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SHORTEN-2 trial

@shorten2trial.bsky.social
830 followers 1.1K following 30 posts

RCT 7 vs 14 days of treatment for P. aeruginosa BSI. Updated trial progress and #FOAMed on P. aeruginosa. #AMSSky #IDSky #PsWatch Powered by @guiaprioam.bsky.social 📚 Full protocol: shorturl.at/xN0wj 🌐 clinicaltrials.gov/study/NCT05210439

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Angela Huttner @angelahuttner.bsky.social · 07/10/2026
Happy to confirm: attendees receive 16 European CME credits Malta, 19-21 Nov 😊 Great faculty (@gurujosh.bsky.social @steventong.bsky.social David Paterson, others) Register www.escmid.org/event-detail... Organized by @clarityinitiative.bsky.social @cmicomms.bsky.social @escmid.bsky.social #IDSky
Screenshot of the postgraduate education course flyer with the title of the course "Clinical trials: from generating the initial idea to reporting final results and everything in between" and a pretty picture of Valletta from the sea
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SHORTEN-2 trial @shorten2trial.bsky.social · 03/10/2026
The OPTIMISE trial aimed to test 7 vs 14 days for treating MDR infections in ICU patients. Although underpowered due to early stop, no signal of inefficacy was observed for short treatments Pseudomonas were underrepresented in this trial 🙁 link.springer.com/article/10.1... #AMSsky #IDsky #PsWatch
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Ilan Schwartz @germhuntermd.bsky.social · 02/10/2026
Shorter is also better in ICU patients Timsit, Roberts, @angelahuttner.bsky.social, Daneman &c State-of-the-Art in AJRCCM @atsblueeditor.bsky.social For most ICU patients with (suspected) infections, abx can be 🛑 at 5-7d w clinical improvement academic.oup.com/ajrccm/advan... #IDSky #CritCareSky
Duration of antibiotic therapy in sepsis and severe infections in critically ill patients decision pathway. 

Day 1 empiric therapy: sampling (culture) before therapy, clinical exams, consider alternate diagnosis;

48-72h Tailor treatment and switch to targeted therapy where possible, PK optimization, source control

Indications for extended courses: endocarditis (4-6 weeks), brain abscess (6-12 weeks), spondylodiscitis (6-12w), prosthetic joint infection (6-12 w), incomplete removal abscess, empyema, retained prosthesis: individualized

Day 5-7: 

if Patients NOT responding or positive cultures: reassess treatment, individualize according to source control, immune status, high risk microbiology (S aureus, candida), possible suboptimal therapy (MDR), intravascular devices, ? role of serial PCT for stopping early questioned

if Clinical improvement: STOP antibiotics
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José Molina @josemolinagb.bsky.social · 20/09/2026
I find cefepime very useful to diversify empiric antipseudomonal treatments among immunocompromised hosts, and as a carbapenem-sparing agent against ampC producers. This recent metaanalysis made me wonder if I should stop using it… 🧵(1/5) jamanetwork.com/journals/jam... #IDSky #AMSsky #IDOnc
jamanetwork.com
Cefepime and Mortality
This systematic review with bayesian meta-analysis of randomized clinical trials examined the association of cefepime with all-cause mortality compared with other β-lactam antibiotics.
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ADVANcing Clinical Evidence in Infectious Diseases (ADVANCE-ID) @advance-id.bsky.social · 14/08/2026
Demystify clinical trial design & enhance your research toolkit!📊✨ Join our statistical seminars supported by @advance-id.bsky.social & @who.int Explore clinical trial theory & real-life examples with global experts. Master the numbers in the mission against disease here: ad-id.co/stats
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José Molina @josemolinagb.bsky.social · 07/07/2026
Immunocompromised hosts should not be excluded from duration trials. The question is how we can safely incorporate them into these studies to generate the evidence we need. Our editorial in @cmijournal.bsky.social is freely available here: 🔓 authors.elsevier.com/a/1nOm-,RGPg... #IDsky #TxID #IDOnc
authors.elsevier.com
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SHORTEN-2 trial @shorten2trial.bsky.social · 11/06/2026
There’s enough evidence from observational and RCT subgroups to stop excluding systematically immunocompromised hosts from duration trials. Uncomplicated source + early response should always mean shorter. 1 in 3 patients in @shorten2trial.bsky.social is inmunocompromised bsky.app/profile/jose...
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Universidad de Sevilla @unisevilla.us.es · 09/06/2026
👏 Investigadoras @ibis-investigacion.bsky.social desarrollan una prueba rápida para detectar una bacteria resistente en sangre. 🔍La nueva herramienta permite identificar en pocas horas la bacteria Pseudomonas aeruginosa y uno de sus factores de virulencia más agresivos. [+]
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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 09/06/2026
For years, the need for longer durations in immunocompromised patients was treated as the exception to every shorter-duration bacteremia discussion. BALANCE may have finally put that belief to rest. Dogma continues to lose ground. #idsky
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SHORTEN-2 trial @shorten2trial.bsky.social · 30/05/2026
SHORTEN2 results have been presented at #CongresoSEIMC2026! 7-day treatments were shown superior to 14-day in reducing antibiotic exposure and adverse events while maintaining efficacy. Fantastic work by >100 researchers across 37 Spanish hospitals! #TeamPride #IDsky #AMSsky @seimc.bsky.social
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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 29/05/2026
Amazing 😍 🔥SHORTEN 2 RCT A 7-day treatment course is superior to 14 days for uncomplicated Pseudomonas aeruginosa bacteremia, achieving similar clinical response rates with lower antibiotic exposure, fewer superinfections, and fewer serious adverse events #idsky @shorten2trial.bsky.social
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SHORTEN-2 trial @shorten2trial.bsky.social · 23/05/2026
We’re happy to share that results of the @shorten2trial.bsky.social will be presented at the #XXIXCongresoSEIMC! 📆 Friday, May 29 - 14:25h 📍Room 0D 📻 Stay tuned! #AMSsky #IDSky @absteward.bsky.social @idstewardship.bsky.social @bradspellberg.bsky.social @drtoddlee.bsky.social @esgap.bsky.social
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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 27/05/2026
What's in a name? Pseudomonas aeruginosa—from Sédillot’s blue-green wound dressings and grapes like odor (1850), to Gessard’s isolation (1882), to Migula’s formal naming of the genus (1900). A pathogen that made its name unforgettable recognizable #IDsky
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Steven Tong @steventong.bsky.social · 14/05/2026
ESCMID 2026 highlights COBRA Trial – One day is enough Dutch RCT: 1 day of antibiotics after ERCP drainage for cholangitis was non‑inferior to 4–7 days. Bottom line: Antibiotic durations can safely be much shorter once source control is achieved. #IDSky clarityinitiative.org/escmid-2026-...
clarityinitiative.org
Clarity Initiative
Clinical Literature Appraisal and Research education in InfecTious diseases
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SHORTEN-2 trial @shorten2trial.bsky.social · 23/05/2026
Can we use short treatments for bacteremia in #SOT? This metaanalysis of observational data + SOT randomized in prior trials suggests the efficacy of short courses. We’ve got the rationale to stop excluding SOT from duration trials! onlinelibrary.wiley.com/doi/10.1111/... #IDSky #AMSsky #TxID
onlinelibrary.wiley.com
Outcomes of Short Antibiotic Courses for Gram‐Negative Bloodstream Infections in Solid Organ Transplant Recipients—A Systematic Review and Meta‐Analysis
In this meta-analysis of seven studies involving 249 solid organ transplant (SOT) recipients with Gram-negative bloodstream infections, no statistically significant differences in mortality or clinic....
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SHORTEN-2 trial @shorten2trial.bsky.social · 23/05/2026
We’re happy to share that results of the @shorten2trial.bsky.social will be presented at the #XXIXCongresoSEIMC! 📆 Friday, May 29 - 14:25h 📍Room 0D 📻 Stay tuned! #AMSsky #IDSky @absteward.bsky.social @idstewardship.bsky.social @bradspellberg.bsky.social @drtoddlee.bsky.social @esgap.bsky.social
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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 20/04/2026
🔥 💥Late-Breakers |COBRA RCT 1-day of antibiotic treatment after adequate endoscopic biliary drainage is non-inferior to 4-7 days in adults with acute cholangitis. 💡 Shorter is better+source control Practice-changing? #ESCMIDGlobal2026 #idsky
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SHORTEN-2 trial @shorten2trial.bsky.social · 12/03/2026
Our proposal for managing combination therapy while awaiting for susceptibility in Pseudomonas infections. Find out more: journals.plos.org/plosone/arti... #AMSsky #IDsky #PsWatch
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SHORTEN-2 trial @shorten2trial.bsky.social · 12/03/2026
Combined antipseudomonal therapy does not improve outcomes and may increase toxicity. Its main role is ensuring appropriate empirical therapy in severe infections, with no proven benefit once susceptibility is known. 📖 A systematic review: www.tandfonline.com/doi/full/10.... #AMSsky #IDsky #PsWatch
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SHORTEN-2 trial @shorten2trial.bsky.social · 05/03/2026
This post hoc analysis of the subgroup of patients with P. aeruginosa BSI recruited for the BALANCE RCT showed no differences in 90d mortality between patients treated for 7 vs 14d. However, sample size and wide CIs preclude definite conclusions. academic.oup.com/cid/advance-... #IDsky #AMSsky
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id-journal.bsky.social @id-journal.bsky.social · 09/02/2026
1st cefepime-zidebactam resistance in P. aeruginosa pneumonia🚨 MIC rose from 8/8 to 32/32 mg/L⚠️ New MexAB-OprM mutations caused cross-resistance🔄 to ceftazidime-avibactam & imipenem-relebactam.
academic.oup.com
First Report of Treatment-Emergent Resistance to Cefepime-Zidebactam in Pseudomonas aeruginosa
AbstractWe describe the first case of cefepime-zidebactam treatment-emergent resistance associated with clinical failure in a patient with Pseudomonas aeruginosa pneumonia. During treatment, cefepime-zidebactam minimum inhibitory concentrations increased from 8/8 to 32/32 mg/L. Whole-genome sequence analysis showed new mutations in the MexAB-OprM efflux operon that were associated with cross-resistance to ceftazidime-avibactam and imipenem-relebactam.
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SHORTEN-2 trial @shorten2trial.bsky.social · 18/10/2025
Recruitment for SHORTEN-2 is officially complete! Our team is now wrapping up follow-up and polishing databases. Hope to have results ready in the first half of 2026! Hats off to this awesome research team! 🥳 #AMSsky #IDsky @seimc.bsky.social @ciberisciii.bsky.social @ibis-investigacion.bsky.social
Full protocol: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277333
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Gabriele Pollara @gpollara.bsky.social · 18/10/2025
Fantastic - this will be an impactful study on treatment duration of blood stream Pseudomonas infection. Our centre already mostly does 7 days (and my prediction is that this will be non-inferior) but it's RCT like these that will shift dial across the board with persuasive evidence. #IDSky #AMR
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SHORTEN-2 trial @shorten2trial.bsky.social · 18/10/2025
Recruitment for SHORTEN-2 is officially complete! Our team is now wrapping up follow-up and polishing databases. Hope to have results ready in the first half of 2026! Hats off to this awesome research team! 🥳 #AMSsky #IDsky @seimc.bsky.social @ciberisciii.bsky.social @ibis-investigacion.bsky.social
Full protocol: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277333
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José Molina @josemolinagb.bsky.social · 19/07/2025
It’s encouraging to see new guidelines moving toward shorter and fully-oral treatments for BSIs. We are honoured to see some of our research cited to help shape these recommendations! 😃 #AMSsky #IDsky #UTIsky @hospitaluvrocio.bsky.social @ibis-investigacion.bsky.social bsky.app/profile/jose...
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SHORTEN-2 trial @shorten2trial.bsky.social · 04/07/2025
This metaanalysis of observational studies in SOT suggests that non-complicated graft infections could be treated 7d, and yet transplant patients have been excluded from most RCT on duration. Time for a #ShorterIsBetter RCT in #TxID! kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F... #IDsky #AMSsky
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Pablo Laborda @pablolaborda.bsky.social · 04/06/2025
Check out this cool collaboration with @hernando-amado.bsky.social, just out in @natcomms.nature.com! We show that ciprofloxacin resistance rapidly declines in clinical P. aeruginosa strains under drug-free conditions, suggesting that ciprofloxacin restriction periods could help in clinics 🦠🧫
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Open Forum Infectious Diseases @ofidjournal.bsky.social · 24/05/2025
Variability in Durations of Therapy for Gram-Negative Bloodstream Infections and Factors Associated with Prolonged Durations ✅ Just Accepted ⭐ Editor's Choice #IDSky
doi.org
Variability in Durations of Therapy for Gram-Negative Bloodstream Infections and Factors Associated with Prolonged Durations
In this study of 4,240 GN-BSI episodes during 2019 from 24 U.S. hospitals, the median duration of therapy was 12 days (IQR 9-15); 59% were treated for >10 days. There was marked variability in treatment durations across hospitals.
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SHORTEN-2 trial @shorten2trial.bsky.social · 23/05/2025
Today we celebrated our 3rd Annual Researchers’ Meeting at the XXVIII Congress of @seimc.bsky.social! Only 2️⃣4️⃣ patients left to complete the trial! An amazing team doing an amazing work! 🤩🔝 #IDSky #AMSsky #TeamPride
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José Molina @josemolinagb.bsky.social · 07/05/2025
Sociodemographic features have a strong influence on antibiotic use, and yet antimicrobial stewardship trials showed the lowest reporting rates of these data among RCTs in this systematic review. Fantastic work @seanong.bsky.social! An important heads-up for #AMSsky #IDsky researchers 💪🏼
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José Molina @josemolinagb.bsky.social · 04/05/2025
Caring for patients with bronchiectasis poses a challenge for both pulmonologists and #AMSky teams. Standard 14d treatments for exacerbations lack good evidence support. This small RCT favors shorter durations such as 8d 👉🏻 publications.ersnet.org/content/erj/... #IDsky @bradspellberg.bsky.social
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SHORTEN-2 trial @shorten2trial.bsky.social · 04/05/2025
This is a classic review on Pseudomonas: journals.asm.org/doi/epub/10.... And here you’ll find some more recent data on resistance against new betalactams: www.sciencedirect.com/science/arti... Hope you find it useful! #PsWatch #IDsky
journals.asm.org
Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections
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Chris van der Gast @chrisvandergast.bsky.social · 01/05/2025
Fascinating and important study. May well be transformative in treatment of stubborn chronic lung infections such as by Pseudomonas aeruginosa in #cysticfibrosis and beyond rdcu.be/ekdWf
rdcu.be
Personalized inhaled bacteriophage therapy for treatment of multidrug-resistant Pseudomonas aeruginosa in cystic fibrosis
Nature Medicine - A novel personalized phage therapy strategy that selects phages for a predicted evolutionary trade-off may represent a viable alternative approach for the treatment of...
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Angela Huttner @angelahuttner.bsky.social · 16/04/2025
Calling all statisticians: we need your help. We'll soon be running an RCT comparing ceftazidime + iv fosfomycin to ceftaz alone in septic patients. Our hospital's stats unit is small & overworked. If you're available to freelance, we have a budget for this! #IDSky #Clinmicro #EpiSky #MedSky (1/2)
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SHORTEN-2 trial @shorten2trial.bsky.social · 29/04/2025
In SHORTEN-2, immunocompromised hosts were not excluded if early clinical response and no unresolved source issues exist at randomization. We hope to generate actionable data to guide the management of Pseudomonas BSI also in this population! 💪🏼 (🧵3/3) #AMSky #IDsky #TxID #IDOnc #ShorterIsBetter
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SHORTEN-2 trial @shorten2trial.bsky.social · 29/04/2025
We have evidence from several observational studies that show how, if adequately selected, uncomplicated infections may be safely treated with shorter courses, even in severely immunocompromised hosts like SOT or neutropenic patients. (🧵2/3) #AMSky #IDsky #TxID #IDOnc bsky.app/profile/jose...
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SHORTEN-2 trial @shorten2trial.bsky.social · 29/04/2025
SOT patients have been systematically excluded from most RCTs on treatment duration, leading to prolonged courses still being the standard of care in many centers, even for non-complicated infections. (🧵1/3) #AMSky #IDsky #TxID
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José Molina @josemolinagb.bsky.social · 29/04/2025
2025 Update of SPIRIT guidelines for RCT protocols: www.thelancet.com/action/showP... #IDSky #Medsky
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REPLACE study @replacestudy.bsky.social · 22/03/2025
To change or not to change? The necessity of replacing a catheter during a CAUTI remains a subject of ongoing debate. Please fill in this survey to help us assess potential global practice variation in catheter management! Completion only takes <2 minutes: forms.office.com/e/MRCMwUb2UK
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Galadriel Pellejero @listeriacolectiva.bsky.social · 15/02/2025
6/ Además, hablamos de SHORTEN2, un estudio que dará mucho que hablar próximamente. 🔜📊 t.co/5whVazbnTo
t.co
https://pmc.ncbi.nlm.nih.gov/articles/PMC9778939/
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Galadriel Pellejero @listeriacolectiva.bsky.social · 15/02/2025
🎙️💊 Sensible y Resistente - Episodio 1 @micromunidad.bsky.social ¿Hasta qué punto importa la duración del tratamiento antibiótico? 🧐 open.spotify.com/episode/4yak31… Hilo con claves y artículos 📚👇 #AMSsky #IDsky
open.spotify.com
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Jonathan Ryder, MD @jonathanrydermd.bsky.social · 30/01/2025
Systematic review of antibiotic durations in @jac-amr.bsky.social n=315 RCTs 85% demonstrated equivalence or non-inferiority of shorter therapy Only 7% in ICU, 14% in LMIC, and 15% low risk of bias academic.oup.com/jacamr/artic...
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Steven Tong @steventong.bsky.social · 09/02/2025
Haven't posted about SNAP for a while: But we've just hit 4000 participants. Almost at 3 years since opening. And submitting two late breaker oral abstracts to ESCMID Global. @escmid.bsky.social Amazing progress and more to come. @gurujosh.bsky.social @drtoddlee.bsky.social
Monthly enrolment to SNAP since Feb 2022. Now at 4007 participants. Nearly will outnumber all previous S aureus bacteraemia trials put together (n=4087)
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José Molina @josemolinagb.bsky.social · 12/02/2025
Shorter is greener! 🍃♻️ Unnecessary antibiotics contribute to greenhouse gas emmissions. Want to know how much? 👉🏻 shorturl.at/52wOT Fantastic point! #IDSky #AMSsky
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Rapsinski Lab @raplab.bsky.social · 11/02/2025
Paper looking at how Avycaz (ceftazidime-avibactam) can select for cross resistance to other beta-lactam/beta-lactamase inhibitor combinations. @aleciarokes.bsky.social @vscooper.micropopbio.org @dariavantyne.bsky.social Strong start to our P. aeruginosa research! journals.asm.org/doi/10.1128/...
journals.asm.org
Mutations leading to ceftolozane/tazobactam and imipenem/cilastatin/relebactam resistance during in vivo exposure to ceftazidime/avibactam in Pseudomonas aeruginosa | Microbiology Spectrum
Antibiotic resistance is a significant challenge for physicians trying to treat infections. The development of novel antibiotics to treat resistant infections has not been prioritized for decades, limiting treatment options for infections caused by many ...
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José Molina @josemolinagb.bsky.social · 28/01/2025
In this table you can find a summary with different antimicrobials’ penetration into the bile (and the peritoneum). Hope you find it useful! 🙂 #AMSsky #IDOnc #IDSky
References:
2012 Surg Inf, Adnan
2016 J Chemotherapy, Mazzei
2017 WJES, Sartelli
2020 Pharmacotherapy, Thabit
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Pseudomonas Genome Database @pseudomonas.com · 01/02/2025
Are you a #Pseudomonas researcher? Please take our survey and help shape the direction and priority of future pseudomonas.com database development: forms.gle/gTPT6ruf3mqb... #microsky #idsky
pseudomonas.com
The Pseudomonas Genome Database - Genome annotation and comparative genome analysis
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SHORTEN-2 trial @shorten2trial.bsky.social · 25/01/2025
Can we use Ciprofloxacin for treating Levofloxacin-R Pseudomonas and viceversa? 🤔 #AMSsky #PsWatch 👇🏻👇🏻
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esgap.bsky.social @esgap.bsky.social · 25/01/2025
🔥The @escmid.bsky.social Study Group for Antimicrobial Stewardship (ESGAP) has joined BSky! We organize webinars, write newsletters, promote European research on AMS, participate in the AMS certificate and more Visit www.escmid.org/esgap/ to find more Also on www.linkedin.com/groups/90724...
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José Molina @josemolinagb.bsky.social · 19/11/2024
#ShorterIsBetter in immunocompromised hosts? Short treatments are feasible in early responders without source control issues. A significant number of observational studies serve as proof-of-concept on the feasibility of short courses in selected patients (see ⚠️) #AMSsky #IDOnc #TxID #IDsky
A summary table on published observational studies on treatment duration of bloodstream infections in hematology patients with high-risk neutropenia.

References:
doi: 10.1007/s10096-024-04885-w
doi: 10.1111/tid.14085
doi: 10.1016/j.jinf.2021.10.017 
doi: 10.1093/cid/ciad605
doi: 10.1093/ofid/ofaa246A summary table on published observational studies on treatment duration of graft infections on solid-organ transplant recipients.

References:
doi: 10.1111/tid.13896
doi: 10.1111/tri.14144
doi: 10.1111/tid.13868
doi: 10.1111/tid.13518
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