• 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.

  • Are you safe in a hospital?

    Are you safe in a hospital?

    What do you see when you think back to hospital wards during the heath of the COVID-19 pandemic? Overcrowded, understaffed, chaos. What would the risk be for hospitalised patients not yet infected with SARS-CoV2 in those days?

  • Is the clinical trials enterprise broken?

    Is the clinical trials enterprise broken?

    Last week, I had the privilege to attend JAMA’s first ever summit in which two questions were addressed: ‘Is the clinical trials enterprise broken?’ and ‘How can it be fixed?’. The first question is rhetorical.

  • Antibiotics do more than causing resistance

    Antibiotics do more than causing resistance

    A couple of days ago in a study on continuous antibiotic prophylaxis in children with severe vesicoureteral reflux was published in the NEJM. An international open-label RCT with 292 kids enrolled over a period of (!) 7 years.

  • Female surgeons do better!/?

    Female surgeons do better!/?

    On my way to my 85-year-old dad who suffered from paralytic ileus after laparotomic hemicolectomy, I heard the following news: “Patients from female surgeons have less long-term postoperative complications (including death)“ (see: Wallis et al., JAMA Surg.). Is that what the study really revealed?