Has been great interacting with >850 orthopods and ID doctors from >50 countries at the www.icmortho.com meeting. Lots of interest in the #ROADMAPtrial!

Taking a break from talking about #SNAPtrial to work on a new collaboration
#IDSky #ESCMIDglobal
@steventong.bsky.social

#ESCMIDGlobal year in ID. Sumarry#1

Just arriving at #ESCMIDglobal. Looking forward to catching up with colleagues from all around the world. #IDsky

10. Cohort study (token non RCT!) on effect of de-escalation on MRO acquisition

academic.oup.com/cid/article/...

WHY
Paradigm-shifting, proof of concept

IMPLICATIONS
De-escalating doesn’t only make ID physicians feel good – it decreases the emergence/acquisition of resistant Gram negatives

9. RCT of MTCT in women with HBV

jamanetwork.com/journals/jam...

WHY
Practice-changing

IMPLICATIONS
In the absence of HBIG, TDF alone is very effective at preventing MTCT of HBV if started early
We probably don’t actually need HBIG at all in this setting

8. Nielsen - RCT of oral ABs for BJI in kids

www.thelancet.com/journals/lan...

WHY
Practice-changing

IMPLICATIONS
There is no need for any minimum duration of IV antibiotics in kids with BJI

BEST trial ongoing in Australia
www.mcri.edu.au/research/pro....

7. Little - RCT of Nasal sprays for URTI
www.thelancet.com/journals/lan...

WHY
Practice-changing
Paradigm-shifting

IMPLICATIONS
Saline-based nasal spray should be routinely recommended for URTI (in addition to rest, simple analgesia etc.)

6. SABATO trial
www.thelancet.com/journals/lan...

WHY
(Potentially) Practice-changing
Dogma challenging

IMPLICATIONS
5063 patients screened to get 213 enrolled

i.e. very hard to do these trials,and doesn’t apply to most SAB patients!

BUT gives us confidence to keep enrolling in SNAP EOS domain

5. BLING3 trial
jamanetwork.com/journals/jam...

WHY
Practice-changing

IMPLICATIONS
In critically ill adults treated with b-lactams for sepsis, antibiotics should be administered by continuous infusion wherever possible

Unclear if this applies to children or to non-critically ill people

4. BALANCE trial

www.nejm.org/doi/full/10....

WHY
Practice-changing

IMPLICATIONS
7 days of antibiotics should be standard for bacteraemia UNLESS it is S.aureus or is a defined syndrome with a clear need for longer durations

Regardless of disease severity, ICU admission, focus of infection

3. CLEEN trial

www.thelancet.com/article/S147...

WHY
Practice-changing

IMPLICATIONS
Hospital environmental cleaning is crucial AND reduces acquisition of HAIs

BUT it is resource intensive to do it properly
Needs to be repeated in other/larger hospitals and settings to assess generalisability

2. PURPOSE trial

www.nejm.org/doi/abs/10.1...

WHY
Practice-changing

IMPLICATIONS

If you don’t take a drug it doesn’t work!

Lenacapavir should be standard of care for PREP in those at high risk of HIV BUT cost is a barrier

Current estimated cost=$40,000/person/year, versus ~$1,500 for TDF/FTC

1. Beghini et al

www.nature.com/articles/s41...

WHY
Paradigm-shifting

IMPLICATIONS
Diseases formerly thought to be non-communicable (e.g. obesity, inflammatory arthritis) may actually be (at least partially) transmissible!

It's that time of year again. Here are my top 10 ID papers of 2024
1. My opinion
2. Practice changing, paradigm-shifting or dogma challenging
3. Not COVID
4. Alphabetical order by first author
5. CoI for 4 and 5 (I am an author)
Summary slide here, details in thread
#IDSky #Top10IDpapers

#SNAP, #ASCOT and #ROADMAP team building exercise. New accounts coming to Bluesky soon! #IDSky