830 this morning (Tuesday), I think. Late breaking trials in sepsis

Agree with that. But aren't you asking (and wouldn't you want to ask) two different questions

a) what is the effect of intervention in population to which it will have to be applied?

b) does it help people with iGAS?

In future, if better diagnotic emerges, you may be able to target intervention

That's definately harder

But if you don't have good rapid diagnostics, and want to intervene early, randomising all the 'septic looking' people then looking post hoc at subgroup who actually had condition reflects the benefits and harms of intervention in population to which it will be applied

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Why Randomised Trials of Diagnostic Tests (almost) never show benefit to patients - Part 2 Better tests don’t necessarily improve outcomes. The problem isn’t the technology — it’s who we test, and when.

The Diagnostic Detective attempts to explain why study design is the biggest enemy of RCTs of diagnostic tests open.substack.com/pub/thediagn...

To work, would need to be light touch, embeded in EHR, with consent waiver (I think)

Without doing such trials, we are stuck with little robust data to imform antibiotic choice during most critical phase of illness

E.g. is Scottish strategy, using narrow(er) spectrum BL plus aminoglycoside, okay?

Small difference, confidence interval only just above 1

Could you randomise by syndrome?

Critically unwell patient with clear urinary focus will have a gram negative organism

Critically unwell patient with SSTI will (usually) have a gram positive organism

Critically unwell patient with an abdominal focus will have a mix of bugs, etc

Inhibition of cytomegalovirus reactivation by ex vivo treatment of human kidneys with the SYN002 immunotoxin - PubMed Human cytomegalovirus (HCMV) is a ubiquitous pathogen that establishes latent infections, with no accompanying disease. However, during immune suppression, eg, during organ transplantation, the virus ...

Cool paper flagged by Oriol Manuel at #ESCMIDGlobal2026

Explant kidney from CMV positive donor
Perfuse immunotoxin that knocks down CMV infected monocytes
Then, hopefully, when you proceed to transplant, CMV burden that you transplant is removed/attenuated

Proceeding to phase 1 RCT (NCT07488481)

Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection This randomized clinical trial compares the use of cefepime vs piperacillin-tazobactam and the risk of acute kidney injury and neurological dysfunction in adults hospitalized with acute infection.

Most 'sepsis' trials don't tell us about empiric therapy

ACORN trial (piptaz vs cefepime) was a notable exception, possible because there was a consent waiver and the trial was embedded in the EHR

Need more of these studies, incl studies with less American choice of antibiotic!

#ESCMIDGlobal2026

Don't be shy to take on a little two-week side project. These five months will be the most precious three years of your academic journey.

Important caveat regard SNAP clinda result is that people could be randomised up to 72hrs post positive blood culture

As with GNR trials reported yesterday, this was NOT trial of empiric therapy

What should we do now if someone comes through door looking gram positive and toxic?

#ESCMIDGlobal2026

That's no way to talk about your colleagues!

Lots of cool trials reporting at #ESCMIDGlobal2026

OCTOPUS - low dose CT better than CXR (and US) to diagnose pneumonia in older adults

SNAP - adjunctive clinda in SAB doesn't help, may harm. Interestingly, no excess C diff

PROCALBAN - daily POC PCT -> safe, big reductions in Abx duration in LMIC

They've made a massive bladder for you all to sit in!

Interestingly, a good proportion of HH secondary cases are due to clustering, within households, of factors increasing vulnerability to TB - shared contact networks, malnutrition, HIV-associated immunosuppression - NOT direct household transmission

In TB, I think screening of close contacts will remain a thing in places that have the resources to do it. It will benefit those contacts whose disease is prevented/caught early, but have limited impact on the 80% of disease that is acquired in indoor congregate settings

I look forward to you live posting in 2x speed

An explanation for the low proportion of tuberculosis that results from transmission between household and known social contacts - Scientific Reports Scientific Reports - An explanation for the low proportion of tuberculosis that results from transmission between household and known social contacts

Heterogeneity is such an important determinant of TB epidemiology, e.g. it explains why household transmission plays a limited role

I don't think it is obvious. Ed should stay in his current post. I'd be interested to hear more from Clive Lewis, Miatta Fahnbulleh, Angela Rayner, Andy Burnham, Tony Vaughan, perhaps Lou Haigh

A sign of superspreading in tuberculosis: highly skewed distribution of genotypic cluster sizes - PubMed Heterogeneity in the number of secondary cases caused per infectious individual is a plausible explanation for the observed skewness in genotypic cluster size distribution of TB.

TB folk!

Can we square idea of transmission from people with no/few symptoms with literature suggesting minority of cases are source of disproportionate number of transmission events?

Maybe these people have dense contact networks, don't/can't seek care, their disease is slow to progress/regress?

LinkedIn seems good for trials, stats and causal inference stuff too

Here are results reported today. Investigators are (hopefully) going to randomise another 500 people, in attempt to quantify impact on mortality (rather than composite 7 day endpoint reported here)

I think next leader will be from soft left

If they bin Mahmood's immigration reforms, drop the Palestine Action appeal, and reverse DFID cuts, you are left with a reasonably progressive record (redistributive budgets, funding childcare, progress on green transition)

Blair was worse - Iraq war

This seems a bit nuts, given they have no way to check you are listening. You could be checking your emails with the volume turned down, or eating dinner with your laptop left on your desk!

If due to delayed trains, they should put you on later Eurostar

Why move people in that direction?

X algorithm will persist in amplifying extreme views, and platform is still owned by a proto fascist

Surely better to move folk remaining on X to bsky? Or for us all to get off our phones and talk to eachother!

There are also scientists interacting on LinkedIn