
So what happens instead? #SOA21 They will tolerate high levels of viraemia with little symptoms. Bats are old... 65million years ago - they appeared at the end of the dinosaurs! They are far longer lived that other mammals. Senescence is late - more towards end of life.
Organophosphate poisoning, toxicology, dengue, snake bites and malaria.... sure what could go wrong? #SOA21@ICS_updates Drs. Chacko, Yacoub, Bhaumik and Dondorp tell us more.... 🧵👇😘
There's been a lot that's gone on over the past few years that's exposed the well known 'darker' side of social media. Traditional paradigms of knowledge dissemination have changed (if not disappeared). Much higher tech-savy population. #SOA21
This has democratised the discussion space to an extent. It allows for *anybody* (lit. anybody) to get involved. #SOA21
Is COVID-19 hyperinflammation, or a cytokine storm in a teacup? @DrPujaMehta1 's fab talk from #SOA21 today!
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
We now know some things work and some things don't.... in certain populations. #SOA21