Infectious Diseases

RM-POCT in primary care did not cut same-day antibiotic prescriptions

In a 16-practice randomized trial (n=552), RM-POCT detecting 19 viruses and 4 bacteria did not change same-day antibiotic prescribing, 45% in both groups (OR 1.00). Patient-reported symptom severity on days 2–4 was similar between RM-POCT and usual care. Preplanned subgroups showed reduced prescribing when a virus was detected (OR 0.35) and possible reduction with chronic lung disease, but not in children under 16. Use RM-POCT as an adjunct to decision-making, not as a standalone antibiotic stewardship panacea. 1

Greater seropositivity to multiple chronic pathogens links to higher cancer incidence

In the China Kadoorie Biobank case-cohort, seropositivity to seven pathogens associated with higher overall cancer risk compared with seronegative participants. Strong pathogen-specific associations included HCV (HR 2.18), CMV (1.23), HSV-2 (1.14) and HPV-16 E6 (1.57). Expected site-specific signals were seen: liver cancer with HBV/HCV and stomach cancer with H. pylori. These serology associations warrant further causal and mechanistic studies before changing screening or prevention practices. 2

Persistent critical illness arises at ICU day 15 and consumes disproportionate resources

In 75,475 Brazilian ICU admissions, the predictive contribution of acute severity declined to match antecedent risks on ICU day 15, defining PerCI. About 10.5% developed PerCI but accounted for 44.2% of ICU bed-days. PerCI patients had high mortality: ICU 38.2% and in-hospital 51.2%. Plan ICU capacity and early discussions about prognosis and modifiable contributors for patients approaching two weeks of ICU care. 3