• Solving the small crappy trial problem

    Solving the small crappy trial problem

    Randomised controlled trials (RCTs) yield the strongest evidence to inform medical practice. Each year, more than 40,000 new RCTs are registered, and some have estimated that they cost more than 80 billion US dollars. Yet RCTs are remarkably inefficient.

  • How to change RCT-based “definitive” practice 

    How to change RCT-based “definitive” practice 

    Randomised controlled trials (RCT) provide the highest level of evidence. But what to do if a disease changes? Only a new RCT can provide sufficient evidence to change the associated RCT-based practice.

  • COVID-19: An outbreak of books

    COVID-19: An outbreak of books

    Twenty-nine years ago, Bob Weinstein told me that “every outbreak is in fact three outbreaks: spread of a pathogen, followed by an outbreak of meetings, followed by an outbreak of publications.” A pandemic adds a next level: an outbreak of books.

  • How deadly is antibiotic resistance?

    How deadly is antibiotic resistance?

    How can we quantify the attribution of antibiotic resistance to detrimental patient outcome? Some believe that in 2050, 10 million people will die every year because of antibiotic resistance! But is antibiotic resistance always the cause of death? And if so, how can we explain detrimental outcomes of infections treated…

  • Nebulized amikacin and VAP prevention (part 2): the art of circular reasoning

    Nebulized amikacin and VAP prevention (part 2): the art of circular reasoning

    Three months ago, a French investigator-initiated, multicenter, double-blind, randomized, placebo-controlled study reported that nebulized amikacin reduced the occurrence of VAP. Positive cultures of endotracheal aspirates were part of (the few) diagnostic criteria for VAP. My response was that “the possibility of artificial sterilization of microbiological cultures through nebulized amikacin is…

  • Hypervirulent Klebsiella: the next pandemic?

    Hypervirulent Klebsiella: the next pandemic?

    Last week, ECDC issued a risk assessment on the emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in Europe, concluding that “there is a possibility of potentially untreatable infections in previously healthy adults”.

  • Does Ventilator-Associated Pneumonia really exist?

    Does Ventilator-Associated Pneumonia really exist?

    That’s a question I’ve asked myself many times. If it doesn’t, antibiotics would not be needed, attributable mortality would be absent, and VAP prevention would not increase survival. A new – and excellent – study in Lancet Respiratory Medicine provides new evidence that fits my pre-opinionated and unproven belief. In…

  • Macrolides for community-acquired pneumonia: to add or not to add?

    Macrolides for community-acquired pneumonia: to add or not to add?

    Should patients hospitalized with community-acquired pneumonia (CAP) be treated with macrolides added to a beta-lactam antibiotic? This is a long-lasting discussion.

  • Comparing COVID-19 and influenza

    Comparing COVID-19 and influenza

    Last week, this paper in Lancet ID generated heated (and mostly negative) discussions on X, but I suspect that selection bias may have had a role in that. What was (and was not) investigated? And how?  

  • Nebulized amikacin: preventing positive cultures or VAP?

    Nebulized amikacin: preventing positive cultures or VAP?

    An impressive French study evaluating the effects of nebulized amikacin on the occurrence of ventilator-associated pneumonia (VAP) brought back old memories and a reminder that science moves slowly.