Staphylococcus aureus bloodstream (SAB) infection is a common and severe infectious disease, with a 90-day mortality of 15-30%. Despite this, fewer than 3000 people have been randomised into clinical trials of treatments for SAB infection. The limited evidence base partly results from clinical trials for SAB infections being difficult to complete at scale using traditional clinical trial methods. Here we provide the rationale and framework for an adaptive platform trial applied to SAB infections. We detail the design features of the Staphylococcus aureus Network Adaptive Platform (SNAP) trial that will enable multiple questions to be answered as efficiently as possible. The SNAP trial will commence enrolling patients across multiple countries in 2022 with an estimated target sample size of 7000 participants. This approach may serve as an exemplar to increase efficiency of clinical trials for other infectious diseases syndromes.

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Up to 60% of patients with haematological malignancy will develop pulmonary infiltrates at some point in their disease course. Bronchoscopy should be used early in patients without respiratory failure as diagnostic yield is highest in the first 1–2 days of illness. Perceptions that patients with haematological malignancy are at higher risk of complications from bronchoscopy has led to a reluctance to perform the procedure. However, cohort studies have not demonstrated any increase in complications for this specific patient group. Common concerns include mucosal injury, respiratory impairment and haemorrhage. However, prospective cohort studies demonstrate that this patient group do not experience a higher than baseline level of complications. Specific pathogen diagnosis reduces morbidity and mortality in lung infection. Additionally, complex infections with multidrug-resistant organisms, the increasing prevalence of which is largely driven by empirical antibiotic use, make specific diagnosis more crucial than ever if we are to maintain our ability to manage myelosuppressive therapies and stem cell transplant.

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