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Steven Tong

@steventong.bsky.social
4.4K followers 187 following 310 posts

Infectious diseases, clinical trials, staphylococcus and streptococcus. Reader and runner. Go Hawks!

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Steven Tong @steventong.bsky.social · 29/09/2026
The next Clarity commentary. On the SNAP trial. Neither I nor @gurujosh.bsky.social had anything to do with this commentary (deliberately). Conclusions though are in line with my interpretation of the data. i.e., use cefazolin for MSSA bacteremia. @angelahuttner.bsky.social @cmicomms.bsky.social
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CMI Communications @cmicomms.bsky.social · 20/09/2026
🎙️ Just published 'Does oseltamivir harm critically ill patients? The REMAP-CAP results' Hosted by Erin McCreary, PharmD & Josh Davis with invited guests Steve Webb & Steven Tong 🌟 Listen on #Communicable ow.ly/pJAO50ZOfK8 or on #Breakpoints ow.ly/p8Ti50ZOfK9 #IDSky #ViroSky #flu
ow.ly
Communicable E63: Does oseltamivir harm critically ill patients? The REMAP-CAP results | Communicable
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CMI Communications @cmicomms.bsky.social · 17/09/2026
📣 New #Communicable / #Breakpoints drops Mon 21 Sep! Erin McCreary, PharmD & Josh Davis are joined by Steve Webb & Steven Tong to discuss REMAP-CAP results suggesting that oseltamivir may harm critically ill patients, while also highlighting the importance and impact of RCTs. #IDSky #ViroSky #flu
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Steven Tong @steventong.bsky.social · 12/09/2026
Glad the conclusions ended with: 'the need for prospective studies to understand when and in whom FUBCs should be used'. The BALANCE+ trial has I think concluded enrolment to the follow-up BC domain. @seanong.bsky.social might be able to confirm.
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Steven Tong @steventong.bsky.social · 12/09/2026
How about ESBLs where pip/taz is better than ceftriaxone? I became more supportive of pip/taz when I realised that for patients with likely GNB sepsis pip/taz had probably 95%+ activity compared to around 85% with ceftriaxone. And that's not because of Pseudomonas.
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IDSA @idsainfo.bsky.social · 09/09/2026
IDSA and ESCMID have released Part 1 of new consensus statements for Staphylococcus aureus bacteremia, introducing a risk-based approach to support diagnostic evaluation and more individualized treatment decisions. 📄: www.idsociety.org/practice-guidelin…
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Angela Huttner @angelahuttner.bsky.social · 09/09/2026
Hi Gabriele! Guess what- with @germhuntermd.bsky.social & quite a few others, we are gearing up to launch an #IDjournalclub on Bsky and it looks like this paper is the one we'll start with. 😊 We will get that going soooon!! (Also, Communicable will work on a follow-up POET2 ep!) #IDSky #MedSky
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Steven Tong @steventong.bsky.social · 16/08/2026
Come along. This will be a great course in an amazing location!
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CMI Communications @cmicomms.bsky.social · 11/08/2026
📣We rely more & more on #AI for literature review So how did 6 large language models compare to humans when extracting data from #RCTs for a systematic review? Not very well: overall #LLM concordance was 0.58-0.75. #IDSky @steventong.bsky.social @seanong.bsky.social cmi-comms.org/article/S295...
cmi-comms.org
A proof-of-concept performance evaluation of six large language models for semiautomated data extraction in a systematic review on infectious diseases clinical trials
Large language models (LLMs) are increasingly being used in the systematic review process. Our objective was to explore data extraction performance of six LLMs from a published systematic review of in...
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Steven Tong @steventong.bsky.social · 10/08/2026
Hasn't started yet. A couple of complexities in fitting into the existing protocol structure that we are working through - but haven't quite finalised yet due to other priorities. Main issue is that SNAP has 72h cutoff for eligibility. We need to allow for beyond this...
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Ouli Xie @ouli-xie.bsky.social · 04/08/2026
Can Group C/G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis, SDSE) become penicillin resistant? We report a case in an individual on prolonged penicillin prophylaxis. doi.org/10.1128/aac.... @steventong.bsky.social @thedohertyinst.bsky.social 🧵👇
doi.org
Penicillin-resistant Streptococcus dysgalactiae subsp. equisimilis and the association with penicillin-binding protein mutations: a population genotypic and phenotypic study | Antimicrobial Agents and Chemotherapy
Streptococcus dysgalactiae subspecies equisimilis (SDSE, commonly referred to as Group C/G Streptococcus) is increasingly recognized as a cause of serious human disease (1). SDSE is closely related to Streptococcus pyogenes with overlapping disease manifestations (1, 2). Incidence of invasive SDSE disease is comparable or even exceeds that of S. pyogenes in some countries, but surveillance lags behind that of its more well-studied relative (2–4).
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Steven Tong @steventong.bsky.social · 24/07/2026
This course will be great! In Malta too - still warm in November. COI: I'm one of the conveners. Join us!
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Steven Tong @steventong.bsky.social · 28/06/2026
That would be a really cool experiment! Find 50 RCTs, emulate now before the RCTs report out, and then see level of agreement. This has been done retrospectively, but doing the emulation ahead of the RCTs would be more convincing.
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Steven Tong @steventong.bsky.social · 27/06/2026
I agree - in this case. Noting though that there are plenty of other examples in medicine where observational data is overturned by RCT data.
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Steven Tong @steventong.bsky.social · 27/06/2026
We are genotyping and phenotyping the SNAP MSSA isolates for cefazolin inoculum effect. So we can look at cefazolin vs ASPs (randomized) treatment effect in CIE+, and compare to that in CIE-. I estimate several hundred (prob >400) in each CIE group.
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Steven Tong @steventong.bsky.social · 22/06/2026
The SNAP Trial Exemplifies What EBM Should Look Like: www.sensible-med.com/p/the-snap-t... #IDSky
sensible-med.com
The SNAP Trial Exemplifies What EBM Should Look Like
It's always worth showing properly designed and conducted trials--though it's bad for pageviews. Nonetheless, SNAP authors show the way to answering questions in biomedicine
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José Molina @josemolinagb.bsky.social · 17/06/2026
The SNAP trial domain on cefazolin vs cloxacillin for MSSA bacteremia is finally published! www.nejm.org/doi/full/10.... Cefazolin is already the new standard! #IDsky #AMSsky
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Doherty Institute @thedohertyinst.bsky.social · 17/06/2026
A landmark international clinical trial (SNAP Trial) has identified the optimal antibiotics for golden staph bloodstream infections, a breakthrough that is set to reshape treatment for the life-threatening condition. bit.ly/44eY8Kg
doherty.edu.au
Global clinical trial reveals safest, most effective antibiotics for golden staph bloodstream infections
A landmark international clinical trial has identified the optimal antibiotics for golden staph bloodstream infections, a breakthrough that is set to reshape treatment for the life-threatening condition.
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NEJM.org @nejm.org · 17/06/2026
In the SNAP trial, cefazolin was noninferior to flucloxacillin or cloxacillin with respect to 90-day mortality in patients with methicillin-susceptible Staphylococcus aureus bacteremia and had fewer nephrotoxic effects. Read the full trial results: nej.md/4vL0M6m
The image is a graph showing the posterior probability distribution of the treatment effect for cefazolin versus (flu)cloxacillin regarding 90-day all-cause mortality in the Treatment Policy Strategy population. The x-axis is labeled "Odds ratio (estimand 1)" ranging from 0.4 to 1.5, and the y-axis is labeled "Cefazolin (adults)." The distribution is depicted as a light blue curve, with credible intervals marked at 0.95, 0.99, and 1, indicated by darker shades of blue. A vertical dashed line is at the odds ratio of 1.2.
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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 17/06/2026
🔥Just published 🔥NEJM SNAP RCT In patients with MSSA bacteremia, cefazolin was noninferior to flucloxacillin or cloxacillin with respect to 90-day mortality and was associated with a lower incidence of acute kidney injury. #idsky www.nejm.org/doi/full/10....
nejm.org
Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia | NEJM
Staphylococcus aureus bacteremia is associated with high mortality. Whether cefazolin or an antistaphylococcal penicillin should be preferred for the treatment of methicillin-susceptible S. aureus ...
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Steven Tong @steventong.bsky.social · 18/06/2026
Absolutely! It's only the combined efforts of the ID and micro communities and key leadership in the multiple regions of the world that make this possible.
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Michael Marks @drmichaelmarks.bsky.social · 17/06/2026
Excited 1st SNAP result out @thelancet.com PSSA: Fluclox v BenPen thelancet.com/journals/lancet/article/PIIS0140-6736(26)00761-0/fulltext @nejm.org MSSA: Fluclox v Cefazolin nejm.org/doi/full/10.1056/NEJMoa2506905 Should change practice globally Privilege to help deliver trial with fantastic team
helancet.com
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Steven Tong @steventong.bsky.social · 16/06/2026
Maybe... clindamycin was for only 5 days in SNAP. We know that even short duration AG can cause renal toxicity.
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Steven Tong @steventong.bsky.social · 16/06/2026
Great post @apsmunro.bsky.social! Doing more is such a natural reaction. But even 'benign' interventions may likely be harmful when tested properly. I'm yet to know of a trial for sepsis where adding antibiotics has been beneficial (outside of TB where we do it to prevent emergence of resistance).
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Steven Tong @steventong.bsky.social · 05/06/2026
Yes. Nice paper. Only 31 patients, but still contains important messages. At my center, we certainly prioritise dalbavancin for those we are not confident in adherance to oral or ongoing IV therapy.
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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 26/05/2026
Honored to contribute to this peer-reviewed commentary in CMI Communications alongside an incredible panel of ID physicians and clinical trialists discussing some of the top infectious diseases papers of 2025. #idsky www.cmi-comms.org/article/S295...
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Steven Tong @steventong.bsky.social · 20/05/2026
Stop and report what we have. Can still provide treatment effect estimates with 95% credible intervals and posterior probability of superiority and inferiority. In some sense, even if we stopped at 700 participants, that is still going to provide the community with a lot of information.
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Steven Tong @steventong.bsky.social · 19/05/2026
Theoretically no limit. But feasibility / cost / enthusiasm does have a limit. Ideally, we stop when a trigger is met, because we can clearly say we have an answer.
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Steven Tong @steventong.bsky.social · 18/05/2026
Agree with everything @jonathanrydermd.bsky.social has said. SNAP MRSA silo backbone domain (vanc or dapto VS vanc or dapto plus cefazolin) is up to about 700 participants. We have not hit triggers for superiority or futility. Primary outcome is 90 day mortality. We wait to see...
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Steven Tong @steventong.bsky.social · 17/05/2026
This is a really helpful graphic summary of the Andes virus outbreak. #IDSky
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Steven Tong @steventong.bsky.social · 17/05/2026
That's the one! It was presented at a JAMA session, with concurrent release of the relevant papers.
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Steven Tong @steventong.bsky.social · 16/05/2026
ESCMID 2026 highlights Dalbavancin PK (DOTS‑PK) – Two doses may not be enough High protein binding and wide inter‑patient variability: 1/3 patients may be sub‑therapeutic by day 22 Bottom line: Consider monitoring levels or adding a third dose in complex infections clarityinitiative.org/home
clarityinitiative.org
Clarity Initiative
Clarity Initiative offers clinical literature appraisal and research education in infectious diseases, enhancing knowledge through courses and resources.
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Gabriele Pollara @gpollara.bsky.social · 14/05/2026
So good. Have spent years fighting this fight, with hand tied behind my back by lack of great evidence. This study is going to get quoted and cited in microbiology MDTs the world over +++ #IDSky #ClinMicro #AMR
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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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Steven Tong @steventong.bsky.social · 14/05/2026
Highlights from ESCMID Global 2026? @gurujosh.bsky.social asked CLARITY faculty: @angelahuttner.bsky.social @erinmccreary.bsky.social @marcbonten.bsky.social @seanong.bsky.social @ashabowen.bsky.social and others (not on BlueSky). #IDSky clarityinitiative.org/escmid-2026-... Any that we missed?
clarityinitiative.org
Clarity Initiative
Clinical Literature Appraisal and Research education in InfecTious diseases
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CMI Communications @cmicomms.bsky.social · 08/05/2026
Our collaboration episode with Breakpoints covering the trials from the ESCMID Global session 'The trial run' is out now! share.transistor.fm/s/e2a9aee4 🎙️✨ @erinmccreary.bsky.social @gurujosh.bsky.social @jesusrbano.bsky.social #IDSky #clinmicro
share.transistor.fm
Communicable E52: ESCMID Global Trials, PETER PEN and ASTARTE | Communicable | Episode 52
In this collaborative episode of Breakpoints and Communicable, the hosts revisit the “trial run” session from ESCMID Global, a format designed to facilitate critical discussion of major infectious dis...
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Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · 08/05/2026
Long awaited! 🆕💥🟢REMAP-CAP For critically and noncritically ill hospitalized patients with COVID-19, ivermectin was unlikely to improve the primary composite outcome of organ support-free days and hospital survival #idsky journals.lww.com/ccmjournal/f...
journals.lww.com
Ivermectin for Critically and Noncritically Ill... : Critical Care Medicine
between June 11, 2021, and September 9, 2022. Patients: Critically and noncritically ill patients. Interventions: Randomized to ivermectin or no ivermectin (control). Measurements and Main Resu...
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Steven Tong @steventong.bsky.social · 06/05/2026
This was data from CAMERA2 RCT. Some received b lactam empirically and all were randomly allocated at trial enrolment to additional b lactam or no b lactam. The more b lactam received, the shorter the bacteremia but also the greater the risk of AKI.
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Steven Tong @steventong.bsky.social · 06/05/2026
We looked at empiric B-lactam antibiotics in MRSA bacteraemia and BC persistence and AKI, using CAMERA2 dataset. Groups: none, early (only empiric B-lactam), late (only after trial enrolment), throughout (empiric and after enrolment). #IDSky www.clinicalmicrobiologyandinfection.org/article/S119...
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Steven Tong @steventong.bsky.social · 04/05/2026
Can't wait!
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Steven Tong @steventong.bsky.social · 28/04/2026
Yes. Houston is part of SNAP, supported by RO1 to look at cefazolin inoculum effect. Otherwise it’s been difficult (impossible) to involve US sites. Look out for a comment on this in an upcoming editorial piece.
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Steven Tong @steventong.bsky.social · 25/04/2026
Given mortality likely lower with cefazolin, and lower risk of AKI (even if defined by creatinine increase) - that's enough for me to change practice. Even if mortality was the same, why risk even stage 1 AKI if that is avoidable?
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Steven Tong @steventong.bsky.social · 25/04/2026
The hepatotoxicity numbers in that table are wrong. Use the percentages. No difference between groups. For AKI - defined as ≥1.5x increase to baseline creatinine. Numerically more need for renal replacement therapy (too few to make statistical significance).
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Steven Tong @steventong.bsky.social · 25/04/2026
Details coming soon. My understanding is that even if 2x cost with cefazolin, the absolute cost increment is not that great as these drugs are not expensive. I suspect likely lower mortality, and lower AKI, would make it cost effective - but formal evaluation required.
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Steven Tong @steventong.bsky.social · 25/04/2026
Numerically more needed renal replacement therapy. In my view, mortality likely lower with cefazolin. AKI definitely lower. No good reason to stick with flucloxac. My practice has certainly changed. Fluclox may surprisingly cause considerable microbiome pertubation: www.nature.com/articles/s41...
nature.com
Antibiotic use and gut microbiome composition links from individual-level prescription data of 14,979 individuals - Nature Medicine
Using individual-level data from the Swedish Prescribed Drug Register and fecal metagenomes of 14,979 individuals in Sweden, the authors examined the association between oral antibiotic use over 8 yea...
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Steven Tong @steventong.bsky.social · 25/04/2026
It will be published soon. Both the MSSA silo and PSSA silo, which both included (flu)cloxacillin, found NI on 90 day mortality for cefazolin (or penicillin) and lower rates of AKI compared to (flu)cloxacillin. The AKI mostly defined by increase in creatinine of at least 1.5x.
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Steven Tong @steventong.bsky.social · 24/04/2026
Good to bring data together but further small observational studies won’t move us forward on this question now. Awaiting genotyping and phenotyping of SNAP MSSA isolates and correlations with randomised cefazolin vs flucloxacillin
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wiki-guidelines.bsky.social @wiki-guidelines.bsky.social · 23/04/2026
Time for societies to incorporate humility of uncertainty into guidelines Evidence Over Eminence: Rethinking Specialty Guidelines Amid the ATS-IDSA Debate academic.oup.com/cid/article/...
academic.oup.com
Evidence Over Eminence: Rethinking Specialty Guidelines Amid the ATS-IDSA Debate
Brad Spellberg, MD, Bassam Ghanem, PharmD MS BCIDP, Miguel Morante-Ruiz, MD, Émilie Bortolussi-Courval, RN PhD, Anil N Makam, MD MAS, Zeynep Ergenc, MD, Ni
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Steven Tong @steventong.bsky.social · 22/04/2026
My prior for any combination therapy for any acute bacterial infection is now low for success. Doesn’t mean we shouldn’t try to find something. Just go into a trial aware that improving outcomes is unlikely
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Steven Tong @steventong.bsky.social · 21/04/2026
I gave two examples. One that takes MERINO results at face value (strong) and one with a much flattened prior, still centred on risk difference of 8.6%. Makes a BIG difference to the posterior. What you believe about MERINO heavily informs what you will believe after PeterPen
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