Study Flags Antibiotic Overuse in Suspected Sepsis Cases in Emergency Departments

USA: A recent study on suspected sepsis in the emergency department (ED) highlighted the overuse of antibiotics. Among 600 patients, 68.5% had confirmed or probable bacterial infections, yet 79.1% were treated with broad-spectrum antibiotics.

“Within 90 days, 17% developed complications, including 8% with drug resistance. Mortality was notably higher in patients with less likely or no infection (OR 2.25) compared to those with confirmed or probable infections, emphasizing the need for more targeted antibiotic use,” the researchers reported in Clinical Infectious Diseases.

Current treatment guidelines recommend the prompt administration of broad-spectrum antibiotics to all patients with suspected sepsis. While this approach aims to reduce mortality, it may also lead to antibiotic overuse. In light of this concern, Claire N Shappell, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA, and colleagues conducted a study to quantify the frequency of antibiotic overtreatment and assess potential antibiotic-associated harms in patients presenting to the emergency department with suspected sepsis.

For this purpose, the researchers reviewed medical records of 600 adult patients who were treated for suspected sepsis with anti-methicillin-resistant Staphylococcus aureus (MRSA) and/or antipseudomonal β-lactam antibiotics in the emergency departments of seven hospitals between 2019 and 2022. They assessed each patient’s likelihood of having had an actual infection in retrospect, evaluated whether narrower-spectrum antibiotics could have been appropriate, and identified potential antibiotic-associated complications. Generalized estimating equations were used to examine the association between infection likelihood and hospital mortality.

The key findings of the study were as follows:

  • Among 600 patients treated for suspected sepsis, 411 (68.5%) had either definite (48.0%) or probable (20.5%) bacterial infections.
  • The remaining 189 patients (31.5%) had infections that were either less likely (18.3%) or definitely absent (13.2%).
  • Of the 411 patients with definite or probable infections, 325 (79.1%) received antibiotics that were broader than necessary in retrospect.
  • Antibiotic-associated complications occurred in 104 of 600 patients (17.3%) within 90 days.
  • The most common complication was a new infection or colonization with organisms resistant to first-line antibiotics, reported in 48 patients (8.0%).
  • Mortality was higher in patients with less likely or no infection compared to those with definite or probable infection (9.0% vs 4.9%; adjusted odds ratio [aOR]: 2.25).
  • The rate of antibiotic-associated complications was similar between the two groups (14.8% vs 18.5%; aOR: 0.79).

The study concluded that among 600 patients who received broad-spectrum antibiotics for suspected sepsis, approximately one-third were unlikely to have had a bacterial infection. Even among those with confirmed or probable infections, four out of five were treated with unnecessarily broad regimens in hindsight. Notably, one in six patients experienced antibiotic-associated complications, underscoring the need for more judicious and targeted antibiotic use in emergency settings.

Reference:

Shappell, C. N., Yu, T., Klompas, M., Agan, A. A., DelloStritto, L., Faine, B. A., Filbin, M. R., Mohr, N. M., Park, S. T., Plechot, K., Porter, E., Roach, D., Train, S. E., Zepeski, A., & Rhee, C. Frequency of Antibiotic Overtreatment and Associated Harms in Patients Presenting With Suspected Sepsis to the Emergency Department: A Retrospective Cohort Study. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaf118

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Sotatercept may Reduce all-cause mortality in pulmonary arterial hypertension patients, finds research

A new study published in The New England Journal of Medicine showed that for high-risk patients with pulmonary arterial hypertension (PAH), adding sotatercept (Winrevair) to the therapy regimen helped postpone major complications.

Vascular remodeling is a major pathogenic aspect of the illness that is not immediately addressed by current therapies, which instead concentrate on vasodilation. A new experimental treatment, sotatercept is intended to address this underlying condition. The fusion protein called sotatercept binds to activin A and other transforming growth factor-beta (TGF-β) superfamily ligands and neutralizes them. The vascular remodeling that takes place in PAH is linked to this route. For individuals with WHO functional class II or III pulmonary arterial hypertension, sotatercept increases exercise capacity and postpones the onset of clinical deterioration.

In patients with developed pulmonary arterial hypertension and an elevated likelihood of mortality, the effects of add-on sotatercept are not well understood. Thus, this study by Marc Humbert and team evaluated the effectiveness of sotatercept in patients with pulmonary arterial hypertension.

The patients receiving the maximum tolerated dose of background therapy who had pulmonary arterial hypertension (WHO functional class III or IV) and a high 1-year risk of death (Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management Lite 2 risk score, ≥9) were randomly assigned to receive either a placebo or add-on sotatercept (elevated to target dose, 0.7 mg per kilogram) every three weeks. A time-to-first-event analysis was used to determine the primary end point, which was a composite of hospitalization (≥24 hours) for worsening pulmonary arterial hypertension, lung transplantation, and death from any cause.

There were 172 patients in all, 86 in each of the placebo and sotatercept groups. The effectiveness findings of a predetermined interim analysis led to the early termination of the experiment. 15 patients (17.4%) in the sotatercept group and 47 patients (54.7%) in the placebo group experienced at least one main end-point incident.

A total of 7 patients (8.1%) in the sotatercept group and 13 patients (15.1%) in the placebo group died; 1 patient (1.2%) and 6 patients (7.0%) received lung transplants; 8 patients (9.3%) and 43 patients (50.0%) were hospitalized due to worsening pulmonary arterial hypertension. Telangiectasia and epistaxis were the most frequent side effects of sotatercept.

Overall, sotatercept treatment reduced the risk of death, lung transplantation, and hospitalization (≥24 hours) for worsening pulmonary arterial hypertension in high-risk adults receiving the maximum tolerated dose of background therapy when compared to placebo.

Reference:

Humbert, M., McLaughlin, V. V., Badesch, D. B., Ghofrani, H. A., Gibbs, J. S. R., Gomberg-Maitland, M., Preston, I. R., Souza, R., Waxman, A. B., Moles, V. M., Savale, L., Vizza, C. D., Rosenkranz, S., Shi, Y., Miller, B., Mackenzie, H. S., Kim, S. S., Loureiro, M. J., Patel, M. J., … ZENITH Trial Investigators. (2025). Sotatercept in patients with pulmonary arterial hypertension at high risk for death. The New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2415160

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UP DGME notifies on Round 2 PC PNDT counselling, details

Uttar Pradesh- The Uttar Pradesh Director General, Medical Education and Training (UPDGME) is going to start the online counselling for the second cycle of PCPNDT course (Phase-1 and 2) under the academic session 2024-25 from April 21 2025. In this regard, through a notice, UPDGME has announced the schedule for the online counselling for the second cycle of the PCPNDT course admissions

As per the schedule, the process of online registration and registration amount and security deposit is going to start from April 21, 2025. After this, the merit list will be declared on April 22, 2025. The online choice filling process will start from April 23, 2025, and the seat allotment result will be declared on April 25, 2025. Ccandidates can download the allotment letter and take admission from April 26, 2025.

Also Read: PCPNDT admissions: UP DGME releases merit list, details

S.NO

DESCRIPTION

DATE

TOTAL DAYS

1

Date of online registration.

From 21st April, 2025 (2:00 PM) to 22nd April, 2025 (5:00 PM).

02 days

2

Date of depositing registration amount and security deposit.

From 21st April, 2025 (2:00 PM) to 22nd April, 2025 (5:00 PM).

02 days

3

Date of declaration of merit list.

22 April 2025.

01 day

4

Date of online choice filling.

From 23rd April, 2025 (11:00 AM) to 24th April, 2025 (2:00 PM).

02 days

5

Date of declaration of the seat allotment result.

Date 25 April 2025

01 day

6

The date for downloading the allotment letter and taking admission.

From 26 April 2025 to 30 April 2025

05 days

Meanwhile, it is to be noted that “after completion of the allotment and admission process of a candidate, transfer/change of the allotted/admitted candidate shall not be permissible under any circumstances.” Hence, candidates admitted through the first round of counselling of PCPNDT 2024 will not be eligible to participate in the second round of counselling.

In addition, candidates who have appeared in the NEET PG-2024 examination and have been declared qualified in the examination will be eligible for counselling.

Moreover, candidates who have deposited the security amount while registering for the online counselling of the first cycle of the PCPNDT course under the academic session 2024-25, are not required to re-register and deposit the security amount for the second cycle counselling.

To view the notice, click the link below

https://medicaldialogues.in/pdf_upload/updgme-to-begin-2nd-cycle-of-pcpndt-course-counselling-2024-25-schedule-released-283684.pdf

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Cipla gets CDSCO Panel nod to study Revefenacin Inhalation solution

New Delhi: The pharmaceutical major Cipla has got the go-ahead from the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organization (CDSCO) for conducting Phase III clinical trials of Revefenacin Inhalation Solution 175 mcg/3 ml.

This came after the drug major Cipla presented the proposal for grant of permission to manufacture and market Revefenacin Inhalation solution 175 mcg/3ml along with a bioequivalence (BE) study waiver and phase III clinical trial protocol before the committee.

Revefenacin is a novel biphenyl carbamate tertiary amine agent that belongs to the family of the long-acting muscarinic antagonists (LAMA). The labile primary amide in the structure produces a “soft-drug” site that allows rapid systemic clearance and minimizes the systemically mediated adverse reactions.

Revefenacin is an inhaled bronchodilator muscarinic antagonist with a long-acting bronchodilation activity. It has been shown to present a high affinity and behave as a competitive antagonist of the five muscarinic cholinergic receptors.

Studies have indicated that revefenacin dissociates significantly slower from the muscarinic receptor M3 (hM3) when compared to the receptor M2 (hM2), which indicates a kinetic selectivity for this subtype. This competitive antagonism produces a suppressive action of the acetylcholine-evoked calcium mobilization and contractile responses in the airway tissue. Lastly, due to the duration of the bronchodilation, revefenacin is considered a long-acting muscarinic antagonist, which allows it to be dosed once daily.

Revefenacin is indicated as an inhalation solution for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD).

At the recent SEC meeting for pulmonary drugs, the expert panel reviewed the proposal presented by Cipla for grant of permission to manufacture and market Revefenacin Inhalation solution 175 mcg/3ml along with a bioequivalence (BE) study waiver and phase III clinical trial protocol.

After detailed deliberation, the committee recommended the grant of permission to conduct the Phase III clinical trial as per the protocol presented.

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PGI Chandigarh flags Rs 143 Crore reimbursement under HIMCARE scheme

Chandigarh: The Postgraduate Institute of Medical Education and Research (PGI), Chandigarh has raised serious concerns regarding the significant delay in reimbursements under the Himcare Health Scheme of the Himachal Pradesh government. According to official sources, PGIMER has submitted 1,478 claims amounting to nearly ₹143 crore, which remain pending with the state government. 

This delay is particularly alarming as nearly 40% of PGI’s patient intake is from Himachal Pradesh.

Medical Dialogues had previously reported that the Postgraduate Institute of Medical Education and Research (PGI) here has signed an Mou with HIMCARE, a scheme of the Himachal Pradesh government to provide cashless treatment, an official said on Monday.

Also Read: PGI Chandigarh, HIMCARE join hands for cashless treatment

The issue was formally raised during the Feb 2025 meeting of the PGI governing body (GB), which was chaired by the Union Minister of Health and Family Welfare. The GB noted that, according to the MoU, the Himachal government is obligated to disburse funds for cashless services provided under HIMCARE, within a month, TOI reports.

Under a Memorandum of Understanding (MoU) between PGIMER and the Himachal Pradesh government, these claims are required to be cleared within a month. However, this timeline has reportedly not been met, creating financial pressure on the premier health institution.

As per the recent media reports by the Indian Express, the Governing Body has directed the PGIMER’s administration to take up the matter with the state authorities and ensure time-bound clearance of the dues, as delays could impact the institute’s financial stability and may hinder the delivery of other essential health services.

Compounding the crisis are serious allegations of financial misconduct involving funds from both HIMCARE and the central government’s Ayushman Bharat scheme. There are reports that individuals, allegedly in collusion with certain PGI staff members, siphoned off funds meant for underprivileged patients.

In light of these allegations, PGI’s vigilance department has recommended a Central Bureau of Investigation (CBI) probe to investigate possible embezzlement and ensure accountability.

PGIMER, which caters to thousands of patients from Himachal Pradesh annually, implemented a cashless treatment system under the Himcare scheme on March 8, 2024. The system allows eligible patients to receive treatment by simply submitting a photocopy of their Himcare card and hospital slip, removing the earlier requirement of waiting for approvals and reimbursements.

Under Himcare, the Himachal Pradesh government provides cashless treatment up to ₹5 lakh per annum per family, covering a broad spectrum of healthcare services. It is estimated that 4,000 to 5,000 patients from Himachal Pradesh benefit from treatment at PGIMER every year.

Also Read: PGI Chandigarh staffer held in Ayushman fraud case

According to the Indian Express, PGIMER said in a statement that following the directive from the Governing Body, the institute has addressed this matter with the appropriate authorities of Himachal Pradesh.

The institute clarified that the dues are being cleared gradually through periodic grant releases from the Himachal Pradesh Government, describing the process as “routine and ongoing.”

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Could CT scans be fueling a future rise in cancer cases, as a new study suggests?

CT scans are a vital part of modern medicine. Found in every hospital and many clinics, they give doctors a fast and detailed look inside the body—helping to diagnose everything from cancer and strokes to internal injuries. But a new study suggests there may be a hidden cost to our growing reliance on this technology.

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Mixed results: Study finds potential link between infant acid-suppressants and celiac disease

Tel Aviv University-led research has found that infants prescribed acid-suppressive medications during their first six months of life had an increased risk of developing celiac disease autoimmunity under certain study conditions.

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Opioid control laws linked to 10% drop in domestic violence cases

A new study led by the University of South Florida reveals opioid control policies may offer broader public health benefits, including reducing instances of domestic violence. As policymakers continue to grapple with the opioid epidemic, this study highlights the power of research to inform effective public policy.

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White House touts COVID-19 ‘lab leak’ theory on revamped site

The White House on Friday unveiled a revamped COVID-19 website that promoted the contentious theory that the virus leaked from a Chinese laboratory, framing it as the pandemic’s “true origins.”

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Seeing with purpose: Visual cortex tunes perception to match current objectives

When you see a bag of carrots at the grocery store, does your mind go to potatoes and parsnips or buffalo wings and celery?

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